Biofeedback

Early experimental work on visceral learning

Neal E. Miller published a paper titled 'Learning of visceral and glandular responses' in Science in 1969, and work of this kind is usually cited in the background to biofeedback research. Only the bibliographic record was read for this draft, because the abstract is not available; its indexing terms point to animal experiments on conditioning of autonomic responses such as heart rate and blood pressure. The paper is cited here for its place in the literature and not for any clinical claim, and biofeedback should not be attributed to a single inventor.

Applied psychophysiology as a field

A 2003 historical review by Paul Lehrer describes the field of applied psychophysiology as overlapping with behavioural and psychosomatic medicine, Eastern disciplines and complementary medicine. The author characterises its history as one of innovation that was often at odds with conventional wisdom, and says the review covers the earliest research in biofeedback together with later work on muscular and autonomic control, including heart rate variability biofeedback. This is an abstract-level reading, so the specific early studies and dates the review discusses are not reported here.

Professional bodies and what remains undated

The Biofeedback Certification International Alliance (BCIA) states that it was created in 1981 as the Biofeedback Institute of America, to certify people who meet education and training standards in biofeedback, and that it took its present name in March 2010. The Association for Applied Psychophysiology and Biofeedback (AAPB) states that a task force with BCIA and the International Society for Neurofeedback and Research met in late 2007 to agree a definition; an approval date of 2008 was not confirmed on the page itself.

The sources reviewed do not give a dated account of when biofeedback entered clinical use, who first used the term, or how the different instrument-based approaches developed. A dated history from a scholarly source is still needed before this section can be considered complete.

The standard definition

The AAPB page presents a definition developed with BCIA and the International Society for Neurofeedback and Research: biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. The page names brainwaves, heart function, breathing, muscle activity and skin temperature among the signals that instruments may measure. It is cited here for the definition only. The same page makes efficacy statements without references, and those are not relied on in this article.

Modality-specific names

Names usually follow the signal that is measured or the body region treated. The reviews used here refer to electromyograph (EMG) biofeedback, manometry biofeedback and balloon sensory biofeedback in constipation, to perineometry and pelvic floor electromyography as biofeedback in pelvic floor training, and to neurofeedback for feedback based on brain activity. Heart rate variability biofeedback appears in a historical review. These labels describe different instruments and aims, so a statement about one does not automatically apply to another.

A technique rather than a profession

Biofeedback is described in these sources as a method applied within other services and not as a tradition with its own belief system. The Cochrane review describes it as used for people referred to specialist services in secondary and tertiary care, and BCIA certifies individuals who already hold qualifications in health care fields. The sources reviewed do not describe a protected professional title of biofeedback practitioner in the United Kingdom or Ireland.

The basic loop

In the definition used by the professional bodies, an instrument measures a physiological signal and the person uses that information to learn to change the activity being measured. The signals named include brainwaves, heart function, breathing, muscle activity and skin temperature. The sources reviewed do not describe how the information is displayed, how many sessions are usual or how long a session lasts, and these details are likely to differ by signal, condition and service.

Variation in methods

The Cochrane review of adult constipation notes that different methods of biofeedback are used in different centres. In its included trials, EMG biofeedback was the most commonly used method, and other trials used manometry or balloon-based feedback. The review found a lack of evidence on whether any one method is more effective than another. In neurofeedback for ADHD, a 2025 meta-analysis distinguishes trials using established standard protocols from other approaches.

Who delivers it

BCIA describes a voluntary certification programme for individuals, valid for four years, and states that its certification is not a substitute for a state-issued licence or other credential to practise one's profession. It also states that people without a professional licence must work under the legal supervision of a licensed provider when treating medical or psychological disorders. This is a United States certification body's account of its own programme and does not describe delivery in the United Kingdom or Ireland.

General statements of purpose

The professional definition frames biofeedback as a way of learning to change physiological activity for the purposes of improving health and performance. That wording is broad, and it does not specify conditions. The AAPB page goes on to make condition-specific efficacy statements without references, and those statements are not repeated here because the systematic evidence reviewed for this article does not match them in at least one case, neurofeedback for ADHD.

