Rheoencephalography

1. Introduction

Version followed: rheoencephalography (REG) as a measurement method, as described in the published reviews by Moskalenko & Andreeva (2015) and Bodo (2010); there is no published REG-based biofeedback or neurofeedback treatment protocol to follow (see below).

What it is. REG is a non-invasive way of recording the electrical impedance (conductivity) of the head through scalp electrodes. Because blood conducts electricity well, the pulsatile change in impedance was taken as an index of cerebral blood volume and blood flow. [source: Wikipedia, Rheoencephalography; Moskalenko & Andreeva 2015] It is a measurement and monitoring method, not a therapy. Bodo (2010) describes it as electrical impedance measurement of the brain and proposes it for neuro-critical care monitoring and stroke-risk screening, while naming the lack of established physiological and pathological correlations as its main limitation. [source: Bodo 2010, abstract]

Status (as sources state it).

• Historical peak and decline: Moskalenko & Andreeva write that REG popularity peaked by the mid-1970s, that interest fell between about 1975 and 1980 because the signal was hard to interpret quantitatively and confused clinicians in complex cases, and that Doppler ultrasound methods displaced it from the early 1980s. A long-running dispute over whether the signal reflects intracranial or extracranial (scalp) circulation also held it back; the authors themselves reject the purely extracranial view. They report that only a few companies still make REG equipment. [source: Moskalenko & Andreeva 2015]
• Interpretation problems: later work showed the signal reflects the shifting balance between blood and cerebrospinal fluid volumes in the skull, and that blood conductivity also depends on flow velocity, so the early 'blood volume' reading was oversimplified. [source: Moskalenko & Andreeva 2015]
• Current research use: the same authors call monitoring of cerebrovascular reactivity "the single application of REG which continues to this day", and propose combining REG with transcranial Doppler; Bodo and colleagues continue to test REG as a non-invasive index of cerebral autoregulation and intracranial pressure: in a 2024 study of 19 healthy volunteers, the REG pulse waveform changed during head-down tilt in the way the intracranial-pressure waveform changes when pressure rises, and a correlation study in neurocritical-care patients had begun; the authors also propose uses in space research and military medicine. [source: Moskalenko & Andreeva 2015; Szabo, Totka, Nagy-Bozsoky, Pinter, Bagany & Bodo 2024, abstract] Its advocates describe a 'second birth'; this is the view of its proponents, not an established clinical consensus. [source: Moskalenko & Andreeva 2015]
• Overall label for the therapist: in mainstream Western practice REG is largely historical and a research-stage monitoring method; its diagnostic value is contested (an early paper in Bodo's reference list is titled 'Inadequacy of "rheoencephalography"'). [source: Bodo 2010 reference list] It was used extensively in Soviet physiology, including space-flight studies on the Salyut station (1968–1980). [source: Moskalenko & Andreeva 2015] It may still be offered commercially as a diagnostic test in parts of the former Soviet Union, and no current clinical guideline endorsing it was identified. [uncertain]
• Regulatory status: no FDA, EMA, MHRA or NICE document on REG, either as a diagnostic or as a biofeedback device, was identified. [uncertain]

REG-based biofeedback. The only trace found is a 1995 conference presentation, 'The Use of REG Biofeedback in Occupational Medicine' (V. E. Tokarev, 26th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback), listed as a reference on the Wikipedia page; it is known only from that listing. [uncertain] No published therapeutic protocol for REG-based biofeedback or neurofeedback was found in the sources cited: none of the reviews mentions biofeedback or therapeutic use, and REG does not appear among BCIA's certification areas (general biofeedback, neurofeedback, HRV, pelvic muscle dysfunction biofeedback). [source: Moskalenko & Andreeva 2015; Bodo 2010; BCIA certification pages] This guide therefore does not describe an REG training procedure, and none should be inferred from it.

Not the same as hemoencephalography (HEG). The 'blood-flow neurofeedback' lead associated with Hershel Toomim and Jeffrey Carmen is hemoencephalography, an optical method (near-infrared nirHEG, Toomim, term coined 1997; passive infrared pirHEG, Carmen), not impedance-based REG. [source: Wikipedia, Hemoencephalography; Sherrill 2004] The HEG literature consists mainly of small, uncontrolled or case-based studies, several by proponents. [source: Wikipedia, Hemoencephalography] Clients may hear 'REG' and 'HEG' used loosely; HEG belongs with the neurofeedback family and is not covered here.

