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date: 20 October 2021

Biofeedback for Sport and Performance Enhancement

Abstract and Keywords

The technology of biofeedback has great promise for sport psychology and specifically for psychological skills training. Psychological skills learned through biofeedback training can be applied in practice and competition and can lead to improved athletic performance. This chapter includes a brief literature review of biofeedback and biofeedback training and describes the current state of biofeedback research in sport and its implications for athletic performance enhancement. Further, biofeedback training models such as the Wingate Five-Step Approach and the Learning-Modification-Application (LMA) Approach, based on the periodization principle, are presented. Finally, future directions and conclusions for the integration of biofeedback training as part of athletic preparation are presented.

Keywords: biofeedback, biofeedback training, psychological skills training, periodization principle, performance enhancement

Sport achievement is the result of well-planned hard training with progressively growing demands and challenges over a long time period. The main goal of the training process is to increase the athlete’s work capacity and skill capabilities as well as to develop strong psychological qualities for successful performance (Bompa & Haff, 2009; Carrera & Bompa, 2007). The training process should be organized and planned in advance based on the athlete’s personality, competition calendar, and demands of the sport discipline. In the 1960s, scientists and practioners from the eastern bloc countries developed the concept of periodization (Harre, 1982; Matveyev, 1981). In the late 1990s, Bompa (1999) adapted and popularized this principle in the West. According to the periodization principle, sport training consists of phases/periods in which workloads, intensity, volume, and recovery time are planned and manipulated over weeks, months, and years. In line with this principle, an athlete’s training program consists of three major phases: preparation (general and specific), competition, and transition. Each of the phases is distinguished by training volume, load, specific tasks, and maintenance. The main objective of practice in the preparation phase is to strengthen the athlete’s physical, technical, and psychological foundations. In the competition phase, the athlete is required to perform at his or her best against another skilled and motivated opponent in a competitive setting. The main objective of the transition phase is to help the athlete to recover from competitive events, emphasizing the physical and psychological perspectives (Bompa, 1999; Bompa & Haff, 2009). Each phase of the training program is composed of four preparations: physical, technical, tactical, and psychological. Each preparation makes a specific and unique contribution to the athlete’s performance and success (Balague, 2000; Blumenstein, Lidor, & Tenenbaum, 2005, 2007; Bompa & Haff, 2009).

The focus of this chapter is on psychological preparation and its role as an integrated part of the training program. According to Williams and Krane (2001), most athletes and coaches have reported that psychological preparation is vital to professional athletic success. The main objective of psychological preparation in sport is teaching athletes to cope with training and competitive stress. For this reason, the athlete learns and practices psychological techniques that can help him or her to overcome psychological barriers, such as a high level of anxiety, lack of focus, or difficulty in recovering from injury (Hardy, Jones & Gould, 1996: Moran, 2004). However, elite athletes tend to use mental techniques more in competition than in daily practice as part of their physical training regimen (Raalte & Petitpas, 2009). What might be the reason? In our opinion, psychological preparation is often provided in the laboratory, apart from the athlete’s practice, and is not directly linked to athlete’s training goals. In many cases, sport psychology consultants do not have enough information or knowledge regarding the theory and methodology of sport training. In addition, most coaches do not know enough about applied sport psychology. At the same time, the possibility of integrating psychological support into training and competition as part of the athlete’s preparation has been suggested in recent scientific research and psychological practice (Beauchamp, Harvey, & Beauchamp, 2012; Blumenstein & Orbach, 2012a,b; Blumenstein, Lidor, & Tenenbaum, 2007; Holliday et al., 2008).

The traditional and familiar techniques used in mental training are physical relaxation/arousal regulation, imagery, goal setting, thought management, biofeedback training, self-talk, and focusing (Vealey, 2007). One of these techniques, biofeedback training, is discussed below.

Biofeedback training is a popular technique used by sport psychologists to assist elite athletes in achieving performance success. Biofeedback training in sport can be found in the scientific literature as an application integrated within elite=level preparation in various sports (Blumenstein, Bar-Eli, & Tenenbaum, 2002; Blumenstein & Orbach, 2012a,b; Blumenstein & Weinstein, 2011; Perry, Shaw, & Zaichkowsky, 2011; Strack & Sime, 2011; Zaichkowsky, 2009). This article includes an overview of the origins and history of biofeedback in sport, a concise research description, and innovative biofeedback applications as part of athletic preparation programs.

