- Biofeedback is a process that uses your body’s own signals like heart rate and body temperature to bring about healthy changes.
- Neurofeedback (or EEG biofeedback) is a type of biofeedback that specifically uses brain wave signals to bring about healthy changes.
- Biofeedback can improve health issues that are caused or worsened by stress. Using a two-step process, biofeedback can help you relax and reduce your stress.
- Neurofeedback can improve health through shifting brain wave patterns in such a way there is a concomitant shift in cognition or mood.
- Clinical biofeedback involves interaction between a provider, a client, and a machine/device providing feedback from body-derived signals.
Background and Policy on 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.
Biofeedback Safety and Effectiveness
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 prostectotomy, 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.
All Biofeedback trainers must be Licensed Healthcare Professionals. Examples include but are not limited to: psychology, nursing, occupational therapy, physical therapy, social work, counseling. Additionally, they must be trained in the specific modality they offer. Professionals should consult with their local discipline leadership to ensure the biofeedback training they intend to practice is within their scope/core privileges or determine if a modification to a scope of practice or additional privileges are needed. Additionally, the following guidance documents may be helpful in starting a biofeedback program:
- Guidance on Supported Biofeedback/Neurofeedback Modalities for VA Facilities
- Guidance Standards for VA Employees Utilizing Biofeedback/Neurofeedback
- Guidance on Standards for Community Care Network Providers of Biofeedback/Neurofeedback