Fourth Edition
A Practitioner's Guide

Edited by Mark S. Schwartz and Frank Andrasik

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This comprehensive volume is widely regarded as the definitive practitioner resource and text in the field of biofeedback and applied psychophysiology. Leading experts cover basic concepts, assessment, instrumentation, clinical procedures, and professional issues. Chapters describe how traditional and cutting-edge methods are applied in treatment of a wide range of disorders, including headaches, temporomandibular disorders, essential hypertension, pelvic floor disorders, attention-deficit/hyperactivity disorder, tinnitus, and others. Applications for optimizing physical performance among artists and athletes are also reviewed. A wealth of information and empirical research is presented in an accessible style, including helpful glossaries.

New to This Edition

“Anyone interested in biofeedback would absolutely need this book on their shelf as there is nothing currently equal to it….Yet another gold mine of information. This book will be absolute reading in any graduate program where biofeedback is covered or taught….It is a tour de force in both presentation and thoroughness.”

Child and Family Behavior Therapy

“This is a needed resource for clinicians and researchers who are interested in biofeedback and psychophysiology. ****!”

Doody's Review Service

Biofeedback has come to be recognized as seminal, compulsory reading for students, clinicians, and scientists entering and working in the field of applied psychophysiology and biofeedback. With their fourth edition, Schwartz and Andrasik have produced yet another state-of-the-science volume that reflects our evolving knowledge of the mind-body connection and the promise it holds for improving human health and performance. This is the essential desk reference for the field.”

—Aubrey K. Ewing, PhD, BCB, BCN, past president, Association for Applied Psychophysiology and Biofeedback

Biofeedback: A Practitioner’s Guide has long been the essential go-to source for the fields of biofeedback and neurofeedback. The fourth edition—even more encyclopedic than its predecessors—broadens the coverage of neurofeedback, extends the discussions of disorders treated by biofeedback therapies, and introduces emerging evidence in such areas as cardiorespiratory biofeedback, slow cortical potentials for epilepsy, and neurofeedback for traumatic brain injury and autism. Contributors include many pioneers in the field. I recommend this book as an indispensable resource for students and advanced professionals alike.”

—Donald Moss, PhD, Dean, College of Integrative Medicine and Health Sciences, Saybrook University

“An incredible achievement. Prior editions were notable for excellent content and readability, and this tradition is upheld in the fourth edition. There are many new chapters dealing with EEG biofeedback and instrumentation and other cutting-edge subject matter, while chapters carried over from the prior edition have all been updated. Comprehensive and well organized, the book is an ideal text for students of biofeedback. Instructors, practitioners, and researchers will find it a valuable reference and a source for lifelong learning.”

—Paul Loubser, MD, Department of Anesthesiology, University of Texas Medical School at Houston

“This book has been a vital resource for biofeedback research, teaching, and clinical care since its first edition. The fourth edition will continue to be the definitive biofeedback reference for years to come. Chapters on professional issues, instrumentation, and clinical applications for a wide range of medical and psychological conditions have been expanded, and remain outstanding. New chapters offer crucial coverage of cognitive-behavioral therapy as well as more on theories and methods of relaxation therapies. A 'must' for biofeedback professionals and graduate students.”

—Jay R. Skidmore, PhD, Department of Clinical Psychology (Emeritus), Seattle Pacific University; consultant in pain and rehabilitation medicine, Northwest Return to Work Rehabilitation Center, Lynnwood, Washington

“For both clinicians and researchers, this book provides easy access to authoritative information on biofeedback and other applied psychophysiological approaches. Attention is given to psychosomatic conditions traditionally covered in biofeedback texts, as well as to novel applications for which evidence is just beginning to accumulate. As in prior editions, clinicians will enjoy 'how-to' tips from expert practitioners on establishing and maintaining successful practices. The field of biofeedback has clearly come a long way, and Schwartz and Andrasik position it solidly within current conceptualizations of evidence-based practice.”