History and Background of Biofeedback in Sport

Biofeedback application originated from the field of psychophysiology at the end of the 1960s. Surwillo (1986) defines psychophysiology as a “scientific study of the relationship between mental and behavior activities and bodily events” (p. 3). Therefore the relevance of biofeedback interventions to athletic preparation based on the psychophysiological principle presented by Green, Green, and Walters (1970) is understandable. This principle states that every change in the physiological state is accompanied by a parallel change in the mental and emotional states and, conversely, every change in the mental and emotional states—conscious or unconscious—is accompanied by an appropriate change in the physiological state. Therefore, generally speaking, the biofeedback application can be presented as an application of psychophysiology in sport and exercise.

It is important to understand that although the terms biofeedback and biofeedback training are frequently used synonymously in the literature, they are two separate concepts. Biofeedback (BFB) is the use of special electronic devices with electrodes and sensors in order to assess, monitor, and feed back psychophysiological information to a person. The main idea of BFB is to provide the individual with information about his or her body’s or mind’s reactions to various situations (Schwartz, 1979). Today, owing to modern technology, it is possible to measure physiological indices—such as heart rate, muscular activity, brain wave activity, respiration, blood pressure, skin temperature and sweat gland activity—during real-time events. These physiological changes are presented to the athlete on a PC screen in a graphic or multimedia form and help regulate the mind and body according to the psychophysiological principle.

Biofeedback training is a technique of gaining control of self-regulation, based on information or feedback received from the athletes’ body and mind. Following intensive BFB training, psychological skills become automatic reflexes. Various types of instrumentation (or BFB modalities) are used for physiological signal recording and are applied as the feedback. The modalities include the following measures: (1) muscle tension is measured by surface electromyography (sEMG feedback); (2) the brain’s electrical activity is measured by electroencephalography (EEG feedback), which has recently become known as neurofeedback (NF); (3) the electrical activity of the skin surface (electrodermal activity, or EDA) is measured by skin resistance (historically known as the galvanic skin response, or GSR), by skin conductance (SC), and by skin potential (SP); (4) heart activity is measured by electrocardiography (heart rate feedback, or HR), the most recent form of which is heart rate variability (HRV), measured by interbeat interval (IBI); (5) blood pressure, measured by sphygmomanometry (blood pressure feedback, or BP); (6) the respiratory rate (R) is measured by a strain-gauge device (R feedback); and (7) thermal feedback (T) is measured by peripheral skin temperature, often referred to as temperature feedback.

Biofeedback for Sport and Performance Enhancement

Figure 1 Biofeedback training and performance enhancement.

The role of BFB training in athletic performance enhancement is presented in Figure 1.

As shown in Figure 1, competitive stress (1) is usually accompanied by changes in physiological indices, such as increased heart rate, blood pressure, muscle tension, and respiration (2). Based on the psychophysiological principle, the physiological changes are linked to the state of the athlete’s body and mind. The process of BFB training includes learning and improving self-monitoring and self-regulation skills with different BFB modalities (3). The final result is an improvement in the athlete’s self-regulation skills, (4) which leads to performance enhancement (5) under competitive stress.

Brief Description of Research

Historically, the first biofeedback approaches were limited to clinical medical practice. In the 1960s and 1970s, it was demonstrated that subjects could learn to control/regulate their body and mind by brain waves (Kamiya, 1968), single-motor units (Basmajian, 1972), and peripheral skin temperature (Green, 1973). Leonard Zaichkowsky (1975) was the first researcher to use BFB technology to learn about athletes’ self-regulation. However, the high cost of BFB equipment and the newly developed technology associated with BFB were barriers to a wider use of this method. In the 1980s more studies were conducted using BFB, owing to the acknowledgment of the value of this technology for athletes’ self regulation (e.g., Hatfield & Landers, 1987; Landers, 1985; Peper & Schmid, 1983). In this initial period BFB studies were focused on reduced state anxiety and muscle tension and improving athletic performance, usually using EMG, EEG, and GSR feedback (French, 1978; Weinberg & Hunt, 1976). However, numerous studies using BFB training suggested that improved performance was not automatically associated with reduced muscle tension (e.g., Nielsen & Holmes, 1980; Shellenberger & Green, 1986; Zaichkowsky & Fuchs, 1988). Significant components of BFB training for improving performance are the volume, length of treatment (session × time), BFB modalities, and a combination of BFB training with other techniques (see De Witt, 1980; Griffiths, Steel, Vaccaro, & Karpman, 1981).

