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The use of biofeedback has become increasingly popular—from athletes to CEOs—seeking to manage stress and optimize performance.

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By Blake Pinto


The body’s reaction to stress can range from sweaty palms to a racing heart. Often, this response can hinder the ability to perform at your best—whether writing a paper or working out.

But what if you had the power to influence your body’s “involuntary” response to stress, or harness the response to increase focus and reach a level of performance you didn’t know you were capable of.

Researchers in the field of psychophysiology are proving biofeedback therapy can make this possible.

The next frontier for competitive athletics

As a competitive figure skater in 1982, Margaret Dupee, Ph.D., didn’t know the butterflies in her stomach before competition would play such a major role in her future career. Learning to manage her anxiety, alone on the ice in front of thousands of people, through her own unique self-regulation techniques is what initially piqued her interest in the human body’s physiological response mechanisms.

Today, Dr. Dupee is a leading researcher in the field of psychophysiology and works with elite athletes seeking to gain an edge on the competition by harnessing the power of their mind-body connection through biofeedback therapy.

“My research is focused on optimal performance,” says Dr. Dupee, assistant professor of the Psychophysiology and Optimal Performance course at Saybrook University. Her expertise helped Canadian athletes during the 2010 Winter Olympics in Vancouver and the 2012 Summer Olympics in London. “I continue to work with many different athletes, helping them recognize what’s happening in their nervous system during stressful events using biofeedback. Then I work on teaching them self-regulation techniques to manage it so that they’re performing at the optimal level.”

Like Dr. Dupee during her days of competitive figure skating, many athletes she works with have already developed personal self-regulation techniques as a necessity to cope with the stress brought on by intense competition.

For example, basketball players may develop a meticulous routine before shooting free throws. Some even focus on adjusting their breathing (deep breathe in, deep breathe out) before stepping to the line—possibly unaware this could be classified as a self-regulation strategy.

To the athlete, this routine may feel like it calms their nerves. However, psychophysiological interventions, such as biofeedback, offer tangible evidence of how effective this self-regulation strategy is by using innovative technology to produce readouts of their body’s response to the technique.

“It offers concrete data about one’s internal state or environment,” Dr. Dupee says. “In the past, sport psychologists had to rely on talk therapy techniques with questions like ‘how do you feel’ or ‘what are you thinking’ and really had no way to measure these concepts.”

This intersection between technological innovation, physiology, and psychology is becoming increasingly valued, but not just with athletes. Today, with the rise of wearable technology and portable equipment, biofeedback therapy is used to optimize performance in a variety of professions—from restaurant workers and elementary school teachers, to military personnel and business executives.

A proactive approach to stress management

Therapists use biofeedback to help clients learn to control some of the body’s psychophysiological responses, often triggered by stress.

“This can be your breathing rate, heart rate, muscle tension, sweat gland activity, or the temperature of your hands and feet,” says Dr. Dupee, adding that biofeedback is about bringing greater awareness to what's happening in the body using these five indicators. “Basically, when we're stressed, those stress indicators are affected in measurable ways.”

For example, a person’s hand temperature will drop while stressed because the body’s blood vessels constrict, causing less blood to reach extremities.

“Different individuals may identify with a specific indicator,” says Dr. Dupee, adding that she is a temperature responder. “The first thing that happens when I'm stressed is my hands get cold, but someone else may experience an accelerated heart rate.”

To assist in the recognition of these stress indicators, a biofeedback session consists of attaching electrical sensors to different parts of a person’s body. The sensors are connected to interactive computer software, which provides visible cues for someone to recognize when a stress response has been activated—even if they’ve yet to realize it. It is a proactive approach to stress management.

It’s kind of like training wheels for self-regulation techniques.


Over multiple sessions, biofeedback can teach someone to more quickly recognize when their stress responders are activated, thus allowing them to better mitigate the response through various self-regulation strategies.

“It’s kind of like training wheels for self-regulation techniques,” says Tim Herzog, Ed.D., adjunct professor of Psychophysiology and Optimal Performance at Saybrook University. “Ultimately, you want the person to be capable of replicating what they’ve done in a real-world setting, without the equipment.”

For elite athletes, this can help them perform at their highest level during competition. But for others, biofeedback therapy can be useful in managing their body’s daily response to stress. “It could be something as simple as your boss yelling at you. For one person, it’s not a big deal, but another person’s psychological and physiological response could be similar to facing death,” Dr. Herzog says. “So this type of training or therapy can be useful for anyone, not just athletes, to better recognize how their body responds to situations and learn to better cope with them.”

Rising acceptance, growing demand

Dr. Herzog first witnessed the effectiveness of biofeedback during his work with U.S. military personnel. During a time when sport and performance psychology was looking for clearer career paths for its trainees, the U.S. Army initiated a program at bases around the country. The Army Center for Enhanced Performance program mirrored a performance program at West Point, which emphasized psychophysiology and utilized biofeedback.

“I remember having a lieutenant colonel hooked up to the machine and inducing a stress response. We discovered that having him do simple math—one plus one equals two, two plus two equals four, and so on—would positively affect his heart rate variability. It could take him from a stress response—consumed with thinking about issues to address in the Battalion he commanded—to a place where he was self-regulated, calm, and alert.

“I also worked with snipers,” Dr. Herzog says. “These guys were already pretty good self-regulators because they’re trained in breathing techniques. But they would get very caffeinated from energy drinks because of their rigorous schedules. So we were able to see some of physiological effects of energy drinks and develop alternative energy management strategies.”

Today, biofeedback is a recommended treatment for conditions such as PTSD by Veterans Families United and an approved treatment under Tricare, the health care program for current and former service members and their families Dr. Herzog says acceptance of biofeedback has grown over the years.

“Back in the 1960s and 1970s, it was regarded as something people associated with transcendental meditation. It wasn’t taken as seriously,” Dr. Herzog says. “It has come a long way since then. I’m presenting at a sport psychology conference where we’re expecting at least 100 people to attend our pre-conference workshop. Years ago, we would have been lucky to have a few people show up.  Folks have begun to recognize that there is a natural ‘marriage’ between sport psychology and biofeedback; it makes mind-body techniques concrete.”

The rising acceptance of the science surrounding biofeedback is coinciding with a boom in the availability of wearable fitness technology. According to “The Wearable in U.S. Healthcare Report” by Business Insider Intelligence, “U.S. consumer use of wearables jumped from nine percent in 2014 to 33 percent in 2018.”

Previously, one of the main barriers to entry for those interested in biofeedback therapy was the high cost of equipment—which also often required the person being monitored to remain stationary. Some of the equipment could cost as much as $20,000. More affordable consumer-friendly and mobile devices such as smartwatches, and even smartshirts, are changing this.

“Wearables are definitely the next big thing, and we’re already moving in that direction,” says Dr. Herzog, noting that the Apple Watch can already provide a primitive form of heart rate variability measurement. “But I think it would be ill-advised for consumers to take a do-it-yourself approach to this type of therapy. That’s where programs like Saybrook’s become critical in teaching professional practitioners. It teaches students how to basically operate what’s under the hood and give their clients exactly what they need through a much more custom and prescriptive approach.”

Both Drs. Herzog and Dupee agree that greater awareness about new types of technology and biofeedback therapy is ultimately a good thing. Each believes every person can benefit from understanding more about their ability to control what were previously thought to be the body’s involuntary responses. “Recognizing what is happening in your nervous system and then being able to manage it is an extremely useful skill for any person,” Dr. Dupee says. “Learning to regulate your nervous system is something we should all learn to improve.”

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