Biofeedback
Biofeedback
What is Biofeedback?
Biofeedback is often used to help with stress-related concerns and to manage chronic pain. It works in two steps:
- It helps you become more aware of your body’s responses.
- It helps you learn how to influence those responses.
Biofeedback training uses signals from your body—such as heart rate and temperature—to help you make healthy changes.
In clinical biofeedback, you work with a trained provider who uses a machine to monitor and give you feedback about your body’s signals. This helps you learn how to influence your body’s responses and improve your health and well-being.
How do I get started?
Ask your health care provider if biofeedback is right for you.
You can also reach out to your local Whole Health Point of Contact to see if biofeedback - and other complementary and integrative health care options - are available at a VA facility near you.
How can biofeedback help you?
Biofeedback can help you manage certain health conditions and improve overall well-being by teaching you how to positively influence your nervous system. It may be useful for:
- Tension or migraine headaches
- Bladder problems after prostate surgery
- High blood pressure
- Stroke recovery
What can I expect during a session?
Sensor attachment: Small sensors are placed on different parts of your body to measure changes in real time.
Reaction: Your body reacts to both external situations and internal thoughts in ways you might not notice—your heart rate may increase, breathing may change, or muscles may tense. Biofeedback helps you become aware of these changes and teaches you how to adjust them, which can help you feel better. The number of sessions needed will depend on your care team’s recommendations and local policies.
Is biofeedback safe and effective?
An evidence map of biofeedback was developed by the VA Health Services Research & Development. Conditions with evidence of positive effect include: migraine and tension-type headaches, secondary outcomes of headaches (medication intake, muscle tension, anxiety, and depression, etc.), Stroke, urinary incontinence (related to prostatectomy), fecal incontinence. Conditions with potential positive benefit: balance/gait training, fibromyalgia, hypotension. Conditions with mixed or unclear benefit: sleep bruxism, chronic idiopathic constipation, knee osteoarthritis, balance/gait training.
Also found was high-confidence evidence that biofeedback as an adjunctive treatment for pelvic floor muscle training (PFMT) can result in both immediate- and long-term improvements in urinary incontinence for men after a prostatectomy as compared with PFMT alone.
Policy and Research
Background and Policy in VA
Biofeedback is one of the evidence-based complementary and integrative health (CIH) approaches covered by the Veterans medical benefits package when deemed clinically necessary by their care team per VA Directive 1137 — Provision of Complementary and Integrative Health (recertified December 2022). Based on literature review these approaches were found to be safe and have sufficient evidence of benefit to be recommended as appropriate components of care for the Veteran population.
- Guidance Standards for VA Employees Utilizing Biofeedback/Neurofeedback
- Guidance on Standards for Community Care Network Providers of Biofeedback/Neurofeedback
Highlighted Publications
Citation: Freeman, M., Ayers, C., Kondo, K., Noonan, K., O'Neil, M., Morasco, B., & Kansagara, D. (2019). Guided Imagery, Biofeedback, and Hypnosis: A Map of the Evidence (VA ESP Project #05-225). Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service.
Summary: This report provides an evidence map of guided imagery, biofeedback, and hypnosis interventions based on systematic reviews and meta-analyses. It identifies health conditions for which these interventions have been examined, summarizing their effectiveness and associated harms. The map aims to guide decision-making and future research prioritization within the Veterans Health Administration.
Citation: Kondo, K., Noonan, K. M., Freeman, M., Ayers, C., Morasco, B. J., & Kansagara, D. (2019). Efficacy of Biofeedback for Medical Conditions: an Evidence Map. J Gen Intern Med, 34(8), 1618–1629.
Summary: This evidence map synthesizes findings from 16 high-quality systematic reviews on biofeedback for various clinical conditions. The study found strong, consistent evidence that biofeedback effectively reduces headache pain and benefits men with urinary incontinence after prostatectomy. It also indicates that biofeedback may improve fecal incontinence and stroke recovery, while evidence for most other conditions remains insufficient or unclear.
Citation: Kenemore, J., Benham, G., Charak, R., & Hernandez Rodriguez, J. (2024). Heart Rate Variability Biofeedback as a Treatment for Military PTSD: A Meta-Analysis. MILITARY MEDICINE, 189(9-10), e1903.
Summary: This meta-analysis investigated the efficacy of heart rate variability biofeedback (HRVB) for reducing PTSD symptoms in military service members. The findings from five studies with a combined sample of 95 participants indicate a moderate to large overall effect size for HRVB in reducing PTSD symptoms. Additionally, the study reports a significantly lower cumulative attrition rate (5.8%) for HRVB compared to traditional PTSD treatments, suggesting it may be a viable and acceptable complementary approach for this population.
Citation: Carlson, J., Ross, G. W., Tyrrell, C., Fiame, B., Nunokawa, C., Siriwardhana, C., & Schaper, K. (2025). Infra-low frequency neurofeedback impact on post-concussive symptoms of headache, insomnia and attention disorder: Results of a randomized control trial. Explore, 21, 103137.
Summary: This randomized controlled trial investigated the impact of infra-low frequency neurofeedback (ILF NFB) on post-concussive symptoms (headache, insomnia, and attention disorders) in combat veterans with mild traumatic brain injury (mTBI). The intervention group demonstrated clinically and statistically significant improvements in headache, sleep, and attention, as well as in quality of life, depressive symptoms, and PTSD symptoms, compared to the control group. The study concludes that ILF NFB shows promise as a safe and effective intervention for these chronic post-concussive symptoms.
Citation: Schuman, D. L., Lawrence, K. A., Boggero, I., Naegele, P., Ginsberg, J. P., Casto, A., & Moser, D. K. (2023). A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder. Applied Psychophysiology and Biofeedback, 48(1), 51–65.
Summary: This pilot study examined a brief, three-session mobile app-adapted heart rate variability biofeedback (HRVB) intervention for veterans with military-related PTSD. The intervention group showed significant improvements in depression and heart rate variability, with a marginal improvement in PTSD intrusion symptoms. The study found the brief protocol to be acceptable to veterans, with over 83% completing the study, although adherence to home practice was low.
Citation: Schoenberg, P. L., & David, A. S. (2014). Biofeedback for psychiatric disorders: a systematic review. Applied psychophysiology and biofeedback, 39(2), 109–135.
This review looks at how biofeedback can help treat mental health issues like anxiety, depression, autism, eating disorders, and schizophrenia. Biofeedback uses technology to help people control their body's responses, such as heart rate and muscle tension. The review found that biofeedback is mostly used to treat anxiety and can effectively reduce symptoms for many mental health problems. However, the studies on biofeedback vary a lot in quality and methods. More standardized and controlled research is needed to fully understand its benefits and how it can be best used in regular mental health treatments.
Citation: Yu, B., Funk, M., Hu, J., Wang, Q., & Feijs, L. (2018). Biofeedback for everyday stress management: A systematic review. Frontiers in ICT, 5, Article 23.
This review examines the use of biofeedback for managing everyday stress. Biofeedback involves using sensors to monitor physical reactions like heart rate and breathing, and then displaying this information to help individuals learn to control these responses. The study found that heart rate variability (HRV) and multimodal biofeedback are the most common techniques, often using visual displays on screens. The review highlights the challenges of integrating biofeedback into daily life, emphasizing the need for user-friendly, engaging designs. It suggests that new technologies could help make biofeedback more accessible and effective for stress management outside clinical settings.
Learn more
Learn more about other complementary and integrative health care options by visiting the Complementary and Integrative Health overview page or clicking the links below.