Two major BFB training programs are applied in research and practice. The first is BFB training with one modality, and the second is the multifaceted BFB training program, which includes several modalities as part of the psychological intervention package. An example of the first program is neurofeedback (NF) training. NF or EEG feedback teaches a person the sensation of being in a specific cortical activity state. Eventually, the person learns how to achieve and regulate such a state under his or her own will (Angelakis et al., 2007). Research on the efficacy of NF training has shown a positive effect, specifically in aiming tasks such as archery, shooting, and golf (Arns, Kleinnijenhuis, Fallahpour, & Breteler, 2007; Landers et al., 1991; Vernon, 2005) as well as in other sport disciplines (Perry, Shaw, & Zaichkowsky, 2011). Another example of BFB training with selected modalities (EMG, GSR, or HR) is related to enhancing motor performance and movement patterns in sport disciplines such as gymnastics (Zaichkowsky, 1983), shooting (Landers, 1985), and kayaking (Blumenstein & Bar-Eli, 1998).

Going further, research has focused on combining BFB training with other psychological techniques and strategies, such as relaxation, imagery, self-talk, and breathing. It was found that BFB training as part of an intervention package has an augmenting effect on athletic performance enhancement (e.g., Beauchamp, Harvey, & Beauchamp, 2012; Blumenstein, Bar-Eli, & Tenenbaum, 1995, 2002; Crews & Landers, 1993; Petruzzello, Landers, & Salazar, 1991). In addition, as research in BFB training developed, it was suggested, primarily by Blumenstein and colleagues (Blumenstein, Bar-Eli, & Collins, 2002; Blumenstein et al., 1997, 2002), that it is important to choose the biofeedback modality for the specific sport discipline, sport demands, and competition conditions. For example, shooting and archery sports demand from the athlete stable breathing and body position; therefore EEG is more suitable (Landers et al., 1991). In contrast, in judo or fencing sports, in which performance involves a high level of tactile and proprioceptive sensitivity and intense emotional involvement, EMG and GSR seem to be the most efficient modalities (Blumenstein, 2002). In biofeedback research and practice, HR, EEG, and respiratory biofeedback training are usually related to performance in aiming tasks (e.g., archery, shooting, golf); EMG and GSR biofeedback training are used in combat sports (e.g., taekwondo, fencing, judo). Temperature, EDA/GSR, and EMG biofeedback are used in gymnastics (Blumenstein, 2002). Moreover, current research has shown a positive effect of biofeedback intervention on training transfer from practice to competition, especially in motor learning and in perfecting movement technique (Issurin, 2013).

Biofeedback training is used in research and practical programs as an integrated component of psychological skills training (PST). An example of such a program was developed for the Canadian National Short Track Speed Skating team over a 3-year period leading up to the Vancouver 2010 Olympic Games (Beauchamp et al., 2012). This program approach emphasized a seven-phase model in an effort to enhance sport performance: (1) orientation/observation, (2) sport analysis, (3) individual and team assessment, (4) concept utilization, (5) PST intervention strategies, (6) implementation, and (7) evaluation. This approach has been used successfully and should be applied with other sport disciplines and research designs to strengthen its qualities. The integration of biofeedback training within PST has been documented in a variety of sport disciplines, such as, archery (Filho, Moraes, & Tenenbaum, 2008), judo (Blumenstein & Orbach, 2012c), soccer (Wilson, Peper, & Moss, 2006), swimming (Bar-Eli & Blumenstein, 2004), windsurfing (Blumenstein & Orbach 2012d), and in other activities such as dancing (Raymond, Sajid, Parkinson, & Gruzelier, 2005) music (Bazanova, 2012; Trechak, 2011), and in the military (Oded, 2011). The significant efficacy of biofeedback training on athletic performance enhancement is unquestionable and has been described in numerous academic reviews (e.g., Collins & McPherson, 2006; Leonards, 2003a,b; Strack & Sime, 2011) and in the practitioner literature (Blumenstein & Orbach, 2012a; Edmonds & Tenenbaum, 2012). However, most studies and practitioners point to the fact that there is a lack of knowledge and experience applying biofeedback training from the laboratory setting to real life. Therefore we agree with Crews, Lochbaum, and Karoly (2001), who said “one of the criticisms of biofeedback training has been the ability to transfer the learned response to performance in the real world” (p. 578).

