Biofeedback history really began with the practice of yoga about 5000 years ago, since yogic exercises can teach self-regulation of the same body systems monitored by biofeedback without the aid of instrumentation. While biofeedback devices were used in the late 1800s, the concepts of biofeedback and self-regulation were rediscovered in the 1960s. The discipline of biofeedback/applied psychophysiology that was born in 1969 is truly dynamic and interdisciplinary. The founding of the Bio-Feedback Research Society and its state societies, the publication of a journal and magazine, and the sponsorship of international and regional meetings have facilitated communication and collaboration among professionals from diverse disciplines.


Technological advances have expanded the psychophysiological responses that biofeedback can monitor and reduced a laboratory of stand-alone biofeedback instruments to a case that is smaller than a paperback book. The forces of miniaturization and computerization have produced portable data acquisition systems that can monitor stationary and ambulatory behavior, identify and remove artifacts (false signals), perform powerful data analysis, and provide sophisticated feedback displays that rival videogames.

This unit covers the History of biofeedback (I-B).

Students completing this unit will be able to discuss:

  1. Pioneers in biofeedback
  2. Forces leading to the emergence of biofeedback (e.g., operant conditioning, self-regulation, cybernetics, miniaturization, computerization, founding of the Biofeedback Society of America)

The concepts of self-regulation (voluntary control of biological processes) and biofeedback (providing information about personal biological performance) are ancient, despite our current rediscovery of them. Hindus practiced meditation roughly 5000 years ago in India. Before the term biofeedback was popularized in 1969, contributors repeatedly demonstrated this learning process without understanding its implications and wider application. Until the Bio-Feedback Research Society's founding in 1969, professionals largely worked in isolation. They were unaware of others' work and unable to draw connections between findings in areas as different as operant conditioning and EEG training.

Bernard (1878)
proposed that the body strives to maintain a steady state (milieu interieur).

Cannon (1914)
expanded on this concept when discussing stress (a force that acts to disturb internal homeostasis) and homeostasis (a steady state).

Selye (1963)
studied the endocrine effects of chronic stress and popularized the term, stress, in The stress of life (1956)

Bell, Tarchanoff and Bair really pioneered contemporary study of self-regulation.

Alexander Graham Bell (1872)
studied teaching the deaf to speak using biofeedback.

He investigated Leon Scott's phonautograph, which translated sound vibrations into tracings on smoked glass to show their acoustic waveforms.


Bell also examined Koenig's manometric flame, which displayed sounds as patterns of light.


Tarchanoff (1885)
showed that voluntary control of heart rate could be fairly direct (cortical-autonomic) and did not depend on "cheating" by altering breathing rate.

Bair (1901) studied voluntary control of the retrahens muscle that wiggles the ear. He found that subjects learned this skill by inhibiting interfering muscles. This was a solid demonstration of skeletal muscle self-regulation.

Wiener (1961) developed cybernetic theory that proposed that systems are controlled by monitoring their results. Your home heating system is a good example of a cybernetic system. Cybernetic theory contributed concepts like system variable (what is controlled), setpoint (goal), feedback (corrective instructions), and feedforward (orders to perform an action).

The participants at the landmark 1969 conference at the Surfrider Inn in Santa Monica coined the term biofeedback from Weiner's feedback (Moss, 1998).

Thorndike (1913) advanced the term instrumental learning to describe voluntary responses that obtain a desired outcome. His law of effect proposed that successful responses are mechanically stamped in by their successful consequences.

Skinner's (1938)
operant conditioning research expanded on Thorndike's law of effect. Based on extensive laboratory findings, he argued that animals repeat responses followed by favorable consequences.

Skinner introduced several concepts that have influenced biofeedback theory. Reinforcement is a process where the consequence of a voluntary response increases the likelihood it will be repeated. Consequences that strengthen responses are called reinforcers. Punishment is a process that actively suppresses responses. The consequence of a voluntary response decreases the likelihood that it will be repeated. Consequences that weaken responses are called punishers.

Researchers who applied Skinner's work to biofeedback used operant theory to decide which responses could be voluntarily controlled and which could not. Scientists like Kimble (1961) concluded that while subjects could learn to consciously control skeletal muscle responses, autonomic processes (like heart rate) were involuntary, could only be classically conditioned, and were forever outside of conscious control.

The belief that only skeletal muscles could be voluntarily controlled ignored Indian yogis' practice of autonomic control for almost 5000 years. It also ignored research by Lapides, Sweet, and Lewis; Lisina; Kimmel; and Miller and DiCara that demonstrated voluntary control of autonomic responses. Ironically, Skinner observed in 1938 that performers can learn to cry (an autonomic response) on cue.

