Biofeedback areas of application & effectiveness
The possible applications of the treatment technique are very diverse. The most common applications are in the fields of psychosomatics, pain therapy, psychology, ADHD, migraine therapy and muscle rehabilitation. Biofeedback is also used for training in the fields of sport, peak performance training and coaching.
For many of the indication areas listed, sound evidence of efficacy has been provided in the form of controlled studies and medium to large effect sizes have been shown in meta-analyses.
The following are examples of some of the most important areas of application for biofeedback and neurofeedback.
In addition to countless reports from users in the field, there is now also a large amount of scientific literature available on proof of efficacy. The US-American AAPB In its review published in 2023, the following indications, among others, were named as effective or probably effective.
Effective and specific:
- Attention deficit hyperactivity disorder (ADHD)
- Panic disorders
- Asthma
- Depression
- Diabetes Mellitus
- Erectile dysfunction
- Incontinence (adults)
- Pre-eclamation
Effective:
- Headache
- Chronic back pain
- High blood pressure
- Irritable bowel syndrome
- Post-traumatic stress disorder (PTSD)
- Raynaud's syndrome
- Temporomandibular dysfunction (TMD)
- Cerebral palsy
- Stroke
- Epilepsy
- Peak performance
- Incontinence (children)
Probably effective:
- including alcohol and drug addiction
- Fibromyalgia
- Generalised anxiety disorder (GAS)
- Arthritis
- Autism spectrum disorders
- Tinnitus
- Chemotherapy-induced peripheral neuropathy
- Chronic obstructive pulmonary disease (COPD)
- Tumour pain
- Phantom pain
- Coronary heart disease
Possibly effective:
- Specific phobias
- Chemobrain
- Functional abdominal pain
- Hyperhidrosis
- Vasovagal syncope
Frequent bio- and neurofeedback application areas
Stress & burnout
Biofeedback is used to work with stress and burnout, as well as to prevent such complaints, and has been shown to be effective in these areas (see „Effectiveness“).
Another possible application is to raise awareness of stress, as the „feeling“ for one's own bodily processes has often already been weakened by chronic stress.
Pain therapy
The treatment of pain using biofeedback is one of the most successful areas of application.
Biofeedback for tension headaches
Biofeedback is ideal for breaking the vicious circle of tension. A summarised evaluation of studies proved the effectiveness of biofeedback for this indication. One user reported success in just eight sessions.
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Biofeedback for migraine
The effectiveness of biofeedback has also been clearly proven in the treatment of migraines, with stable effects over time. Vasoconstriction training and temperature training are used here.
Meta-analyses report an average reduction in attacks of 35%-45%. This effect can be further enhanced by combining it with other procedures.
Biofeedback for chronic back pain
Biofeedback has been shown to be an empirically proven method for the treatment of back pain.
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Biofeedback for bruxism and facial pain
In the course of treating bruxism and facial pain using biofeedback, EMG feedback of the masseter, temporalis and frontalis muscles is used to improve discriminative muscle perception.
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Anxiety disorders
Anxiety is a hurdle for those affected in coping with everyday life. Biofeedback supports the client (e.g. by means of breathing training) through general relaxation to reduce the likelihood of anxiety occurring.
In addition, intensive confrontation training is also used. Here, the patient learns to relax in the face of the anxiety-inducing stimulus. After just 6 to 12 sessions, improvements and significant symptom reductions can be seen.
Depression
Biofeedback can support the goals of cognitive and behavioural interventions and contribute to the improvement of self-efficacy or cognitive beliefs.
A study using HRV biofeedback, among other things, concluded that biofeedback appears to be a useful adjunctive therapy for the treatment of major depression.
High blood pressure
Breathing biofeedback and HRV training are frequently used in the treatment of high blood pressure with biofeedback.
In the study „Evidence-Based Practice in Biofeedback and Neurofeedback“, biofeedback therapy for high blood pressure was rated with the second highest level of effectiveness.
Rehabilitation
Even the smallest movements of paralysed or atrophied muscles can be recorded using EMG biofeedback. These are reported back to the test person on the screen.
In small steps, the test subjects learn to activate and train the muscle.
This treatment method has proven long-term effects.
ADHD
The treatment of ADHD with neurofeedback is one of the most scientifically proven areas of application in the world of neurofeedback. Children learn to actively influence different frequency bands in their brain in order to improve their ability to concentrate.
