Biofeedback for Psychiatric Disorders: A Systematic Review

Abstract

Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders, depression, dissociation, eating disorders, schizophrenia and psychoses] to date and provide a useful reference for consultation by clinicians and researchers planning to administer a biofeedback treatment. A systematic search of EMBASE, MEDLINE, PsycINFO, and WOK databases and hand searches in Applied Psychophysiology and Biofeedback, and Journal of Neurotherapy, identified 227 articles; 63 of which are included within this review. Electroencephalographic neurofeedback constituted the most investigated modality (31.7 %). Anxiety disorders were the most commonly treated (68.3 %). Multi-modal biofeedback appeared most effective in significantly ameliorating symptoms, suggesting that targeting more than one physiological modality for bio-regulation increases therapeutic efficacy. Overall, 80.9 % of articles reported some level of clinical amelioration related to biofeedback exposure, 65.0 % to a statistically significant (p < .05) level of symptom reduction based on reported standardized clinical parameters. Although the heterogeneity of the included studies warrants caution before explicit efficacy statements can be made. Further development of standardized controlled methodological protocols tailored for specific disorders and guidelines to generate comprehensive reports may contribute towards establishing the value of biofeedback interventions within mainstream psychiatry.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Acosta, F. X., & Yamamoto, J. (1978). Application of electromyographic biofeedback to the relaxation training of schizophrenic, neurotic, and tension headache patients. Journal of Consulting and Clinical Psychiatry, 46(2), 383–384.

    Article  Google Scholar 

  2. Agnihotri, H., Paul, M., & Sandhu, J. S. (2007). Biofeedback approach in the treatment of generalized anxiety disorder. Iranian Journal of Psychiatry, 2, 90–95.

    Google Scholar 

  3. Baehr, E., Rosenfeld, J. P., & Baehr, R. (1997). The clinical use of an alpha asymmetry protocol in the neurofeedback treatment of depression: Two case studies. Journal of Neurotherapy, 2(3), 10–23.

    Article  Google Scholar 

  4. Barlow, D. H., Cohen, A. S., Waddell, M. T., Vermilyea, J. A., Klosko, J. S., Blanchard, E. B., et al. (1984). Panic and generalized anxiety disorders: Nature and treatment. Behavior Therapy, 15, 431–449.

    Article  Google Scholar 

  5. Beckham, J., Greene, T. B., & Meltzer-Brody, S. (2013). A pilot study of heart rate variability biofeedback therapy in the treatment of perinatal depression on a specialized perinatal psychiatry inpatient unit. Archives of Women’s Mental Health, 16(1), 59–65.

    PubMed Central  PubMed  Article  Google Scholar 

  6. Canter, A., Kondo, C. Y., & Knott, J. R. (1975). A comparison of EMG feedback and progressive muscle relaxation training in anxiety neurosis. British Journal Psychiatry, 127, 470–477.

    Article  Google Scholar 

  7. Chernigovskaya, N. V., Vaschillo, E. G., Petrash, V. V., & Rusanovskii, V. V. (1991). Voluntary control of the heart rate as a method of correcting the functional state in neurosis. Institute of Experimental Medicine, Academy of Medical Sciences of the USSR, 16(2), 58–64.

    Google Scholar 

  8. Choi, S. W., Chi, S. E., Chung, S. Y., Kim, J. W., Ahn, C. Y., & Kim, H. T. (2011). Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study. Neuropsychobiology, 63, 43–51.

    PubMed  Article  Google Scholar 

  9. Coben, R., & Padolsky, I. (2007). Assessment-guided neurofeedback for autistic spectrum disorder. Journal of Neurotherapy, 11(1), 5–23.

    Article  Google Scholar 

  10. D’Amato, R. (1996). Evaluating the efficacy of biofeedback intervention to reduce children’s anxiety. Journal of Clinical Psychology, 52(4), 469–473.

    PubMed  Article  Google Scholar 

  11. Des Jarlais, D. C., Lyle, C., Crepaz, N., & the TREND Group. (2004). Improving the reporting quality of non-randomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366.

    PubMed Central  PubMed  Article  Google Scholar 

  12. Glucek, B., & Stroebel, C. (1975). Biofeedback and meditation in the treatment of psychiatric illness. Comprehensive Psychiatry, 16(4), 303–321.

    Google Scholar 

  13. Hammond, D. (2003). QEEG-guided neurofeedback in the treatment of obsessive compulsive disorder. Journal of Neurotherapy, 7(2), 25–52.

