Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.
As it is noninvasive and does not involve drugs, there is a low risk of undesirable side effects.
This could make it suitable for those who wish to avoid medications, or those who cannot use them, such as during pregnancy.
It is often combined with relaxation training.
There are three common types of biofeedback therapy:
- Thermal biofeedback measures skin temperature.
- Electromyography measures muscle tension.
- Neurofeedback, or EEG biofeedback focuses on electrical brain activity.
During a biofeedback session, the therapist attaches electrodes to the patient's skin, and these send information to a monitoring box.
The therapist views the measurements on the monitor, and, through trial and error, identifies a range of mental activities and relaxation techniques that can help regulate the patient's bodily processes.
Eventually, patients learn how to control these processes without the need for monitoring.
How many sessions will I need?
Sessions typically last less than one hour.
For some conditions, patients experience relief in eight to 10 sessions. For other conditions, such as high blood pressure, improvements may take 20 sessions to appear.
Alongside these sessions will be mental and relaxation activities that the individual will complete at home for 5 to 10 minutes a day.
When a person experiences stress, their internal processes — such as blood pressure — can become irregular. Biofeedback therapy teaches relaxation and mental exercises that can alleviate symptoms.
People often seek biofeedback and relaxation techniques to treat headaches and migraine, but studies into its effectiveness have produced mixed results.
In 2015, a Japanese study found that biofeedback therapy reduced the frequency and severity of symptoms in people with migraine headaches.
However, in 2009, other researchers reported that while relaxation appears to benefit people with migraine headaches, combining relaxation with biofeedback does not seem to produce additional benefits.
The authors note:
"Biofeedback is an extremely costly and time-consuming treatment modality that, in our study, provided no additional benefit when compared to simple relaxation techniques alone, in the treatment of migraine and tension-type headaches in adults."
The Michigan Headache and Neurological Institute (MHNI) suggest that biofeedback therapy improves symptoms of headache and migraine in 40 to 60 percent of patients, similar to the success rate of medications.
They propose that combining biofeedback with medication may increase the effectiveness of both. However, while biofeedback may help relieve stress-induced migraine, migraines due to other triggers may be less responsive.
Some studies have suggested that EEG biofeedback, or neurofeedback, may help people with ADHD.
According to authors of a systematic review published in The BMJ in 2014, growing evidence indicates that neurofeedback could help with ADHD.
However, they call for further investigations to confirm its effectiveness, because of the weak design of many studies.
Post-traumatic stress disorder
Some types of biofeedback therapy may help patients with post-traumatic stress disorder (PTSD).
One study found that adding heart-variability biofeedback to standard PTSD treatment did not bring any benefit.
However, in 2016, scientists reported that the use of EEG biofeedback "significantly reduced PTSD symptoms" in 17 patients with PTSD.
The Agency for Health Care Policy and Research currently recommend pelvic floor muscle training with biofeedback therapy for the treatment of urinary incontinence, based on findings in clinical studies.
Children's anxiety at the dentist's
Researchers at the Narayana Dental College and Hospital in India examined whether biofeedback therapy might help control children's anxiety when receiving dental restorations.
In the journal European Archives of Paediatric Dentistry, they concluded that "Biofeedback can be used in the initial visits for dentally anxious children, and the usage of simpler biofeedback machines for these appointments in dental setup is suggested."
Raynaud's disease is a condition that causes some parts of the body to feel numb and cool in response to cold temperatures or emotional stress. It results from a problem of blood supply to the skin.
Studies indicate that thermal biofeedback can help alleviate symptoms of Raynaud's disease.
The Raynaud's Association reports that 80 to 90 percent of patients with Raynaud's experienced improved circulation and a reduced frequency of symptoms after therapy.
A team from the University of Iowa found that biofeedback treatment showed better results that the use of laxatives for chronic constipation, and that biofeedback can successfully retrain the muscles that cause chronic constipation.
According to the lead author of the study, "results show that bowel movement improvement is possible in nearly 80 percent of patients through biofeedback."
Scientists at the University of Lübeck in Germany found that combining electrical stimulation with biofeedback therapy helped patients with fecal incontinence.
They reported in the International Journal of Colorectal Disease that "there is sufficient evidence for the efficacy of BF (biofeedback) plus ES (electrical stimulation) combined in treating fecal incontinence. AM-MF (amplitude-modulated medium-frequency) stimulation plus BF seems to be the most effective and safe treatment."
Cognitive and behavioral therapies
Dr. John Krystal, Editor of Biological Psychiatry, said biofeedback may open new avenues for cognitive and behavioral therapies.
He was commenting on a study in which people were able to control the activity of certain regions of the brain when they receive feedback signals by functional magnetic resonance brain imaging (fMRI).
Chronic rectal pain
Studies by researchers at the University of North Carolina have shown that biofeedback is more effective than some other treatments for a type of chronic rectal pain called levator ani syndrome.
Nocturnal bruxism is the clenching, bracing, grinding or gnashing of the teeth and jaws during sleep.
A team at The Turner Dental Hospital, Manchester, in the United Kingdom, investigated the effect of biofeedback therapy on this condition.
Nineteen participants were given a special biofeedback device to wear every night for 5 weeks.
Eleven of the participants experienced a reduction in headaches and jaw-muscle discomfort on waking up in the morning.
The study authors concluded: "The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement."
Participants reported no adverse effects during the study period.
Persisting childhood apraxia of speech
A person with apraxia of speech finds it hard to say what they want to say correctly and consistently. It is due to a problem in the brain, not the speech muscles.
Researchers at Haskins Laboratories in Connecticut looked at the effectiveness of a treatment program that included ultrasound biofeedback for six children with childhood apraxia of speech (CAS), who had persisting speech sound errors.
After 18 treatment sessions, the authors concluded that "a treatment program including ultrasound biofeedback is a viable option for improving speech sound accuracy in children with persisting errors associated with CAS."
Other conditions that may benefit from biofeedback include:
- back pain
- high blood pressure
- chronic pain
- anorexia nervosa
- learning disabilities
- muscle spasms
- motion sickness
Biofeedback therapy can help to optimize performance in sports participants.
Sports psychologist Timothy Harkness used neurofeedback training to help Abhinav Bindra, who won the gold medal in the 10-metres air rifle event at the Beijing Olympics.