Biofeedback vs Neurofeedback: Unlocking the Potential of Mind-Body Connection

Have you ever wanted to slow down your heart from racing before a big presentation or prevent stress from affecting your breathing? Or maybe you are more interested in getting your brain to reach that peak focus zone. Emerging research suggests that both of these may be possible to a certain extent with biofeedback and/or neurofeedback training.

Both of these are noninvasive techniques designed to help individuals regulate physiological functions for better health and well-being. Specialized devices are used to track bodily processes and provide real-time feedback so that you may gain awareness and voluntary control. Neurofeedback training is just a specialized form of biofeedback that focuses on brainwave activity.

While both have been promoted as having significant health benefits, there are no defined training protocols, and the research is pretty inconclusive. In this article, I will examine the science behind biofeedback and its potential benefits, and compare it to neurofeedback.

What is biofeedback?

Biofeedback is a noninvasive technique used to measure physiological functions, provide real-time feedback, and work on learning to regulate them voluntarily. These can include muscle activity, skin temperature, sweat gland activity, respiration, heart rate (HR), heart rate variability (HRV), blood pressure (BP), and brainwave activity. The idea is that learning to regulate typically involuntary functions may help improve certain conditions and overall well-being.

Biofeedback is used in various fields by licensed and trained professionals. While it is not suitable as a stand-alone method for diagnosing or treating any conditions, biofeedback therapy can sometimes be used in addition to prescribed treatment.

There are two main types of biofeedback: biomechanical and physiological, with the latter being further subdivided.

How does biofeedback work?

All types of biofeedback require specialized equipment and rely on active participation from the patient. The precise mechanisms depend on the type of biofeedback, but generally, sensors measure the chosen metric; the data is then processed and turned into comprehensible visual, haptic (vibration), or auditory cues, which are then fed back to the user in real time.

Here is a step-by-step overview:

1. Initial assessment. A doctor or a biofeedback specialist will talk to you about your health history, goals, and issues to determine what metrics need to be worked on and will explain what you need to do. If you are using an at-home device, you will probably need to complete an online test.
2. Set up. After selecting the physical parameters to measure, a dedicated person will set up the equipment and attach the required sensors to your body. For at-home devices, please follow the manufacturer's instructions.
3. Session. The selected measurement will be displayed on a screen, and you will work on controlling it with the guidance of positive and negative feedback.

What is neurofeedback?

Technically, neurofeedback is a type of biofeedback that measures brain activity. However, because brain activity and neurofeedback are complex and diverse, they have their own category of research. I have written an in-depth article about neurofeedback if you are interested in learning more.

In simple terms, neurofeedback involves measuring and analyzing brainwave activity and possibly improving brain function via real-time feedback. Each type of brainwave is associated with certain mental states, thus, neurofeedback aims to promote desired brain states through positive feedback. The idea is that with consistent training, the brain will learn to self-regulate and thus spend more time in desired states.

However, please note that each individual has slightly different specific brainwave frequencies, and neurofeedback tends to be more effective with personalized protocols. Most studies have been done in a clinical setting, and neurofeedback is often an addition to treatment. At-home devices are not suitable for diagnosing or treating any conditions, and you should consult with your doctor.

How does neurofeedback work?

The precise mechanisms of how neurofeedback works will depend on its type.

However, here is a general idea of what happens during a session based on my research and personal experience testing one of the at-home neurofeedback devices.

• Initial assessment. If opting for clinical neurofeedback, you will start by discussing your issues and goals with a licensed practitioner and will likely be given an assessment test, which will be followed up by another conversation to fine-tune a personalized plan. At-home devices tend to be more generic, but some offer personalized guidance.
• Setup. A doctor or a nurse will attach the electrodes to your scalp in the clinic. If you are using an at-home device, you will need to follow the provided instructions.
• Training session. While the precise details of the session will vary, you will usually need to focus on some sort of game or visual/auditory cues.
• Feedback. Your brainwave activity will be processed and fed back to you via the aforementioned cues in real time to guide your brainwave patterns.

In essence, neurofeedback is a bit like a game. Your goal is to stay calm and focused in a meditative-like state, using visual and auditory cues as hints on how well you are doing. The better you do, the higher the score, and like most things, it gets easier with consistent practice, until it becomes second nature and you do not need the device to guide you anymore.

My experience with neurofeedback

A few months ago, I trialed one of the at-home neurofeedback devices for three months. The setup included an assessment test and a call with a neurofeedback coach to determine the protocol most suitable for my goals and needs: improving sleep and reducing stress. I also loved the learning tools and appreciated being able to stream my own videos or podcasts for training. I believe that at-home neurofeedback may be useful as an additional boost to your wellness routine, but, ultimately, it was not for me.

I found it to be too much of a time commitment, 30 minutes at least three times per week, and it became more of a stress-causing factor for me. I think you need to have more free time on your hands to benefit from neurofeedback. For me personally, fitting it in between work, working out, reading, daily walks, summer activities, concerts, sleep, socializing, and traveling was not the best fit.

Key differences between biofeedback and neurofeedback

Simply put: neurofeedback is a type of biofeedback, but because it is so complex and has many types, it is often discussed separately in the scientific literature.

What are biofeedback and neurofeedback used for?

Biofeedback has the potential to improve several health and well-being metrics. However, there is a general lack of established biofeedback protocols, and most studies vary greatly in design, making it difficult to draw conclusions.

Asthma

Biofeedback has been explored as asthma treatment and may be especially useful in cases where asthma is triggered by stress, as stress can provoke airway constriction.

A study of 44 women aged 20–35 who had asthma for 8–15 years found that a single HRV biofeedback session had a protective effect from stress-induced lung alteration and improved lung function metrics when compared to baseline. However, this study is small and short-term to draw definite conclusions.

A randomized controlled trial involving 43 participants found that progressive muscle relaxation combined with biofeedback-assisted relaxation breathing resulted in significant improvements after 8 weeks. Compared to the usual treatment group, the biofeedback treatment group reported significantly lower levels of perceived stress, improved asthma-related quality of life, better asthma control, and increased frequency of physical exercise.

A review paper on biofeedback and asthma highlights that despite being effective, asthma medications can get expensive or cause side effects, and thus, looking into biofeedback therapy may offer an alternative. The paper discusses several moderate-sized studies that have found HRV and muscle relaxation biofeedback to reduce the use of steroidal medication, improve asthma symptoms, and reduce airway inflammation in some people. However, there is still a lack of uniformity in protocols and outcomes of studies, and well-controlled large-scale studies are needed.

Overall, there is some scientific backing for using biofeedback to reduce asthma-related symptoms as additional treatment or as an alternative, however, more research is required to establish medical protocols. If you have asthma, consult with your doctor to see if it is suitable and safe for you to try biofeedback therapy to improve your condition. However, keep in mind that each case and person may respond differently, thus, it is important to monitor how you feel.

Hypertension

Hypertension, or high BP, is partly controlled by the autonomic nervous system, so it is believed that biofeedback may help with hypertension by developing self-regulation over the nervous system.

A systematic review of 20 articles, with a participant median age of 49.3 years old, found that biofeedback significantly improved systolic and diastolic BP. The review included studies with electromyographic (muscle contraction), sweat gland activity, BP, HR, thermal, and respiratory-auditory biofeedback models. The studies also varied in design and duration, making it hard to draw heterogeneous conclusions.

Another systemic review found that biofeedback significantly improved diastolic BP when comparing post-intervention to baseline, and also improved other disease-related factors like stress. The review did not find a difference in effectiveness based on the type of biofeedback used.

Overall, the scientific literature supports the use of biofeedback to help with hypertension; however, the studies vary in design and the type of biofeedback used. For biofeedback to become an effective alternative or additional treatment for hypertension, more in-depth comparisons of different biofeedback types, larger-scale studies, and established protocols are needed.

Stress and anxiety

Untreated stress and anxiety can be debilitating, causing significant disruptions to your health, sleep, appetite, relationships, productivity, and other aspects of life. Various types of biofeedback have been studied for reducing stress and symptoms of anxiety disorders and for improving overall relaxation.

A systematic review of 46 articles concluded that various types of biofeedback may be effective in alleviating stress. However, several challenges and limitations remain in applying biofeedback therapy to everyday use, making it more suitable for clinical use.

There is a lack of quality studies investigating the use of biofeedback to reduce stress and anxiety. Theoretically, learning to control your breathing and heart rate in stressful situations may help you calm down, but stress and anxiety often stem from neural activity in the brain; thus, neurofeedback may be more beneficial for relaxation and reducing generalized anxiety.

Neurofeedback uses

There is some supporting evidence from research that neurofeedback training can help with:

• Improving focus and attention in individuals with ADHD
• Reducing mind wandering
• Contributing to calmer minds and reducing stress
• Potentially improving sleep
• Reducing migraines

Despite several potential benefits, the neurofeedback field requires more large-scale clinical trials to support these health claims.

Which is right for you?

First of all, biofeedback and neurofeedback still lack conclusive evidence, so there is no clear answer about which one is the best. Secondly, it depends on your goals. If you want to learn to control your breathing and heart rate in stressful situations, biofeedback may be better. However, if you want to feel calmer, more focused, and reduce racing thoughts, neurofeedback may be a better fit.

I asked WellnessPulse in-house researcher Paula Vaidelauskaitė, who has a degree in Clinical and Cognitive Neuroscience, to define clinical vs. at-home devices.

Regardless of what type of biofeedback or device you are considering, it would be best to consult with your doctor, especially if you have any underlying conditions.

Final considerations

Biofeedback and neurofeedback are sometimes confused as separate things. However, neurofeedback is a type of biofeedback. The main difference is that biofeedback focuses on physiological responses, while neurofeedback focuses on the brainwaves.

The goal of both is to help individuals learn to control otherwise involuntary bodily functions via real-time feedback to improve well-being. Clinical devices are sometimes used as additional diagnostic or treatment tools when done by licensed professionals. At-home devices are not suitable to diagnose or treat any conditions.

There is some evidence that biofeedback may help with asthma and hypertension, while neurofeedback may help with various mental health conditions such as ADHD, anxiety, or insomnia. However, keep in mind that most of the research is still inconclusive, and each person may respond differently. I would suggest exploring biofeedback as a wellness tool rather than a medical treatment.