    Article  Google Scholar 

  14. Hardt, J., & Kamiya, J. (1978). Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects. Science, 201, 79–81.

    PubMed  Article  Google Scholar 

  15. Hawkins, R. C., Doell, S. R., Lindseth, P., Jeffers, V., & Skaggs, S. (1980). Anxiety reduction in hospitalized schizophrenics through thermal biofeedback and relaxation training. Perceptual and Motor Skills, 51, 475–482.

    PubMed  Article  Google Scholar 

  16. Hickling, E. J., Sison, G. F. P., & Vanderploeg, R. D. (1986). Treatment of posttraumatic stress disorder with relaxation and biofeedback training. Biofeedback and Self-Regulation, 11(2), 125–130.

    PubMed  Article  Google Scholar 

  17. Hoffman, E. (1979). Autonomic, EEG and clinical changes in neurotic patients during EMG biofeedback training. Research Communications in Psychology, Psychiatry and Behavior, 4(3), 209–240.

    Google Scholar 

  18. Holtman, M., & Stadler, C. (2006). Electroencephalographic biofeedback for the treatment of attention-deficit hyperactivity disorder in childhood and adolescence. Expert Review of Neurotherapeutics, 6(4), 433–540.

    Article  Google Scholar 

  19. Hotopf, M., Lewis, G., & Normand, C. (1994). Putting trials on trial—the costs and consequences of small trials in depression: A systematic review of methodology. Journal of Epidemiological Community Health, 51, 354–358.

    Article  Google Scholar 

  20. Hurley, J. (1980). Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology, 36(2), 503–507.

    PubMed  Article  Google Scholar 

  21. Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials; is blinding necessary? Contemporary Clinical Trials (former title: Controlled Clinical Trials), 17 1–12.

  22. Jarusiewicz, B. (2002). Efficacy of neurofeedback for children in the autistic spectrum: A pilot study. Journal of Neurotherapy, 6(4), 39–49.

    Article  Google Scholar 

  23. Jüni, P., Altman, D. G., & Egger, M. (2001). Systematic reviews in health care: Assessing the quality of controlled clinical trials. British Medical Journal, 323, 42–46.

    PubMed Central  PubMed  Article  Google Scholar 

  24. Kappes, B. (1983). Sequence effects of relaxation training, EMG, and temperature biofeedback on anxiety, symptom report, and self-concept. Journal of Clinical Psychology, 39(2), 203–208.

    PubMed  Article  Google Scholar 

  25. Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback, 32, 19–30.

    Article  Google Scholar 

  26. Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F., Wilkey, S. A., Van Rompay, M. L., et al. (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158(2), 289–294.

    PubMed  Article  Google Scholar 

  27. Khanna, A., Paul, M., & Sandhu, J. S. (2007). Efficacy of two relaxation techniques in reducing pulse rate among highly stressed females. Calicut Medical Journal, 5(2), e2.

    Google Scholar 

  28. Kim, S., Wollburg, E., & Roth, W. T. (2012). Opposing breathing therapies for panic disorder: A randomized controlled trial of lowering vs raising end-tidal Pco2. Journal of Clinical Psychiatry, 73(7), 931–939.

    PubMed  Article  Google Scholar 

  29. Klee, S., & Meyer, R. (1981). Alleviation of performance deficits of depression through thermal biofeedback training. Journal of Clinical Psychology, 37(3), 515–518.

    PubMed  Article  Google Scholar 

  30. Kouijzer, M. E., van Schie, H. T., Gerrits, B. J. L., Buitelaar, J. K., & de Moor, J. M. H. (2013). Is EEG-biofeedback an effective treatment in autism spectrum disorders? A randomized controlled trial. Applied Psychophysiology and Biofeedback, 38, 17–28.

    PubMed  Article  Google Scholar 

  31. Kuskowski, M. A., Malone, S. M., Kim, S. W., Dysken, M. W., Okay, A. J., & Christensen, K. J. (1993). Quantitative EEG in obsessive compulsive disorder. Biological Psychiatry, 33(6), 423–430.

    PubMed  Article  Google Scholar 

  32. La Vaque, T. J., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., & Lehrer, P. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions: Efficacy Task Force. Applied Psychophysiology and Biofeedback, 27(4), 273–281.

    PubMed Central  Article  Google Scholar 

  33. Lancet Global Mental Health Group. (2007). Scale up services for mental disorders: A call for action. Lancet, 390(9594), 1241–1252.

    Google Scholar 

  34. Lande, G. R., Williams, L. B., Francis, J. L., Gragnani, C., & Morin, M. L. (2010). Efficacy of biofeedback for post-traumatic stress disorder. Complementary Therapies in Medicine, 18, 256–269.

