What is Biofeedback?

© 2004 by Stephen E. Wall

What Is Biofeedback?

Simply put, biofeedback is a means for gaining control of our body processes to increase relaxation, relieve pain, and develop healthier, more comfortable life patterns.

Biofeedback gives us information about ourselves by means of external instruments. Using a thermometer to take our temperature is a common kind of biofeedback. Clinical biofeedback follows the same principle, using specialized instruments to monitor various physiological processes as they occur. Moving graphs on a computer screen and audio tones that go up and down "reflect" changes as they occur in the body system being measured.

Biofeedback training familiarizes us with the activity in our various body systems so we may learn to control this activity to relieve stress and improve health. Trying to change physiological activity without biofeedback is like playing darts while blindfolded - we can't see whether we are hitting the mark or not. Biofeedback lets us know precisely when we are changing our physiologies in the desired direction.

Biofeedback is not a treatment. Rather, biofeedback training is an educational process for learning specialized mind/body skills. Learning to recognize physiological responses and alter them is not unlike learning how to play the piano or tennis - it requires practice. Through practice, we become familiar with our own unique psychophysiological patterns and responses to stress, and learn to control them rather than having them control us.

Why Do We Need Biofeedback?

When we are confronted with different stressful situations - anything from a sudden stop in traffic to being interviewed for a job - our bodies respond in much the same way, with the "fight or flight response." We automatically prepare either to fight the stressor or to run from it: Our heart rate increases, muscles tense, breathing becomes more shallow, we start to sweat, our minds race, etc. But this ancient, unconscious pattern, which once provided human beings with the responses necessary for self-protection in a challenging physical environment, is today the root of many stress-related illnesses and a reduced quality of life. Throughout our lives, as we confront the various stressors that occur every day, we respond by constantly tensing and relaxing. Eventually, after each instance of tensing, we cease to return to our original level of physiological relaxation. Thus, through the years we establish a stair-step pattern: We adapt to increasing levels of physiological activity. In so doing, we lose familiarity with deeper levels of relaxation and get used to greater levels of tension as the norm. This habituation to unnecessary physiological activity has a wearing effect and can cause such conditions as high blood pressure, headaches, digestive problems, and other illnesses.

Biofeedback at BRI: The Bio Integrator™ and BioIntegration™

The Bio Integrator™, a biofeedback instrument developed at BRI, represents a dramatic breakthrough in the measurement and feedback of EEG and body measures. The Bio Integrator™ makes it possible to see right- and left-brain activity, while at the same time watching peripheral blood flow, respiration, heart rate, electrodermal activity, and skeletal muscle activity. The displays include vivid, full-color graphs, mandalas, nature scenes, and games. The Bio Integrator™ was designed to enhance client learning by providing beautiful, intuitive, and adaptable displays. A wide variety of audio feedback can accompany the visual displays, surrounding the client in an audiovisual feedback envelope that promotes rapid learning.

BRI is pleased to offer a specialized training protocol of multi-modality biofeedback called BioIntegration™. The client is trained to regulate many physiological systems in concert to achieve an appropriate mix of activation for various life situations. Just as in an orchestra, where each instrument must play in harmony with all the others, clients training at BRI learn to regulate various systems of the body to work in harmony with each other to achieve and maintain optimal health. BioIntegration links internal (physiological) and external (environmental) life events so that the individual can choose how to respond as these events occur instead of relying on automatic habitual patterns.

For example, you may notice as you are driving your car that your shoulders are starting to hurt. Not only does this inhibit your ability to drive comfortably, it indicates that you are unconsciously using more muscles and effort than you need to use for the task at hand. BioIntegration™ allows you to be aware of how much effort is needed in each physiology for each task, and promotes an economy of use.

What Is a Biofeedback Session Like?

In a typical biofeedback session, the client settles into a comfortable chair and is hooked up to the biofeedback instrument with sensors attached to the surface of the skin at various locations on the body (usually the shoulders, fingers, back, and head). Electrical impulses from these locations are recorded and reflected on a computer monitor in the form of graphs or other visual displays such as mandalas. Additionally, the client may receive auditory feedback reflecting increases and decreases in body system activity in the form of higher and lower musical tones.

