A good number of veterans while serving in recent combat zones experienced blast injuries resulting in traumatic brain injuries (TBIs), 80% of which were mild (m) with 25%–50% having prolonged postconcussive symptoms (PCSs). Neurofeedback (NFB) has demonstrated a decent degree of efficacy with mTBI PCSs in civilian and veteran populations. Using infra-low frequency NFB, the authors conducted a pilot study to determine the feasibility and initial efficacy with veterans. Because these results were promising, funding for a full clinical trial was subsequently applied for and acquired.

Addiction is a devastating disease of the body, the mind, and even the personality. Recent research shows that heart rate variability biofeedback can help the alcoholic/addict recover in three crucial ways, namely (1) treating the associated comorbidities (depression, anxiety, chronic pain), (2) treating the physiology around craving, and (3) returning to a loving and nurturing relationship with one's own body instead of an abusive and exploitive one.

Lower back pain is experienced by approximately 70% of the world's population, contributing to the worldwide burden of disease. Americans experience lower back pain at an estimated economic cost of $560–$635 billion. One contributing factor for back pain is posture, and more particularly, lack of awareness of dysfunctional posture. For example, many people sit in a slouched or forward-bent position, exacerbated by poor ergonomics while sitting or extended use of handheld digital devices while standing, such as looking down at a smartphone for long periods of time. This report describes a stacksitting technique that is one of the components of the Gokhale Method® for healthy, relaxed sitting and increased awareness of posture. The stacksitting process is illustrated with a case study, where the shape of the spine and the muscle activity are analyzed in parallel during three sitting styles: slouching, arched, and stacksitting. The spine curvature was characterized by the Gokhale SpineTracker™ wearable, which consists of five sensor units attached along the subjects' spines that are used to plot the spinal curve on a digital device such as a smartphone, tablet, or computer. Surface electromyographic (SEMG) recordings were made from the right upper trapezius, left upper trapezius, right midback, and left midback with a second device (Myoscan Pro sensors recorded with Biograph Procomp Infinity) while participants were seated in three postures: a slouched (forward-bent) position, an upright arched position, and an upright stacksitting position as trained by a Gokhale Method teacher. The case observations showed no significant difference in trapezius SEMG activity during each of the three positions. There was a slight increase in SEMG activity of the midback during stacksitting (1.1 μV) as compared with when slouched (0.64 μV), and a significant increase in SEMG activity when sitting arched (4.9 μV). As expected, the spinal activity tracking device showed significant straightening of the lower spine during the stacksitting position as compared with the slouched and arched positions. The observations suggest that the stacksitting position can be taught to others in a way that allows the vertebrae to be parallel to each other with very low levels of corresponding muscle activity. In contrast, sitting in an arched or slouched position could increase asymmetrical pressure on the disks, contributing to vertebral wedging, which could also contribute to spinal disk bulging and eventual back injury. The observations suggest that proper coaching may foster a stacksitting position of the spine, which could foster a healthier posture than slouched or arched spinal positions.

The purpose of this study was to evaluate clients' experience of engaging in a training protocol integrating biofeedback and neurofeedback in conjunction with counseling. The model constructed proposes that biofeedback applications may be used as a means to enrich the counseling experience as defined through the working alliance and treatment satisfaction.

Purchasing biofeedback instruments and learning the technical process of operating each biofeedback instrument with a human subject are not enough. These steps are necessary, but they do not clearly guide one as to how the instruments should be used. A treatment protocol is required that provides an explanation of the patient's current suffering or problem, as well as a rationale for using biofeedback training in a fashion that can reasonably be expected to relieve that suffering. Such models or protocols are necessary to organize the process of the biofeedback training and provide a reasonable explanation to motivate the trainee/client. Experience shows that clients who understand how the intervention is relevant for their complaint apply themselves more fully and follow through with any homework more reliably. There are a number of such protocols, including biofeedback-assisted relaxation training, the breath training and respiratory biofeedback model, resonance frequency heart rate variability training, the neuromuscular rehabilitation model, various neurofeedback training models, and psychophysiological psychotherapy. This article will introduce biofeedback-assisted relaxation training (BART). BART is a widely applied biofeedback protocol in clinical practice and has been documented as effective in clinical studies from 1969 to the present, for anxiety disorders, diabetes, headaches, and a variety of other common medical and psychological conditions.