—Kevin T. Larkin, PhD, ABPP, Department of Psychology, West Virginia University

Table of Contents

I. Orientation to Biofeedback

1. The History and Definitions of Biofeedback and Applied Psychophysiology, Mark S. Schwartz, Thomas F. Collura, Joe Kamiya, & Nancy M. Schwartz

2. Entering the Field and Assuring Competence, Fredric Shaffer & Mark S. Schwartz

II. Instrumentation

3. A Primer of Traditional Biofeedback Instrumentation, C.J. Peek

4. Advanced Topics in Surface Electromyography: Instrumentation and Applications, Jeffrey E. Bolek, Ronald L. Rosenthal, & Richard A. Sherman

5. Cardiorespiratory Measurement and Assessment in Applied Psychophysiology, Richard N. Gevirtz, Mark S. Schwartz, & Paul M. Lehrer

6. Electroencephalographic Measures and Biofeedback: A Primer, Nicola Neumann, Ute Strehl, Niels Birbaumer, & Boris Kotchoubey

7. Quantitative Electroencephalography and Electroencephalographic Biofeedback/Neurofeedback, Robert W. Thatcher

8. Introduction to Psychophysiological Assessment and Biofeedback Baselines, John G. Arena & Mark S.Schwartz

9. Consumer- and Home-Based Biofeedback, Mark S. Schwartz & Frank Andrasik

III. Adjunctive/Complementary Interventions

10. Dietary Considerations, Keith I. Block, Charlotte Gyllenhaal, & Mark S. Schwartz

11. Biofeedback and Cognitive-Behavioral Interventions: Reciprocal Contributions, Daniel Hamiel & Arnon Rolnick

IV. Relaxation Interventions

12. Relaxation Today: Self-Stressing and Psychological Relaxation Theory, Jonathan C. Smith

13. Cardiorespiratory Biofeedback, Richard N. Gevirtz, Paul M. Lehrer, & Mark S. Schwartz

V. Practice Issues

14. Intake and Preparation for Intervention, Mark S. Schwartz

15. Adherence, Jeanetta C. Rains & Mark S. Schwartz

16. Problems Associated with Relaxation Procedures and Biofeedback, and Guidelines for Management, Mark S. Schwartz, Nancy M. Schwartz, & Vincent J. Monastra

17. Ethical Practice Issues and Concerns, Sebastian Striefel

18. Myths, Insurance, and Other Professional Topics and Issues, Sebastian Striefel, Ronald L. Rosenthal, Robert Whitehouse, & Mark S. Schwartz

19. Evaluating Research in Clinical Biofeedback, Frank Andrasik & Mark S. Schwartz

VI. Clinical Applications: Traditional General Biofeedback Practice

20. Headache, Frank Andrasik & Mark S. Schwartz

21. Temporomandibular Muscle and Joint Disorders, Alan G. Glaros & Leonard L. Lausten

22. Raynaud's Disease and Raynaud's Phenomenon, Maria Katsamanis, Mark S. Schwartz, & Keith Sedlacek

23. Essential Hypertension, Wolfgang Linden & Angele V. McGrady

24. Diabetes Mellitus, Angele V. McGrady & Deloris M. Lakia

25. Tinnitus: Nothing Is as Loud as a Sound You Are Trying Not to Hear, Herta Flor & Mark S. Schwartz

26. Anxiety Disorders, Arnon Rolnick, Dana Bassett, Udi Gal, & Anat Barnea

27. Fibromyalgia Syndrome, Peter T. Dorsher & Mark S. Schwartz

28. Irritable Bowel Syndrome, Mark S. Schwartz

29. Asthma, Paul M. Lehrer & Frederick Wamboldt

VII. Clinical Applications: Electroencephalographic, Neuromuscular, and Pelvic Floor Biofeedback Specialties

30. Attention-Deficit/Hyperactivity Disorder, Vincent J. Monastra & Joel F. Lubar

31. Neuromuscular Reeducation and Gait Training, Timothy L. Fagerson & David E. Krebs

32. Bowel, Bladder, and Pelvic Floor Disorders, Jeanette Tries & Eugene Eisman

VIII. Optimization

33. Performing Artists, Marcie Zinn & Mark Zinn

34. Sports, Vietta Sue Wilson, Wesley E. Sime, & Timothy Harkness

IX. Other Special Populations and Applications

35. Pediatric Applications, Timothy Culbert & Gerard A. Banez

36. Work-Related Musculoskeletal Disorders, Susan Middaugh

X. The Frontier and a Nod to the Future

37. Biofeedback of Slow Cortical Potentials in Epilepsy, Ute Strehl

38. Traumatic Brain Injury, Quantitative Electroencephalography, and Electroencephalographic Biofeedback, Kirtley E. Thornton

39. Biofeedback Interventions for Autism Spectrum Disorders, Lynda Thompson, Michael Thompson, James W. G. Thompson, & Andrea Reid-Chung

