What is biofeedback?
Biofeedback uses the mind and body connection. Using medical equipment, biofeedback teaches patients how to be aware of their biological processes so they can learn to control them. These processes are things which usually happen involuntarily, such as your heart rate, blood pressure and muscle tension. This in depth study on the use of biofeedback in medicine defines biofeedback as, “a mind–body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health.”
You will have already come across a form of biofeedback in your day to day life, for example using a mirror to see what you look like or using a thermometer to check your temperature if you don’t feel well.
Biofeedback was first studied in the 1960’s at Yale University. Research continued from there and the value of biofeedback methods were explored. In the present, biofeedback is becoming increasingly well established as a valid scientific treatment for a variety of health conditions including mental health and learning disabilities along with physical illness. The Foundation for Peripheral Neuropathy explains that biofeedback is primarily used to treat, “high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence.”
What happens during biofeedback?
Biofeedback is usually carried out as part of a physical therapy programme. Alternatively you might be referred to biotherapy by your doctor or specialist, which will be carried out at a clinic or a hospital. Typically biofeedback sessions will last between 30 and 60 minutes. How many sessions you need depends on the health issues you are addressing and how you react to the treatment. While some patients may need 8 to 10 sessions, others may require up to 20 sessions to see long term results.
A trained biofeedback technician or therapist will explain the process to you. They will then attach you to a monitor via sensors known as electrodes. These electrodes pick up on your biological processes and display them on the monitor’s screen. This is completely painless. Usually the sensors are just sticky patches which the therapist will put on specific points on your skin. The type of monitor and sensors used will depend upon your specific needs and the goals of the therapy.
Biofeedback is an active rather than passive treatment. This means that the patient takes an active role in the therapy. The therapist will guide you through talking about or imagining specific scenarios. They’ll ask you to pay attention to how your body reacts when you’re stressed, and in contrast, when you’re relaxed, by looking at the feedback displayed on the monitor. For example if you’re focusing on heart rate, when you’re stressed your heart rate will rise. This will cause the monitor to beep or flash, and you’ll be able to see how high your heart rate is.
The therapist will then teach you how to recognise those states of stress and relaxation within your body. Together you will work on how to actively calm yourself. You’ll be able to see your progress on the monitor. The goal is to give you an awareness of what is happening within your body and equip you with the tools to actively relax yourself without the use of the monitor. You’ll then be able to use these techniques in your day to day life to help you tackle your health issues.
Approaches and machines which may be used include:
- Electroencephalogram (EEG): An EEG monitors brainwaves during different mental states. This is known as neurofeedback.
- Electrocardiograms (ECG): ECG monitors heart rate. (These are quite commonly used. You might have experienced an ECG at the doctor’s office or in hospital before).
- Electromyogram (EMG): An EMG detects muscle tension.
- Pneumographs: These measure chest expansion and respiratory rate.
- Photoplethysmographs (PPG): This measures blood flow.
- Temperature biofeedback: During temperature biofeedback sensors are typically attached to the patient’s fingers or feet. These are usually thermometers which measure temperature. This can be used to treat some circulation disorders. Temperature often drops during a state of stress, so this can also be useful when focusing on relaxation (we’ve included a warming meditation at the end of this post)
- Galvanic skin response training: During galvanic skin response training, sensors detect the amount of sweat on the patient’s skin. We sweat more when we are anxious or stressed. This may involve Electrodermographs (EDG) which detects “the electrical properties of the skin”.
- Hemoencephalographs (HEG): This measures the amount of oxygenated and deoxygenated blood in the brain.
- Rheoencephalographs (REG): REG measures blood flow in the brain.
The relaxation techniques used depend on the therapist and the needs of the patient. They tend to include:
- Breathing exercises
The therapist may guide you through simple breathing exercises. These typically involve slowing your breathing. You may be asked to take deep breaths in and slow breaths out. This encourages a state of relaxation and calm.
There are many forms of mindfulness, all focused on being present in the moment rather than worrying about the past or future. Mindfulness is about being relaxed and at ease, and can be highly effective for stress relief among other benefits.
- Progressive muscle relaxation (PMR)
PMR involves being guided through tensing each individual group of muscles and then relaxing them. PMR can help to untense muscles and fully relax the body.
- Guided imagery
The therapist may ask you to imagine specific scenarios which help your body and mind to relax.
How can biofeedback treat chronic pain?
