The cover of this issue of Biofeedback shows a photograph reflecting the mindfulness theme of this special issue. Thanks to Shutterstock for the use of this photo.

Mindfulness and acceptance practices have become increasing popular and better accepted in Western culture in the recent decades. There now exists a wealth of empirical evidence demonstrating the positive effect of mindfulness meditation on physical and mental health, as well as its ability to influence brain structure and function. Mindfulness and acceptance skills may enhance internal awareness of physiological states, facilitate passive volition, improve learning, memory, and attention, and encourage structural and functional brain changes conducive to lower sympathetic arousal. All of these factors are vital to biofeedback success. This paper will introduce a framework for integrating mindfulness and acceptance skills into biofeedback and provide treatment relevant example of using these skills.

Compassion has emerged as a major factor in the therapeutic benefit of mindfulness-based techniques, which have been integrated into mainstream healthcare. Combining compassion practices with biofeedback can maximize the advantageous psychological and physical changes that are seen with both. This article will provide a framework for augmenting biofeedback treatment with compassion-based techniques and discuss treatment considerations.

Meditation has several beneficial effects. However, learning how to meditate is not easy, as there are no clearly visible outward signs of performance, making it difficult for teachers to provide feedback. Neurofeedback from the posterior cingulate cortex (PCC), a brain region that is associated with both meditation and mind wandering, may provide a valuable tool to help individuals learn to meditate.

A pilot study was conducted with clients at a university student counseling center stress management and biofeedback clinic to determine whether mindfulness and compassion-based instruction in relaxation strategies, along with peripheral biofeedback, would reduce perceived stress, enhance perceived coping, and lead to improvement in symptoms of anxiety, depression, and academic distress. Results support that the inclusion of mindfulness and compassion-based biofeedback may enhance treatment efficacy for stress and its associated problems above and beyond that of mindfulness and compassion-based relaxation skills training provided in the absence of biofeedback.

Practitioners using heart rate variability biofeedback (HRVB) often must supplement the biofeedback training with other therapeutic techniques. In this article, I describe some of the ways in which my interns and I integrate a mindfulness-based therapy called ACT (acceptance and commitment therapy) into our biofeedback based clinical protocols. I describe some aspects of the HRVB, provide a short overview of ACT, and discuss how they can be combined.

The concept and practice of mindfulness can enrich the biofeedback process in several ways: interpersonally, intrapersonally, and in the “triad” relationship that includes two people plus the ongoing biofeedback data display. Improving the relationship between clients and their somatic changes underlying the biofeedback data—including sensations, emotions, and the ever-fluctuating self-image—seems central, and benefits from mindfulness are apparent—specifically, the act of pulling back and accepting instead of striving for change. Even the familiar “body scan” promotes a detached observing attitude, with transient benefits similar to a more formal mindfulness focus. Knowing the related brain-processing correlates of meditation can enhance confidence in the process, and a prime element of modern mindfulness training—compassion—can be extended toward one's own bodily processes being revealed during biofeedback.

The author introduces the pathways model, a three-level approach for integrating self-directed lifestyle change, the acquisition of self-regulation skills, and the use of community resources into a comprehensive mind-body treatment approach. The pathways model is illustrated with a case study of a 34-year-old executive with public speaking anxiety. Mindfulness strategies are integrated into each phase of treatment for this individual, along with emotional journaling, participation in Toastmasters, and heart rate variability biofeedback.

According to the American Tinnitus Association, up to 30 million people suffer from tinnitus and, of those, 12.2 million experience tinnitus severe enough to warrant medical attention. Tinnitus is believed to result from an abnormal auditory perception reflecting dysregulation of the central (CNS) and autonomic nervous system (ANS). However, regulating the ANS has received very little research attention despite the fact that stress is correlated with exacerbation of symptoms and distress. It is believed that when the autonomic nervous system is calm, the presence of severe tinnitus will be less noticeable and individuals can shift their experience from one of severe debilitation to one of acceptance and peace. Three case studies are presented as an initial investigation into the impact heart rate variability biofeedback may have on the subjective perception of tinnitus and the accompanying distress. Further research is needed, but heart rate variability biofeedback may prove to be an effective adjunct intervention for tinnitus.