Scientific research across a number of areas, including applied psychophysiology, biofeedback, and neurofeedback, is facing considerable scrutiny for poor replication rates, high numbers of false-positive findings, and insufficient scientific rigor. There are many factors underlying this replication crisis in scientific research; yet incentives for more rigorous research practices at the institutional and editorial levels lag behind the need for improvement. The author provides examples of replication and rigor difficulties in scientific research with an eye toward psychophysiological research, including researcher flexibility in data analysis, “p-hacking,” insufficient sample sizes, and lack of availability and implementation of rigorous methodological and publication guidelines. Subsequently, the author highlights examples and opportunities for improvement, including decreasing researcher flexibility, reporting sample size information, increasing sample sizes through collaboration, improving reporting standards/following established guidelines for reporting psychophysiological data, and increasing adoption of preregistration and registered reports. The author concludes that the Association for Applied Psychophysiology and Biofeedback (AAPB) can improve clinical practice and perception of public and scientific credibility by implementing rigorous and transparent research practices with a focus on replicability and clear methodological and reporting techniques and standards.

The resonance frequency (RF) is the rate at which a system, like the cardiovascular system, can be activated or stimulated for maximal variability. Precise RF measurement is needed to standardize training protocols to help researchers determine the importance of RF breathing in achieving clinical and optimal performance outcomes. Lehrer and colleagues have developed and standardized a psychometrically reliable RF measurement protocol that can facilitate training and replication. This article provides a detailed description of their protocol and explains the nuanced decision-making process involved in identifying the RF. The validity and reproducibility of results using this protocol depend on quality control in (a) confirming that individuals successfully follow a breathing pacer, and (b) manually removing artifacts from data records. While this protocol requires an electrocardiogram or photoplethysmograph sensor and a respirometer, professionals should consider the addition of autonomic, musculoskeletal, and respiratory measures to better understand the patterns of physiological activity produced by different breathing rates.

Human electroencephalogram (EEG) biofeedback (neurofeedback) started in the 1940s using one EEG recording channel, then four channels in the 1990s, and in 2004, expanded to 19 channels using Low Resolution Electromagnetic Tomography (LORETA) of the microampere three-dimensional current sources of the EEG. In 2004–2006 the concept of a real-time comparison of the EEG to a healthy reference database was developed and tested using surface EEG z score neurofeedback based on a statistical bell curve called real-time z scores. The real-time or live normative reference database comparison was developed to help reduce the uncertainty of what threshold to select to activate a feedback signal and to unify all EEG measures to a single value (i.e., the distance from the mean of an age-matched reference sample). In 2009 LORETA z score neurofeedback further increased specificity by targeting brain network hubs referred to as Brodmann areas. A symptom checklist program to help link symptoms to dysregulation of brain networks based on fMRI and positron emission tomography (PET) and neurology was created in 2009. The symptom checklist and National Institutes of Health–based networks linking symptoms to brain networks grew out of the human brain mapping program started in 1990 that continues today. A goal is to increase specificity of EEG biofeedback by targeting brain network hubs and connections between hubs likely linked to the patient's symptoms. Developments first introduced in 2017 provide increased resolution of three-dimensional source localization with 12,700 voxels using swLORETA with the capacity to conduct cerebellar neurofeedback and neurofeedback of subcortical brain hubs such as the thalamus, amygdala, and habenula. Future applications of swLORETA z score neurofeedback represent another example of the transfer of knowledge gained by the human brain mapping initiatives to further aid in helping people with cognition problems as well as balance problems and parkinsonism. A brief review of the past, present, and future predictions of z score neurofeedback are discussed with special emphasis on new developments that point toward a bright and enlightened future in the field of EEG biofeedback.

This article presents the argument that mindfulness-based meditation (MM) techniques are beneficial and share many of the same outcomes as similar mind-centered practices such as transcendental meditation, prayer, imagery, and visualization and body-centered practices such as progressive muscle relaxation (PMR), autogenic training (AT), and yoga. For example, many standardized mind-body techniques such as mindfulness-based stress reduction and mindfulness-based cognitive therapy (a) are associated with a reduction in symptoms of anxiety and depression, (b) can be mastered in relatively brief time frames, and (c) are relatively cost-effective. Functional magnetic resonance imaging studies suggest that MM, along with other mind-body techniques, can influence brain centers that regulate stress reactions (e.g., eliciting increased activity in cerebral areas related to attention and emotion regulation). Furthermore, MM and other mind-body techniques may provide benefit by mediating breathing processes that in turn regulate gamma aminobutyric acid, a major inhibitory neurotransmitter, which can quiet the overactivation of the sympathetic nervous system. This article compares the efficacy of mindfulness-based techniques to that of other self-regulation techniques and identifies components shared between mindfulness-based techniques and several previous self-regulation techniques, including PMR, AT, and transcendental meditation. The authors conclude that most of the commonly used self-regulation strategies have comparable efficacy and share many elements. The authors propose that additional research is needed to explore shared mechanisms among the self-regulation techniques and to identify any factors that might favor using one technique over another.

