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Biofeedback vs. Neurofeedback: What's The Difference & Which Is The Better Tool For Coaches & Therapists?

Introduction

In the title of this article we have two questions. The former (what's the difference between biofeedback and neurofeedback) is deceptively simple, while the latter is more debatable and a matter of perspective (e.g. it depends on what you aim to achieve). I shall have quite a bit to say about both.

A simple answer to the former would be this: neurofeedback is a sub-type of biofeedback, in which the measured parameter is of brain activity, directly rather than some “down-stream” expression. An example of a neurofeedback parameter is EEG (by far the most commonly used in neurofeedback) while a biofeedback parameter could be muscle tension (measured as EMG), which is distinct from brain activity but of course controlled by brain activity.

However there's much more to say before we can appreciate the difference in depth. We need to start by defining biofeedback.

What Is Biofeedback?

Biofeedback is a tool for training the mind and/or brain (and nervous system). A biofeedback device measures some aspect of physiology that correlates with how you think or feel or pay attention. By feeding back this measurement in real time, as it changes in relation to your changing mental state, you can become more aware of how the mind works, or how the mind-body connection works, and ultimately it's a basis for learning greater “control”.

Biofeedback is non-invasive: the device doesn't do anything to you; it doesn't of itself change your physiology. Change is what you do, in response to the feedback. In the longer term, benefits are a result of learning, i.e. biofeedback and neurofeedback are vehicles for learning.

How Do We Learn?

From a pragmatic point of view, the most significant form of learning is learning how to do something, or skills acquisition. Learning simple facts is much less interesting (and has nothing to do with biofeedback).

Psychology textbooks mostly talk about learning in terms of conditioning, especially operant conditioning. Operant conditioning is a fundamental capacity of nervous systems, present even in very simple life forms. The archetypal example in psychology is the pigeon in a cage with a lever. When the bird pecks the lever, it is presented with a reward in the form of a food pellet. The pigeon soon learns this association, and being motivated to obtain food, repeatedly pecks the lever – it has acquired a new behaviour for finding food.

Biofeedback, and especially neurofeedback, are held to be examples of operant conditioning. When the brain produces a particular behaviour in the form of e.g. generating certain brainwaves (which it does initially by chance) it is rewarded with e.g. a sound or the scoring of a point in a video game. With practice (i.e. repeated experience) the initially random brain behaviour becomes “controllable”, or at least it happens more frequently.

A key point about learning by operant conditioning is that it's entirely automatic or non-volitional (hence simple life forms can do it). But doesn't real-life human learning involve the conscious mind (volition)?

Human Learning

Humans undoubtedly exhibit operant conditioning, as well as the other well-known form of conditioning, classical. An example: a child has a tantrum in a public place. To placate the child the parent gives it a sweet. The child learns that tantrums bring rewards.

But I don't think simple conditioning is enough to explain all cases of human learning or skills acquisition. I'm not suggesting the conditioning model is wrong, but I suspect that more complex learning systems are built out of and "on top of" the mechanisms behind operant conditioning.

To clarify what I think is missing, I'd like to discuss three topics in real-world learning: (i) goals, (ii) feedback and (iii) the role of the conscious mind in learning. And I'll use a real-world example: learning to play tennis (a case of skills acquisition).

Goals, Intention and Motivation

A tennis player typically has the goal of winning the match. There are sub-goals, such as winning games, points, and even for a single shot the goal is to hit the ball into the court. The player must keep the goal in mind, which requires motivation (wanting to play a good shot, win, etc.) For each shot the player holds an intention.

In the standard examples of operant conditioning, it's not clear that intention is present, certainly in the simpler life forms. The child having a tantrum may not have any conscious awareness of wanting to obtain a reward.