    PubMed  Article  Google Scholar 

  35. Lavallee, Y. J., Lamontagne, Y., Pinard, G., Annable, L., & Treteault, L. (1977). Effects on EMG feedback, diazepam and their combination on chronic anxiety. Journal of Psychosomatic Research, 21(1), 65–71.

    PubMed  Article  Google Scholar 

  36. Lavellee, Y., Lamontagne, Y., Annable, L., & Fontaine, F. (1982). Characteristics of chronically anxious patients who respond to EMG feedback training. Journal of Clinical Psychiatry, 43(6), 229–230.

    PubMed  Google Scholar 

  37. LeBoeuf, A., & Lodge, J. (1980). A comparison of frontalis EMG feedback training and progressive relaxation in the treatment of chronic anxiety. British Journal of Psychiatry, 137, 279–284.

    PubMed  Article  Google Scholar 

  38. Lubar, J. F. (1991). Discourse on the development of EEG diagnostics and biofeedback for Attention Deficit/Hyperactivity Disorders. Biofeedback and Self-Regulation, 16, 201–225.

    PubMed  Article  Google Scholar 

  39. Lustman, P., & Sowa, C. (1983). Comparative efficacy of biofeedback and stress inoculation for stress reduction. Journal of Clinical Psychology, 39(2), 191–197.

    PubMed  Article  Google Scholar 

  40. Manchester, C. F., Allen, T., & Tachiki, K. H. (1998). Treatment of dissociative identity disorder with neurotherapy and group self-exploration. Journal of Neurotherapy, 2(4), 40–52.

    Article  Google Scholar 

  41. Meuret, A. E., Wilhelm, F. H., & Roth, W. T. (2001). Respiratory biofeedback-assisted therapy in panic disorder. Behavior Modification, 25(4), 584–605.

    PubMed  Article  Google Scholar 

  42. Mills, G., & Solyom, L. (1974). Biofeedback of EEG alpha in the treatment of obsessive ruminations: an exploration. Journal Behavioural Therapy and Experimental, 5, 37–41.

    Article  Google Scholar 

  43. Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., Stroup, D. F., et al. (1999). Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. Quality of reporting meta-analyses. Lancet, 354(9193), 1896–1900.

    Google Scholar 

  44. Moher, D., Schultz, K. F., & Altman, D. G. (2001). The CONSORT statement: Revised recommendations for improving the quality or reports of parallel-group randomized trials. Lancet, 357, 1191–1194.

    PubMed  Article  Google Scholar 

  45. Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2005). Electroencephalographic biofeedback in the treatment of Attention-Deficit/Hyperactivity Disorder. Applied Psychophysiology and Biofeedback, 30(2), 95–114.

    PubMed  Article  Google Scholar 

  46. Moriyama, T. S., Polanczyk, G., Caye, A., Banaschewski, T., Brandeis, D., & Rohde, L. A. (2012). Evidence-based information on the clinical use of neurofeedback for ADHD. Neurotherapeutics, 9, 588–598.

    PubMed Central  PubMed  Article  Google Scholar 

  47. Nigl, A., & Jackson, B. (1979). Electromyograph biofeedback as an adjunct to standard psychiatric treatment. Journal of Clinical Psychiatry, 40, 433–436.

    PubMed  Google Scholar 

  48. Nunes, J., & Marks, I. (1975). Feedback of true heart rate during exposure in vivo. Archives of General Psychiatry, 32, 933–936.

    PubMed  Article  Google Scholar 

  49. Nunes, J., & Marks, I. (1976). Feedback of true heart rate during exposure in vivo: Partial replication with methodological improvement. Archives of General Psychiatry, 33(11), 1346–1350.

    PubMed  Article  Google Scholar 

  50. Pal Singh, G., & Kaur, J. (2007). Biofeedback and its clinical efficacy in patients with anxiety disorders: A brief review. Eastern Journal of Psychiatry, 10(1&2), 47–50.

    Google Scholar 

  51. Peniston, E. G. (1986). EMG biofeedback-assisted desensitization treatment for Vietnam combat veterans post-traumatic stress disorder. Clinical Biofeedback and Health, 9(1), 35–41.

    Google Scholar 

  52. Peniston, E. G., & Kulkosky, P. J. (1989). Alpha-theta brainwave training and beta endorphin levels in alcoholics. Alcoholism, Clinical and Experimental Research, 13(2), 271–279.