Multiple sclerosis (MS) is a chronic disease, marked by demyelination of the central nervous system and a wide variety of symptoms, including blurred vision, muscle weakness, and impaired motor control, most of which occur in a remitting and relapsing pattern. In many cases the illness is progressive with severe disability. Current treatments combine interventions to manage the current episode and disease-modifying agents to reduce the risk of further episodes. The treatments for MS are only partially effective, and patients often face a confusing and frightening progression of their illness, despite treatment. Many patients utilize complementary therapies, especially dietary changes, nutritional supplements, and relaxation skills. This article presents the case narrative of a 36-year-old woman who was referred for depression and anxiety accompanying a 3-year period of recurring MS episodes. She combined many complementary therapies along with the medical management of her illness, and benefitted especially from mindfulness skills and biofeedback training.

This article provides readers with a guide for evaluating physiological readings during biofeedback assessment and treatment, with the goal of facilitating treatment planning and tracking of treatment progress and outcomes. The author reviews expected values for measurements of breathing, heart rate, heart rate variability, peripheral temperature, and skin conductance.

Hagedorn (2014) has highlighted the infection risks in biofeedback and neurofeedback practice and identified broad strategies for mitigating infection risk. In the age of Clostridum difficile, Methicillin-resistant Staphylococcus aureus, and human immunodeficiency virus, infection risk cannot be ignored in any health discipline that attaches sensors to patients' skin in most treatments. The present article discusses specific guidelines for care and hygiene of biofeedback and neurofeedback instruments, encoders, cables, and sensors. Attention to practice standards can greatly reduce the risk to practitioner and client alike.

The tapestry of biofeedback history has been woven from many independent threads. Some contributors started with much vigor and nurtured others, and then they faded away. Yet they seeded ideas that the next generation rediscovered as their own. Others blossomed and disappeared, whereas still others have continued to actively nurture the field. Interest in biofeedback has waxed and waned in response to the historical forces of technology, social culture, beliefs, and economics.

Slouching posture may be observed when people interact with digital devices such as sitting at a computer screen or looking downwards at a smartphone while sitting or walking. The study investigated two procedures: the effect of head position on perceived head rotation and the effect of neck scrunching on symptom development. In the first study, 87 students sat in either a head-erect or head-forward position and rotated their heads from side to side. Ninety-two percent of the participants reported that they significantly increased their head rotation range during the head-erect position as comparted to the head-forward position, and that it was much easier to rotate their head in the erect position (M = 8.5; SD = 2.4) than in the slouched position (M = 4.3; SD = 1.9), F(1, 171) = 152, p < 0.001. In the second study, 125 students were asked to scrunch their neck for 30 seconds. After neck scrunching, 98.4% of participants reported experiencing an average pain rating of 5.3 on a scale from 0 (none) to 10 (severe), which consisted of pressure in the head (M = 6.7), stiff neck (M = 5.9), eye tension (M = 4) and headaches (M = 3.8). For a subset of 12 students, the effects of head-forward position and neck scrunching (compression) on cervical and trapezius muscles was monitored with electromyography. The average cervical surface electromyography (sEMG) was higher during head-forward position and neck scrunching than during pre- and post-baseline, and the average trapezius sEMG was higher during the neck scrunching than during pre- and post-baseline. For most participants, the effect of their head/neck position on rotation and neck scrunching on symptom development was a total surprise. Experiential practices can provide somatic feedback as an education tool to teach awareness and thus motivate participants to change their body posture so that they reduce slouching and neck scrunching.

Colectomy is psychologically very stressful, but little information is available to help patients manage stress. The client presented with anxiety, high heart rate, and apparent arrhythmias 9 months after colectomy. After 7 weeks of daily practice of controlled breathing and positive visualization, she showed no apparent arrhythmias and felt less anxious. She then suffered a stroke and underwent ileostomy surgery, but she was soon feeling less anxious, and her blood pressure and heart rate variability resumed normal values. This case demonstrates the effectiveness of autoregulatory practices for controlling stress after colectomy.