To overcome this limitation, the Wingate 5-Step Approach (W5SA) was developed (Blumenstein, Bar-Eli, & Tenenbaum, 1997). It has been used in a variety of research studies and sport disciplines and is established as an effective means to achieving successful performance (Blumenstein et al., 2002; Blumenstein & Orbach, 2012a; Blumenstein & Weinstein, 2011). For a more effective use of the W5SA in daily athletic preparation and in competition, it was necessary to understand the principles of theory and methodology of sport training (see Bompa, 1999; Bompa & Haff, 2009). One of the basic principles of sport training is the periodization principle. In line with this rational the three-dimensional approach, the LMA (Learning-Modification-Application), was developed (Blumenstein & Orbach, 2012b). The LMA provides the possibility of integrating the biofeedback training with other psychological interventions as part of psychological skills training (PST), to sport training and competitions. Moreover, LMA can be presented as a further development of the W5SA, making the mental training process more applied, compact, mobile, and understandable to athletes and their coaches.

The Wingate Five-Step Approach

The W5SA is a self regulation technique incorporating BFB training. Its main aim is the development and the transfer of self-regulation skills from the laboratory to the training and competition setting. The W5SA is composed of a self-regulation test and five steps, in which the first three steps are provided in the laboratory and the last two steps are provided in training/competition settings:

  1. Step 1. Introduction: This step focuses on learning basic self-regulation strategies/techniques, such as relaxation, imagery, concentration, self-talk, and BFB training. Practice takes place in the lab; the main goal is to achieve the ability to master relaxation-excitation waves. For example, the individual is asked to achieve relaxation with one of the BFB modalities for about 2 or 3 minutes, followed by deep relaxation for 5 to 10 minutes, and then excitation for about 2 to 3 minutes (Blumenstein, Bar-Eli, & Collins, 2002).

  2. Step 2. Identification: This step concentrates on identifying and strengthening the most efficient BFB response/modality, according to the sport discipline. Practice takes place in the lab, where the athlete is required to master the relaxation-excitation waves quickly, accurately, and reliably. In this step, relaxation/excitation speed and quality are highly important.

  3. Step 3. Simulation: This step provides BFB training with simulated competitive stress using audio/visual material. Practice takes place in the lab, where the athlete practices shifting from one mental state to another by observing films from competitions and listening to competitive noises specific to his or her sport discipline.

  4. Step 4. Transformation: This step focuses on transferring mental preparations from laboratory to the field using a portable BFB device. Practice takes place in an actual training setting, and in different locations such as before/after warm-up, games, races, and matches, as well as in the hotel, locker room, and bus.

  5. Step 5. Realization: This last step focuses on achieving optimal regulation in a competition setting. The athlete applies self-regulation skills in precompetitive activities and preperformance routines.

Biofeedback for Sport and Performance Enhancement

Figure 2 Schematic description of the Wingate Five-Step approach for mental training.

Each of the steps consists of 10 to 15 mental training sessions, and in between each step a self-regulation test (SRT) is conducted. SRT is used to examine the athlete’s baseline self-regulation level before the mental training program is applied and later during the various steps of the program. The athlete’s psychophysiological responses (HR, GSR, and EMG) are recorded during four imagery states (i.e., rest, tension, relaxation, and competition). The SRT results indicate the type of alteration that occurs in each response modality as well as its relative intensity (Blumenstein et al., 1997, 2002; Blumenstein & Orbach, 2012a). A schematic description of the W5SA for mental training is presented in Figure 2.

