After an early influence of classical music, Bishara began experimenting with electronic and experimental music, becoming interested in Tangerine Dream. He became engrossed in horror film scores after watching the silent film The Cabinet of Dr. Caligari of 1920 and the 1922 horror classic Nosferatu. In the late 1980s he became a member of the industrial band Yesterday's Tear, later known as Drown. By around 1994, he was signed to a record and touring contract with Drown. He also briefly toured with Prong.
Although Bishara's film score work began with the Biblical drama Joseph's Gift in 1998, most of his subsequent work has comprised horror films starting with Unearthed and The Gravedancers in 2006 and Night of the Demons in 2009. His collaborations with filmmaker James Wan led to his prominence as a film score composer and popularity in the industry.
He began to be the subject of more media attention with the Wan-directed film Insidious in 2011. The New York Times film critic Mike Hale remarked that Bishara's score helped the film recover from some of its negative attributes such as "pedestrian camerawork". Writing for Howlin' Wolf Records, Jason Comerford referred to the film soundtrack as a "dense, bristling effort jam-packed with invention and energy". Journalist Jonathan Barkan of Dread Central and Bloody Disgusting named the musical accompaniment as "one of the great masterpieces of horror music from this century". The score was performed by a string quartet accompanied by Bishara producing sounds on a rusted piano using hammers, files, and other "experimental instruments" of his design. Much of the music was recorded before Wan began shooting the film, the musicians improvising some parts as they went along but following Bishara's broad structure and concept. Bishara began sending completed recordings to Wan as he was editing the film so Wan could work the score into the film according to the structure he desired. Though film composers are typically more involved in music placement, Bishara noted the process used on Insidious felt "free". He also acted in the film, portraying a demon that served as the film's main antagonist.

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