    PubMed  Article  Google Scholar 

  53. Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta brainwave neurofeedback therapy for Vietnam veterans with combat-related post-traumatic stress disorder. Medical Psychotherapy, 4, 47–60.

    Google Scholar 

  54. Pharr, M., & Coursey, R. (1989). The use and utility of EMG biofeedback with chronic schizophrenic patients. Biofeedback and Self-Regulation, 14(3), 229–245.

    PubMed  Article  Google Scholar 

  55. Plotkin, W., & Rice, K. (1981). Biofeedback as a placebo: Anxiety reduction facilitated by training in either suppression or enhancement of alpha brainwaves. Journal of Consulting and Clinical Psychology, 49(4), 590–596.

    PubMed  Article  Google Scholar 

  56. Pop-Jordanova, N. (2000). Psychological characteristics and biofeedback mitigation in preadolescents with eating disorders. Paediatrics International, 42(1), 76–81.

    Article  Google Scholar 

  57. Pop-Jordanova, N. (2009). Heart rate variability in the assessment and biofeedback training of common mental health problems in children. Medical Archives, 63(5), 248–252.

    Google Scholar 

  58. Porges, S. W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123–146.

    PubMed  Article  Google Scholar 

  59. Putman, J. (2000). The effects of brief, eyes-open alpha brain wave training with audio and video relaxation induction on the EEG of 77 army reservists. Journal of Neurotherapy, 4(1), 17–28.

    Article  Google Scholar 

  60. Raskin, M., Bali, L. R., & Peeke, H. V. (1980). Muscle biofeedback and transcendental meditation. Archives of General Psychiatry, 37, 93–97.

    PubMed  Article  Google Scholar 

  61. Reed, M., & Saslow, C. (1980). The effects of relaxation instructions and EMG biofeedback on test anxiety, general anxiety, and locus of control. Journal of Clinical Psychology, 36(3), 683–690.

    PubMed  Article  Google Scholar 

  62. Reiner, R. (2008). Integrating a portable biofeedback device into clinical practise for patients with anxiety disorders: Results of a pilot study. Applied Psychophysiology and Biofeedback, 33, 55–61.

    PubMed  Article  Google Scholar 

  63. Rice, K. M., Blanchard, E. B., & Purcell, M. (1993). Biofeedback treatment of generalized anxiety disorder: Preliminary results. Biofeedback and Self-Regulation, 18(2), 93–105.

    PubMed  Article  Google Scholar 

  64. Rupert, P. A., Dobbins, K., & Mathew, R. J. (1981). EMG biofeedback and relaxation instructions in the treatment of chronic anxiety. American Journal of Clinical Biofeedback, 4(1), 52–61.

    Google Scholar 

  65. Rupert, P., & Schroeder, D. (1983). Effects of bidirectional heart rate biofeedback training on the heart rates and anxiety levels of anxious psychiatric patients. American Journal of Clinical Biofeedback, 6(1), 6–13.

    Google Scholar 

  66. Sargunaraj, D., Kumaraiah, V., Mishara, H., & Kumar, K. A. (1987). A comparison of the efficacy of electromyograph and alpha biofeedback therapy in anxiety neurosis. Nimhans Journal, 5(2), 103–107.

    Google Scholar 

  67. Sarkar, P., Rathee, S. P., & Neera, N. (1999). Comparative efficacy of pharmacotherapy and bio-feedback among cases of generalised anxiety disorder. Journal of Projective Psychology and Mental Health, 6(1), 69–77.

    Google Scholar 

  68. Saxby, E., & Peniston, E. G. (1995). Alpha-theta brainwave neurofeedback training: An effective treatment for male and female alcoholics with depressive symptoms. Journal of Clinical Psychology, 51(5), 685–693.

    PubMed  Article  Google Scholar 

  69. Scandrett, S. L., Bean, J. L., Breeden, S., & Powell, S. (1986). A comparative study of biofeedback and progressive relaxation in anxious patients. Issues in Mental Health Nursing, 8, 255–271.

    PubMed  Article  Google Scholar 

  70. Schneider, C. J. (1987). Cost effectiveness of biofeedback and behavioural medicine treatments: A review of the literature. Biofeedback and Self-Regulation, 12(3), 71–92.

    PubMed  Article  Google Scholar 

  71. Schneider, F., Heimann, H., Mattes, R., Lutzenberger, W., & Birbaumer, N. (1992a). Self-regulation of slow cortical potentials in psychiatric patients: Depression. Biofeedback and Self-Regulation, 17(3), 203–214.