The W5SA has been used successfully in scientific research and applied experience for more than 20 years (e.g., four summer Olympic Games), and has received international acknowledgment (Blumenstein & Bar-Eli, 2005; Blumenstein & Orbach 2012a; Edmonds & Tenenbaum, 2012). This experience indicates the applicability of this approach with different populations (e.g., children, adolescent, elite), a variety of tasks (i.e., various sports/activities), and diverse situations (e.g., training, top competitions). Moreover, studies that are based on the W5SA model demonstrate that the first three steps (i.e., introduction, identification, simulation) are appropriate for instructional, coach-child athlete relationships, whereas the overall model is more suitable to the elite-level athlete preparing for competition (Bar-Eli & Blumenstein, 2004; Blumenstein & Bar-Eli, 2005). Detailed descriptions of the W5SA can be found in published scientific literature (Blumenstein et al., 1997, 2002; Blumenstein & Orbach, 2012a; Blumenstein & Weinstein, 2011). A further development of the W5SA is the incorporation of mental training with other athletic preparations based on the periodization principle (see LMA approach).

Unquestionably there is great interest in BFB training from the research and practical aspects (e.g., Beauchamp et al., 2012; Blumenstein & Orbach, 2012a; Edmonson & Tenenbaum, 2012). However, what was said in 2002 still actual today: “biofeedback applications to modern sport … are not yet a regular part of the training process” (Blumenstein, Bar-Eli, & Collins, 2002, p. 74). There are two major obstacles to integrating BFB training as part of the athlete’s daily practice and preparation for competition. First, the current state of modern technology does not yet provide telemetric BFB devices, which may allow the use of BFB training in applied settings. Modern BFB technology and scientific studies are currently investing resources to overcome this obstacle. Second, sport psychologists lack the knowledge related to sport training that is necessary for an optimal integration of PST as part of the training process. The LMA approach integrates BFB training into the athlete’s psychological preparation, and is based on the periodization principle (Blumenstein & Orbach, 2012b).

The Three-Dimensional Approach: LMA

The LMA approach is a multifaceted psychological program that integrates biofeedback training with other psychological strategies as one intervention package. The innovation of this program is its integration with the athlete’s training process, and it is based on the periodization principle. The LMA approach is composed of three dimensions: learning, modification, and application (LMA). Throughout the training program, psychological skills are learned and practiced to become more specific to sport and to be applied quickly, reliably, and accurately. For this reason, mental training is offered under seven stress distractions/situations in laboratory and training settings. This process is accompanied by BFB support, which makes it fast and reliable. The athlete observes his or her response in each stage and therefore is better able to understand his or her concrete goals on the way to performance enhancement. The skills are applied initially in the lab and ultimately in preperformance and precompetitive routines.

In the initial stages of the LMA approach, the athlete practices psychological strategies/techniques separately, while finally the main goal is to put together the strategies to a mental training package. Moreover, the program is performed under various stress situations, which allows the transfer of psychological skills to real competitive events. Finally, the periodization principle and sport specialization should be taken into account in the LMA approach, in order to achieve the athlete’s optimal preparation and function (Balague, 2000; Blumenstein, Lidor & Tenenbaum, 2005, 2007; Blumenstein & Orbach, 2012b; Beauchamp et al., 2012; Holliday et al., 2008).

The LMA Approach and Athletic Preparation

Biofeedback for Sport and Performance Enhancement

Figure 3 The integration of the Learning-Modification-Application (LMA) approach with the periodization principle.

A major component of athlete preparation should be acquiring psychological skills using BFB support as a key component, based on the LMA approach and the periodization principle. It is important to understand the integration of the LMA approach with the periodization principle in order to better plan the athlete’s preparation (see Figure 3).