40. Brain–Computer Communication: An Alternative Communication Channel for Paralyzed Patients, Tobias Kaufmann, Niels Birbaumer, & Andrea Kübler

41. Substance Use Disorders and Neurofeedback, Estate M. "Tato" Sokhadze, David L. Trudeau, Rex L. Cannon, Eugenia Bodenhamer-Davis, & Richard E. Davis

42. More Frontiers and Further Forward, Mark S. Schwartz & Frank Andrasik


About the Editors

Mark S. Schwartz, PhD, is past chair of the Biofeedback Certification Institute of America (now Biofeedback Certification International Alliance; BCIA); serves on the Mayo Clinic Emeritus Staff; and has a private practice in Jacksonville, Florida. He recently served as Visiting Professor in the Department of Psychology at the University of North Florida. Past president of the Association for Applied Psychophysiology and Biofeedback (AAPB), Dr. Schwartz is board certified by the BCIA, a Diplomate in Clinical Sexology of the American Board of Sexology, and a Diplomate of the American Board of Assessment Psychology.

Frank Andrasik, PhD, is Distinguished Professor and Chair of Psychology at the University of Memphis. He is Editor-in-Chief of Applied Psychophysiology and Biofeedback, Associate Editor of Cephalalgia, and past Editor-in-Chief of Behavior Therapy. His extensive publications include, most recently, the coedited volume Biopsychosocial Assessment in Clinical Health Psychology. Dr. Andrasik is past president of the Association for Behavioral and Cognitive Therapies and the AAPB. He is board certified as a Senior Fellow by the BCIA and is a Fellow of the Society of Clinical Psychology and Society for Health Psychology (Divisions 12 and 38 of the American Psychological Association), the Association for Psychological Science, the Society of Behavioral Medicine, the Association for Behavioral and Cognitive Therapies, and the American Headache Society.


Frank Andrasik, PhD, Department of Psychology, University of Memphis, Memphis, Tennessee

John G. Arena, PhD, Mental Health Service Line, Department of Veterans Affairs Medical Center, and Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia

Gerard A. Banez, PhD, Pediatric Pain Rehabilitation Program, Cleveland Clinic Children’s Hospital for Rehabilitation, Cleveland, Ohio

Anat Barnea, DSc, private practice, Givat Chaim Ichud, Israel

Dana Bassett, MA, Hornsby Psychology Clinic, Sydney, New South Wales, Australia

Niels Birbaumer, PhD, Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany

Keith I. Block, MD, Block Center for Integrative Cancer Treatment, Skokie, Illinois

Eugenia Bodenhamer-Davis, PhD, Department of Rehabilitation, Social Work and Addictions, University of North Texas, Denton, Texas

Jeffrey E. Bolek, PhD, Emeritus Staff, Cleveland Clinic, and Motor Control Restoration, LLC, Cleveland, Ohio

Rex L. Cannon, PhD, Neural Potential, West Palm Beach, Florida

Thomas F. Collura, PhD, BrainMaster Technologies, Inc., Bedford, Ohio

Timothy Culbert, MD, FAAP, Integrative Medicine, PrairieCare Medical Group, Chaska, Minnesota

Richard E. Davis, MS, Neurotherapy Associates of Texas, Denton, Texas

Peter T. Dorsher, MSc, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida

Eugene Eisman, PhD, Emeritus Staff, Department of Psychology, University of Milwaukee, Milwaukee, Wisconsin

Timothy L. Fagerson, DPT, Spine–Orthopaedic–Sports Physical Therapy, Wellesley, Massachusetts

Herta Flor, PhD, Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

Udi Gal, MA, private practice, Manof, Israel

Richard N. Gevirtz, PhD, Department of Clinical Psychology, California School of Professional Psychology, Alliant International University, San Diego, California

Alan G. Glaros, PhD, School of Dentistry, University of Missouri–Kansas City, Kansas City, Missouri

Charlotte Gyllenhaal, PhD, Block Center for Integrative Cancer Treatment, Skokie, Illinois

Daniel Hamiel, PhD, Baruch Ivcher School of Psychology, IDC Herzliya, Herzliya, Israel; Cohen–Harris Resilience Center, Haifa, Israel; and Tel-Aviv Brull Community Mental Health Services, Tel-Aviv, Israel

Timothy Harkness, MA, Chelsea Football Club, London, United Kingdom

Joe Kamiya, PhD, Emeritus Staff, Department of Medical Psychology, University of California, San Francisco, San Francisco, California

