Definition

Biofeedback training (BFT) and neurofeedback training (NFT) involve the same learning processes we use to develop motor skills or master a videogame. An individual acts (breathes effortlessly), observes the results (heart rate variability increases), and repeats this action during meetings with clients. Clients actively learn to regulate their psychophysiology (Thompson & Thompson, 2016).

Biofeedback is also a "psychophysiological mirror" that teaches individuals to monitor, understand, and change their physiology (Peper, Shumay, & Moss, 2012). Biofeedback teaches clients to listen to their bodies. Although they initially use equipment to track their physiology, biofeedback training progressively replaces external with internal cues. Graphic by Dani S@unclebelang adapted from Erik Peper.





NFT is a branch of BFT that provides real-time displays using an electroencephalograph (EEG), as opposed to an electromyograph (EMG), heart rate variability (HRV), skin temperature, or other psychophysiological measures. An electroencephalograph monitors brain electrical activity (e.g., brainwaves), while an electromyograph detects muscle action potentials from skeletal muscles. These modalities differ in the signals they detect, process, and display (Collura, 2014).

The Process of Neurofeedback
Neurofeedback is the process of interacting with an electronic device that measures and feeds back information about brain electrical activity.

The goals of this process are to:
(1) ensure correct regulatory function in the brain's neuromodulating systems
(2) encourage global neuropsychophysiological change
(3) correct specific, distinct, identifiable disorders or barriers to optimal performance that result from underlying dysregulation
(4) enhance performance by optimizing nervous system functioning

What Neurofeedback Does
(1) Neurofeedback provides accurate, timely, and helpful information to the client in the form of visual, auditory, or tactile feedback that responds to meaningful changes in monitored neuronal systems
(2) Neurofeedback training promotes flexibility, resilience, and choice

Click on the link to view Neurofeedback Overview, produced by the International Society for Neuroregulation and Research (ISNR). Graphic © ibreakstock/Shutterstock.com.






BFT may be more effective when training promotes mindfulness. A mindfulness approach teaches clients to focus on their immediate feelings, cognitions, and sensations in an accepting and non-judgmental way, to distinguish between what can and cannot be changed, and to change the things they can (Khazan, 2013).

Clients can become stuck when they focus on outcomes they cannot immediately control. For example, James, an undergraduate Psychology major, was diagnosed with ADHD. For example, James, an undergraduate Psychology major, was diagnosed with ADHD. When he ruminated about his mistakes on daily quizzes, this undermined his motivation to study and resulted in lower scores. He could not study while he worried about his quiz performance. When James learned to accept occasional mistakes without fear, his studying and course grade improved. James succeeded by changing what he could: his reaction to unavoidable errors. Graphic © Ivelin Radkov/Shutterstock.com

BCIA Blueprint Coverage

This unit addresses I. Orientation to Neurofeedback - A. Definition of Neurofeedback (EEG
Biofeedback).



This unit covers Definitions of Biofeedback and Neurofeedback, Physiological Monitoring and Modulation Are Not Biofeedback, and Quantum Biofeedback and Lenyosis^TM.

Please click on the podcast icon below to hear a full-length lecture.

Definitions of Biofeedback and Neurofeedback

Since neurofeedback is a specialized application of biofeedback, we will start with the Biofeedback Alliance and Nomenclature Task Force definition (Schwartz, 2010).

Biofeedback Alliance and Nomenclature Task Force (2008)

Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately 'feed back' information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.

The main elements of this definition are that (1) biofeedback is a learning process that teaches an individual to control her physiological activity, (2) biofeedback training aims to improve health and performance, (3) instruments rapidly monitor an individual's performance and display it back to her, (4) the individual uses this feedback to produce physiological changes, (5) changes in thinking, emotions, and behavior often accompany and reinforce physiological changes, and (6) these changes become independent of external feedback from instruments. Graphic © rumruay/Shutterstock.com.






The Biofeedback Certification International Alliance (BCIA) emphasized that neurofeedback is a form of biofeedback in its Blueprint of Knowledge.

Biofeedback Certification International Alliance (2016) definition of neurofeedback

Neurofeedback is employed to modify the electrical activity of the CNS, including EEG, event-related potentials, slow cortical potentials and other electrical activity either of subcortical or cortical origin. Neurofeedback is a specialized application of biofeedback of brainwave data in an operant conditioning paradigm. The method is used to treat clinical conditions as well as to enhance performance.