How change happens. For REG there is no published change model, because it is not a treatment. [source: as above] For the psychotherapist, the useful 'change' is in the client's decision-making: helping them understand what they are being offered, get a proper medical assessment for any physical symptoms, and choose care with a known evidence base. [synthesis]

2. Framework

There are no published treatment phases, session counts or progression criteria for REG or REG biofeedback. [source: Moskalenko & Andreeva 2015; Bodo 2010; no protocol found] The framework below is the psychotherapist's own process when a client brings an REG test result or an offer of 'REG-based' training. [synthesis]

[synthesis throughout]

3. Guiding principles

• Name it accurately. REG is an impedance measurement method, not a treatment; say so without mockery. Practical meaning: use the sources' wording ('historical', 'research-stage', 'contested') rather than your own verdicts. [source: Moskalenko & Andreeva 2015; Bodo 2010]
• Say plainly when no protocol exists. Practical meaning: never improvise or reconstruct an REG training procedure, settings or session plan, and do not let the client think you endorse one. [synthesis]
• Physical symptoms go to a physician. REG has been used around headache, dizziness, hypertension-related and cerebrovascular complaints; these need medical assessment, not a psychotherapist's opinion on an REG trace. Practical meaning: refer for medical review, especially with any stroke warning signs. [source: Moskalenko & Andreeva 2015 on historical uses; synthesis for the referral rule]
• Stay in your scope. Practical meaning: you do not interpret REG recordings or reports; you can explain what the method is and help the client ask good questions. [synthesis]
• Respect autonomy and culture. Clients raised in health systems where REG is routine may trust it; practical meaning: explain the status respectfully, never shame the client or their previous doctors. [synthesis]
• Credentials matter but do not validate a method. BCIA certification shows training in biofeedback or neurofeedback, but BCIA is not a government licensing body and REG is not in its blueprints. Practical meaning: check licence and certification, and still ask what evidence supports the specific method. [source: BCIA, BF Entry Level; Wikipedia, BCIA for its non-governmental status]
• Protect the therapy. Practical meaning: keep working on the presenting problem with methods of known value while the client decides; do not make continued therapy conditional on their choice. [synthesis]

4. Intervention inventory

The inventory has two parts: (A) a factual, descriptive account of REG as published, with no device settings; (B) the psychotherapist's own interventions when a client brings REG results or is offered 'REG-based' services. No REG training technique is listed, because none is published in the sources found. [source: Moskalenko & Andreeva 2015; Bodo 2010]

A1. What an REG recording is (descriptive)

• Purpose: to let you explain to a client what was done to them or what is being proposed.
• Description: electrodes are attached to the scalp at set points, and a device (a rheoencephalograph) records the tissue's electrical conductivity continuously; the pulsatile change is read as a sign of cerebral blood filling. [source: Wikipedia, Rheoencephalography] Researchers now interpret the signal as reflecting the redistribution of blood and cerebrospinal fluid in the skull, and use it mainly to study cerebrovascular reactivity and autoregulation, sometimes alongside transcranial Doppler. [source: Moskalenko & Andreeva 2015; Bodo 2010] Historical clinical results were reported in relative units without specific quantitative analysis. [source: Moskalenko & Andreeva 2015]
• Who delivers it: in research and neurocritical-care studies, physiologists, engineers and physicians (e.g. Bodo at the Naval Medical Research Center). [source: Bodo 2010] Who is entitled to perform it clinically in each jurisdiction was not found. [uncertain]
• Watch for: a client describing REG as a 'brain scan' or as proof of a brain disorder; it is neither an imaging method nor a validated diagnostic test in mainstream guidelines found. [source: Moskalenko & Andreeva 2015; synthesis]
• Example language (illustrative): "REG measured how well electricity passed through your head, to estimate blood flow. It isn't a brain scan and it doesn't diagnose a brain disorder." [synthesis]

A2. REG-based biofeedback (status only)

