Standards for Performing Biofeedback

The Association for Applied Psychophysiology and Biofeedback (AAPB) intends the standards detailed in this document to apply to every provider of biofeedback-related services whether or not he or she is a member of AAPB. It is anticipated that State health departments and other professional organizations will use these standards to assist in codifying the requirements for providing biofeedback-related services within their areas of jurisdiction.

This document was prepared by AAPB’s 2013 Standards Committee, which consisted of Richard Sherman (Chair), Paula Amar-Schwartz, Frank Andrasik, Shawn Criswell, Louis Csoka, and Linda Walker.

Table of Contents

I. Definition and Explanation of Biofeedback

II. What Biofeedback is Used for and Efficacy of its Applications

III. Organizations Setting the Standards for Biofeedback

IV. Training Required to Ethically and Knowledgeably Provide Biofeedback-Based Services

  1. Professional Training and Credentials Needed to Provide Interventions
    1. Technicians
    2. Licensed/credentialed providers
    3. Academic providers
  2. The Requirement to Understand the Physiological and Psychological Relationships Between the Problem and the Underlying Physiological Dysfunction Causing or Contributing to It
  3. The Requirement to Know How to Effectively Use Biofeedback Devices to Produce Accurate Readings and to Provide Optimal Learning
  4. Maintaining Competency Through Training and Supervision

V. Special Issues Related to Biofeedback Equipment Use

  1. Using Biofeedback Devices Initially Designed for Health Care for Optimal Performance Training
  2. Selling Biofeedback Devices Directly to the Public

VI. Special Issues Related to Biofeedback Practice

  1. Selecting and Charging for Interventions, Informed Consent and Duty to Protect/Client Abandonment
  2. Issues in Advertising Biofeedback-Based Services
  3. Considerations for Client Privacy and Dignity
    1. Touch
    2. Chaperones
  4. Hygiene
  5. Providing Distance Interventions
  6. Coaching Clients During a Biofeedback Session
  7. Medications and Other Co-occurring Therapies

VII. Use of Biofeedback Within the Research Environment

VIII. Appendix

AAPB Ethics Document

BCIA Ethics Document

I. Definition and Explanation of Biofeedback

In 2008, the Association for Applied Psychophysiology (AAPB), the Biofeedback Certification International Alliance (BCIA), and the International Society for Neurofeedback and Research (ISNR) approved the following definition of biofeedback:

“Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately "feed back" information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.”

Biofeedback is a physiologically based learning tool to help people recognize how their physiologies are functioning under various circumstances. They can use this information to learn how to control those aspects that are not functioning optimally.

With proper training, biofeedback can be used by professionals in many fields. Biofeedback is NOT used as a treatment alone, nor can it be used alone to make a diagnosis. Rather it is an adjunctive tool to be combined with other standard interventions carried out by knowledgeable clinicians, educators, or coaches.

Biofeedback techniques tend to be known as often by the physiological systems they monitor as by the problems they are used to help. For example, when muscle tension is being monitored, people conducting biofeedback tend to refer to it as “SEMG feedback”. SEMG stands for “surface electromyogram”, which is the way muscle tension is normally recorded. When brain activity is fed back (shown to a client on a monitor, etc.), the process is usually called “neurofeedback”, EEG biofeedback, or brain wave training.

Hundreds of well-controlled studies have shown that the signals usually recorded as the basis for performing biofeedback (such as muscle tension and brain waves) are related to the symptoms being addressed. The recording technology is standardized and is accepted within professional communities involved with making psychophysiological recordings. The United States Food and Drug Administration (FDA) and equivalent international bodies provide regulatory support for biofeedback equipment.

Some devices used with biofeedback do not actually measure or feed back real-time information about a trainee. Instead, they send signals to entrain or stimulate the body's functioning. These devices do not provide biofeedback, whose hallmarks involve training and self-regulation. An example is audio-visual entrainment devices, which help entrain the brain's functioning by means of an external light and sound stimulus. Other devices may send a micro-current to influence hormone or neurotransmitter production or stimulate muscle activity or blood flow. Some of these devices label themselves as biofeedback devices but do not meet the legally accepted definition and characteristics.