The International Society for Neurofeedback and Research (ISNR) provided a comprehensive definition of neurofeedback that described the similarities and differences between neurofeedback and biofeedback.

International Society for Neurofeedback and Research (2010) definition of neurofeedback

Like other forms of biofeedback, NFT uses monitoring devices to provide moment-to-moment information to an individual on the state of their physiological functioning. The characteristic that distinguishes NFT from other biofeedback is a focus on the central nervous system and the brain. Neurofeedback training (NFT) has its foundations in basic and applied neuroscience as well as data-based clinical practice. It takes into account behavioral, cognitive, and subjective aspects as well as brain activity.

NFT is preceded by an objective assessment of brain activity and psychological status. During training, sensors are placed on the scalp and then connected to sensitive electronics and computer software that detect, amplify, and record specific brain activity. Resulting information is fed back to the trainee virtually instantaneously with the conceptual understanding that changes in the feedback signal indicate whether or not the trainee's brain activity is within the designated range. Based on this feedback, various principles of learning and practitioner guidance, changes in brain patterns occur and are associated with positive changes in physical, emotional, and cognitive states. Often the trainee is not consciously aware of the mechanisms by which such changes are accomplished although people routinely acquire a 'felt sense' of these positive changes and often are able to access these states outside the feedback session.

NFT does not involve either surgery or medication and is neither painful nor embarrassing. When provided by a licensed professional with appropriate training, generally trainees do not experience negative side-effects. Typically trainees find NFT to be an interesting experience. Neurofeedback operates at a brain functional level and transcends the need to classify using existing diagnostic categories. It modulates the brain activity at the level of the neuronal dynamics of excitation and inhibition which underlie the characteristic effects that are reported.

Research demonstrates that neurofeedback is an effective intervention for ADHD and Epilepsy. Ongoing research is investigating the effectiveness of neurofeedback for other disorders such as Autism, headaches, insomnia, anxiety, substance abuse, TBI and other pain disorders, and is promising.

Being a self-regulation method, NFT differs from other accepted research-consistent neuro-modulatory approaches such as audio-visual entrainment (AVE) and repetitive transcranial magnetic stimulation (rTMS) that provoke an automatic brain response by presenting a specific signal. Nor is NFT based on deliberate changes in breathing patterns such as respiratory sinus arrhythmia (RSA) that can result in changes in brain waves. At a neuronal level, NFT teaches the brain to modulate excitatory and inhibitory patterns of specific neuronal assemblies and pathways based upon the details of the sensor placement and the feedback algorithms used, thereby increasing flexibility and self-regulation of relaxation and activation patterns.

This definition was ratified by the ISNR Board of Directors on January 10, 2009, and edited on June 11, 2010. It emphasizes that neurofeedback is a "self-regulation method" that teaches clients to voluntarily change central nervous system activity. It draws a sharp distinction between neurofeedback and neuromodulatory approaches like audio-visual entrainment (AVE) and rTMS that alter the brain by exposing it to a stimulus. While these are potentially valuable adjunctive procedures, they do not provide feedback of brain activity nor teach self-regulation.

Perspective

Two issues that require clarification are the focus of biofeedback and NFT and the possibility or likelihood of negative side effects.

First, the ISNR definition states: "The characteristic that distinguishes NFT from other biofeedback is a focus on the central nervous system and the brain." This description supports the view that while NFT is top-down, biofeedback training (BFT) is bottom-up. A more nuanced explanation is that both NFT and BFT involve top-down and bottom-up interventions. The arbitrary differentiation between body-centered and central nervous system (CNS) interventions results from an incomplete understanding of the interconnections between these systems. For example, the CNS is instrumental in modifying behaviors like respiration, and changes in respiration modulate CNS activity. Hyperventilation leading to hypocapnia causes a general slowing of the EEG (Takahashi, 2005).

Therefore, NFT and BFT share components like breathing, education about the training process, mindfulness, and problem-solving, involving the "central nervous system and the brain." Likewise, since the central and peripheral nervous systems cooperate through complex feedback and feedforward loops, we can conceptualize them as one complex integrated system.

Core Elements of Neurofeedback

The client-practitioner relationship is the foundation of BFT and NFT. Neurofeedback is most effective when clients and providers are mindful because this promotes self-awareness and a sense of agency. Neurofeedback promotes self-regulation when a practitioner provides effective coaching (Khazan, 2019).