• Purpose: to answer clients accurately.
• What sources show: one 1995 conference presentation on 'REG biofeedback in occupational medicine' is listed on Wikipedia and is known only from that listing. [uncertain] No manual, developer training, outcome trial, BCIA blueprint area or regulator listing was found. [source: Wikipedia; BCIA certification pages; reviews above]
• What to say: there is no published therapeutic protocol; any session plan offered is the provider's own and should be asked about directly. [synthesis]
• Watch for: confusion with HEG (optical blood-flow neurofeedback, Toomim/Carmen) or with EEG neurofeedback, which have their own (separately assessed) literatures. [source: Wikipedia, Hemoencephalography]
• Example language (illustrative): "I couldn't find any published treatment protocol for REG biofeedback, so it's worth asking the provider exactly what the sessions involve and what they are based on." [synthesis]

B1. Clarifying what is on offer

• Purpose: find out exactly what the client has been offered before you say anything about it.
• Steps: (1) ask the client to describe the service in their own words and bring any leaflet, report or invoice; (2) ask whether it is a test, a monitoring study, a research trial or a paid training course; (3) ask what problem it is meant to address and what the provider promised; (4) ask who the provider is (profession, licence, certification) and the total cost and number of sessions proposed; (5) note any physical symptoms the client is worried about. [synthesis]
• Example language (illustrative): "Before I give you any view, can you tell me exactly what they said the REG would do for you, and what it costs?"
• Watch for: promises of cure, fixed expensive packages, pressure to pay up front, claims of a 'brain blood-flow problem' identified only by the device. [synthesis]

B2. Psychoeducation on REG

• Purpose: give a balanced, sourced account the client can use.
• Steps: (1) explain that REG measures the electrical conductivity of the head and was used to estimate brain blood flow; (2) say that it was popular in the 1960s–70s, especially in the Soviet Union, then largely replaced by ultrasound (Doppler) methods; (3) say that today it is mainly a research tool, that its readings are hard to interpret, and that some researchers are trying to revive it for intensive-care monitoring; (4) say that no published treatment protocol using REG for biofeedback was found; (5) invite questions. [source: Moskalenko & Andreeva 2015; Bodo 2010]
• Example language (illustrative): "The researchers who still work on REG say it fell out of use because the readings were hard to interpret. They see promise for hospital monitoring, but I couldn't find any published treatment that uses it."
• Watch for: the client feeling their earlier doctors are being criticised; frame it as how medicine changed, not who was wrong. [synthesis]
• Working when: the client can describe REG accurately and ask the provider informed questions. [synthesis]

B3. Distinguishing REG, HEG and EEG neurofeedback

• Purpose: clients and providers sometimes blur these terms.
• Steps: (1) REG = electrical impedance of the head; (2) HEG = light-based sensors on the forehead, either near-infrared (Toomim) or passive infrared (Carmen), used in neurofeedback; (3) EEG neurofeedback = training based on brain electrical activity; (4) ask the provider which one they actually use. [source: Wikipedia, Rheoencephalography; Wikipedia, Hemoencephalography; Sherrill 2004]
• Example language (illustrative): "It's worth asking them which signal the machine actually records, because these methods are often confused and the evidence for each is different."
• Watch for: a provider unable to say what the device measures. [synthesis]

B4. Recognising when to suggest a medical review

• Purpose: REG has historically been applied around neurological, cerebrovascular and hypertension-related complaints; such symptoms need a physician. [source: Moskalenko & Andreeva 2015]
• Steps: (1) ask about headaches, dizziness, fainting, visual changes, weakness, numbness, speech problems, high blood pressure; (2) any sudden neurological symptom (face drooping, arm weakness, speech difficulty) = emergency services now; (3) otherwise suggest the client see their GP or neurologist and take the REG report along; (4) with consent, write a short referral note describing the symptoms, not interpreting the REG. [synthesis; stroke warning signs as standard public-health guidance, not from the REG sources]
• Example language (illustrative): "These headaches deserve a proper medical check. Would you be willing to see your GP and take this report with you?"
• Watch for: a client using REG training instead of seeing a doctor; somatic anxiety being reinforced by repeated 'blood-flow' tests. [synthesis]

B5. Supporting informed consent and shared decision-making

• Purpose: help the client make their own informed choice; you neither approve nor forbid.
• Steps: (1) help the client write questions for the provider: What exactly does the device measure? What published studies support using it for my problem? Is it approved or registered for this use, and by whom? What are the risks, costs and number of sessions? What happens if it does not help? Is this part of a research study with ethics approval? (2) review the answers together; (3) explore the client's hopes and worries; (4) respect the decision and keep the door open. [synthesis]
• Example language (illustrative): "It's your decision. My part is to make sure you have the answers you need before you commit."
• Watch for: vague answers, refusal to give written information, claims that the method is 'beyond' research. [synthesis]

