When you think of treating a disease or health issue, odds are your mind jumps to medications and lifestyle changes. But there’s also biofeedback.
Biofeedback is a method of gathering information about physiological functions in the body, so you can learn how to harness those changes to improve health and performance, according to the Association for Applied Psychophysiology and Biofeedback. It’s used by doctors, physical therapists, psychologists, and other healthcare professionals to manage and treat various health issues, such as urinary incontinence, anxiety, and chronic pain.
“Basically, biofeedback is any feedback that the patient receives about their body in the moment to help them figure out what their body is doing, so they can improve coordination and awareness,” says Nora Arnold, DPT, a physical therapist with the Johns Hopkins Rehabilitation Network who specializes in pelvic health.
There are many ways to receive biofeedback. A practitioner may attach sensors to your scalp to monitor brain activity, your abdomen or chest to monitor your breathing patterns or heart rate, or any number of other places on your body, per the Mayo Clinic.
Here are several potential health and wellness benefits of this therapy.
1. May Aid Rehabilitation
Roger W. Gerland, the director of rehabilitation services at Northwell Health in New York City, often uses biofeedback with patients recovering from surgery. “It [can help] reeducate the muscle to start firing again,” he says.
Gerland relies on electromyography (EMG) biofeedback, a type of biofeedback that involves attaching sensors to the patient’s target muscles to monitor their contractions. The sensors connect to a device that lights up or emits beeps when the muscle reacts. “The stronger the patient makes a muscle contraction, the higher the lights will light up and the more the beeps will beep,” Gerland says.
EMG biofeedback is often used to improve muscle function in people with paralysis in one side of the body (known as hemiplegia), a common side effect of strokes, spinal cord injuries, and seizures, according to a past review.
A randomized controlled trial published in February 2021 in Acta Neurologica Belgica tested the efficacy of EMG biofeedback in combination with conventional physiotherapy in patients with hemiplegia. One group of patients received EMG biofeedback therapy five days a week for three weeks. Sensors were attached to the tibialis anterior (a muscle that extends the ankle) to monitor the electrical activity that causes muscle contraction.
The patients who gained ability to gauge when and how well they moved their ankles experienced greater improvement in walking than those who relied on conventional physiotherapy alone.
Another randomized controlled trial, published in September 2019 in Scientific Reports found similar results in elderly adults recovering from hemiplegia after a stroke.
2. May Improve Stress Urinary Incontinence
EMG biofeedback is often used alongside pelvic-floor-strengthening exercises to treat stress urinary incontinence (SUI), or the accidental leakage of urine. SUI is most common in women, and occurs when the muscles and other tissues that control the release of urine become weak, per the Mayo Clinic.
Biofeedback for SUI is typically done by attaching sensors to the lower abdomen or inserting a sensor into the vagina to measure the tension of pelvic floor muscles. The sensors record the tension and relay the information to a monitor that lights up or emits sounds when the pelvic floor muscles are contracted correctly, according to a review published in the Cochrane Database of Systematic Reviews.
This biofeedback may be especially helpful for areas of the body like the pelvic floor. “The pelvic floor is an area of our body that we can’t visually observe very easily, and a lifetime of not really seeing what’s happening there can lead to some confusion about how we’re recruiting or controlling the muscles there,” Arnold says.
According to the Cochrane review, which included 24 studies involving 1,583 women, those who received biofeedback along with pelvic floor muscle training were significantly more likely to report that their SUI was improved than the women who received only pelvic floor muscle training.
The authors noted that the biofeedback groups also had more contact with healthcare professionals than the training-only groups, which may have contributed to their positive results.
Newer research is potentially more promising. After looking at 21 studies, the authors of a systematic review and meta-analysis published in June 2021 in Advances in Therapy concluded that EMG biofeedback combined with pelvic floor muscle training achieved better outcomes in the management of SUI than training alone.
3. May Help Treat Epilepsy
Epilepsy is a brain disorder that causes repeated seizures. A seizure is a sudden, uncontrolled electrical disturbance in the brain that creates changes in behavior, movements, feelings, or levels of consciousness, according to the Mayo Clinic.
Normally, epilepsy is treated with prescription medication. But about 30 percent of people with epilepsy don’t respond to medication and continue to have seizures, according to a past article.
Biofeedback may help — in particular, a method known as galvanic skin response (GSR), which monitors changes in the heat and electricity passed through the skin (also known as skin conductivity). GSR is often used in lie detectors, because skin conductance changes in response to emotional thoughts, according to a systematic review and meta-analysis published in April 2019 in Frontiers in Neurology.
GSR biofeedback may help prevent epileptic seizures by increasing control of, and reducing the emotional and physiological arousal that can lead to seizures, creating changes in areas of the brain that are associated with loss of consciousness, per the aforementioned review. And after reviewing four studies, the authors concluded that GSR biofeedback may be an effective tool to reduce epileptic seizures in people who don’t respond to medications.
The research in GSR biofeedback for epilepsy is still limited and lacking. More studies with higher sample sizes are needed to confirm whether it's useful.
4. May Boost Mental Health
Learning to harness body functions that contribute to stress and anxiety — such as breathing, heart rate, and blood pressure — may improve mental health.
A review published in November 2017 by the Canadian Agency for Drugs and Technologies in Health examined five randomized controlled trials on patients with post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and major depressive disorder. The studies used various biofeedback methods, including breath monitoring, neurofeedback (the use of sensors attached to the scalp to monitor brain activity), and heart rate variability (a measure of the variation in time between each heartbeat). Often, biofeedback was combined with conventional mood therapies and showed added benefit when used with CBT and psychotherapy.
Overall, patients who received biofeedback training of some type, by a health professional, saw more significant improvements in symptoms than people who did not.
The authors warned that many of the studies they reviewed included small sample sizes and omitted relevant details about study design. Larger, higher-quality studies are needed to confirm the findings.
Another review and meta-analysis, published in March 2021 in Scientific Reports, found that heart rate variability (HRV) biofeedback in particular may improve depression and mental well-being. Lower HRV, or less variation in time between each heartbeat, may be linked with a greater risk of developing depression, the authors postulated. With HRV biofeedback, you may be able to learn how to control your breathing to create changes in heart rate and HRV. As HRV increases, symptoms of depression decrease, per the review’s findings.
5. May Improve Asthma
Learning to control your breathing through HRV biofeedback may also lower stress. While this is helpful in many situations, it may be especially beneficial for people with asthma. According to the Asthma and Allergy Foundation of America, stress is a well-known trigger of asthma attacks.
In a study published in April 2019 in Respiration Physiology and Neurobiology, researchers checked whether HRV biofeedback might prevent stress-induced airway constriction in people with asthma. They gave participants a single HRV biofeedback session and then had them complete a stressful three-part test in which they read color names as quickly as possible. After the stressful test, researchers measured participants’ lung function through spirometry, a common test used to measure how much air you inhale, exhale, and how quickly, according to the Mayo Clinic. They found that people with asthma performed significantly better on the spirometry test after they received HRV biofeedback.
Still, more research is needed.