Feedback

In operant conditioning, the feedback is the reward (e.g. the pigeon getting a food pellet). In real-world human learning, feedback seems to play a different role. It lets you know how you did – did you successfully achieve your goal, or move in the right direction, or not? It seems to be essential for complex learning. But it's distinct from the goal. Consider this example: you're driving on a motorway, and you want to keep in your lane. The position of the road lane markings in your field of vision, relative to your car, give you this feedback: if you drift out of lane the lines change their relative position.

In tennis, feedback is obvious and abundant. Seeing where your shot ended up is feedback, as is the sound of the ball pinging off the centre of your racket (or the frame), as is the feel of a well-timed shot.

Ideally feedback has the following characteristics:

  • Feedback should be sensory-based, or perceivable through the physical senses (sight, hearing, etc).
  • Feedback should be relatively immediate and relatively continuous or at least frequent.
  • Feedback should differentiate between the goal state and a problem state, or moving towards the goal or getting further away from it (e.g. being in the middle of your lane vs. drifting out of lane)
  • You should be able to take some action that directly and immediately affects the feedback (steering the car to correct your position in your lane) – i.e. you have control.

Later, we'll consider how these criteria apply in biofeedback and neurofeedback.

The Role Of The Conscious Mind In Learning

We've already discussed how intention and motivation are needed in learning, but another factor that seems to be requisite to real-world learning such as tennis is attention. You have to pay attention to what's actually going on. If you're thinking about something else you're likely to make mistakes. Paying attention here means attending to sensory experience. Note that thinking takes you away from your direct experience. Even thinking about what you're doing, e.g. thinking that you have to get your footwork right in tennis can cause you to fail – better to be absorbed or “in flow”.

Neurofeedback practitioners typically say that neurofeedback learning is involuntary, and the conscious mind plays no role. Why is this? Is there a discrepancy here?

It's true to say that learning is automatic, in a sense. You don't have to try to learn, or think about learning, and you don't have to pay attention to learning itself. It's also true that the conscious mind can get in the way and make things worse – I've talked about this mental dynamic a lot in my other articles, where I've referred to it as the quicksand trap. This applies to even complex learning – in tennis you need to watch the ball, and not get caught up in thinking about your footwork or your grip.

I think it will be useful to briefly review my dual intelligence model, which I've used to resolve the paradox of what to do to avoid the quicksand trap. The idea is to distinguish two parts of the mind, the thinking intelligence and the body intelligence, or the conscious mind and the automatic mind.

dual intelligence model

What I'm suggesting here is that the conscious mind needs to pay attention – not to the mechanics of learning but to direct sensory experience. Then (as long as there is motivation) learning will happen automatically (i.e. the automatic mind will look after the learning).

We could also say that the automatic mind gives us a kind of internal feedback in the form of (subjective) feelings: when we get something right it generally feels good, or feels right (e.g. a tennis shot, or healthy breathing).

So far we've covered a lot of background on how learning happens, now we're ready to return to biofeedback and neurofeedback.

How Biofeedback & Neurofeedback Create Change

Earlier I said that fundamentally, biofeedback and neurofeedback create lasting change because they are vehicles for learning. We're now in a position examine how the ideas about learning we've looked at, apply in the context of biofeedback and neurofeedback, and to show how neurofeedback and biofeedback differ in significant ways.

In another article, I wrote about three ways in which biofeedback creates change – it is a good time to review these ideas. The three ways are:

  • Gaining insight: biofeedback can show you how the mind-body connection plays out – how thoughts and feelings mutually affect each other, and what works and what doesn't work in terms of influencing emotional states.
  • Developing mind-body skills: learning how to guide your own physiology towards resourceful states such as calm, clear focus.
  • Building brain fitness: through exercise, you can build fitness in your brain so you can respond more effectively to the challenges life throws up.

My view is that different biofeedback parameters emphasise one of the three above the others.

Let's consider skin conductance (SC), a simple peripheral biofeedback parameter. (It's also known as Galvanic Skin Response or GSR). The mechanism behind changing SC is that bursts of Sympathetic Nervous System (SNS) activation (associated with “fight or flight”) trigger sweating in the hands, and thus increases in SC (spikes in the biofeedback signal).

