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Biofeedback, or applied psychophysiological feedback, is a patient-guided treatment that teaches an individual to control muscle tension, pain, body temperature, brain waves, and other bodily functions and processes through relaxation, visualization, and other cognitive control techniques. The name biofeedback refers to the biological signals that are fed back, or returned, to the patient in order for the patient to develop techniques of manipulating them.


Biofeedback has been used to successfully treat a number of disorders and their symptoms, including temporomandibular joint disorder (TMJ), chronic pain, irritable bowel syndrome (IBS), Raynaud's syndrome, epilepsy, attention-deficit hyperactivity disorder (ADHD), migraine headaches, anxiety, depression, traumatic brain injury, and sleep disorders.
Illnesses that may be triggered at least in part by stress are also targeted by biofeedback therapy. Certain types of headaches, high blood pressure, bruxism (teeth grinding), post-traumatic stress disorder, eating disorders, substance abuse, and some anxiety disorders may be treated successfully by teaching patients the ability to relax and release both muscle and mental tension. Biofeedback is often just one part of a comprehensive treatment program for some of these disorders.
NASA has used biofeedback techniques to treat astronauts who suffer from severe space sickness, during which the autonomic nervous system is disrupted. Scientists at the University of Tennessee have adapted these techniques to treat individuals suffering from severe nausea and vomiting that is also rooted in autonomic nervous system dysfunction.
Recent research also indicates that biofeedback may be a useful tool in helping patients with urinary incontinence regain bladder control. Individuals learning pelvic-floor muscle strengthening exercises can gain better control over these muscles by using biofeedback. Sensors are placed on the muscles to train the patient where they are and when proper contractions are taking place.



In 1961, Neal Miller, an experimental psychologist, suggested that autonomic nervous system responses (for instance, heart rate, blood pressure, gastrointestinal activity, regional blood flow) could be under voluntary control. As a result of his experiments, he showed that such autonomic processes were controllable. This work led to the creation of biofeedback therapy. Willer's work was expanded by other researchers. Thereafter, research performed in the 1970s by UCLA researcher Dr. Barry Sterman established that both cats and monkeys could be trained to control their brain wave patterns. Sterman then used his research techniques on human patients with epilepsy, where he was able to reduce seizures by 60% with the use of biofeedback techniques. Throughout the 1970s, other researchers published reports of their use of biofeedback in the treatment of cardiac arrhythmias, headaches, Raynaud's syndrome, and excess stomach acid, and as a tool for teaching deep relaxation. Since the early work of Miller and Sterman, biofeedback has developed into a front-line behavioral treatment for an even wider range of disorders and symptoms.
During biofeedback, special sensors are placed on the body. These sensors measure the bodily function that is causing the patient problem symptoms, such as heart rate, blood pressure, muscle tension (EMG or electromyographic feedback), brain waves (EEC or electroencophalographic feedback), respiration, and body temperature (thermal feedback), and translates the information into a visual and/or audible readout, such as a paper tracing, a light display, or a series of beeps.
While the patient views the instantaneous feedback from the biofeedback monitors, he or she begins to recognize what thoughts, fears, and mental images influence his or her physical reactions. By monitoring this relationship between mind and body, the patient can then use these same thoughts and mental images as subtle cues, as these act as reminders to become deeply relaxed, instead of anxious. These reminders also work to manipulate heart beat, brain wave patterns, body temperature, and other bodily functions. This is achieved through relaxation exercises, mental imagery, and other cognitive therapy techniques.

