Biofeedback

Does Biofeedback Actually Work? The Science and the Skepticism

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For some conditions, yes, and the evidence is strong; for others, the research cannot say yet. A 2019 evidence map of 16 good-quality systematic reviews found high-confidence evidence that biofeedback reduces migraine and tension-type headaches, benefit for urinary incontinence after prostate surgery, no benefit for urinary incontinence in women or for high blood pressure, and too little evidence to judge most other uses.

How strong is the evidence, condition by condition?

Read together, the findings of the 2019 evidence map in the Journal of General Internal Medicine fall into rough tiers:

  • Strong: migraine and tension-type headaches, where the map rated the evidence of benefit as high-confidence.
  • Positive but narrower: urinary incontinence in men after prostatectomy; for fecal incontinence, electrical stimulation combined with biofeedback did better than electrical stimulation alone, with moderate confidence.
  • Possible: balance, stroke recovery, fibromyalgia pain with muscle feedback, and low-confidence evidence for biofeedback-guided dialysis in some patients.
  • Unclear: Bell’s palsy, chronic constipation, swallowing difficulty, knee osteoarthritis, labor pain, Raynaud’s and teeth grinding during sleep.
  • Not beneficial in the studies available: urinary incontinence in women and the management of high blood pressure.

Why is the evidence weak where it is weak?

The authors name the reasons. Low confidence came from small combined sample sizes, poor study quality, differences in the treatments that biofeedback was combined with, and inconsistent results across studies. Even the negative findings for incontinence in women and for high blood pressure, they note, are limited by small samples and weak methods.

That matters for how to read the gaps. “Unclear” means the research is not good enough to decide. It does not mean biofeedback has been shown not to work, and it does not mean it works.

Why do professional recommendations go further?

Because they rest on a different evidence base. The Association for Applied Psychophysiology and Biofeedback, a professional association, provides clinical guidelines and lists biofeedback as efficacious for a range of conditions, including anxiety. The map’s authors note that those guidelines are based on a series of white papers, that only the one on headache disorders met their inclusion criteria, and that none of the systematic reviews on anxiety did.

Their conclusion is direct: the small number of controlled trials leaves uncertainty about the true effect of biofeedback for many conditions for which the association currently recommends it. A recommendation from a professional body and a finding from an independent review are two different kinds of statement.

Where should research go next?

The authors single out balance and gait training, fibromyalgia and low blood pressure during dialysis as promising areas without enough data from systematic reviews to support routine clinical use, and as good targets for further study.

Three tests for any biofeedback claim

When a clinic, a device or an article says biofeedback works for something, ask three questions. Which condition, exactly? Which type of biofeedback, since a result for muscle feedback says nothing about brainwave training? And what kind of evidence: a systematic review of controlled trials, a guideline from a professional body, or a set of individual stories? The answers place the claim in one of the tiers above.

This article is general information, not medical or psychological advice; talk with a licensed clinician about your own situation.

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