II. Biofeedback Uses and Efficacy

A number of biofeedback-based interventions have been well validated while others are at various stages of research. Many biofeedback-based interventions are accepted by medical societies such as the American Colleges of Pediatrics and Neurology as well as by the FDA as being safe and effective for particular conditions. Examples of validated interventions include treatment of migraine and tension headaches and Attention Deficit Hyperactivity Disorder (ADHD). The efficacy of some forms and uses of biofeedback have not yet been established through accepted types of research with sufficient numbers of clients, controls, and long enough follow-up periods. The book “Evidence-Based Practice in Biofeedback and Neurofeedback”, published by AAPB, can be used along with updated information on AAPB’s web site (www.AAPB.org), “White Paper” efficacy reviews published in Applied Psychophysiology and Biofeedback and Journal of Neurotherapy, and other scholarly sources to estimate the level of efficacy for all of the major uses of biofeedback for clinical conditions.

Psychophysiology and biofeedback are used for many purposes in a variety of settings by many different types of professional in many settings including:

  1. Assessment and treatment of clinical problems such as headache, ADHD, urinary incontinence, stress / anxiety, respiratory problems, sleep problems, drug addiction, pain, and many others.
  2. Education for decreasing test anxiety, increasing focus for learning, and assessing learning processes.
  3. Performance enhancement and optimal functioning for sports, business, and military activities.
  4. 4. Self-exploration including impact of life events on physiology, stretching the imagination, etc.

Professions incorporating psychophysiology and biofeedback into their work include teachers, physicians, nurses, dentists, physician’s assistants, psychologists, therapists, counselors, physical and occupational therapists / physiotherapists, coaches, corporate trainers, and researchers.

Biofeedback is performed in such places as schools, offices, homes, clinics, hospitals, and sports environments.

III. Organizations Setting the Standards for Biofeedback

AAPB is biofeedback’s main professional organization, while BCIA is biofeedback’s main certification body. BCIA sets the minimum training standards anyone providing biofeedback-based interventions must achieve. The AAPB evaluates research on an on-going basis to determine how effective various biofeedback techniques are. It also determines how biofeedback can be provided – in other words, how it is “practiced.”

AAPB and BCIA work together to determine the minimum training standards for individuals providing biofeedback-related interventions. While BCIA certification is voluntary, practitioners must have the equivalent training. AAPB strongly urges practitioners using biofeedback as part of their practice to become certified by BCIA.

People providing biofeedback services must work within the scope of practice set by their parent professional organizations and the credentialing bodies in the state in which they work.

States license or certify professionals to provide certain interventions. There are no “national” licenses in the United States. States set the scope of practice for each profession in conjunction with state and national professional organizations. It is unethical for practitioners to provide interventions outside their scope of practice.

BCIA Certification: BCIA presently offers certification in general biofeedback, pelvic floor biofeedback, and EEG biofeedback. BCIA requires relevant background training, at least a Bachelor's level degree in a health care field, and continuing education for certification renewal. BCIA certification is not a license to practice.

Certified biofeedback practitioners must not mislead potential clients by implying that BCIA certification alone is a license to practice.

IV. Training Required to Ethically and Knowledgeably Provide Biofeedback-Based Services

Even in cases where a state license includes biofeedback as a practice modality, training required to provide biofeedback services must include:

(a) formal professional training from an accredited university (e.g., education, counseling, health care or athletic training),
(b) an understanding of the physiological and psychological relationships between the problem being addressed and the underlying physiological underpinnings, and
(c) competency in use of the biofeedback system as evidenced by formal training.

  1. Professional Training and Credentials Needed to Provide Interventions

    It is neither ethical nor appropriate for practitioners to identify themselves as “biofeedback therapists.” A person cannot be a biofeedback therapist because biofeedback is a tool or technique to be applied by a knowledgeable person within the context of an intervention and within the practitioner’s field of expertise.