The first step of the LMA approach, the learning stage, begins together with the athlete’s general preparation. The modification stage follows, which is parallel to the athlete’s specific preparation. Finally, the application stage is presented in the competitive phase. This approach allows the integration of mental training with the other components of the athlete’s preparations (i.e., physical, technical, tactical). An integral part of the above process is BFB training, which make the overall preparation of the athlete more objective, analytic, and accurate. The BFB training allows the understanding of the importance of the mental process and the effect of the psychological interventions to occur in a systematic manner.

Learning Stage of the LMA Approach

At the beginning of the process, the learning stage is provided as part of the general preparation (GP) of the athlete. The main objective of practice in this phase is to strengthen the physical/technical/psychological foundations of the athlete. A high volume of training, long practice sessions, and moderate intensity are the main characteristics of the GP phase in most sports (Bompa, 1999). In this stage athletes practice the main psychological strategies/interventions, such as biofeedback training, muscle relaxation, concentration, imagery, and self-talk. The process is usually accompanied by BFB control, such as HR, EMG, and EDA/GSR. Moreover, basic psychological strategies are learned and practiced under different levels of stress distractions/situations in laboratory and training setting. A stress distraction scale was developed based on our work with BFB training in a variety of athlete’s levels and sport disciplines (see Table 1).

Table 1 Stress Distraction Scale Used in the LMA Approach




Stress Distraction Level



~2 months



Ordinary laboratory settings


Positive/negative comments


~2 months

Laboratory and training setting


Performance under precise demands (e.g., time, quality, speed)


Reward / punishment for performance


~2 months

Laboratory, training and competition settings


Performance under “true” competition noise (competition audio clips)


Performance under “true” competition sights (competition video clips)


Various combinations of levels 1‒6

(*) The scale ranges from 1, representing light stress, to 7, representing high stress distractions

In the Learning stage the athlete learns and performs basic psychological strategies under “light” stress distractions in laboratory settings (i.e., levels 1 to 2).

  1. Stress distraction level 1: In this level the stress is produced from the initial exposure to a BFB device (e.g., electrodes and BFB data). The mental training session is provided in a sterile laboratory conditions while each mental session lasts approximately 30 to 40 minutes.

  2. Stress distraction level 2: The stress is generated by verbal comments, such as positive and negative remarks during the athlete’s biofeedback training. For example, positive motivation (M+) can be created by remarks such as “wonderful,” “good work,” “good day,” “good performance,” “you are great.” On the other hand, negative motivation (M-) can be created by remarks such as “bad day,” “you are making mistakes,” “you cannot relax today,” “what happened to you today?” The mental sessions are taking part in the consultant’s office and each lasts approximately 30 to 40 minutes.

Biofeedback for Sport and Performance Enhancement

Figure 4a LMA: The initial part of the learning stage.

The length of this stage lasts approximately 2 months (i.e., 7 to 8 sessions), during which a variety of psychological techniques/skills are acquired. In the following figures (4a, 4b, 4c), we present the process of mastering muscle relaxation using BFB data. The major goal of this mental training is to learn the basic version of relaxation and to use it for recovery purposes after intensive practice by the athlete in GP. At this stage the relaxation should last 10 to 15 minutes. At the end of this stage the athlete can use the relaxation skill independently. As can be seen in Figure 4a, during the initial part of the learning stage the athlete makes attempts to relax for only a very short time (i.e., a few seconds) in an inconsistent manner.

Generally, when the line goes down it indicates the ability of the athlete to relax. On the other hand, when the line goes up, it indicates the inability of the athlete to relax or self-regulate his or her mental state.

Biofeedback for Sport and Performance Enhancement

Figure 4b LMA: Learning stage with “light” stress distraction

  1. Notes:

  2. 1: Athlete’s reaction to positive motivation (“good work”).

  3. 2: Athlete’s reaction to negative motivation (“what a mistake”).

  4. 3: Athlete’s reaction to negative motivation (“what happened to you today?”).

In Figure 4b the athlete trains under positive and negative motivation.

This figure shows good relaxation abilities during the first 3 minutes, and the athlete’s reaction to light stress distractions on marks of 3:00 (positive motivation: “good work”), 5:00 (negative motivation: “what a mistake”), and 6:30 minutes (negative motivation: “what is happening to you today?”).