Key terms

Autonomic nervous system — The part of the nervous system that controls so-called involuntary functions, such as heart rate, salivary gland secretion, respiratory function, and pupil dilation.
Bruxism — Habitual, often unconscious, grinding of the teeth.
Epilepsy — A neurological disorder characterized by the sudden onset of seizures.
Placebo effect — Placebo effect occurs when a treatment or medication with no known therapeutic value (a placebo) is administered to a patient, and the patient's symptoms improve. The patient believes and expects that the treatment is going to work, so it does. The placebo effect is also a factor to some degree in clinically-effective therapies, and explains why patients respond better than others to treatment despite similar symptoms and illnesses.
Raynaud's syndrome — A vascular, or circulatory system, disorder which is characterized by abnormally cold hands and feet. This chilling effect is caused by constriction of the blood vessels in the extremities, and occurs when the hands and feet are exposed to cold weather. Emotional stress can also trigger the cold symptoms.
Schizophrenia — Schizophrenia is a psychotic disorder that causes distortions in perception (delusions and hallucinations), inappropriate moods and behaviors, and disorganized or incoherent speech and behavior.
Temporomandibular joint disorder — Inflammation, irritation, and pain of the jaw caused by improper opening and closing of the temporomandibular joint. Other symptoms include clicking of the jaw and a limited range of motion.
As the biofeedback response takes place, patients can actually see or hear the results of their efforts instantly through the sensor readout on the biofeedback equipment. Once these techniques are learned and the patient is able to recognize the state of relaxation or visualization necessary to alleviate symptoms, the biofeedback equipment itself is no longer needed. The patient then has a powerful, portable, and self-administered treatment tool to deal with problem symptoms.
Biofeedback that specializes in reading and altering brain waves is sometimes called neurofeedback. The brain produces four distinct types of brain waves—delta, theta, alpha, and beta—that all operate at a different frequency. Delta, the slowest frequency wave, is the brain wave pattern associated with sleep. Beta waves, which occur in a normal, waking state, can range from 12-35 Hz. Problems begin to develop when beta wave averages fall in the low end (underarousal) or the high end (overarousal) of that spectrum. Underarousal might be present in conditions such as depression or attention-deficit disorder, and overarousal may be indicative of an anxiety disorder, obsessive compulsive disorder, or excessive stress. Beta wave neurofeedback focuses on normalizing that beta wave pattern to an optimum value of around 14 Hz. A second type of neurofeedback, alpha-theta, focuses on developing the more relaxing alpha (8-13 Hz) and theta waves (4-9 Hz) that are usually associated with deep, meditative states, and has been used with some success in substance abuse treatment.
Through brain wave manipulation, neurofeedback can be useful in treating a variety of disorders that are suspected or proven to impact brain wave patterns, such as epilepsy, attention-deficit disorder, migraine headaches, anxiety, depression, traumatic brain injury, and sleep disorders. The equipment used for neurofeedback usually uses a monitor as an output device. The monitor displays specific patterns that the patient attempts to change by producing the appropriate type of brain wave. Or, the monitor may reward the patient for producing the appropriate brain wave by producing a positive reinforcer, or reward. For example, children may be rewarded with a series of successful moves in a displayed video game.
Depending on the type of biofeedback, individuals may need up to 30 sessions with a trained professional to learn the techniques required to control their symptoms on a long-term basis. Therapists usually recommend that their patients practice both biofeedback and relaxation techniques on their own at home.


Before initiating biofeedback treatment, the therapist and patient will have an initial consultation to record the patients medical history and treatment background and discuss goals for therapy.
Before a neurofeedback session, an EEG is taken from the patient to determine his or her baseline brainwave pattern.
Biofeedback typically is performed in a quiet and relaxed atmosphere with comfortable seating for the patient. Depending on the type and goals of biofeedback being performed, one or more sensors will be attached to the patient's body with conductive gel and/or adhesives. These may include:
  • Electromyographic (EMG) sensors. EMG sensors measure electrical activity in the muscles, specifically muscle tension. In treating TMJ or bruxism, these sensors would be placed along the muscles of the jaw. Chronic pain might be treated by monitoring electrical energy in other muscle groups.
  • Galvanic skin response (GSR) sensors. These are electrodes placed on the fingers that monitor perspiration, or sweat gland, activity. These may also be called skin conductance level (SCL).
  • Temperature sensors. Temperature, or thermal, sensors measure body temperature and changes in blood flow.
  • Electroencephalography (EEG) sensors. These electrodes are applied to the scalp to measure the electrical activity of the brain, or brain waves.
  • Heart rate sensors. A pulse monitor placed on the finger tip can monitor pulse rate.
  • Respiratory sensors. Respiratory sensors monitor oxygen intake and carbon dioxide output.


Individuals who use a pacemaker or other implantable electrical devices should inform their biofeedback therapist before starting treatments, as certain types of biofeedback sensors have the potential to interfere with these devices.
Biofeedback may not be suitable for some patients. Patients must be willing to take a very active role in the treatment process. And because biofeedback focuses strictly on behavioral change, those patients who wish to gain insight into their symptoms by examining their past might be better served by psychodynamic therapy.
Biofeedback may also be inappropriate for cognitively impaired individuals, such as those patients with organic brain disease or a traumatic brain injury, depending on their levels of functioning.
Patients with specific pain symptoms of unknown origin should undergo a thorough medical examination before starting biofeedback treatments to rule out any serious underlying disease. Once a diagnosis has been made, biofeedback can be used concurrently with conventional treatment.
Biofeedback may only be one component of a comprehensive treatment plan. For illnesses and symptoms that are manifested from an organic disease process, such as cancer or diabetes, biofeedback should be an adjunct to (complementary to), and not a replacement for, conventional medical treatment.

Side effects

There are no known side effects to properly administered biofeedback or neurofeedback sessions.

Research and general acceptance

Preliminary research published in late 1999 indicated that neurofeedback may be a promising new tool in the treatment of schizophrenia. Researchers reported that schizophrenic patients had used neurofeedback to simulate brain wave patterns that antipsychotic medications produce in the brain. Further research is needed to determine what impact this may have on treatment for schizophrenia.
The use of biofeedback techniques to treat an array of disorders has been extensively described in the medical literature. Controlled studies for some applications are limited, such as for the treatment of menopausal symptoms and premenstrual disorder (PMS). There is also some debate over the effectiveness of biofeedback in ADHD treatment, and the lack of controlled studies on that application. While many therapists, counselors, and mental health professionals have reported great success with treating their ADHD patients with neurofeedback techniques, some critics attribute this positive therapeutic impact to a placebo effect.
There may also be some debate among mental health professionals as to whether biofeedback should be considered a first line treatment for some mental illnesses, and to what degree other treatments, such as medication, should be employed as an adjunct therapy.