Maria Katsamanis, PsyD, Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey

Tobias Kaufmann, PhD, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Boris Kotchoubey, PhD, Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany

David E. Krebs, DPT, PhD (deceased), Institute of Health Professions and Biomotion Laboratory, Massachusetts General Hospital, Boston, Massachusetts

Andrea Kübler, PhD, Institute for Psychology, University of Würzburg, Würzburg, Germany

Deloris M. Lakia, DNP, CNP, CDE, College of Nursing, University of Toledo, Toledo, Ohio

Leonard L. Lausten, DDS, Department of Otorhinolaryngology, University of Kansas Medical Center, Kansas City, Kansas

Paul M. Lehrer, PhD, Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey

Wolfgang Linden, PhD, Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada

Joel F. Lubar, PhD, Emeritus Staff, Department of Psychology, University of Tennessee, Knoxville, Tennessee and Southeastern Neurofeedback Institute, Pompano Beach, Florida

Angele V. McGrady PhD, LPCC, Department of Psychiatry, University of Toledo, Toledo, Ohio

Susan Middaugh, PhD, Emeritus Staff, Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina

Vincent J. Monastra, PhD, FPI Attention Disorders Clinic, Endicott, New York

Nicola Neumann, PhD, Institute of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany

C. J. Peek, PhD, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

Jeanetta C. Rains, PhD, Center for Sleep Evaluation, Elliot Hospital, Manchester, New Hampshire

Andrea Reid-Chung, MA, ADD Centre, Biofeedback Institute of Toronto, Mississauga, Ontario, Canada

Arnon Rolnick, PhD, Rolnick’s Clinic, Ramat Gan, Israel

Ronald L. Rosenthal, PhD, private practice, Miami, Florida

Mark S. Schwartz, PhD, Emeritus Staff, Department of Psychiatry and Psychology, Mayo Clinic, and private practice, Jacksonville, Florida

Nancy M. Schwartz, MA, Department of Psychology, University of North Florida, Jacksonville, Florida

Keith Sedlacek, MD, private practice, Stress Regulation Institute, New York, New York

Fredric Shaffer, PhD, BCB, Center for Applied Psychophysiology, Truman State University, Kirksville, Missouri

Richard A. Sherman, PhD, Department of Psychology, Saybrook University, Oakland, California

Wesley E. Sime, PhD, MPH, Emeritus Staff, Department of Nutrition and Health Sciences, University of Nebraska–Lincoln, and First Step Wellness, Lincoln, Nebraska

Jonathan C. Smith, PhD, Department of Psychology, Roosevelt University, Chicago, Illinois

Estate M. “Tato” Sokhadze, PhD, Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South Carolina

Ute Strehl, PhD, Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany

Sebastian Striefel, PhD, Emeritus Staff, Department of Psychology, Utah State University, Logan, Utah

Robert W. Thatcher, PhD, Applied Neuroscience Research Institute, Largo, Florida

James W. G. Thompson, PhD, Evoke Neuroscience, New York, New York

Lynda Thompson, PhD, ADD Centre, Biofeedback Institute of Toronto, Mississauga, Ontario, Canada

Michael Thompson, MD, ADD Centre, Biofeedback Institute of Toronto, Mississauga, Ontario, Canada

Kirtley E. Thornton, PhD, Neuroscience Center, Charlotte, North Carolina

Jeannette Tries, PhD, OTR, Aurora West Allis Memorial Center, West Allis, Wisconsin, and Clinic for Neurophysiological Learning, Milwaukee, Wisconsin

David L. Trudeau, MD, Foundation Neurofeedback and Neuromodulation Research (FNNR, formerly ISNR-RF), Murfreesboro, Tennessee

Frederick Wamboldt, MD, Department of Medicine, National Jewish Health, Denver, Colorado

Robert Whitehouse, EdD, private practice, Boulder, Colorado

Vietta Sue Wilson, PhD, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

Marcie Zinn, PhD, Department of Community Research, DePaul University, Chicago, Illinois

Mark Zinn, MM, Department of Community Research, DePaul University, Chicago, Illinois


Clinical and health psychologists, social workers, nurses, counselors, and allied health professionals; also of interest to physicians.

Course Use

Serves as a text in graduate-level courses in biofeedback, applied psychophysiology, behavioral medicine, and stress management.
Previous editions published by Guilford:

Third Edition, © 2003
ISBN: 9781593852337

Second Edition, © 1998
ISBN: 9781572304130

First Edition, © 1987
ISBN: 9780898629163
New to this edition: