Biofeedback

What Is Biofeedback, and How Does It Work?

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Biofeedback uses sensors to measure a body process, such as muscle tension, breathing or heart rate, and shows you the reading in real time so you can learn to change it. A 2019 evidence map of systematic reviews found high-confidence evidence that it reduces migraine and tension-type headaches, possible benefit for a few other conditions, and no benefit, in small studies, for urinary incontinence in women or for high blood pressure.

What exactly is biofeedback?

A learning method built on measurement. The authors of a 2019 evidence map in the Journal of General Internal Medicine define it this way: biofeedback “uses instruments to measure and provide real-time feedback on patients’ physiological responses in order to assist patients in learning to change those responses.”

The idea is not new. The Wikipedia article on biofeedback traces its modern conventional roots to the early 1970s, and describes an early study from 1969 that used feedback from the forehead muscle.

How does the feedback loop work?

In four repeating steps:

  1. A sensor measures one body process, such as the tension in a muscle or the temperature of your skin.
  2. A screen or a sound shows it as it changes, second by second.
  3. You try something, such as slowing your breath or letting your shoulders drop, and watch what happens to the reading.
  4. You keep what works. Over repeated sessions, you learn which changes move the signal in the direction you want.

That is the difference between being told to relax and learning how. You may not be able to tell from the inside whether your jaw is clenched or how fast you are breathing; the reading shows you, and the practice gives you a way to test what helps.

What can it measure?

The evidence map lists the most common types of measurement:

  • Muscle activity, through electromyography (EMG).
  • Heart rate and heart rate variability.
  • Breathing.
  • Blood pressure and blood flow.
  • Brainwaves, through EEG, a form also called neurofeedback.
  • Skin temperature.
  • Electrodermal activity, the activity of the sweat glands.

Do you always need a machine?

Not in the long run. The Wikipedia article notes that the changes learned with instruments may eventually be maintained without them, and that no equipment is necessarily required to practice biofeedback. The equipment is there to teach the skill; the aim is to be able to use it without the screen.

What is it used for?

The 2019 map, which reviewed 16 good-quality systematic reviews, gives a mixed picture:

  • Headaches: high-confidence evidence that biofeedback reduces the frequency, duration and intensity of migraine and tension-type headaches.
  • Urinary incontinence after prostate surgery: evidence of benefit in men after prostatectomy.
  • Fecal incontinence, balance and stroke recovery: it may provide benefit.
  • Urinary incontinence in women and high blood pressure: biofeedback was not beneficial, though the authors note these conclusions are limited by small sample sizes and weaknesses in the studies.

For most other conditions, including teeth grinding, labor pain and Raynaud’s, the authors found insufficient evidence to draw conclusions. If a use is not on the list above, this evidence map offers no support for it.

Before you book

Ask what the sensor will measure and why that measure fits your problem. Ask what you will practice at home between sessions. If you are being treated for a condition such as high blood pressure, keep your treatment as it is, and talk to your doctor before adding biofeedback to your plan.

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

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