B6. Checking credentials and scope

• Purpose: see whether the provider is trained and licensed for what they offer.
• Steps: (1) ask for professional licence (e.g. medical, psychology, nursing) and registration body; (2) ask about BCIA certification (BCB for general biofeedback, BCN for neurofeedback) and check it; (3) remember BCIA certification is not a licence: BCIA requires a current licence or credential in an approved health field to treat diagnosed medical or psychological disorders, or else work under the legal supervision of an appropriately credentialed professional [source: BCIA, BF Entry Level], and BCIA is a non-profit without government regulatory powers [source: Wikipedia, BCIA]; (4) note that REG is not among BCIA's certification areas, so certification does not cover it [source: BCIA certification pages].
• Example language (illustrative): "You could ask them what licence and certification they hold. Certification shows biofeedback training, but it doesn't vouch for this particular method."
• Watch for: titles without a checkable register. [synthesis]

B7. Responding to REG reports or diagnoses from another health system

• Purpose: clients who grew up where REG was routine may carry an REG-based diagnosis that shapes their illness beliefs.
• Steps: (1) ask what they were told and how it has affected them; (2) avoid interpreting the report; (3) explain how practice has changed (B2); (4) suggest a review with a local physician if the diagnosis still worries them or guides treatment; (5) work psychologically with health anxiety or illness beliefs if present. [synthesis; historical context from Moskalenko & Andreeva 2015]
• Example language (illustrative): "You've carried this diagnosis for years. A doctor here can tell you whether it still matters medically; meanwhile we can look at how it's affecting you."
• Watch for: shame, mistrust of local services, a sense of being dismissed. [synthesis]

B8. Research participation

• Purpose: REG is still studied (e.g. neurocritical care, autoregulation). [source: Bodo 2010; Journal of Electrical Bioimpedance 2024 abstract]
• Steps: if a client is invited into an REG study, help them check it has ethics approval, written participant information and the right to withdraw, and that it is not presented as treatment. [synthesis]
• Example language (illustrative): "Research is fine to join if you want to; just check it's clearly a study, with approval, and not sold as a cure."
• Watch for: a study that charges fees or promises treatment benefit; pressure to enrol. [synthesis]

B9. Collaboration with the physician or provider

• Purpose: coordinate care with consent.
• Steps: (1) obtain written consent; (2) share your concerns about the presenting problem, not a verdict on the provider; (3) pass on any physical symptoms or adverse experiences the client reports to their physician; (4) document. [synthesis]
• Example language (illustrative, to a GP): "My client reports recurrent headaches and has been offered REG-based training; I'd be grateful for your medical assessment."
• Watch for: sharing more than the client agreed to; letters that read as a verdict on another clinician. [synthesis]

B10. Integrating psychotherapy and offering alternatives

• Purpose: keep the presenting problem treated while the client decides.
• Steps: (1) restate the treatment goal; (2) offer the evidence-based psychological treatments you are trained in for that problem; (3) if the client wants biofeedback, suggest a licensed, BCIA-certified practitioner using an established modality and ask about its evidence for the client's condition; (4) agree a review point. [synthesis; BCIA from bcia.org]
• Example language (illustrative): "Whatever you decide about the REG, we can keep working on the stress and sleep together."
• Watch for: therapy stalling while the client waits for a device to 'fix' the problem. [synthesis]

B11. Monitoring and review

• Purpose: notice benefit, harm or cost.
• Steps: if the client goes ahead, check at intervals on symptoms, wellbeing, money spent, time used, and any new worries the provider raised; advise medical review for any new physical symptom. [synthesis]
• Watch for: escalating packages, new 'abnormal' findings that require more sessions, rising health anxiety. [synthesis]
• Example language (illustrative): "It's been a month. How are the headaches, and how much has this cost you so far? Let's see whether it is giving you what you hoped." [synthesis]

B12. Documentation

• Steps: record what was offered, the information you gave (with sources), referrals made, the client's decision and your review plan. [synthesis]
• Purpose / when: after any session where REG was discussed, so that information given and referrals made can be traced. [synthesis]
• Example language (illustrative): "I'll note what we discussed today and the questions you're taking to the provider, so we can pick it up next time." [synthesis]
• Watch for: records that interpret an REG trace or comment on the provider beyond the facts. [synthesis]

5. Handling problems

The REG sources do not address clinical problems in psychotherapy; all guidance here is [synthesis] unless tagged otherwise.

