Strategies for Entering the Field

You are a licensed healthcare provider or optimal performance coach who wants to add biofeedback to your practice but are overwhelmed by your choices. You want answers to questions like, "What are the different types of biofeedback?" and "Which disorders can I treat with each, or how can I use the various modalities to help clients achieve optimal performance?" We designed this guide to introduce you to the major biofeedback modalities and provide conservative strategies for entering the field.

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Biofeedback, HRV Biofeedback, and Neurofeedback

There are three popular "doors" for entering the field: Biofeedback, HRV Biofeedback, and Neurofeedback. Biofeedback includes the electrocardiograph (ECG), electrodermograph (EDG), electromyograph (EMG), heart rate variability (HRV), respiration, skin conductance, and temperature. HRV Biofeedback encompasses the electrocardiogram (ECG), electromyograph (EMG), photoplethysmograph (PPG), and respiration. Finally, Neurofeedback delivers EEG training using 1 to over 19 scalp sensors.

A special thanks to Dr. Donald Moss and Judy Crawford for their editorial magic.

Licensed healthcare professionals may provide biofeedback to treat diagnosed disorders. You must have an appropriate healthcare license to treat clients with a diagnosed disorder using biofeedback independently. Alternatively, you may work with such clients under the supervision of an appropriately licensed professional. 

Biofeedback may also enhance optimal performance and general stress management, relaxation, and well-being.  In most states, such work does not require a healthcare license. Nevertheless, please check your state's practice act for optimal performance coaching and stress management practice requirements.

Before discussing strategies for entering the field, we will review the major biofeedback modalities. Their description is partly adapted from Moss and Shaffer's (2022) A Primer of Biofeedback, which you can purchase from AAPB in its member or non-member stores. The authors have donated their royalties to AAPB.

Electrocardiograph

The electrocardiograph (ECG) uses surface electrodes to detect the R-spike of the electrocardiogram to monitor and train heart rate variability (HRV). "HRV is the organized fluctuation of time intervals between successive heartbeats defined as interbeat intervals" (Shaffer, Meehan, & Zerr, 2020). Providers use HRV biofeedback when treating anxiety, asthma, depression, diabetes, post-concussion syndrome, preeclampsia, and hypertension (Moss & Shaffer, 2022).

Many electrode placements are possible for the electrocardiogram. In biofeedback, the most widely used is the wrist-to-wrist placement because it does not require removing clothing and preserves the modesty of the client.

Electrodermograph

The electrodermograph (EDG) directly measures skin electrical activity (skin conductance and skin potential) and indirectly (skin resistance) using electrodes placed over the digits or the hand and wrist. Providers use electrodermal biofeedback when treating anxiety disorders, hyperhidrosis (excessive sweating), and stress (Moss & Shaffer, 2022).