How to Become a Biofeedback Therapist

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Biofeedback science lies at the intersection of physiology and psychology. Biofeedback practitioners help patients learn how to help themselves by controlling the neurological and physical functions that cause medical conditions and illnesses. It is a highly technical field and requires biofeedback therapy training. To work in a clinical setting, practitioners must earn biofeedback therapy certification, which requires formal education and years of hands-on experience. Once certified, you can earn a comfortable income and enjoy a great job outlook.

What Is Biofeedback?

Your body is in constant motion: your organs contracting, expanding and pumping to perform their tasks, while your nervous system responds to emotions, outside stimuli and thoughts. When your body's and nervous system activities get out of balance, you can experience pain, get headaches, develop high blood pressure or serious, sometimes chronic illnesses. Some diseases and conditions occur due to factors outside human control, such as the environment or genetics, but some lifestyle choices and behaviors can cause illness.

Using biofeedback, patients with medical conditions can learn to control certain body functions to achieve a desired result. During biofeedback therapy, a practitioner attaches electrical sensors to a patient’s body to monitor certain functions.

For example, a practitioner might attach sensors on various parts of a patient’s body to monitor heart rate. Through extensive monitoring, a patient, with the guidance of the biofeedback practitioner, can learn how to recognize the triggers that increase heart rate and methods for reducing the rate to a normal level. For instance, the practitioner might instruct the patient to relax in a seated position for 10 minutes during times of elevated heart rate.

Or, a psychologist might conduct a biofeedback study to help a patient relieve anxiety. The doctor might measure the patient’s brainwaves while performing mindfulness meditation and listening to music to determine the best outlet for reducing anxiety.

Biofeedback therapy can provide relief for numerous physical and mental conditions, including:

Anxiety, asthma, headaches, high blood pressure and stress.
Attention-deficit hyperactivity disorder.
Chemotherapy side effects.
Constipation, fecal incontinence, irritable bowel syndrome and urinary incontinence.
Fibromyalgia, chronic pain, Raynaud's disease and temporomandibular joint disorder.
Ringing in the ears.
Stroke.

Many patients prefer biofeedback over traditional forms of medicine, because it does not require invasive treatments, gives them more control over their condition, can enhance drug therapies, or eliminate the need for some medications altogether.

Types of Biofeedback Monitoring Devices

Biofeedback practitioners use a variety of monitoring methods, depending on a patient’s condition.

A practitioner can analyze brain waves by attaching sensors to a patient’s scalp and monitoring them using an electroencephalograph.
To evaluate heart rate, a practitioner can attach sensors to a patient’s chest, lower torso and wrists to monitor activity using photoplethysmography to detect blood volume and heart rate variations.
Using an electromyograph, a biofeedback practitioner can monitor electrical activities to determine the causes of muscle contractions.
Through sensors attached to a patient’s fingers, hands and wrists, a practitioner can use an electrodermograph to monitor sweat gland activity, an indicator of anxiety.
A biofeedback practitioner can monitor respiration by attaching bands around a patient’s abdomen and chest and analyzing results on a respiration monitor device.
Using a temperature-monitoring device, a biofeedback practitioner can detect changes in blood flow, often an indicator of stress.

Using data collected during biofeedback therapy sessions, biofeedback practitioners can train patients in methods to improve their conditions or prevent symptoms from occurring. In their daily lives, many biofeedback patients use monitoring devices designed for home use. Various devices currently on the market can monitor physiological changes such as heart or respiratory rate. Some devices are wearable and come with software that enables patients to monitor their conditions on a computer or mobile device.

What Is Neurofeedback?

Neurofeedback is a specific form of biofeedback protocol. While biofeedback can relate to the entire body, including physiological activity and the nervous system, neurofeedback focuses on improving brain activity.

Often referred to as Electroencephalography (EEG) biofeedback, practitioners turn to neurofeedback to treat ADHD, anxiety, epilepsy, sleep disorders and traumatic brain injuries. Like biofeedback, neurofeedback can help patients learn to take control of the way their bodies function by understanding and mastering brainwaves.

How to Become a Biofeedback Practitioner

There are several routes that you can take to become a biofeedback practitioner. Most practitioners are professionals who enter the biofeedback field as coaches, doctors, nurses, psychologists, teachers or therapists. Typically, teachers and coaches need at least a bachelor’s degree or, for college and university level positions, a master’s degree. Doctors and psychologists usually need six to eight years of formal education, plus several years of residency.

Biofeedback Practitioner Certification

Once you establish your professional foundation, you must earn biofeedback certification from the Biofeedback Certification International Alliance, a nonprofit organization. BCIA certification is critical to your career path because three major international biofeedback organizations recognize BCIA’s credentials, including:

Association for Applied Psychophysiology and Biofeedback
Biofeedback Federation of Europe
International Society for Neurofeedback and Research

BCIA bases its certification on scientific evidence, scientific standards and ethical principles. The BCIA only accepts individuals who meet certain education and training standards and recertifies only those candidates who participate in three hours of continuing education in ethics. Because of the evolving nature of biofeedback science, the BCIA continuously revises its certification exams.