As an alternative to medication, neurofeedback is an attractive form of treatment with a lasting training effect. A review of the effectiveness of various biofeedback and neurofeedback procedures assigned neurofeedback the highest level of effectiveness for ADHD.
Heart rate variability
Heart rate variability (sometimes also called heart rate variability) refers to the ability of the organism to change the frequency of the heart rhythm.
As part of HRV diagnostics, the degree of variability of the heart is determined. This can be done either as part of short-term diagnostics or using a 24-hour recording mode. The shorter the recording, the more importance must be attached to artefact-free recording.
Competitive sport
The possible applications of biofeedback parameters in the field of sports training are manifold.
By training respiratory sinus arrhythmia (RSA), athletes can learn to calm their pulse rate. The use of neurofeedback is also very popular here
The US Olympic archery team, the Canadian Olympic short track team and many other outstanding athletes use neurofeedback and biofeedback to improve concentration and performance.
Irritable bowel syndrome
Biofeedback as a stress management strategy
Complete freedom from symptoms in almost 70 % of the test subjects
Cost-saving potential due to small number of necessary meetings
Classified as „Effective“ by the Association for Applied Psychophysiology and Biofeedback
PTSD
In the treatment of post-traumatic stress disorder (PTSD) with biofeedback, for example, breathing training can be used as a supportive treatment for cognitive behavioural therapy. In one study, for example, breathing biofeedback proved to be a practical and easy-to-add treatment method for PTSD.
Dr Liedl and her colleagues have also published a manual on the treatment of traumatised pain patients, which includes biofeedback training.
Asthma
According to experts, breathing biofeedback is a useful and effective addition to the treatment of asthma in children. Breathing biofeedback and EMG feedback are used as part of a systematic desensitisation programme to teach relaxation skills.
These are designed to help sufferers reduce anxiety before and during the attack and learn a favourable breathing pattern.
Tinnitus
Biofeedback is used for chronic tinnitus, as this is very often associated with increased levels of stress and tension. Tension and stress can trigger or worsen tinnitus.
One study came to the conclusion that biofeedback is a very well accepted and effective method for reducing tinnitus stress.
Constipation
The treatment of constipation with biofeedback can be carried out using EMG training and anal probes. Pelvic floor exercises can also be supported in this way.
Some works report the superiority of biofeedback training over other methods.
Erectile dysfunction
Biofeedback can also be used for erectile dysfunction.
While relaxation training can be used to tackle psychogenic problems, anal electrodes can also be used to train the pelvic floor (e.g. after prostate removal).
Hyperventilation
The somatic complaints are provoked by repeated voluntary hyperventilation.
These experienced complaints are discussed after the hyperventilation episode - this is intended to achieve a reattribution of the complaints that may originally have been attributed to a serious, unknown organic disease.
Stress diagnostics
Before starting a biofeedback treatment, it makes sense to first answer a few questions about the individual stress reaction of the test person or client.
There are two ways to do this: short stress tests, which test the body's stress and recovery response, and memory modes, which test stress and recovery over the course of an entire day.
Sleep disorders
Behavioural treatments such as biofeedback should be considered the training of choice for insomnia thanks to their long-term effectiveness and lack of harmful side effects.
In the case of sleep disorders, different variants of biofeedback are often combined in order to practise a kind of sleep protocol (warm up the body, relax the muscles, etc.)
Profession
Biofeedback and neurofeedback are also increasingly being used in two different areas in a professional context. On the one hand, the use of biofeedback in occupational health care is a preventative approach to protecting employees.
On the other hand, top performers (e.g. in management) are also promoted.
Incontinence
Biofeedback is a very successful and effective treatment method for various forms of incontinence.
High success rates have been described for stress urinary incontinence and urge incontinence in particular (success rates of almost 80 % in just a few sessions), but also for anal incontinence.
Raynaud's disease
This disease, also known colloquially as white finger disease, is characterised by numbness, pain and coldness in the fingers and toes. Many therapists use temperature biofeedback in the treatment of Raynaud's disease. The aim of this is to warm the fingers voluntarily.
On average, 5-10 sessions are reported in the literature. The long-term success rate is 70%.
Epilepsy
It is thanks to a coincidence that the treatment of epilepsy using SMR neurofeedback was discovered - the researcher had not actually planned it that way. The method has now been in use for more than 40 years and has shown great success.
Recently, skin conductance training has also become increasingly popular in the treatment of epilepsy and is proving to be highly effective.