Exploring Neurofeedback and Biofeedback Systems

Author: Margot Hartley

What are neurofeedback and biofeedback?

Neurofeedback and biofeedback are treatments based on brain and muscle activity that can be used to regulate symptoms of disorders. Biofeedback refers to the measurement of bodily responses so people may use this information to control reactions. Eventually, they may reach a state of relaxation to mitigate symptoms. Examples of these reactions include: heart rate, blood flow/pressure, muscle tension, pain perception, and activity of sweat glands (GSR). By attempting to control these movements in their body, participants are utilizing what is called the “mind-body connection.”

For both neurofeedback and biofeedback procedures, sensors are placed on the body to measure several different indicators of involuntary bodily functions. Although these functions are believed to be subconscious, this process empowers individuals to influence their activity through self-regulation. With enough practice, people can learn what affects them, how it affects their body, and ways to prevent a stressful response.

Biofeedback therapy has been shown to be useful for some cases of addiction, asthma, chemotherapy side-effects, chronic pain, high blood pressure, fibromyalgia, IBS, tinnitus, and PTSD. EEG biofeedback is what is referred to as neurofeedback. This treatment attempts to help participants identify and control irregular brainwave patterns, possibly helping to reduce the symptoms of anxiety disorders, depression, insomnia, and ADHD.

Neurofeedback sensors measure delta brainwaves (usually occur during deep sleep), theta brainwaves (present when drowsy or daydreaming), alpha brainwaves (relaxed but alert), beta brainwaves (occur when thinking or focusing and, when excessive, can cause anxiety), and gamma brainwaves (learning or problem-solving). These five brainwave types occur at specific frequencies (Hz) that can be measured. The “feedback” part of neurofeedback and biofeedback refers to the translation of this bodily data into an easily understood representation for participants (commonly audio, video, or a combination of the two). An example, from the Drake Institute of Behavioral Medicine, describes how an animation of a car was shown to subjects, and the car would stay in the correct lane if the subjects ' brainwaves were performing as desired.

How do studies implement neurofeedback & biofeedback?

Neurofeedback processes are carried out using brain-computer interface systems (BCI). Some discussion has explored using BCI for video game experiences in virtual reality. Feedback games using VR are already used for sports. At a university in Dublin, a game using EEG signals to control a character balancing on a rope was created using BCI. In London, a college used VR and BCI to see if disabled people could navigate a wheelchair through streets using EEG signals, and in Tokyo, BCI was used to monitor awareness when driving a virtual car.

Another way neurofeedback therapy has been used is to reduce the brain's reaction to addictive substances. A study focused on mitigating the effects of nicotine addiction used EEG patterns to help participants calm their automatic craving response to smoking-related cues. One interesting aspect of the methodology was using images and the subsequent EEG measurements to understand how each subject’s brain reacted to smoking cues. This made the neurofeedback processes more personalized to each individual. In the second part of the study, subjects were shown increasingly triggering substance-related imagery if their EEG patterns showed an activation of craving. If subjects successfully deactivated their response, they were shown more neutral imagery. About 1 month after the training, those who participated in the biofeedback process smoked almost 40% less than they did before.

GSR has been used with biofeedback to understand how patients with epilepsy might experience less seizure activity. Some research has found that increased GSR arousal actually lessens cortical excitement (overactivity in the brain that is sometimes a cause of seizures). In one study, participants were shown an animation of simple images, and as GSR activity increased, the movie moved forward through the images. If the GSR measurement decreased, the movie would reverse. Seizures were significantly reduced after biofeedback therapy: over 50% of participants had fewer seizures than before, while the control group saw no significant change

How does neurofeedback therapy compare to biofeedback therapy?

Efforts have been made to understand the impacts of neurofeedback compared to biofeedback. In a study on children with ADHD, one group was trained with a neurofeedback system and another with an electromyographic biofeedback (EMG-BF) system measuring muscle activation. Subjects were shown bars they had to keep within a certain range through activation or deactivation of certain bodily activities. The neurofeedback process measured theta (drowsy) and beta (focused) brainwaves while EMG-BF measured muscle activity in both arms. The findings indicated that 54% of children from the neurofeedback group and 42% of the EMG-BF group had ADHD symptoms improve by >25%. While the group training brainwaves had slightly better resulting symptoms, they actually got less proficient at the feedback task compared to the EMG-BF group. Researchers were not able to prove that improvement at a neurofeedback task translates to improvement of symptoms. Although it offers beneficial results, it is unclear if neurofeedback therapy is better than other treatments for ADHD.

In some sports contexts, researchers have examined how neurofeedback and biofeedback therapy can improve performance. One explored how hockey shooting performance can be made better. Beta sensorimotor rhythm brainwaves (SMR) were seen in experts and associated with better performance, so subjects were rewarded with audio and visual feedback when they were able to increase SMR. Biofeedback therapy taught subjects to regulate heart rate, respiration rate, body temperature, muscle activity, and GSR. The rate of increased shooting performance was significantly higher for those who followed the biofeedback and neurofeedback training than for those who did not. There was also a significant increase in their ability to control SMR activity in the brain. However, these results did not translate to how the players’ brains worked on the ice. Instead of increasing SMR activity when taking a shot, the subjects actually had a lower presence of SMR when shooting. Even though they got better, it is unclear if the neurofeedback technique had an impact.

There is still more research to be done to understand the role neurofeedback plays in altering involuntary human reactions. Many studies show that neurofeedback therapy is beneficial; however, the overall learning process participants undergo often yields mixed results. It is unclear whether the brainwave patterns they learn to control through feedback actually influence behavior day-to-day.