Lapides, Sweet, and Lewis (1957) temporarily paralyzed male subjects and trained them to stop urination twice as fast as normal using only (autonomically-controlled) smooth muscle.

Lisina (1955) combined classical and operant conditioning to train subjects to change blood vessel diameter. She elicited reflexive blood flow changes and then displayed the changes in their blood flow to teach them voluntary temperature control.

Kimmel (1960) operantly trained subjects to sweat (measured by the galvanic skin response).

Miller and DiCara (1967-1969) operantly conditioned heart rate, blood pressure, kidney blood flow, skin blood flow, and intestinal contraction in both paralyzed and unparalyzed rats. Curare was used to paralyze rats to prevent cheating by changing their breathing pattern. The reinforcer was electrical stimulation to the medial forebrain bundle. Their demonstration that both paralyzed and unparalyzed rats could learn to produce these autonomic changes gave biofeedback scientific credibility and led to Federal NIMH funding for biofeedback research.

Controversy clouded the paralyzed rat studies. While the unparalyzed rat findings have held up, attempts to replicate (reproduce) the curare findings have yielded progressively smaller autonomic changes. Explanations for this include changes in the curare and genetic rat strain, and tightening of the experimental design.

Biofeedback researchers have studied autonomic responses, incontinence, the brain, the skeletal muscle system, cardiovascular system, and pain. We will successively review the major contributions in each of these areas. Remember that in biofeedback's infancy, contributors from different disciplines (like rehabilitative medicine and animal learning) worked in relative isolation. The founding of the Bio-Feedback Research Society in 1969 provided a forum for interdisciplinary exchange.

Mowrer (1938) detailed the use of a bedwetting alarm that sounds when children urinate while asleep. This simple biofeedback device can quickly teach children to wake up when their bladder is full, contract the urinary sphincter and relax the detrusor muscle, preventing further urine release. Through classical conditioning, sensory feedback from a full bladder replaces the alarm and allows children to continue sleeping without urination.

developed the perineometer in 1947 to treat urinary incontinence (urine leakage) in women whose pelvic floor muscles were weakened during pregnancy and childbirth. The perineometer, which is inserted into the vagina to monitor pelvic floor muscle contraction, satisfies all the requirements of a biofeedback device and enhances the effectiveness of popular Kegel exercises (Moss, 1998).


In 1992, the United States Agency for Health Care Policy and Research recommended biofeedback as a first-line treatment for adult urinary incontinence (Whitehead, 1995).

Whitehead (1996) demonstrated the efficacy of biofeedback in eliminating or reducing the frequency of anal incontinence.

Galvani reported electrical currents in animals in 1791, which was confirmed by Aldini in 1794 and Von Humboldt in 1797.

Von Marxow
recorded visual cortical potentials in 1833, but did not describe rhythmic oscillations.

Du Bois Reymond
reported electrical conduction in muscles and peripheral nerves in 1848.

Fritsch and Hitzig discovered that cortical stimulation elicits a localized motor response in 1858 (Swartz & Goldensohn, 1998).

Caton recorded spontaneous electrical potentials from the exposed cortical surface of monkeys and rabbits, and was the first to measure event related potentials (ERPs) in 1875.

published Investigations in the physiology of the brain, which explored the relationship between the EEG and states of consciousness in 1877.

published studies of spontaneous electrical potentials detected from the brains of dogs and rabbits, and was the first to document alpha blocking, where light alters rhythmic oscillations, in 1890.

Sherrington introduced the terms, neuron and synapse, and published the Integrative action of the nervous system in 1906.

Pravdich-Neminsky photographed the EEG and event related potentials from dogs, demonstrated a 12-14 Hz rhythm that slowed during asphyxiation, and introduced the term, electrocerebrogram, in 1912.

Forbes reported the replacement of the string galvanometer with a vacuum tube to amplify the EEG in 1920. The vacuum tube became the de facto standard by 1936 (Swartz & Goldensohn, 1998)

Berger (1924)
published the first human EEG data. He recorded electrical potentials from his son Klaus's scalp. He viewed the EEG as analogous to the EKG and introduced the term, elektenkephalogram. He believed that the EEG had diagnostic and therapeutic promise in measuring the impact of clinical interventions.

