Are you new to the field of biofeedback or wondering if it is right for you? Please take a moment to understand the importance of how you decide to conduct your professional practice in biofeedback. Biofeedback, in all of its forms, has reached a diverse audience of clinical practitioners including, but not limited to, psychology, neurology, counseling, social work, nursing, physical therapy, holistic work, and chiropractic, just to name a few. Additionally, there are more mental and physical health consumers that actively seek the potential benefits of biofeedback therapies. Research is also beginning to show wider pathological and wellness applications with successful outcomes. With such growth in the field combined with the great reward of watching patient success in short term therapies, it is without question why the number of biofeedback practitioners continues to grow.
I discovered biofeedback in the first semester of my doctoral program and have been involved since. With formal education in psychophysiology, a one year pre-doctoral internship working with autonomic dysregulatory disorders, and a leadership position on the Biofeedback Society of California, I am still weighed down by the complexities and sheer quantity of information and experience needed to truly understand the applications of clinical psychophysiology. Maybe it is simply my overdeveloped sense of academic and ethical standards of practice, yet I am discouraged when on occasion I meet practitioners who have been practicing for years and have never taken a formal class or supervised internship. It is easy to get in and little risk to get out. One can merely purchase equipment and try to get guidance from user manuals, blogs, and technical support. Furthermore, discussions with some of these individuals suggest that they are unfamiliar with how to analyze published research for statistically and clinically valid results. It is vital that all new practitioners take it upon themselves to learn appropriate methods of practice. Our field and your practice depend on it.
Without a solid foundation in the basic theories and principles of psychophysiology as well as electronic modalities of measurement, it is completely open to subjective practice and prone to errors. There is enough of divergence of protocols among scientifically founded practitioners, let alone the “willy-nilly” practice that others might be doing. Patients may not get the physiological and perceptual changes that could or should be associated with their therapy. In EEG biofeedback/Neurofeedback, there is some evidence to suggest negative side effects if done incorrectly such as training down strengths or improvements, activating seizures, affective changes, or altering compensatory brain regions (Hammond & Kirk, 2008; Budzynski, Budzyski, Evans, & Abarbanel, 2009). We are governed by professional associations that require ethical practice to be within the scope of our expertise. I am also learning that this can also become problematic in protecting one’s self against professional insurance lawsuits. Ethical standards indicate that one cannot charge for unsupported, novel or experimental treatments. Without familiarity or ability to read reported clinical trials, there is a great risk in breaching this. “Unlicensed and unqualified practitioners pose a risk to the public and to the integrity and future of the profession” (Hammond & Kirk, 2008, Abstract).
What can you do? The field has put in place minimum standards of education. The Biofeedback International Alliance has certification criteria which are based on fundamental knowledge, personal and professional supervised experience. There are brief didactics available to start your knowledge base as well as certified supervisors that are available for guidance. It is imperative to become familiar with nerve conduction, cardio-physiology, neuro electro-chemical communication and associated brain regions, just to start. Know your equipment and the electrical principles on which they rely. Impedance, for example, can make all the difference in the success of the treatment. Personal experience with your own biofeedback will help you understand what patients can expect and how the process works from the other chair. Familiarize yourself with the available resources to become an expert and conduct your practice with professional standards. Contact your local and/or state biofeedback agencies for educational opportunities. You can also visit the website of the Association for Applied Psychophysiology and Biofeedback for a list of state and regional chapters. This is a significantly tougher road, but gaining expertise and practicing patient beneficence will make a difference not only to your patient outcomes and personal career, but will contribute greatly to the field by supporting ethical standards of practice. Taking the right path may seem overwhelming, but if you take your time and always keep the patient’s best interest in mind, biofeedback can open a wonderful world of therapy to your clients.
Budzynski, T. H., Budzyski, H. K., Evans, J. R., & Abarbanel, A. (Eds.) (2009). Introduction to
quantitative EEG and neurofeedback (2nd ed.). New York: NY: Elsevier.
Hammond, D. C., & Kirk, L. (2008). First, do no harm: Adverse effects and the need for practice standards
in neurofeedback. Journal of Neurotherapy, 12(1), 79–88.
Mark J Stern, MA – Doctoral Student – Alliant International University