    Levels of Training

    BCIA credentials individuals for three levels of expertise: technicians, clinicians and academic and performance professionals.
    1. Biofeedback Technicians are people who do not have formal clinical training but who want to participate in providing biofeedback-based interventions for clients with clinical problems. These individuals can work under the direct supervision of an appropriately trained and licensed clinician. The clinician’s training must include biofeedback.

      Knowing how to perform a good psychophysiological recording and produce a useful biofeedback display from the recording is not sufficient for providing the skills needed to train people to control their physiology. Technicians must receive specific direction and guidance from a supervising clinician before facilitating the biofeedback intervention. Any treatment changes must be directed by the supervisor. The supervisor must be present at the location where and when biofeedback-based training is taking place.

      Technicians must meet the minimum training criteria required by BCIA including completion of a course in biofeedback or neurofeedback and in anatomy and physiology.

    2. Clinical Certificants are licensed, degreed practitioners who have added the tool of biofeedback to their practice.

      By identity, they should first present themselves as educators, doctors, coaches, therapists and psychologists who happen to have an additional certification.

      Clinicians must meet the minimum training criteria required by BCIA including completion of a course in biofeedback or neurofeedback and in anatomy and physiology.

    3. Academic and Performance Certificants are individuals who are certified to use  biofeedback devices for research, teaching and performance enhancement. These individuals must have at least a master’s degree from an accredited institution. Refer to www.BCIA.org for further details of required training

  2. The Requirement to Understand the Physiological and Psychological Relationships Between the Problem and the Underlying Physiological Dysfunction Causing or Contributing to It

    A fundamental understanding of the physiological and psychological relationships between presenting problems and the physiological dysfunction causing or contributing to them is essential to competent biofeedback practice.

    This can contribute to poor outcomes and a less than positive reputation for the field among third party payers and regulatory groups. Many people who have never had a course on the biological bases of behavior or pain – blithely assume that they are competent to treat back pain, headaches, and a host of other physiologically based problems. At times, people providing biofeedback do not know that their results are no better than placebo levels because they do not conduct follow-up evaluations or keep abreast of the literature. This situation can occur even when people are true experts in using biofeedback devices and are well qualified professionals in some field but have no or minimal training in how the human body actually works. Many therapists try to train physiological systems to change in ways they cannot because of anatomical and physiological restraints. Anyone conducting any kind of biofeedback must have a thorough and updated understanding of anatomy and physiology. It is also a requirement to be familiar with the effects of medications clients are taking.

  3. The Requirement to Know How to Effectively Use the Biofeedback Device to Produce Accurate Recordings and to Provide Optimal Learning

    Every person providing services or conducting studies that include use of a biofeedback device must meet BCIA’s standards for training in order to be able to use the device safely and effectively. This training must include practices for safe and hygienic use of biofeedback devices.

  4. Maintaining Competency Through Training and Supervision

    Biofeedback devices and techniques are changing rapidly. Practitioners providing biofeedback related services cannot remain competent without (a) keeping up with the literature in biofeedback, (b) taking continuing education training and (c) obtaining supervision. Practitioners providing biofeedback-related services must at least meet BCIA’s standards for maintaining competency.

    Peer review is one way to assure that the best practices are being applied. Reviewers must be expert in both the condition being treated and in the relevant biofeedback techniques being applied. If a provider’s employer requires peer review, the process should always include built-in safeguards for due process including the right to rebuttal and the rights of both service provider and reviewer to add additional clarification.

V. Special Issues Related to Using Biofeedback Devices

Biofeedback devices are used both in the clinical environment to assist in the treatment of diagnosed conditions and in the educational and coaching arenas to help people function better. Because most biofeedback devices were specifically designed for use in treating diagnosed clinical problems, they are under the control of the United States Food and Drug Administration, or the equivalent group in most other nations.

Biofeedback devices are designated as class II by the U.S. food and drug administration. This means they are low risk, but must conform to special controls such as labeling requirements, post-market surveillance, and performance standards.  While most manufacturers have complied with the requirement that their devices be labeled by the FDA when used for clinical purposes, some have not. It is the provider’s responsibility to know and understand the differences between labeled and non-labeled devices. AAPB is strongly opposed to the use of non-labeled biofeedback devices for clinical purposes.