Berger showed that these potentials were not due to scalp muscle contractions. He first identified the alpha rhythm, which he called the Berger rhythm, and later identified the beta rhythm and sleep spindles. He demonstrated that alterations in consciousness are associated with changes in the EEG and associated the beta rhythm with alertness. Finally, he described interictal activity (EEG potentials between seizures) and recorded a partial complex seizure in 1933 (Hassett, 1978; Robbins, 2000; Swartz & Goldensohn, 1998).

and Matthews confirmed Berger's findings in 1934 by recording their own EEGs using a cathode-ray oscilloscope. Their demonstration of EEG recording at the 1935 Physiological Society meetings in England caused its widespread acceptance. Adrian (shown below) used himself as a subject and demonstrated the phenomenon of alpha blocking, where opening his eyes suppressed alpha rhythms (Hassett, 1978).

Gibbs, Davis, and Lennox inaugurated clinical electroencephalography in 1935 by identifying abnormal EEG rhythms associated with epilepsy, including interictal spike waves and 3-Hz activity in absence seizures.

used the EEG to show how sensory signals affect vigilance in 1935.

Walter (1937, 1953) named the delta and theta waves, and the contingent negative variation (CNV), a slow cortical potential that may reflect expectancy, motivation, intention to act, or attention. He located an occipital lobe source for alpha waves and demonstrated that delta waves can help locate brain lesions like tumors. He improved Berger's electroencephalograph and pioneered EEG topography.

Kleitman has been recognized as the "Father of American sleep research" for his seminal work in the regulation of sleep-wake cycles, circadian rhythms, the sleep patterns of different age groups, and the effects of sleep deprivation. He discovered the phenomenon of rapid eye movement (REM) sleep with his graduate student Aserinsky in 1953.

, another of Kleitman's students, described the EEG architecture and phenomenology of sleep stages and the transitions between them in 1955, associated REM sleep with dreaming in 1957, and documented sleep cycles in another species, cats, in 1958, which stimulated basic sleep research. He established the Stanford University Sleep Research Center in 1970.

Andersen and Andersson (1968) proposed that thalamic pacemakers project synchronous alpha rhythms to the cortex via thalamocortical circuits (Swartz & Goldensohn, 1998).

Kamiya (1968) demonstrated that the alpha rhythm in humans could be operantly conditioned. He published an influential article in Psychology Today that summarized research that showed that subjects could learn to discriminate when alpha was present or absent, and that they could use feedback to shift the dominant alpha frequency about 1 Hz. Almost half of his subjects reported experiencing a pleasant "alpha state" characterized as an "alert calmness." These reports may have contributed to the perception of alpha biofeedback as a shortcut to a meditative state. He also studied the EEG correlates of meditative states.

Brown (1970) demonstrated the clinical use of alpha-theta biofeedback. In research designed to identify the subjective states associated with EEG rhythms, she trained subjects to increase the abundance of alpha, beta, and theta activity using visual feedback and recorded their subjective experiences when the amplitude of these frequency bands increased. She also helped popularize biofeedback by publishing a series of books, including New mind, new body (1974) and Stress and the art of biofeedback (1977).

Mulholland and Peper (1968)
showed that occipital alpha increases with eyes open and not focused, and is disrupted by visual focusing.

Green and Green (1986) investigated voluntary control of internal states by individuals like Swami Rama and American Indian medicine man Rolling Thunder both in India and at the Menninger Foundation. They brought portable biofeedback equipment to India and monitored practitioners as they demonstrated self-regulation. A film containing footage from their investigations was released as Biofeedback: The yoga of the West (1974).

They developed alpha-theta training at the Menninger Foundation from the 1960s to the 1990s. They hypothesized that theta states allow access to unconscious memories and increase the impact of prepared images or suggestions. Their alpha-theta research fostered Peniston's development of an alpha-theta addiction protocol.

They pioneered temperature biofeedback training for Raynaud's, migraine, and hypertension, and wrote the classic Beyond biofeedback (1977).

Fehmi (1969) developed Open Focus training, has studied the correlational between global synchrony and states of awareness, and has pioneered the use of neurofeedback to modify brain synchrony, especially in attentional disorders.

Budzynski (1972)
developed a twilight learning device that monitors left hemisphere EEG while a patient sleeps and plays recorded affirmations (positive statements) when theta is present. The premise of twilight learning is that affirmations have greater impact when presented in a transitional state in which theta waves replace the alpha rhythm.

He has studied the lateralization of brain function across the two cerebral hemispheres and the use of neurofeedback and audio-visual stimulation to correct age-related cognitive decline.