Stress and pain become a vicious cycle. They feed into one another and keep the cycle going. When we’re in a state of prolonged stress, we’re stuck in a state of ‘fight or flight’. This is designed to be a useful state for our bodies and minds in the short term, but when stress becomes chronic, it starts to take its toll on our bodies. Stress worsens our chronic pain in many ways including:
- Causing muscles to tense
When your muscles are stuck in this tense state for a long period of time, it can cause a lot of pain. It can also reduce your range of movement and slow your reaction times.
- Mental illness
Prolonged periods of stress can be tough to cope with emotionally. This can lead to or contribute to comorbid mental illness. Our emotional state has an impact on our pain levels. When our mood is low, we’re less likely to manage our pain well or keep up with treatments. This in turn can worsen our symptoms.
- Negative perceptions of pain
When we’re anxious this can contribute to hypervigilance (being overly aware of pain levels), catastrophizing (worrying excessively about our pain) and fear avoidance (avoiding activity for fear of worsening our pain levels). Our perception of pain can affect our pain levels, so if we’re worrying about our pain and being hypervigilant about it, we’re feeding back to our brain that these situations ‘should’ be causing pain. Essentially we’re perpetuating our chronic pain. When we avoid activity, this can lead to deconditioning (meaning our muscles weaken) which then makes our pain levels worse when we do try to be active.
- Lack of sleep
We need a good sleep routine to help our bodies and minds function properly during the day. When you live with chronic pain, it’s tough to sleep well. Stress can contribute to a lack of sleep. This in turn contributes to fatigue and increased symptoms.
The stress hormones released when we’re in a state of ‘fight or flight’ affect the body’s ability to regulate inflammation. Inflammation in turn worsens chronic pain.
The good news is that there are many ways to tackle the stress response and break the stress and pain cycle, biofeedback being one of them. Since biofeedback can teach patients how to relax their bodies, it can actively reduce the stress response. Patient’s can learn to lower their heart rate and respiratory rate for example, taking them out of that ‘fight or flight’ state of mind. When patient’s are able to use this newly acquired skill in their day to day lives, they can tackle stress head on and reduce it, therefore reducing pain.
This reduction in stress means that patients are more likely to be able to sleep restfully, allowing them to function optimally throughout the day. Reduced stress levels lead to a more positive mindset and better mental health, which in turn has a positive impact on pain symptoms. With a more stable mood, patients are far more likely to actively self-manage their pain symptoms, to attend appointments and continue treatments. This contributes to increased functioning and lower pain levels.
Giving patient’s the ability to be aware of muscle tension and actively teaching them to relax their muscles, can relieve pain and prevent muscle tension in the future. Interestingly, biofeedback can also be used to start working weakened muscles as this study explains: “SEMG biofeedback can be used to help “down-train” elevated muscle activity or to “up-train” weak, inhibited, or paretic muscles.” Since inactivity can lead to deconditioning which we discussed earlier, this could be highly beneficial for pain patients.
Biofeedback can allow pain patients to regain a lost sense of control over their bodies. When you live with chronic pain it can make you feel helpless, as though there’s nothing you can do about it. This negative perception can perpetuate chronic pain. Learning how to take control over your bodily processes gives you a renewed sense of confidence and empowerment against your condition. This in turn promotes a more positive perception of pain, actively improving pain levels. This study on the efficiency of biofeedback on treating chronic pain found that biofeedback, “proved to be effective in reducing depression, disability, reduction of muscle tension and improving cognitive coping”.
When biofeedback is used along with other treatments (for example pain neuroscience education or cognitive behavioural therapy) it can bring the best results as this study discusses. Biofeedback can help patients to reduce their symptoms and get their life back!
Try it for yourself. Here’s a progressive warming relaxation meditation from us at Pathways:
Audio message for you:
As the name suggests, within this meditation we’ll guide you on warming each part of your body, leaving you completely relaxed, warm and rejuvenated. You can find more meditations and pain relief exercises by downloading the Pathways app (update Aug 2023: Pathways is now a web app! Start our program here)
- Steven D. Waldman MD, JD, (2009), “Biofeedback”. Pain Review: Pages 623-624
- Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). “Biofeedback in medicine: who, when, why and how?”. Mental health in family medicine, 7(2), 85–91.
- Randy Neblett, (2016), “Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain”. Healthcare: 4(2), 27
- Sielski R, Rief W, Glombiewski JA, (2017), “Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis.” Int J Behav Med. Feb;24(1):25-41.
- Neil A. Jepson, MS, (2008), “Applications of biofeedback for patients with chronic pain”. Techniques in Regional Anesthesia and Pain Management, 12, 111-114
- The Foundation for Peripheral Neuropathy, (2016), “Biofeedback Therapy”.
- Good Therapy, (2016), “Biofeedback”.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.