Before beginning training, the client's measures in the various modalities are recorded without feedback to give the clinician a picture of the client's overall psychophysiological state. This assessment, which provides a foundation for training sessions to come, is conducted during the client's first visit to BRI, which usually takes 1 1/2 to 2 hours. The clinician then prioritizes the issues and problems exhibited by the client and focuses the training on the most appropriate physiological system. At BRI, the client may be directed to pay particular attention to one physiology, while information on the other body systems is monitored by the clinician. While the client is observing the activity of a particular system onscreen, audio feedback in the form of musical tones is also being presented, reflecting activity in the same system or a different one.

Every individual exhibits a unique set of characteristic psychophysiological patterns that reflect the various accommodations to stress that he or she has made over the years. The goal of biofeedback training is to gain self-regulatory skills with which to adjust the activity in various systems to optimal levels for the task at hand. At BRI, we have found that clients have greater success when they train toward a specific range of activity in each modality that research has found to be desirable, rather than simply training to reduce activity. We call these ranges the goal zones.

Biofeedback Modalities

Many physiological processes can be monitored for biofeedback applications. Some of the more common ones are:


Temperature is measured by sensors placed on the ring fingers. The temperature modality indicates the contraction of the smooth muscles surrounding the blood vessels, which determines how much blood reaches the fingertips. When these muscles are contracted (tense), the temperature is cooler because less blood reaches the fingers. We experience this coldness in our hands when we are stressed - for example, when going to a job interview and shaking hands with a prospective boss. It is not uncommon for people's temperature readings to be as low as 70 to 80 degrees Fahrenheit, nor is it uncommon to see a difference of five or ten degrees between right and left hand measures. The brain is organized so that the right hemisphere is associated with activity in the left side of the body, and the left hemisphere is associated with activity in the right side of the body. Some clinicians believe that when one hand is significantly colder than the other, this represents an imbalance in the activity of the right and left hemispheres of the brain. This is also thought to be the case for other bilateral measures (e.g., EMG and BSR).

At BRI, the goal of training is to achieve a balance between right and left hand temperatures in the range between 94 and 97 degrees Fahrenheit.


Muscle activity is measured by the EMG (electromyograph), which detects the electrical activity occurring within certain muscles, typically the trapezius (shoulder) and temporalis (jaw and scalp) muscles. Muscle tension indicates stress; for example, it is common for people to react to the stress of anger by clenching their teeth and generally tensing up. To measure EMG, the skin is cleaned and adhesive sensors with a conductive gel are attached to the shoulder muscles. At BRI, the jaw and scalp sensors placed on the outer forehead are small silver discs held in place by an elastic headband. Muscle activity is measured in microvolts, and it is not uncommon for levels to range from 5 to 40 microvolts.

At BRI, the goal of training is to quiet muscle activity to a range between .5 and 2.5 microvolts.


Basal skin response (BSR) is a measure of eccrine (sweat) gland activity. Most people are familiar with having cold, clammy hands under stressful circumstances, such as meeting new people or having to perform before an audience. The coldness comes from constriction of the smooth muscles surrounding the blood vessels (measured by hand temperature), while the dampness is caused by eccrine gland activity. The eccrine glands secrete a salty solution in response to emotional and stress stimuli. BSR sensors are attached with elastic bands to the first and second fingers of the right and left hands. It is not unusual for people to measure between 150 and 500 kilohms before training.

The goal of training at BRI is to reduce eccrine gland activity to the range between 850 and 1600 kilohms. In this measure, the higher the numbers, the quieter the system is - "higher is drier."

Heart Rate:

Heart rate is measured in beats per minute. Faster heart rates are often caused by stress; our hearts may race and pound when we are afraid. Other kinds of stress, such as depression, may result in lower heart rates. To measure heart rate, we place a sensor on a finger to detect each beat of the heart. We also measure heart rate variability and train toward specific beneficial cardiovascular patterns. This technique is known as RSA training.

The goal of training at BRI is to achieve a heart rate between 56 and 66 beats per minute.


Respiration is measured in breaths per minute, typically by a strain gauge worn around the stomach. Respiration becomes faster, shallower, and uneven when we are stressed, for example, when we gasp in surprise or feel short of breath when frightened. It is not unusual for people to have a breath rate of between 16 and 30 breaths per minute prior to training.

The goal of training at BRI is to reduce breath rate to 6 to 12 breaths per minute, and to establish a healthy breathing pattern.

Neurofeedback (EEG):

Brain waves are measured by the electroencephalograph (EEG). EEG is comprised of several bandwidths: Theta (4-7 Hz), Alpha (8-12 Hz), Beta (13-20 Hz), and Gamma (21+). The overall purpose of EEG training is to develop range of motion among bandwidths, so that the client knows what each bandwidth feels like and how to use each state for its characteristic benefits. Speaking very generally, beta and gamma are useful for directed activity and getting things done; alpha is useful in situations where relaxed vigilance is called for (such as meditation); and theta is useful for creative, day-dreamy generation of imagery (theta is sometimes called the gateway to the unconscious).

At BRI, brain wave measurements are recorded through silver discs placed at three locations: center forehead, the base of the scalp to the right of center (occipital 1), and the base of the scalp to the left of center (occipital 2). (In the case of EEG training for ADD, the sensors are typically located on the crown of the head.)

Unlike some of the body measures, EEG is a very complex phenomenon. BRI has dedicated years of research exploring and interpreting EEG data to establish a unique training protocol called BioIntegration™, which complements and enhances body measure training. At BRI, we measure EEG in several ways. Generally, we focus on Percent Power, an exciting measure that reveals both what activity is occurring and how often it occurs in each bandwidth. Percent Power measures the percentage of activity occurring in theta, alpha, and beta bandwidths. We also look at the relationship of EEG activity between hemispheres.

Brain waves respond to subtle psychophysiological conditions, such as whether the eyes are open or closed, whether or not we are speaking, and the content of our thoughts. At BRI, neurofeedback training generally aims first at reducing activity in the 13-35 Hz bandwidth (Beta-Gamma). This bandwidth typically characterizes our waking state and often accompanies unnecessary tension we habitually carry in our bodies. When a client becomes familiar with how this bandwidth feels, he or she can recognize it and move out of it to accomplish certain goals, for example, to relax. When the client has learned to reduce activity in the beta and gamma bandwidths, training is continued to enhance the production of alpha activity. When the client has learned how to generate increased alpha activity, training moves on to encourage the client's ability to generate theta waves.

It is advantageous for clients to receive feedback in many modalities at once, even if the practitioner chooses to address a specific condition by working primarily with one modality (e.g., using Temperature training as a means of reducing migraine headaches). Multi-modal training recognizes that the human being is a complex whole, whose various systems are constantly interacting in an effort to achieve a point of homeostasis (balance). When a client receives information about several psychophysiological systems during training, he or she can develop an understanding of the interrelationships that support his or her usual psychophysiological state and has more choices in terms of self-regulation skills. Indications for Training

Anxiety disorders Headaches Stress management Stress related disorders Musculoskeletal disorders involving chronic muscle tension Essential tremor Chronic pain syndromes Insomnia High blood pressure Asthma Circulatory problems such as Raynaud's disease Temporomandibular joint syndrome (TMD), jaw pain and dysfunction Bruxism (teeth grinding) Attention Deficit Disorder Concentration improvement for education and meditation Brain wave training for spiritual development and inner calmness

Although biofeedback training may focus specifically on one or two psychophysiological systems as a means of addressing a particular presenting complaint, clients are soon reminded of the holistic nature of the human being as they observe that changes made within one psychophysiological system can create changes in other psychophysiological systems. It is a mistake to think of biofeedback training in any one modality as the only way to approach a certain problem. At BRI, as clients discover the interrelationships that exist between psychophysiological systems, they learn to create a "mix" that addresses their presenting complaints and shows them a path out of habitual patterns of thoughts and behavior. We call this process "BioIntegration" - a strategy by which an individual, through multi-modality training, links internal and external life events such that he or she is able to make more real-time choices instead of being unconsciously dominated by habitual patterns.

Thus, biofeedback training has long-range implications that go beyond the notion of "fixing what ails you." While the training is beneficial for a wide range of complaints and provides relief from many conditions in a gentle and completely noninvasive way, it inevitably provides more than that. It awakens the realization that we have the power to make lasting changes in our bodies and minds, and the accompanying opportunity to direct these changes for life-enhancing benefits.



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