Sterman (1972) showed that cats and human subjects could be operantly trained to increase the amplitude of the sensorimotor rhythm (SMR) recorded from the sensorimotor cortex. He demonstrated that SMR production protects cats against drug-induced generalized seizures (tonic-clonic seizures involving loss of consciousness) and reduces the frequency of seizures in humans diagnosed with epilepsy. He found that his SMR protocol, which uses visual and auditory EEG biofeedback, normalizes their EEGs (SMR increases while theta and beta decrease toward normal values) even during sleep. Sterman also co-developed the Sterman-Kaiser (SKIL) qEEG database.

Birbaumer and colleagues (1981) have studied feedback of slow cortical potentials since the late 1970s. They have demonstrated that subjects can learn to control these DC potentials and have studied the efficacy of slow cortical potential biofeedback in treating ADHD, epilepsy, and schizophrenia.

Lubar (1989) studied SMR biofeedback to treat attention disorders and epilepsy in collaboration with Sterman. He demonstrated that SMR training can improve attention and academic performance in children diagnosed with Attention Deficit Disorder with Hyperactivity (ADHD). He documented the importance of theta-to-beta ratios in ADHD and developed theta suppression-beta enhancement protocols to decrease these ratios and improve student performance.

Peniston and Kulkovsky (1989) reported that 8 of 10 experimental patients who received their alpha-theta protocol for alcoholism maintained abstinence from alcohol compared with none of 10 controls. The two experimental patients who relapsed showed significantly reduced tolerance for alcohol.

Monastra, Monastra, and George (2002) compared 49 children diagnosed with ADHD who participated in a 1-year multimodal program (Ritalin, parent counseling, and academic consultation) with 51 children who participated in the multimodal program combined with neurofeedback. While both groups significantly improved performance on TOVA and the Attention Deficit Disorders Evaluation Scale when medicated with Ritalin, only the group that received neurofeedback maintained performance gains when unmedicated.


Jacobson (1930) developed hardware to measure EMG voltages over time, showed that cognitive activity (like imagery) affects EMG levels, introduced the deep relaxation method, Progressive Relaxation, and wrote Progressive relaxation (1929) and You must relax (1934). He prescribed daily Progressive Relaxation practice to treat diverse psychophysiological disorders like hypertension.

Several researchers showed that human subjects could learn precise control of individual motor units (motor neurons and the muscle fibers they control). Lindsley (1935) found that relaxed subjects could suppress motor unit firing without biofeedback training.

Harris and Mortensen (1962) trained subjects using visual and auditory EMG biofeedback to control individual motor units in the tibialis anterior muscle (of the leg).

Basmajian (1963) instructed subjects using unfiltered auditory EMG biofeedback to control separate motor units in the abductor pollicis muscle (of the thumb) in his Single Motor Unit Training (SMUT) studies. His best subjects coordinated several motor units to produce drum rolls. Basmajian demonstrated practical applications for neuromuscular rehabilitation, pain management, and headache treatment.


Marinacci (1960) applied EMG biofeedback to neuromuscular disorders (where proprioception is disrupted) including Bell's Palsy (facial paralysis), polio, and stroke.

Whatmore and Kohli (1968) introduced the concept of dysponesis (misplaced effort) to explain how functional disorders (where body activity is disturbed) develop. Bracing your shoulders when you hear a loud sound illustrates dysponesis since this action really does not protect you from injury.

These clinicians applied EMG biofeedback to diverse functional problems like headache and hypertension. They reported case follow-ups ranging from 6-21 years. This was long compared with typical 0-24 month follow-ups in the clinical literature. Their data showed that skill in controlling misplaced efforts was positively related to clinical improvement. Last, they wrote The pathophysiology and treatment of functional disorders (1974) that outlined their treatment of functional disorders.

Wolf (1982) integrated EMG biofeedback into physical therapy to treat stroke patients and conducted landmark stroke outcome studies.

Peper (1997) applied SEMG to the workplace, studied the ergonomics of computer use, and promoted "healthy computing."

Taub (1999, 2001) demonstrated the clinical efficacy of constraint-induced movement therapy for the treatment of spinal cord-injured and stroke patients.

Shearn (1962) operantly trained human subjects to increase their heart rates by 5 beats-per-minute to avoid electric shock.

In contrast to Shearn's slight heart rate increases, Swami Rama used yoga to produce atrial flutter at an average 306 beats-per-minute before a Menninger Foundation audience. This briefly stopped his heart's pumping of blood and silenced his pulse (Green & Green,1977).