• Client is convinced REG showed a real brain-blood-flow problem. Do not argue about the trace. Acknowledge the worry, explain the method's status (B2), and route the question to a physician (B4). If the belief drives checking or avoidance, treat it as health anxiety with your usual methods. [synthesis; status from Moskalenko & Andreeva 2015]
• Client has already paid for an REG-based course. Avoid adding shame. Help them ask the provider for written information and evidence (B5); explore whether to continue; keep the psychological work going (B10). [synthesis]
• Client feels you are dismissing their culture or earlier doctors. Repair the rupture: name that REG was mainstream in some systems for decades and that researchers still study it; you are describing how evidence has changed. [synthesis; history from Moskalenko & Andreeva 2015]
• Provider claims it is HEG or 'neurofeedback' when asked. Clarify which signal is recorded (B3). HEG has its own small literature, mostly case-based and proponent-led; evaluate it separately rather than assuming REG findings apply. [source: Wikipedia, Hemoencephalography]
• Client is skipping medical care for the REG course. Raise it directly and repeat the medical-review recommendation; with any sudden neurological symptom, emergency services immediately. [synthesis]
• Client asks you to deliver REG biofeedback or to set up a device. Decline: there is no published protocol, it is outside psychotherapeutic scope, and this guide gives no device instructions. Offer the alternatives in B10. [synthesis; no protocol per sources above]
• Client wants to try home devices or DIY 'brain blood-flow' training. Advise against self-applied electrical devices without medical supervision and suggest discussing any device with their physician. [synthesis]
• Stuck or ambivalent client. Use a decisional balance: what they hope REG will give them, what else could meet that need, what it costs. Respect their choice. [synthesis]
• Overwhelm from conflicting information. Slow down; give one sentence on status, one on next step (medical review), one on what therapy can do meanwhile. [synthesis]
• Non-adherence to referral. Explore barriers (cost, mistrust, language); offer to help draft questions or a letter. [synthesis]
• Escalating costs or new 'abnormal' findings. Name the pattern gently and suggest an independent medical opinion before further payment. [synthesis]

Sources

Online sources:

• Rheoencephalography: Past Popularity, Obvilion at Present and Optimistic Furure (article page) — Moskalenko, Yu. E. & Andreeva, Ju. V. (2015). International Journal of Advances in Life Science and Technology, 2(1), 1–15. doi:10.18488/journal.72/2015.2.1/72.1.1.15 (title spelled as published)
• Full text PDF of the same article
• Studies in Rheoencephalography (REG) — Bodo, M. (2010). Journal of Electrical Bioimpedance, 1(1), 18–40. doi:10.5617/jeb.109 (abstract and reference list)
• Rheoencephalography: A non-invasive method for neuromonitoring — Szabo, S., Totka, Z., Nagy-Bozsoky, J., Pinter, I., Bagany, M., & Bodo, M. (2024). Journal of Electrical Bioimpedance, 15(1), 10–25. doi:10.2478/joeb-2024-0003 (abstract)
• Rheoencephalography — Wikipedia
• Hemoencephalography — Wikipedia
• Effects of Hemoencephalographic (HEG) Training at Three Prefrontal Locations Upon EEG Ratios at Cz — Sherrill, R. Jr. (2004). Journal of Neurotherapy, 8(3), 63–76. doi:10.1300/J184v08n03_05
• Biofeedback Certification International Alliance — Wikipedia
• BF Entry Level — Biofeedback Certification International Alliance

Cited via the sources above, details as given there [uncertain]:

• Lifshitz, K. (1963). Rheoencephalography: I. Review of the technique. Journal of Nervous and Mental Disease, 136(4), 388–398.
• Jenkner, F. L. (1962). Rheoencephalography. Springfield (cited in Moskalenko & Andreeva 2015); Russian edition Reoentsefalografiia, Moscow, 1966 (cited on Wikipedia).
• Tokarev, V. E. (1995). The use of REG biofeedback in occupational medicine. 26th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Cincinnati.