Biofeedback and Neurofeedback Training

Biofeedback refers to a type of therapy that tracks physiological changes—for example, your heart rate, muscle tension, skin temperature, or breathing patterns—to help you see how your body responds to different thoughts, emotions, or relaxation techniques.

The core principle is that once you can observe these typically unconscious processes, you can learn to influence them. For example, watching your heart rate variability on a monitor while practicing deep breathing helps you discover which breathing patterns most effectively calm your nervous system.

Neurofeedback training, or “NFT,” is a specific subset of biofeedback focusing on brainwave imbalances.

Biofeedback can be a great complement or alternative to talk therapy.

Biofeedback aims to help you self-regulate so that you’re better able to be the person you want to be. Biofeedback may help the brain and body learn to identify subconscious thoughts, feelings, and behaviors, and allow more conscious control over things like stress reduction, pain management, and enhancing physical performance.

Some types of biofeedback aim to reduce sympathetic arousal (aka your automatic stress response); monitoring and controlling functions such as blood pressure, gait, heart rate, pain, and respiration.

A common goal of NFT is to support the brain in identifying and maintaining optimal brain waves for a given state or task. For example, remaining relaxed and focused throughout school, work, sports, and social activities.

• Students, athletes, professionals, parents, folks with certain injuries or learning disabilities
• Anyone seeking to optimize functioning, emotional regulation, and peak performance goals may benefit from biofeedback and NFT.

Biofeedback may be a fit for those searching for a more natural treatment option; that is, hoping for results with or without other therapies or medications.

Biofeedback exists in many forms, including:

• Surface Electromyography Biofeedback (sEMG) “down trains” overactive muscles or “up trains” weak/inhibited ones. It’s often used for tension headaches, chronic pain, spasms, joint dysfunction, and or performance issues.
• Respiratory Biofeedback involves wearing bands around the chest to monitor breathing.
• Heart Rate Variability Biofeedback involves wearing a sensor (typically on the ears, fingers, wrist, or chest).

There are also many types of neurofeedback. Some are branded systems which are fairly quick to learn with a single, standardized protocol.

• Infra-Low Frequency (ILF) or Infraslow Fluctuation (ISF) target slow brain wave frequencies.
• The Safe and Sound Protocol (SSP) is a standardized neurofeedback training using bilateral audio (i.e. listening to sounds in each ear).

Other biofeedback systems are individualized for each client’s goals and may require more advanced training for providers, for example:

• Traditional Neurofeedback Training (NFT) utilizes Electroencephalography (EEG) biofeedback data from sensors placed on the scalp, including Alpha/Theta, Inhibit/Enhance, Sensorimotor Rhythm training (SMR) training, and others.

Biofeedback in general has deep roots in both medicine and psychiatry.

NFT began as early as the 1950s with Dr. Joe Kamiya. Kamiya conducted studies to explore consciousness using an electroencephalogram (EEG), finding that subjects could change brain activity using a simple reward system.

Brain waves account for all sorts of things such as reading, eating, or wiggling your toes; they largely dictate how we feel and how we relate to others. When an amplitude is "too fast," we may feel nervous, chaotic, disorganized, reactive, or more sensitive to pain. When "too slow," we might feel sluggish, "checked out," fuzzy, or forgetful.

Learning to identify and control brain waves naturally poses some powerful possibilities.

The efficacy of biofeedback varies depending on how it’s used and by whom. A growing body of evidence supports positive results of training across different contexts and populations.

A 2008 report rated biofeedback training as conclusively "efficacious" for anxiety, ADHD, chronic pain, epilepsy, headaches, and hypertension, and other conditions.

More recent research adds to the evidence for biofeedback, showing positive results for anxiety relief, specific motor responses, and managing and relieving chronic pain.

Both biofeedback and neurofeedback training typically use non-invasive sensors and real-time feedback to help you change unhelpful perceptions and responses.

Biofeedback typically works by using operant conditioning techniques — in other words, by helping you become aware of certain physiological signals (for example, you notice your heart beating faster or your jaw getting tight), then using that awareness to “train yourself” to respond differently to those signals.

Neurofeedback training uses both operant conditioning and real-time feedback of brain activity, which allows you to “see” your unconscious responses on a deeper level.

Unlike talk therapy, you don’t need to talk during most types of biofeedback training. That said, as with many goals, it will take a degree of commitment, time, and (depending on each provider and insurance) investment to see results.

In a neurofeedback training session, a client often sits in a quiet room with a screen and a movie or video game with sound.

• When appropriately focused, the brain enjoys the simple “reward” of the experience being uninterrupted.
• When the brain gets distracted, the screen or sounds may fade or change, “nudging” the brain toward an ideal state again.

Between training sessions, any new symptoms are always worth mentioning to a provider. Sometimes, these are clues to target different areas of the brain (e.g., an anxious/hyper-alert brain needs different training than a depressed/foggy brain). It could also be a sign of an underlying problem (such as a medical condition, medication, or addiction).

Like many treatments, the timeline and structure of biofeedback and neurofeedback training can vary. After an initial assessment, training may occur multiple times a week for the first few months, and results may be evident in as little as 10-25 sessions.

Sessions may last about 15 minutes to an hour or more. As the brain begins to self-regulate without screens or feedback, the frequency may be reduced, and eventually, the training completed.

Some report returning to treatment with new goals or “maintenance” a year or more later, and others find that they are able to maintain a new level of functioning without any additional training later on.

If after reading this, you’re not sure if Biofeedback and Neurofeedback Training is quite the right fit, here are some other types that might be worth looking into: