Biofeedback is a term that vaguely places a role of measuring some general physiological quantity say, electrical conductivity of skin, as a proxy for some other specific condition that is in need of attention and improvement, and where the improvement and training strategies may benefit from monitoring and, well – feedback while working at it. Attention here essentially refers to some kind of adaptation, self-help, learning and re-learning procedures that could be either physical or psychological/behavioural in nature. Practitioners of such methods claim that there are positive and enhancing feedback loops that can be exploited in behavioural medicine (a strange term, if not outright patronising; the general area of such treatment schemes is also sometimes referred to as ‘psychophysiology’) to achieve better outcomes for mostly chronic conditions.

Common monitoring modalities include

For some feedback loops, the measured data are converted to some visual or audible representation so that they can be integrated into a training scheme. Such training schemes are basically conditioning exercises for the functioning of the autonomic nervous system, to develop conditional reflexes. Pavlov’s dogs come to mind: these hungry dogs were trained to salivate merely at a particular audible trigger signal that previously was associated with food being made available.

Biofeedback approaches are being widely used. For example, in counselling for anxiety, EMG or EDA feedback is used to provide an impression of tension or relaxation. In physiotherapy for mobility rehabilitation after a stroke, EMG feedback has been used as an adjunct in attempts to activate remaining neuron – muscle junctions. Biofeedback approaches of some description have been reported for conditions as diverse as fibromyalgia (a chronic pain syndrome), different forms of dysphagia, sleep bruxism (grinding teeth), some temporomandibular (jaw) joint problems, many forms of incontinence or chronic constipation, many forms of neck and (lower) back pain, chronic pain in multiple sclerosis, Bell’s palsy, hypertension, to name just a few.

A large number of studies and publications exist about the whole topic. However, quantity here should very definitely not be equated with quality. There is essentially no hard evidence that any of these biofeedback procedures as adjuncts to other treatment schemes achieve significantly better results, or more rapidly or longer lasting results, than that achieved by physical or psychological schemes alone. Biofeedback is clearly never a suitable stand-alone treatment modality. Unfortunately, many publications in the field are poor-quality studies and do not provide useful or reliable evidence.

One could draw the following conclusion. Biofeedback schemes do not have any serious adverse effects (except, perhaps, on the wallet), so if somebody subjectively finds such approaches helpful, why not use them? However, nobody should be under the illusion that these approaches offer a magic treatment option for any otherwise difficult to treat conditions. And if such schemes lead to financial hardship for some say, in the course of counselling for anxiety, remember that learning to relax does not mandate biofeedback but can be achieved by many other, cost-free methods.