What systems are used for biofeedback?

There are several software programs on the market for biofeedback processes. BIOPAC features products that utilize VR systems to provide visual feedback, including seated, standing, and walking VR. These products can capture physiological, behavioral, and subjective response data. BrainAssistant by bio-medical is a neurofeedback software featuring more than 15 “neuro-responsive” games: i.e., an ocean dive, flying a plane, and tetris. BrainAssistant is customizable and allows users to set thresholds for EEG readings. There is also open-source software on GitHub called BrainBay that uses OpenBCI to read and process EEG signals. BrainBay plays rewarding audio for alpha brainwaves, and the audio is reduced if beta brainwaves are present.

Conclusions

Neurofeedback and biofeedback systems have the potential to greatly impact several areas of healthcare, sports, and learning. It will be interesting to see how this technology continues to be utilized in the new age of AI and immersive VR. Simulated environments may strengthen the training abilities of feedback. AI models may be able to build predictions and recommendations based on biofeedback data. They could especially influence the personalization of results and thresholds. As these systems continue to evolve, there are so many applications that continue to be discovered and new questions that demand answers.

Want to learn more? Further Reading

1. National Library of Medicine - Neurofeedback: A Comprehensive Review https://pmc.ncbi.nlm.nih.gov/articles/PMC4892319/

2. National Library of Medicine - Biofeedback in medicine: who, when, why and how? https://pmc.ncbi.nlm.nih.gov/articles/PMC2939454/

3. MayoClinic - Biofeedback

   https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664

4. GitHub - BrainBay https://github.com/ChrisVeigl/BrainBay

5. SageJournals - Biofeedback and Virtual Environments https://journals.sagepub.com/doi/abs/10.1260/1478-0771.9.4.377

References

1. Marzbani, H., et al. “Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications.” Basic and Clinical Neuroscience Journal, vol. 7, no. 2, Apr. 2016, https://doi.org/10.15412/j.bcn.03070208.

2. Velkoff, D. F. “Biofeedback vs. Neurofeedback: What's The Difference?” Drake Institute, 2026, drakeinstitute.com/articles/treatment-technology/biofeedback-vs-neurofeedback.

3. Nagai, Yoko, et al. “Clinical Efficacy of Galvanic Skin Response Biofeedback Training in Reducing Seizures in Adult Epilepsy: A Preliminary Randomized Controlled Study.” Epilepsy & Behavior, vol. 5, no. 2, 1 Apr. 2004, pp. 216–223, https://doi.org/10.1016/j.yebeh.2003.12.003.

4. Maurizio, Stefano, et al. “Comparing Tomographic EEG Neurofeedback and EMG Biofeedback in Children with Attention-Deficit/Hyperactivity Disorder.” Biological Psychology, vol. 95, Jan. 2014, pp. 31–44, https://doi.org/10.1016/j.biopsycho.2013.10.008.

5. Christie, Sommer, et al. “The Effect of an Integrated Neurofeedback and Biofeedback Training Intervention on Ice Hockey Shooting Performance.” Journal of Sport and Exercise Psychology, vol. 42, no. 1, 1 Feb. 2020, pp. 34–47, https://doi.org/10.1123/jsep.2018-0278.

6. Bu, Junjie, et al. “Effect of Deactivation of Activity Patterns Related to Smoking Cue Reactivity on Nicotine Addiction.” Brain, vol. 142, no. 6, 28 Apr. 2019, pp. 1827–1841, https://doi.org/10.1093/brain/awz114..     Marzbani, H., et al. “Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications.” Basic and Clinical Neuroscience Journal, vol. 7, no. 2, Apr. 2016, https://doi.org/10.15412/j.bcn.03070208.

7. Velkoff, D. F. “Biofeedback vs. Neurofeedback: What's The Difference?” Drake Institute, 2026, drakeinstitute.com/articles/treatment-technology/biofeedback-vs-neurofeedback.

8. Nagai, Yoko, et al. “Clinical Efficacy of Galvanic Skin Response Biofeedback Training in Reducing Seizures in Adult Epilepsy: A Preliminary Randomized Controlled Study.” Epilepsy & Behavior, vol. 5, no. 2, 1 Apr. 2004, pp. 216–223, https://doi.org/10.1016/j.yebeh.2003.12.003.

9. Maurizio, Stefano, et al. “Comparing Tomographic EEG Neurofeedback and EMG Biofeedback in Children with Attention-Deficit/Hyperactivity Disorder.” Biological Psychology, vol. 95, Jan. 2014, pp. 31–44, https://doi.org/10.1016/j.biopsycho.2013.10.008.

10. Christie, Sommer, et al. “The Effect of an Integrated Neurofeedback and Biofeedback Training Intervention on Ice Hockey Shooting Performance.” Journal of Sport and Exercise Psychology, vol. 42, no. 1, 1 Feb. 2020, pp. 34–47, https://doi.org/10.1123/jsep.2018-0278.

11. Bu, Junjie, et al. “Effect of Deactivation of Activity Patterns Related to Smoking Cue Reactivity on Nicotine Addiction.” Brain, vol. 142, no. 6, 28 Apr. 2019, pp. 1827–1841, https://doi.org/10.1093/brain/awz114.

AI was utilized to assist with understanding some term definitions and correcting grammar in this blog post. All content was reviewed and fact checked to ensure that information was applicable and accurate. All writing is completely human.