Robbins, Jim. A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback. Boston, MA: Atlantic Monthly Press, 2000.


Robbins, Jim. "On the Track with Neurofeedback." Newsweek 135, no. 25 (June 2000): 76.


Association for Applied Psychotherapy and Biofeedback. 10200 W. 44th Avenue, Suite 304, Wheat Ridge, CO 80033-2840. (303) 422-8436.
Biofeedback Certification Institute of America.10200 W. 44th Avenue, Suite 310, Wheat Ridge, CO 80033. (303) 420-2902.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


1. the provision of visual or auditory evidence to a person of the status of an autonomic (involuntary, vital) body function such as heart rate, blood pressure, or respiratory rate, as a method of teaching control of certain visceral responses previously thought to be exclusively dictated by the autonomic nervous system and therefore involuntary or unconscious.

Examples of the kinds of biological feedback that can be provided include information about changes in skin temperature, muscle tonicity, cardiovascular activities, blood pressure, and brain wave activities. With the aid of such sensitive electronic equipment as the electrocardiograph, electromyograph, and electroencephalograph, it is possible for the person to become consciously aware of the response being measured and to learn to control it. The feedback may be presented in the form of musical tones, lights, or direct visualization of scales or meters which indicate variance in the response.

In clinical biofeedback, the patient must practice the particular desired response many times under the supervision of professional persons who are skilled in the techniques of psychophysiology. An example in which biofeedback may be used clinically is in the treatment of raynaud's disease, in which the patient learns to consciously raise skin temperature in the extremities and thus reduce vasoconstriction.
2. in the nursing interventions classification, a nursing intervention defined as assisting the patient to modify a body function using feedback from instrumentation.
alpha biofeedback a procedure in which a person is presented with continuous information, usually auditory, on the state of his brain-wave pattern, with the intent of increasing the percentage of alpha activity; this is done with the expectation that it will be associated with a state of relaxation and peaceful wakefulness. Called also alpha feedback.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


A training technique that enables a patient to gain some element of voluntary control over autonomic body functions; based on the principle that a desired response is learned when received information such as a recorded increase in skin temperature (feedback) indicates that a specific thought complex or action has produced the desired physiologic response.
Farlex Partner Medical Dictionary © Farlex 2012


The technique of using monitoring devices to furnish information regarding an autonomic bodily function, such as heart rate or blood pressure, in an attempt to gain some voluntary control over that function. It may be used clinically to treat certain conditions, such as hypertension and migraine headache.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


A process in which a patient learns to influence physiologic responses—e.g., blood pressure, heart rate—which are either involuntary or which are usually unconsciously regulated, for which regulation has broken down due to trauma or disease.
A method of controlling a living system by informing it of its previous performance.
A psychological technique for controlling psychosomatic responses through heightened awareness and practice.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.


1. A process in which a Pt learns to influence physiologic responses which are either involuntary or usually well-regulated, but the regulation has broken down because of trauma or disease.
2. A method of controlling a living system by informing it of its previous performance. See Biofeedback device.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


A training technique that enables a person to gain some element of voluntary control over autonomic body functions; based on the learning principle that a desired response is learned when received information such as a recorded increase in skin temperature (feedback) indicates that a specific thought complex or action has produced the desired physiologic response.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


The provision, usually in ‘real time’, of information to a person about the levels of activity of normally unconscious bodily processes. This is done in the hope that some control or adjustment may be exercised. The information is provided in the form of a moving meter needle, a changing sound, a light of varying brightness, or any other form of display. There is evidence that biofeedback methods can lower blood pressure, but only by a small amount. It is probably valuable as an aid to learning how to relax. Most of the popular claims for biofeedback cannot be substantiated.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


A technique whereby visual (or bodily) processes normally under involuntary control (e.g. accommodation) are displayed to the subject, enabling voluntary control to be learnt. It has been used in myopia control and in acuity improvement but the value of the technique in these conditions is still unproven. See SILO response.
Millodot: Dictionary of Optometry and Visual Science, 7th edition. © 2009 Butterworth-Heinemann


A training technique that enables a patient to gain some element of voluntary control over autonomic body functions or involuntary unwanted behaviors or reactions; based on the principle that a desired response is learned when received information such as a recorded increase in skin temperature indicates that a specific thought complex or action has produced the desired physiologic response.
Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about biofeedback

Q. where can you find the biofeedback device shown in Dr. Liponis' column in Parade magazine on 12/14/08 I need to know where you canpourchase the biofeedback device and where you can get instructions on its use

A. if you ask me- before buying any new device, it might be a good idea to try it. go to couple of sessions with a certified therapist. see if you react well and then buy a machine. i'm sure he can recommend certain brands and what to avoid.

More discussions about biofeedback
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