Because SNS activation is involuntary, it's not easy to learn to influence. You can influence it, but only by indirect control – you can't will it in the same way as you can move your finger. Rather, the value of SC biofeedback is in the insight (first of the three change principles) that it offers: you can learn about the nature of emotional responses in the body, and what works in terms of influencing them, and importantly how you can very easily make them worse by trying hard to control the uncontrollable. In summary, SC biofeedback creates lasting change primarily via the first of my three change principles.

Another peripheral biofeedback parameter is EMG, for muscle tension training. EMG biofeedback also offers opportunity for insight into the mind-body connection, but chiefly it is a means of developing skill in fully relaxing – so the second of my three change principles.

Heart Rate Variability or HRV biofeedback trains a state called heart coherence, which is founded on (i) breathing in a certain way, i.e. slowly and regularly and (ii) maintaining positive emotion or at least letting go of negative emotions. I would say HRV biofeedback works on the basis of a combination of all of my change principles, but especially the latter two: skills development, plus exercise or fitness training (i.e. through regular practice).

What about EEG neurofeedback?

How EEG Neurofeedback Creates Change

I would say that most neurofeedback works by exercise or fitness training, and does rather poorly for insight and skills development, at least in terms of conscious skills.

This brings us to a key difference between neurofeedback and peripheral biofeedback: all peripheral biofeedback parameters measure something that can at least in principle be perceived without a biofeedback device. They refine and enhance that awareness. But when it comes to EEG, we have no way to be aware of brainwaves directly (more on this shortly).

This takes us back to the characteristics that a good biofeedback parameter should have, which I will restate here in a slightly different way:

  • The parameter should be directly perceivable; it should feel subjectively different when it is high vs when it is low.
  • The parameter should reflect some difference between a problematic state (e.g. anxiety) and a solution state, e.g. calmness. So, a high reading should feel bad and low good, or vice versa.
  • The parameter should be controllable – it should be possible to (learn to) guide the parameter from high to low or vice versa.

EMG as a biofeedback parameter meets all three criteria: we can feel when muscles are tight and when they are relaxed; relaxed muscles feel good while tight muscles don't, and we can consciously and deliberately release tension (or at least learn to).

Heart rate doesn't do so well as a biofeedback parameter because it isn't really controllable: it's very difficult to deliberately slow your heart rate. It's also quite difficult to perceive most of the time, unless the heart is pounding from emotions or physical exertion.

How does EEG fare in terms of these three criteria?

EEG As A Biofeedback Parameter

EEG is not directly perceivable. Although we can learn to recognise some brainwave states such as high alpha, this is more a case of recognising a state of mind that was previously identified as alpha by a device. If you never measured EEG with an amplifier you would never know what an alpha state felt like – unlike say muscle tension, which you can naturally be aware of even if you never do biofeedback.

While many people can learn to recognise alpha, other more esoteric EEG parameters, such as say, beta coherence measured between C4 and P4, are virtually impossible to be consciously aware of. That doesn't mean to say neurofeedback with this parameter is impossible, but it would be a case of involuntary learning.

So on the whole, EEG doesn't do too well in terms of the first of the above criteria, being directly perceivable. What about the second (different between problem and solution)?

Here EEG does better. There are some well-established measures that correlate with mood. Just one example is left-right balance, in the alpha range or even the beta range or both. However, this is a general pattern that's not necessarily reflected in immediate experience. If you look at left-right balance on a second-by-second timescale, there will be a lot of fluctuation, that seems (subjectively) like random variation or “noise” – your mood wouldn't change on a second-by-second basis.

Another example: alpha amplitude is often said to correlate with relaxed awareness. Alpha also typically jumps up a lot when you close your eyes. But you don't necessarily feel more relaxed just for closing your eyes. It would be naïve to treat alpha as a simple anxiety/relaxation measure.