Chronic pain has a significant impact on the quality of lives for millions of people. Because it is resistant to traditional medical intervention, the optimal approach to chronic pain management relies on a biopsychosocial understanding of health and treatment. To date, cognitive behavioral therapy (CBT) has been the treatment of choice. However, CBT's emphasis on active control can prove counterproductive because the cognitions, behaviors, and emotions related to pain are difficult to directly confront. More recently, CBT has begun to integrate mindfulness, shifting toward paradigms of accepting sensations rather than trying to change them. This is difficult for individuals with chronic pain, who frequently spend significant resources avoiding and trying to minimize sensations. Biofeedback can be a useful tool for shaping mindfulness because it allows a focus on an external signal that in fact reflects the internal process. Over time, individuals can learn to integrate mindfulness techniques in their daily life that minimize the influence of pain, allowing them to focus on other aspects of their lives.

Patients today frequently present with conditions caused by or aggravated by stress, lifestyle, and behavior. The number of patients with one or more chronic illnesses has increased worldwide, and lifestyle and behavior frequently contribute to these chronic conditions. Biomedical care fails to address many of the behavioral, lifestyle, and environmental factors causing and aggravating these conditions. The article proposes that integrative healthcare is better suited than biomedicine to address the biopsychosocial aspect of modern illness. In addition, mindfulness-based coping and mindfulness meditation are introduced as valuable tools for integrative medicine and integrative practitioners. The article introduces the concepts of the mindful practitioner, the mindful treatment encounter, mindful engagement of the patient, and mindfulness as treatment.

Teaching mindfulness skills as part of psychological rehabilitation for PTSD patients can be highly beneficial. However, certain factors must be considered such as determining at what stage of therapy to introduce mindfulness training, the length of the practices, and the focal point of the training (e.g., attention, open focus, loving kindness). This article will address these considerations and outline ways in which psychophysiological monitoring and biofeedback can assist therapists in guiding their clients through the process. Specifically, it will highlight how the elevated arousal levels typical of PTSD and the lack of physiological habituation result in rigid and negatively biased attention, which in turn propels the elevated arousal levels into a vicious cycle. Mindfulness practices and approach may help achieve increased flexibility; however, the process must be tailored for each client in accordance with the severity of his or her PTSD symptoms.

This paper proposes an integration of three therapeutic languages—biofeedback, mindfulness, and multiple-person oriented therapy (family, couple, etc.)—using a novel narrative we call the “Stairway to Togetherness.” Relying on recent theoretical and empirical developments, we present a model that combines these three languages into a single coherent therapeutic approach. This approach points to a new direction for multiperson therapy, emphasizing mindfulness interventions, conflict de-escalation, and psychophysiological mutual-regulation patterns, as opposed to content-based and behavioral interventions that have so far been the norm. We suggest that mindfulness and biofeedback practices and insights can find a proper place in the context of multiperson therapy, by making the intersubjective space between individuals the object of mindful attention. We show how mindfulness principles apply to this relational space, and how biofeedback can support this endeavor. A metaphor of a four-story home is provided to help couples navigate their relationship as they attempt to reach a place of felt togetherness—a therapeutic goal that goes beyond problem solving or communication training. Although this paper focuses on couples therapy, it can easily encompass other forms of multi-person therapy.

Biofeedback is recommended as the first line of treatment for patients with stress or urge urinary incontinence (Fantl et al., 1996). Research supports the use of biofeedback for bowel dysfunction (Bartlett, Sloots, Nowak, & Ho, 2011). There is mounting evidence for the use of Mindfulness-Based Stress Reduction for the use of bladder and bowel dysfunction and pelvic pain (Fox, Flynn, & Allen, 2011; Paiva & Carneiro, 2013). The following case reports demonstrate the utility of Mindfulness-Based Stress Reduction in helping patients who suffer from bowel, bladder, and pelvic pain syndromes. Mindfulness training can be used to bring attention to how emotions and food choices have a direct impact on the gastrointestinal tract. Present moment awareness of the urinary tract functioning also improves bladder function. Noticing tension in the pelvic floor muscles helps to improve pelvic pain symptoms (Anderson, Wise, Sawyer, Glove, & Orenberg, 2011; Fox et al., 2011; Paiva & Carneiro, 2011).

Heart rate variability (HRV) is a medical index for morbidity and wellness. Lower HRV accompanies many illnesses; high HRV accompanies healthy states, resilience, and optimal functioning. Heart rate variability biofeedback (HRVB) uses real-time electronic feedback of the moment-to-moment changes in HRV to train patients to produce increases in HRV. Outcome studies on HRVB have shown therapeutic benefit for a wide variety of medical and mental health disorders. Lehrer and colleagues have published evidence-based protocols for HRV assessment and HRV treatment. Here, the authors review outcome studies on a sampling of common disorders: asthma, chronic muscle pain, depression, heart failure, hypertension, and posttraumatic stress disorder. HRVB offers promising therapeutic benefit for any medical or mental health disorder known to be accompanied by autonomic nervous system dysregulation.