Biofeedback: how it works, where it is used in the NHS and how strong the evidence is

Many body processes happen without attention, so it is hard to tell whether a change in how you breathe, tense or relax is making a difference. Biofeedback closes that gap. A sensor picks up a signal, which is displayed on a computer screen or turned into a sound, and you adjust what you are doing until the display changes in the direction you want.

NCCIH describes biofeedback-assisted relaxation as using devices to monitor and manage physical responses. The technique is therefore a training method rather than a treatment delivered to you, and its value depends on whether the skill transfers to everyday life once the equipment is removed.

The clearest NHS description relates to urinary incontinence. A GP may refer you to a specialist physiotherapist or continence adviser, who assesses your ability to contract the pelvic floor muscles and designs a programme. The NHS describes training as a minimum of eight muscle contractions at least three times a day for at least three months, continuing if there is improvement.

If you cannot contract the muscles on your own, the NHS describes two alternatives. One is electrical stimulation using a probe. The other is biofeedback, in which either a probe or electrodes on the skin around the abdomen or anus detect muscle activity and show it on a computer display.

The NHS is direct: there is not much good evidence that biofeedback offers a significant benefit to people using pelvic floor muscle training for urinary incontinence, although the feedback may help motivate some people. It also states that pelvic floor muscle training can benefit everyone with urinary incontinence.

The practical reading is that the exercises matter most. Biofeedback may help someone stay engaged or confirm that they are contracting the correct muscles, but it should not be presented as a stronger treatment than the exercises themselves.

NCCIH places biofeedback-assisted relaxation alongside progressive relaxation, autogenic training, guided imagery, self-hypnosis and breathing exercises. For the group of techniques as a whole it reports strong evidence for anxiety, dental and surgical anxiety, labour pain and blood-pressure reduction with slow breathing, and moderate evidence for headaches, low-back pain and post-surgical pain.

Those findings are not specific to biofeedback, and the summary does not break out how much of the benefit is attributable to the devices. The NHS cites relaxation techniques among the approaches that can help prevent migraine attacks, again without singling out biofeedback.

Relaxation techniques are generally considered safe for healthy people, with rare reports of problems in people with epilepsy, certain psychiatric conditions or trauma histories. The probes used in pelvic floor biofeedback are internal, so sessions are carried out by trained clinicians in a clinical setting.

If you are offered biofeedback, it is reasonable to ask what the sensor measures, how many sessions are planned, what you will practise at home, and how progress will be judged.

• Ask the clinician what the feedback will show and how it relates to your symptoms.

• Ask how success will be measured and when the plan will be reviewed.

• Keep doing prescribed exercises between sessions; the feedback is a guide, not a replacement.