The third criterion for a good biofeedback parameter is controllability. Here also, EEG isn't great. For people training with neurofeedback, it may take several sessions before they “get it” - i.e. they get what they need to do to achieve success. Some people never get that sense from neurofeedback. Compare this to EMG biofeedback where most people get a clear sense of controllability within minutes or even seconds.

Another point is that even for people who benefit from neurofeedback, the training parameter (e.g. theta to beta ratio) doesn't necessarily shift in a consistent way over time – it may for some trainees but not for others.

Neurofeedback & Skills Development

In summary, neurofeedback differs from most peripheral biofeedback parameters insofar as most of its power comes from training and exercising the brain directly, rather than invoking insights and developing skills. Loosely speaking, neurofeedback is training for the brain, while biofeedback is training for the mind.

It's possible my argument will sound like a criticism of neurofeedback but it's not intended to be. I'm just trying to clarify the difference between the two. Neurofeedback is mediated by the involuntary or non-conscious mind (or brain). Most neurofeedback practitioners would agree with this. But neurofeedback is a very powerful technique, and can achieve some things that biofeedback can't begin to.

But is it really true to say neurofeedback doesn't involve skills development? In a sense, no. You could say neurofeedback develops automatic, non-conscious skills, for example improved cognitive performance.

Actually, even the idea that neurofeedback doesn't train conscious skills is an over-generalisation. It depends on the way you use neurofeedback, and also which aspects of the EEG you choose to work with.

Joe Kamiya was one of the early pioneers of neurofeedback, and one of the most important figures in its history. Working in the 1960's, a time when the operant conditioning model of EEG training model was dominant, Kamiya developed a more explicitly psychological model. He became interested in the alpha rhythm. Rather than simply training alpha amplitude by (non-volitional operant conditioning), Kamiya taught subjects to consciously recognise the presence of the alpha rhythm (which naturally waxes and wanes over time periods of several seconds). Most of his subjects were successful in learning this conscious discrimination skill. Furthermore, they were able to go on to develop control - i.e. to consciously and volitionally produce alpha brainwaves. Kamiya found trainees learned this control faster when they had first learned to be aware of alpha - and the more accurately they learned to recognise alpha, the better their subsequent control.

Kamiya's work inspired Elmer and Alyce Green, who went on to develop alpha-theta training, based on their interest in EEG correlates of meditation.

The idea that neurofeedback can be used to support meditation practice (which is of course a conscious and voluntary exercise in control of the mind) has continued to develop. One proponent is Dr Jeff Tarrant, who has established the NeuroMeditation Institute, and whose training I attended recently. Dr Tarrant is clear that he's using the feedback in a quite different way to "mainstream" neurofeedback. He is not interested in achieving increases (or decreases) in specific EEG parameters, as the operant conditioning model aims to do, but rather he uses the feedback as feedback: it tells the meditator when he is in the desired psychophysiological state, and when not (or at least, moving towards or away from it).

Another view of neurofeedback that I respect is that the goal is not some particular favoured brain state, but neurophysiological flexibility, or the ability to enter the most adaptive brain state given the circumstances you face.

In summary, it is possible to use neurofeedback to train and develop conscious skills of self-awareness and discrimination, also voluntary control of attention. My guess is this way of working with neurofeedback depends on what EEG parameters you select. Alpha amplitude is an apt choice. Dr Tarrant uses others besides. But I don't think my earlier example, beta coherence measured between C4 and P4, could be used this way.

Other Differences Between Biofeedback & Neurofeedback

1. Neurofeedback takes many more sessions.

Neurofeedback typically takes at least 20 sessions, and more like 30 or 40 if you want to be sure the changes are bedded in. Peripheral biofeedback typically takes a handful of sessions - in my own experience as a professional practitioner, rarely more than 10.

This relates to the type of change being cultivated. Mental skill acquisition is probably quicker, and especially when there is the opportunity to practice these skills without a biofeedback device (as is often the case).

We can speculate that neurofeedback stimulates neuroplasticity, in the form of growing or re-growing synaptic connections, etc., and this just takes time.

That said, Kamiya was able to teach his students to consciously discern the "alpha state" in as few as one or two sessions (an example of skills development).

2. Neurofeedback is more complex, and is harder to do.

EEG is an extremely complex phenomenon. Whether you're training yourself or you're a professional practitioner, learning to choose a protocol (which parameter to train, and where on the head) is a considerable undertaking.

Also, I would say the technical aspects of EEG are more challenging than for peripheral biofeedback. It's all-too-easy to get artefacts in the EEG which you need to recognise and correct.

As a neurofeedback trainee, it also takes more time to get what's going on - it can be quite mystifying at first.

3. Integrating with Coaching & Therapy

If you're a professional coach or therapist thinking of adding biofeedback or neurofeedback to your practice, you already have skills in communicating with clients, and you may be wondering how these new tools fit with what you already know. Almost certainly you don't want to ditch your current way of working (successfully) with clients, but would like to add to it.

My opinion is that peripheral biofeedback integrates more closely and effectively with "talking therapy" than does neurofeedback. That's because it focuses on creating insights and developing "mind-body" skills, which is what a lot of coaching and psychotherapy does in other ways.

I touched on an example earlier: Skin Conductance (SC) biofeedback helps clients see the way in which emotions play out in the mind and body, and that trying too hard to suppress them actually feeds their energy and makes them stronger (i.e. the "quicksand trap").

EEG neurofeedback does also integrate with coaching and therapy to a point, but it's likely to be a case of splitting your session into segments: you'd do a neurofeedback session, then you'd talk about how your client experienced it, or what changes are happening, etc.

When doing neurofeedback with a client, your "instructions" are likely to be fairly simple and straight-forward: just experience the feedback, and let your brain do the work for you, don't get in the way. With peripheral biofeedback, the practitioner's skill in presenting how to work with biofeedback is more significant. In my experience it's necessary to take time to set up the right mindset in your client.

Which Is Best: Biofeedback or Neurofeedback?

By now you'll appreciate there's no simple answer to this question. It depends on your aims

On the whole I would say I personally prefer peripheral biofeedback when working with clients. But that's because my practice has focused on stress and anxiety cases. I like to help clients build skills and resources for working with anxiety - I feel there's no substitute for the confidence that grows from knowing what to do when difficult emotions arise.

On the other hand, neurofeedback is more powerful in other ways, sometimes far more powerful. If you're working with things like migraines, epilepsy, autism, dementia, etc., then I wouldn't expect muscle tension biofeedback to have much impact. But some neurofeedback practitioners claim very good success with these conditions. (Disclaimer: I personally am not qualified to work with more "medical" conditions such as these, so don't have my own experience to call upon.)

Do Peripheral Biofeedback First

One of the best established protocols within EEG neurofeedback is alpha-theta or deep states neurofeedback, first conceived by the Greens and later developed by Peniston and Kulkosky. The latters' method (which they used with addiction and PTSD cases) started with peripheral biofeedback. It has been claimed that neurofeedback work progresses faster after first doing some peripheral biofeedback. This makes a lot of sense to me personally, whatever kind of neurofeedback you do. Whilst I'm unable to cite research data to back this up, many leading neurofeedback practitioners standardly incorporate some peripheral biofeedback, most typically heart coherence biofeedback. The (mind-body) skills developed will stand the neurofeedback trainee in good stead, especially for alpha or alpha-theta neurofeedback.

In my own approach, since I favour skills development especially for managing anxiety, I like to start with peripheral biofeedback before moving to neurofeedback training in the Kamiya and alpha-theta mould. I use Mind-Body Training Tools biofeedback & neurofeedback software, which I developed myself, but which also can be used for more traditional forms of neurofeedback.

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