Biofeedback for Sport and Performance Enhancement

Figure 4c LMA: The final part of the Learning stage

  1. Notes:

  2. 1: Athlete’s reaction to positive motivation (“good work”).

  3. 2: Athlete’s reaction to negative motivation (“what a mistake”).

Finally, in Figure 4c, the athlete is successful and demonstrates good relaxation under stress distraction on marks of 4.00 and 7.00 minutes.

Modification Stage of the LMA Approach

Biofeedback for Sport and Performance Enhancement

Figure 5a LMA: Modification stage (short relaxation and imagery)

  1. Notes:

  2. 1: Short relaxation: Achieving relaxation within 3-minutes.

  3. 2: Imagery of a competitive match in Judo lasting 5-minutes.

The modification stage is applied parallel to the specific preparation (SP) phase of athlete’s training. The main objective of the SP phase is to further develop the athlete’s physical ability according to the unique physical and physiological characteristics of the sport (Bompa, 1999; Bompa & Haff, 2009; Carrera & Bompa, 2007). Moreover, at this stage the athlete integrates into his or her practice the technical and tactical components of his or her preparation. Therefore the mental sessions and psychological strategies are modified according to the practice. For example, during the mental sessions, the athlete focuses on concentration and imagery techniques in which he or she visualizes technical elements of him or herself or his or her opponents in combat sports. Moreover, the length of psychological interventions and their packaging are relevant to the sport discipline. For example, in judo the BFB training includes short relaxation for 1 to 3 minutes (i.e., preparation time before the match) followed by imagery for 5 minutes (i.e., the length of the real-life match) (see Figure 5a).

The length of the modification stage is approximately 2 months (i.e., 7 to 8 sessions). These sessions are provided in a lab/training setting under “moderate” stress distractions (levels 3 to 4, see Table 1).

  1. Stress distraction level 3: The main goal of mental session is to practice with concrete mental tasks. Athletes learn self-regulation skills fast, exactly, stably, and according to the sport discipline. The stress in the mental tasks is produced by specific demands, such as quality performance and time limits: (a) perform relaxation (or concentration) to achieve a concrete value (delta) in HR, EMG, or EDA/GSR measures; (b) ability to relax or concentrate with a time limit of 30 seconds and then 1, 3, and 5 minutes. For example, the athlete’s goal is (a) to achieve relaxation with HR BFB during 2 minutes with a delta of 10 bpm (i.e., from 72 bpm to 62 bpm); and (b) to achieve frontalis (forehead) muscle EMG relaxation within the range of 2.4 to 1.4 µV during 1 minute. The mental sessions are provided in laboratory while each lasts 40 to 45 minutes.

  2. Stress distraction level 4: The stress of this level is produced under the same conditions as the previous level, but with reward/punishment demands, which were stressful to the athletes, such as the number of push-ups the athlete is capable of doing. The mental session is provided in laboratory and training settings.

Biofeedback for Sport and Performance Enhancement

Figure 5b LMA: Modification stage (relaxation within time limit and delta)

Figure 5b demonstrates the athlete’s practice relaxation technique with GSR BFB under time demand and relaxation quality performance. The goal of the athlete was to achieve relaxation within 1 minute and delta of 100 kΩ.

To perform this exercise successfully the athlete had to master the self-regulation skills at a high level.

Application Stage of the LMA Approach

The application stage of the LMA approach is linked to the competition phase of the periodization principle (see Figure 3). The focus of this stage is to practice the technical/tactical elements of the athlete’s performance. The practice includes simulation of previous competition events and generating real-life situations using a variety of stress distractions. Therefore mental training sessions in this period include the practice of skills such as relaxation, concentration, and imagery with biofeedback under competitive stress. For this purpose, competitive noises and scenes were prepared and practiced (see Table 1, stress distractions 5 to 7).

  1. Stress distraction level 5: The stress of this level is generated by real-life competition sound clips. The athlete practices his or her mental skills under conditions that include spectators’ sounds, referees’ remarks, competition music, and all other specific environmental and competition sounds. The mental session is provided in laboratory and training settings.

  2. Stress distraction level 6: The stress is produced by video clips of the athlete and his or her opponents. In addition, the video clips include winning/losing matches, races, successful/unsuccessful attempts, and starts.