Conditions with reviewed evidence

Biofeedback has been used for chronic constipation in adults, most often where dyssynergic defecation is present, and the Cochrane review and a 2026 meta-analysis both address it. NICE guidance on urinary incontinence in women discusses biofeedback in the context of pelvic floor muscle training. Neurofeedback has been proposed as a treatment for attention-deficit/hyperactivity disorder, and a 2025 meta-analysis tested that proposal.

Other uses that are commonly attributed to biofeedback, such as headache, anxiety or high blood pressure, were not supported by any source verified for this draft. No claim about them is made here, and a specific review or guideline would need to be sourced first.

Chronic constipation in adults

A Cochrane review (search to December 2013) included 17 trials with 931 participants, most with chronic constipation and dyssynergic defecation. Sixteen trials were at high risk of bias for blinding and meta-analysis was not possible. One trial of 60 people reported improvement at three months in 21 of 30 given EMG biofeedback and 7 of 30 given oral diazepam. Another found more complete spontaneous bowel movements per week with manometry biofeedback (4.6) than with sham biofeedback (2.8) in 52 people. The reviewers rated the evidence low or very low quality and concluded that firm conclusions were not yet possible.

A 2026 meta-analysis of 19 randomised trials (search to August 2025) reported a higher overall response rate with biofeedback than with controls (risk ratio 1.23, 95% confidence interval 1.12 to 1.34) and about 1.6 more bowel movements a week. It also reported lower constipation symptom scores. This is an abstract-level reading. The authors say the reliability of their conclusions is limited by small samples and methodological weaknesses, and not all comparators were sham treatments.

Neurofeedback for ADHD

A 2025 meta-analysis in JAMA Psychiatry pooled 38 randomised trials with 2,472 participants aged 5 to 40. For ADHD total symptoms rated by people probably unaware of treatment allocation (20 trials, 1,214 participants), the standardised mean difference was 0.04 (95% confidence interval -0.10 to 0.18), which is no significant improvement. A small effect (0.21) appeared in nine trials using established standard protocols, and a small effect on processing speed was also reported. The authors concluded that neurofeedback did not appear to meaningfully benefit people with ADHD at group level. This finding applies to neurofeedback for ADHD only and is not evidence about other forms of biofeedback.

Pelvic floor training guidance

NICE guideline NG123, dated 2019, advises against perineometry or pelvic floor electromyography as biofeedback as a routine part of pelvic floor muscle training for women with urinary incontinence. It also advises that electrical stimulation and biofeedback should be considered for women who cannot actively contract the pelvic floor muscles, to aid motivation and adherence. The guidance is cited here for what it recommends and not as a general endorsement of biofeedback; the evidence tables behind these recommendations were not reviewed.

Reported adverse events

The Cochrane review reports that no adverse events were recorded for biofeedback in constipation, while noting that adverse events were not specifically reported in most of the included studies. In the same review, surgical comparators were associated with wound infection, faecal incontinence, pain and bleeding. The 2026 meta-analysis found no statistically significant difference in adverse events between biofeedback and control groups. Incomplete reporting is not evidence that harms do not occur, and neither source examined harms from neurofeedback or from other signals and instruments.

Suitability and what the sources do not cover

The sources reviewed do not set out contraindications, device-specific hazards, age limits or the suitability of biofeedback for particular people, and they do not assess consumer wearable devices that are marketed with the same word. Whether the technique suits a person depends on the signal, the condition and the service delivering it, which is a matter for a qualified clinician. The null result for ADHD shows that an instrument-based approach can be offered for a condition without showing a meaningful benefit in well-blinded trials.

Training, regulation, consent and care boundaries

BCIA certification is private and voluntary and does not replace a professional licence. No source verified for this article states how biofeedback is regulated in the United Kingdom or Ireland, so no claim is made about protected titles or statutory requirements there. As a general editorial principle, a person should be told what a session involves and can ask questions, pause or stop at any point. Biofeedback should not delay or replace assessment or treatment that a clinician considers necessary.