While that app isn’t exactly the most high-tech version
of the tool, Lehrer says that psychologists can be certified in
biofeedback and acquire the necessary equipment without a
major financial investment. And biofeedback is as effective as it
is accessible, he adds. “It’s a very powerful technique.”
“A lot of the pharmacological interventions we have [for
these disorders] were shots in the dark,” says Kymberly Young,
PhD, a neuropsychologist who studies fMRI neurofeedback at
the Laureate Institute for Brain Research in Tulsa, Oklahoma.
With neurofeedback, “we can use what we’ve learned from
neuroscience studies to target specific regions of the brain. It’s a
huge step forward for treatment.”
The goal of biofeedback is to teach people to take control of
physiological functions such as heart rate, respiratory rate and
muscle tension. In a typical training session, a person is hooked
up to electrical sensors that provide information about those
functions. Over time, the person can learn to pace breathing or
relax muscles to produce a desired change in physiology. After
mastering the technique, says Lehrer, most people are able to
replicate the benefits in their everyday lives, without help from
Lehrer focuses on heart rate variability feedback. He finds
it especially useful for managing anxiety and panic disorders,
which are typically marked by hyperventilation and a racing
heart, he explains. But he and other proponents emphasize that
almost anyone can benefit from the technique.
As a clinical psychologist, Lehrer spends most of the time in
his sessions with clients using standard techniques of cognitive
and behavior therapy. Biofeedback might only account for a
fraction of the time spent in a typical session, he says — “but
for some patients, it’s the most important thing I do.”
“Biofeedback is not common,
and that’s a shame,” agrees Carol
Austad, PhD, a psychologist at Central
Connecticut State University.
She frequently teaches biofeedback
to the college students she counsels to
help them manage stress by regulating
their respiration and heart rate
variability. Her clients have also found
it helpful in managing depression,
anxiety and chronic pain, she says.
“As an adjunctive aid to
psychotherapy, it’s fantastic,” she adds.
“The patient feels as though they
have control over their own bodily
functions. When they have that feeling
of mastery, you can accomplish more in
Other clinicians have found similar benefits with
biofeedback that provides information about the brain.
Electroencephalography (EEG) neurofeedback measures the
brain’s electrical activity through sensors placed on the scalp,
allowing people to learn to regulate their brain function.
EEG neurofeedback may help with a variety of brain-based disorders, including anxiety, mood disorders and sleep
disorders. To date, though, most of the clinical evidence for
the technique involves the treatment of ADHD, says Lynda
Thompson, PhD, who directs the ADD Centre and Biofeedback
Institute of Toronto.
In a meta-analysis of randomized controlled trials, Jean-Arthur Micoulaud-Franchi, MD, PhD, and colleagues found
that EEG neurofeedback improves symptoms of inattention
for children with ADHD (Frontiers of Human Neuroscience,
2014). And in a study two years ago, Naomi Steiner, MD, and
colleagues found that EEG neurofeedback was more effective
than cognitive behavioral therapy for reducing ADHD
symptoms (Pediatrics, 2014).
The typical training looks a lot like a video game, Thompson
“Mind-body medicine is so prominent
right now, and this is a way to help
people learn mindfulness more
quickly. This is a tool that should be in
most psychologists’ toolboxes.”
Carol Austad, PhD
Central Connecticut State University