    PubMed  Article  Google Scholar 

  72. Schneider, F., Rockstroh, B., Heiman, H., Lutzenberger, W., Mattes, R., Elbert, T., et al. (1992b). Self-regulation of slow cortical potentials in psychiatric patients: Schizophrenia. Biofeedback and Self-Regulation, 17(4), 277–292.

    PubMed  Article  Google Scholar 

  73. Schoenberg, P. L. A., Sierra, M., & David, A. S. (2012). Psychophysiological investigations in Depersonalization Disorder and effects of electrodermal biofeedback. Journal of Trauma and Dissociation, 13(3), 311–329.

    PubMed  Article  Google Scholar 

  74. Schwentker, A., & Vovan, L. (1995). Complementary therapies primer, prepared for the American Student Medical Association’s 1995 preconvention conference: “Back to tradition and forward to the future”. Virginia: American Medical Student Association.

    Google Scholar 

  75. Scolnick, B. (2005). Effects of electroencephalogram biofeedback with asperger’s syndrome. International Journal of Rehabilitation Research, 28(2), 159–163.

    PubMed  Article  Google Scholar 

  76. Siepmann, M., Aykac, V., Unterdörfer, J., Petrowski, K., & Meuck-Weymann, M. (2008). A pilot study on the effects of heart rate variability biofeedback in patients with depression and in healthy subjects. Applied Psychophysiology and Biofeedback, 33, 195–201.

    PubMed  Article  Google Scholar 

  77. Sokhadze, T. M., Cannon, R. L., & Trudeau, D. L. (2008). EEG biofeedback as a treatment for substance use disorders: Review, rating of efficacy, and recommendations for further research. Applied Psychophysiology and Biofeedback, 33, 1–28.

    PubMed Central  PubMed  Article  Google Scholar 

  78. Song, H. S., & Lehrer, P. M. (2003). The effects of specific respiratory rates on heart rate and heart rate variability. Applied Psychophysiology and Biofeedback, 28(1), 13–23.

    PubMed  Article  Google Scholar 

  79. Uhlmann, C., & Froscher, W. (2001). Biofeedback treatment in patients with refractory epilepsy: Changes in depression and control orientation. Seizure, 10, 34–38.

    PubMed  Article  Google Scholar 

  80. Vanathy, S., Sharma, P. S. V. N., & Kumar, K. B. (1998). The efficacy of alpha and theta neurofeedback training in treatment of generalized anxiety disorder. Indian Journal of Clinical Psychology, 25(2), 136–143.

  81. Victoria, C. G., Habicht, J.-P., & Brice, J. (2004). Evidence-based public health: Moving beyond randomized trials. American Journal of Public Health, 94, 400–405.

    Article  Google Scholar 

  82. Walker, J. E., & Lawson, R. (2013). FB02 beta training for drug-resistant depression—a new protocol that usually reduces depression and keeps it reduced. Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience, 17(3), 198–200.

    Article  Google Scholar 

  83. Watson, C. G., & Herder, J. (1980). Effectiveness of alpha biofeedback therapy: Negative results. Journal of Clinical Psychology, 36(2), 508–513.

    PubMed  Article  Google Scholar 

  84. Weinman, M. L., Semchuk, K. M., Gaebe, G., & Mathew, R. J. (1983). The effect of stressful life events on EMG biofeedback and relaxation training in the treatment of anxiety. Biofeedback and Self-Regulation, 8(2), 191–205.

    PubMed  Article  Google Scholar 

  85. Wollburg, E., Roth, W. T., & Kim, S. (2011). Effects of breathing training on voluntary hypo-and hyperventilation in patients with panic disorder and episodic anxiety. Applied Psychophysiology and Biofeedback, 36, 81–91.

    PubMed  Article  Google Scholar 

  86. Yang, A. C., Hong, C-J., & Tsai, S-J. (2010). Heart rate variability in psychiatric disorders. Taiwanese Journal of Psychiatry (Taipei), 24(2), 99–109.

  87. Zucker, T., Samuelson, K. W., Muench, F., Greenberg, M. A., & Gevirtz, R. N. (2009). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: A pilot study. Applied Psychophysiology and Biofeedback, 34, 135–143.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Poppy L. A. Schoenberg.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schoenberg, P.L.A., David, A.S. Biofeedback for Psychiatric Disorders: A Systematic Review. Appl Psychophysiol Biofeedback 39, 109–135 (2014). https://doi.org/10.1007/s10484-014-9246-9

Download citation

Keywords

  • Biofeedback
  • Psychopathology
  • Psychophysiology
  • Anxiety
  • Behavior therapy