Inter-Brain Synchrony

Therapy provides a structured environment where patients can repeatedly experience and strengthen inter-brain synchrony (Meehan, 2025; Sened et al., 2022). In inter-brain synchrony, the neural activity of two individuals becomes aligned during social interactions. This synchrony is observed in therapeutic settings when a therapist and a patient engage in shared emotional and cognitive processes, such as maintaining eye contact, mirroring expressions, and synchronizing speech rhythms.

This mutual alignment of brain activity, often termed neural coupling, facilitates a deeper interpersonal connection and effective communication Over time, this repeated neural coupling can lead to lasting neurobiological adaptations, reinforcing healthier emotional and cognitive frameworks. Vagus nerve graphic © Axel_Kock/Shutterstock.com.




Further evidence suggests that synchrony strengthens emotional bonds and improves cognitive flexibility. When neural coupling occurs, it facilitates better communication between brain regions associated with decision-making, problem-solving, and emotional processing. This may explain why clients who engage in therapy with high levels of synchrony often experience deeper insights, improved emotional resilience, and greater capacity for behavioral change. Understanding and intentionally fostering this synchrony can, therefore, be a powerful tool in therapeutic practice, enhancing the overall efficacy of interventions.

For therapists, these findings underscore the importance of fostering therapeutic synchrony as an active component of treatment. Beyond verbal communication, nonverbal cues such as body language, tone of voice, and paced responsiveness contribute significantly to inter-brain synchrony. Therapists who practice mindfulness, attunement, and embodied presence may enhance their ability to facilitate neural synchrony with clients, potentially amplifying the effectiveness of therapy.

Moreover, this perspective encourages therapists to view relational healing not only as a psychological process but also as a neurobiological one. Clients who struggle with attachment issues, social difficulties, or trauma may particularly benefit from interventions that emphasize relational presence, attunement, and co-regulation.

Relational presence refers to the therapist’s capacity to fully engage with the client, establishing an environment of genuine connection and trust where the client feels seen and valued. Attunement is the process by which the therapist accurately perceives and sensitively responds to the client’s emotional signals, thereby fostering a therapeutic interaction that validates the client’s internal experience. Co-regulation involves a collaborative dynamic in which the therapist supports the client in managing and modulating their emotional states, ultimately aiding the client in developing effective self-regulation skills. Collectively, these processes help create a secure relational framework essential for healing and developing adaptive emotional responses.

Physiological Monitoring and Modulation Are Not Biofeedback

Physiological monitoring, detecting biological activity like blood pressure, is only one biofeedback component. When nurses measure your blood pressure, this is physiological monitoring. Nurses provide biofeedback when they report these values to you because this gives you information about your biological performance. When your nurse announces that your blood pressure was 120/70, this closes the loop and allows you to refine your self-awareness and control of your physiology. Graphic © Sean Locke Photography/Shutterstock.com.





Listen to a mini-lecture on Physiological Monitoring and Modulation © BioSource Software LLC.

Likewise, modulation, stimulating the nervous system to produce psychophysiological change, is not biofeedback because it acts on your body instead of providing you with information about its performance.

For example, a physical therapist might treat back pain through a modality called muscle stimulation. A current delivered to postural muscles fatigues them so that they cannot produce painful spasms. After muscle stimulation brings spasms under control, a physical therapist can initiate surface electromyographic (SEMG) biofeedback to teach the patient to increase awareness and control of postural muscle contraction. Graphic © DreamBig/Shutterstock.com.




Similarly, various devices that input signals into the central nervous system are not biofeedback devices but are generally known as entrainment devices. These include Audio-Visual Entrainment (AVE), Cranial Electrotherapy Stimulation (CES), repetitive Transcranial Magnetic Stimulation (rTMS), repetitive Transcranial Direct Current Stimulation (rTDCS), pulsed ElectroMagnetic Frequency Stimulation (pEMF), and others. These interventions may be useful and may provide an effective adjunct to biofeedback. However, since they do not provide information directly to the individual in a learning paradigm, they are not biofeedback. They represent treatment, not training. For this reason, providers should confirm that the use of these modalities falls within their scope of practice. The David Delight Pro, an AVE device, is shown below.

Quantum Biofeedback and Lenyosis^TM

Slawecki (2009) cautioned consumers in "How to Distinguish Legitimate Biofeedback/Neurofeedback Devices."

The Sept. 3, 2009 Seattle Times published an exposé on pseudo-biofeedback devices: "Miracle Machines: The 21st-Century Snake Oil."