The BCIA does not recognize or encourage the use of the title “biofeedback therapist” because biofeedback is a set of intervention techniques within a practitioner’s primary field. For instance, a psychologist might use biofeedback techniques to help a patient control depression, or a cardiologist might train a patient in biofeedback techniques to maintain proper blood pressure.

BCIA offers three levels of certification for academic and performance professionals, clinicians and technicians.

Entry-Level Certification

BCIA’s entry-level certification is open to professionals who hold a bachelor of arts or bachelor of science degree from an accredited school in health care such as nursing or psychology, and who have less than five years of biofeedback experience. Candidates who meet the prerequisites for ELC can earn a board certified in biofeedback certificate, which certifies them in electromyography, heart rate variability, respiration and temperature skin conductance training.

Before you can take the ELC exam, you must:

Complete a course in human anatomy, biology or physiology that covers all 11 bodily systems.
Complete a 42-hour didactic education course at an accredited school that covers all topics outlined in the Blueprint of Knowledge, which includes topics such as autonomic nervous system applications, ethics, intervention strategies, professional conduct and respiratory applications, to name a few.
Complete 20 hours of mentoring with a BCIA-approved mentor. The mentoring program includes 10 sessions in which you must role play as a patient and demonstrate that you know how to attach sensors on yourself and monitor results. You also must complete 50 sessions with patients and 10 detailed case studies that cover patients’ entire biofeedback histories, from intake to discharge.

BCIA gives the ELC exam in English only. It covers topics outlined in the Blueprint of Knowledge and consists of 100 multiple choice questions derived from a core reading list. Candidates have three hours to complete the certification exam.

Certification by Prior Experience

BCIA offers certification by prior experience credentials to health care professionals with at least five years of experience in biofeedback and extensive education and training. To qualify for the CPE credential, you must:

Hold a current professional credential or license to practice in a field such as chiropractic, counseling, dental hygiene, medicine, nursing, occupational therapy, rehabilitation, social work or sports medicine.
Have completed at least 100 hours of post-professional education from an accredited school. The coursework must include 42 hours of material outlined in the Blueprint of Knowledge. The remaining hours must include topics related to one or more of the blueprint topics.
Have at least 3,000 patient hours of biofeedback experience over a period of at least five years using biofeedback modalities such as skin conductance, heart rate variability or respiration monitoring.
Have completed human anatomy or human physiology coursework related to biofeedback applications.
Have completed at least 25 hours of mentoring in clinical skills training.
Have completed a validation exam. The validation exam consists of 100 multiple choice questions. BCIA does not score the tests, but instead uses the collected information from exams to validate current tests and as a road map for creating new exams.

Entry-Level Neurofeedback Certification

BCIA’s entry-level neurofeedback certification program is available to people who do not have a health-related degree but work for a licensed, BCIA-certified biofeedback professional. Biofeedback employees who earn the entry-level neurofeedback certification benefit by receiving a credential, but BCIA does not list them in its practitioner directory. To qualify for certification, you must:

Complete a neuroanatomy, neurophysiology or physiological psychology course offered by an accredited school.
Complete 36 hours of didactic education that covers all topics in the Blueprint of Knowledge.
Complete 25 hours of mentoring, which includes 10 self-regulation sessions, 100 patient sessions and 10 full case studies.

Biofeedback Practitioner Training

A few colleges and universities offer biofeedback practitioner training programs that can help prepare you for BCIA certification. The Department of Counseling and Psychological Services at the University of California Riverside offers a biofeedback technician course that teaches students how to train patients in imagery and relaxation techniques. The course teaches students how to operate biofeedback equipment and analyze information collected in a therapy session.

The three-quarter course enables you to gain hands-on experience, working under the supervision of a certified technician for six to eight hours each week with patients in a clinical setting. Depending on your education level and biofeedback experience, the course could prepare you for the ELC or entry-level neurofeedback certification exams. The biofeedback therapy training coursework includes all BCIA-required didactic education, including 48 hours of biofeedback and 36 hours of EEG neurofeedback coursework. You will also receive 20 hours of BCIA-approved mentoring, including 10 self-regulation sessions, 50 patient sessions and 10 case studies.

Biofeedback Technician Salaries

The U.S. Bureau of Labor Statistics does not track the salaries of biofeedback practitioners specifically. However, in a 2018 study of all medical and clinical laboratory technologists and technicians, the BLS found a median salary of around $52,300. The median salary represents the center of the salary range for medical and clinical laboratory technologists and technicians. Technicians and technologists at the bottom of the pay scale made nearly $30,000, while top earners took home more than $80,000.

According to the career website Glassdoor, biofeedback technicians earn an average salary of nearly $55,500 per year. A survey by the employment website PayScale revealed that certified biofeedback therapists earned an average annual income of around $42,000. Salaries often vary widely by employer and location.

The BLS, Glassdoor and PayScale salary estimates apply most closely to biofeedback professionals who hold entry-level neurofeedback certification. Registered nurse, physician and psychologist biofeedback practitioners typically earn higher salaries.