Biofeedback Newsletter
October 2011

The topic of this newsletter is the efficacy of biofeedback and neurofeedback for various medical and psychological conditions. These are modalities in which I have trained in New Zealand, Australia, and the USA. I have been involved in the Biofeedback Society of NZ during the last 20 years, and I work with most of the efficacious conditions mentioned below.


Fran Lowe, PhD, Registered Psychologist

Biofeedback Definition

Three USA professional biofeedback organisations, the Association for Applied Psychophysiology and Biofeedback(AAPB), Biofeedback Certification Institution of America (BCIA), and the International Society for Neurofeedback and Research (ISNR), arrived at a consensus definition of biofeedback in 2008:


Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately 'feed back' information to the user. The presentation of this information - often in conjunction with changes in thinking, emotions, and behavior - supports desired physiological changes. Over time, these changes can endure without continued use of an instrument (AAPB, 2008)."

Neurofeedback is encephalographic biofeedback, training to change brainwave patterns that underlie some psychological/behavioural conditions such as autism and head injury.




There have been a number of white papers evaluating the scientific evidence for biofeedback and neurofeedback. Moss, LeVaque, and Hammond (2004) observed that "Biofeedback and neurofeedback seem to offer the kind of evidence-based practice that the health care establishment is demanding......... From the beginning biofeedback developed as a research-based approach emerging directly from laboratory research on psychophysiology and behaviour therapy, The ties of biofeedback/neurofeedback to the biomedical paradigm and to research are stronger than is the case for many other behavioural interventions" (p. 151).



Yucha and Montgomery (2008) rated biofeedback treatments for the five levels of efficacy recommended by a joint Task Force and adopted by the Boards of Directors of the AAPB and the ISNR.

Level 1: Not empirically supported. This designation includes applications supported by anecdotal reports and/or case studies in non-peer reviewed venues. Yucha and Montgomery (2008) assigned eating disorders, immune function, spinal cord injury, and syncope to this category.

Level 2: Possibly efficacious. This designation requires at least one study of sufficient statistical power with well identified outcome measures but lacking randomized assignment to a control condition internal to the study. Yucha and Montgomery (2008) assigned asthma, autism, Bell palsy, cerebral palsy, COPD, coronary artery disease, cystic fibrosis, depression, erectile dysfunction, fibromyalgia, hand dystonia, irritable bowel syndrome, PTSD, repetitive strain injury, respiratory failure, stroke, tinnitus, and urinary incontinencein childrento this category.

Level 3: Probably efficacious. This designation requires multiple observational studies, clinical studies, wait list controlled studies, and within subject and intrasubject replication studies that demonstrate efficacy. Yucha and Montgomery (2008) assigned alcoholism and substance abuse, arthritis, diabetes mellitus, fecal disorders in children, fecal incontinence in adults, insomnia, pediatric headache, traumatic brain injury, urinary incontinence in males, and vulvar vestibulitis (vulvodynia) to this category.

Level 4:Efficacious. This designation requires the satisfaction of six criteria:

(a) In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control using randomized assignment, the treatment under investigation is shown to be statistically significantly superior to the control condition or the treatment under investigation is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences.

(b) The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner.

(c) The study used valid and clearly specified outcome measures related to the problem being treated.

(d) The data are subjected to appropriate data analysis.

(e) The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers.

(f) The superiority or equivalence of the treatment under investigation has been shown in at least two independent research settings.

Yucha and Montgomery (2008) assigned anxiety, chronic pain, epilepsy, constipation (adult), headache (adult), hypertension, motion sickness, Raynaud's disease, and temporomandibular disorder to this category.

Level 5: Efficacious and specific. The treatment under investigation must be shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings. Yucha and Montgomery (2008) assigned urinary incontinence (females) to this category.



Critics question how these treatments compare with conventional behavioural and medical interventions on efficacy and cost. Biofeedback should gain greater acceptance if researchers can demonstrate that it complements traditional treatments (like physical therapy), achieves comparable or superior efficacy, is more cost effective, and enjoys a better side effect profile (Yucha and Gilbert (2004)). Summaries above adapted from Wikipedia.

Association for Applied Psychophysiology and Biofeedback "What is biofeedback?"..Consumer's page 2008-05-18. Retrieved 14/09/11.

Moss D., LaVaque T. J., Hammond D. C. (2004). "Introduction to White Papers Series series-Guest editorial". Applied Psychophysiology and Biofeedback 29 (3): 151-152.

Yucha, C., & Gilbert, C. (2004). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback.

Yucha, C; Montgomery D (2008) (pdf). Evidence-based practice in biofeedback and neurofeedback, Wheat Ridge, CO: AAPB.


Contact me if you would like more information, or if you would like the newsletter emailed to you or you would prefer not to receive these newsletters.

Email Franlowe@napiercounselling

Phone 021 055 4897

Address PO Box 100

Bay View