Engel (Engel & Chism, 1967) operantly trained subjects to decrease, increase, and then decrease their heart rates (this was analogous to ON-OFF-ON EEG training). He then used this approach to teach patients to control their rate of premature ventricular contractions (PVCs) where the ventricles contract too soon. Engel conceptualized this training protocol as illness onset training since patients were taught to produce and then suppress a symptom. Peper has similarly taught asthmatics to wheeze to better control their breathing.

Schwartz (1971, 1972) examined whether specific patterns of cardiovascular activity are easier to learn than others due to biological constraints. He examined the constraints on learning integrated (two autonomic responses change in the same direction) and differentiated (two autonomic responses change inversely) patterns of blood pressure and heart rate change.

Schwartz, Weinberger, and Singer (1981)
studied cardiovascular patterning in six emotions using imagery, nonverbal expression, and exercise tasks. Their dependent variables were diastolic and systolic blood pressure, and heart rate. Participants' cardiovascular responses discriminated anger from fear (blood pressure), and anger and fear from happiness and sadness (all three variables).

Schultz and Luthe (1969) developed Autogenic Training which is a deep relaxation exercise derived from hypnosis. This procedure combines passive volition with imagery in a series of three treatment procedures (standard Autogenic exercises, Autogenic neutralization, and Autogenic meditation). Clinicians at the Menninger Foundation coupled an abbreviated list of standard exercises with thermal biofeedback to create autogenic biofeedback. Luthe (1973) also published a series of six volumes titled Autogenic therapy.

Fahrion and colleagues (1987) reported on an 18-26 session treatment program for hypertensive patients. The Menninger program combined breathing modification, autogenic biofeedback for the hands and feet, and frontal EMG training. The authors reported that 89% of their medication patients discontinued or reduced medication by one-half while significantly lowering blood pressure. While this study did not include a double-blind control, the outcome rate is impressive.

Freedman (1991) demonstrated that hand-warming and hand-cooling are produced by different mechanisms. The primary hand-warming mechanism is beta-adrenergic (hormonal), while the main hand-cooling mechanism is alpha-adrenergic and involves sympathetic C-fibers. This contradicts the traditional view that finger blood flow is exclusively controlled by sympathetic C-fibers. The traditional model asserts that when firing is slow, hands warm; when firing is rapid, hands cool. Freedman's studies mean that hand-warming and hand-cooling represent entirely different skills.

Budzynski and Stoyva (1969) showed that EMG biofeedback could reduce frontalis muscle (forehead) contraction. They demonstrated in 1973 that analog (proportional) and binary (ON or OFF) visual EMG biofeedback were equally helpful in lowering masseter SEMG levels.

Budzynski, Stoyva, and Adler (1971)
reported that auditory frontalis EMG biofeedback combined with home relaxation practice lowered tension headache frequency and frontalis EMG levels. A control group receiving noncontingent (false) auditory feedback did not improve. This study helped make the frontalis muscle the placement-of-choice in EMG assessment and treatment of headache and other psychophysiological disorders.

Sargent, Green, and Walters (1972, 1973) demonstrated that hand-warming could abort migraines and that autogenic biofeedback training could reduce headache activity. The early Menninger migraine studies, although methodologically weak (no pretreatment baselines, control groups, or random assignment to conditions), strongly influenced migraine treatment.

Flor (2002) trained amputees to detect the location and frequency of shocks delivered to their stumps, which resulted in an expansion of corresponding cortical regions and significant reduction of their phantom limb pain.

Hubbard and Gevirtz (1993) proposed that SNS innervation of muscle spindles underlies trigger points.

1969 - first meeting of the Bio-Feedback Research Society (BRS) at the Surfrider Inn in Santa Monica
1975 - American Association of Biofeedback Clinicians was founded
1976 - BRS was renamed the Biofeedback Society of America (BSA)
1980 - Biofeedback Certification Institute of America (BCIA) offered the first national certification examination in biofeedback
1989 - BSA was renamed the Association for Applied Psychophysiology and Biofeedback
1991 - BCIA offered first national certification examination in stress management
1994 - Brain Wave and EMG sections were established within AAPB
1995 - Society for the Study of Neuronal Regulation (SSNR) was founded
1999 - SSNR was renamed the Society for Neuronal Regulation (SNR)
2002 - SNR was renamed the International Society for Neuronal Regulation (iSNR)
2006 - ISNR was renamed the International Society for Neurofeedback & Research (ISNR)

Now that you have completed this module, is there a contributor who has significantly influenced your understanding or practice of biofeedback? Describe that contributor's impact on you.

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