  3. Stress distraction level 7: In this level, the stress is produced by a combination of stress distractions 1 to 6. The mental session is provided in laboratory and training settings.

For example, a major feature of the application stage is the simulation and practice of the event itself within the mental preparation. This process is accompanied by BFB training, while the goal is to perform psychological skills quickly and accurately under actual competition time.

Biofeedback for Sport and Performance Enhancement

Figure 6. LMA: Application stage (relaxation-excitation waves).

Therefore in the mental sessions, the imagery for rhythmic gymnast lasts about 1:30 minutes, similar to real competition performance; relaxation for taekwondo lasts about 1 minute and is applied three times, with a pause of 1 minute between periods; relaxation and imagery for swimming start lasts 10 to 20 seconds and is accompanied by the command “step up, take your mark, go.” Figure 6 demonstrates the athlete’s practices with one of the exercises on excitation-relaxation waves.

The athlete focuses and imagines in this example his or her swimming start three times. The cycle begins with imagery of the start, as can be seen in the peak of the line, followed by the jump and the beginning of the swim.

The practice based on the LMA approach helps the athlete to “bring everything together” in critical moments of competition. It allows the athlete to integrate the mental skills as part of the precompetitive and preperformance routine as well as for performance enhancement.


BFB training has gone through many developments in the last decade. The application of this process in sport has been expanded from lab to field, from one BFB modality to packaging with other psychological interventions, and finally the integration of BFB training as part of athletic preparation. This trend has been observed in recent research and practice (Beauchamp et al., 2012; Blumenstein & Orbach, 2012c,d; Blumenstein & Weinstein, 2011; Dupee & Werthner, 2011; Edmonson & Tenenbaum, 2012; Wilson et al., 2006; Zaichkowsky, 2009). We believe that in the future the main focus of BFB training should be associated with increasing training transfer and performance enhancement to competition. Therefore the data of BFB effect in competition needs additional research support in various sports. For this purpose, the development of telemetry devices, such as portable heart rate device (e.g., the Polaris HR), can be beneficial. In addition, it is important to ensure that BFB devices (e.g., electrodes) will be comfortable and user-friendly for the practice of athletes during their performances.

Beyond the psychological benefits of BFB training to the athlete’s performance, there is another major advantage to this technique. Athletes are used to receiving objective feedback during practice in regard to their physical achievements. Similarly, BFB training can provide the athlete with objective feedback in regard to his or her mental achievements. Therefore we recommend that applied sport psychologists learn to use BFB techniques as part of psychological skills training. In addition, they should understand the theory and methodology of sport training for the successful integration of PST in athletic performance.

In recent years there has been an enormous interest in psychophysiology in sport, and particularly in BFB training. Based on research and practical experience, we have suggested and identified a number of future directions for developing BFB training in sport.

  • Research on the transfer effect of BFB training from laboratory to competition on performance enhancement needs additional support.

  • More research on the effect of BFB training in team sports is needed. It is possible to suggest that BFB training has a positive effect on group dynamic, cohesion, communication, group relations, and coach-players relationships.

  • Research on the effect of gender differences in biofeedback training is needed.

  • Research examining the effects of BFB training on coaches, such as their ability to cope with competitive stress, would be beneficial for coach and their athletes.

  • Developing research on the effect of BFB training on rehabilitation after sport injury would be valuable.

  • Development of biofeedback training protocols for different preparation phases in various sport disciplines is needed.

For additional scientific and applied information, it is recommended to refer to major international BFB organizations, such as (1) The Association for Applied Psychophysiology and Biofeedback (AAPB) in North America, (2) The Biofeedback Foundation of Europe (BFE), and (3) The International Society for Neurofeedback and Research (ISNR). Moreover, two major professionals journals are published: (1) Applied Psychophysiology and Biofeedback (APB) and (2) Biofeedback.

We hope that this chapter will be useful to readers and will encourage sport psychologists to systematically apply BFB training as part of their psychological skills training.


The authors would like thanks Ms. Dinah Olswang and Mr. Rami Maklada, who helped this chapter see the light of day.


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