When used in the treatment of a diagnosed condition, the FDA requires that use of biofeedback  devices be prescribed by an appropriately licensed provider such as a psychologist. In most states, this includes virtually all licensed or certified health care providers. The word “prescribed” does not imply that the provider be a physician or dentist but, rather, that the state credentialing and licensing entities permit the use of biofeedback as one of the therapeutic approaches within a professional's scope of practice.

It is both illegal and unethical to treat a diagnosed condition with clinical biofeedback device if the provider does not have the appropriate license or state certification, or is not working under the direct supervision of a professional who does.

  1. Using Biofeedback Devices Designed for Health Care for Optimal Performance Training

    Biofeedback devices used in conjunction with optimal performance education and training (generally referred to as performance enhancement) are readily available and typically pose no danger when used by qualified practitioners. Most of the guidelines within this document apply equally to performance biofeedback providers. There are some exceptions and they have been noted accordingly throughout this document.

    Performance biofeedback practitioners in the field of sport or performance psychology must have the prerequisite academic credentials (advanced degrees in the field) and have the appropriate knowledge and experience in the applications of biofeedback. Every person providing services, which include use of a biofeedback device, and must meet BCIA’s standards for training.

    Most sports and performance psychologists are members of the Association for the Advancement of Sport Psychology and many are members of AAPB as well. Both organizations provide guidelines on the proper use of their professionals’ expertise and of biofeedback technology.

  2. Selling Biofeedback Devices Directly to the Public

    Biofeedback devices expressly designed for clinical purposes and which do not have a clear non-clinical use must not be sold to individuals who are unqualified to prescribe them. Most biofeedback devices, however, can also serve within legitimate self-exploration interventions and be used by any consumer, coach or educator. A gray area concerns the sale of biofeedback devices useable for treating diagnosed clinical problems to the public when there is no intent to use these devices to treat diagnosed problems. Biofeedback devices can be marketed for clinical or non-professional use.  It is in the interest of the professionals, public and the manufacturers to clearly designate the intended use.  Failure to do so may result in an inappropriate application resulting in an ineffective treatment for the consumer or, in the extreme, harm.

    Biofeedback devices designed for professional use must be sold only to qualified clinicians, coaches, therapists, members of the medical profession and educators who provide evidence of training as outlined in earlier portions of this document (see section IV, V).    Non-professional (i.e. “home” devices) can be used to augment the treatment given in the professional setting.  Home devices targeting the general population must have detailed instructions as to the correct use of the unit.  Ideally, there would be some resource available (phone/web support) to guide the public. The explosion in the creation of biofeedback “apps” for iphones/droid systems presents unique challenges for the profession.  Whenever and wherever possible biofeedback professionals/manufacturers should educate the public on the correct use of such applications.  This may include educating the creator of such an app as to how to make the app more effective for the targeted audience.

VI. Special Issues Related to Biofeedback Practice

  1. Selecting and Charging for Interventions, Informed Consent and Duty to Protect/Client Abandonment

    Providers of biofeedback services must remain abreast of current professional literature related to the problem being addressed. This includes understanding efficacy of the treatments being utilized and the ability to apply current principles of evidence-based medicine to choose the appropriate intervention.

    Providers must use their knowledge of the field to develop optimal interventions for each client. The intervention must be based on sound practice principles and include a logical progression through the intervention.

    Ethical considerations in charging for non-validated biofeedback based interventions

    There is solid evidence, which meets all of the usually accepted criteria for clinical efficacy, that several disorders can be effectively treated with biofeedback-based interventions. Providers having the appropriate training and credentials can ethically provide and charge for these treatments.

    Before charging for an intervention, therapists/providers must avail themselves of all resources addressing the intervention’s efficacy (see Section II). Written informed consent must be obtained for non-validated uses of biofeedback.

    If there is no reasonable support for biofeedback’s efficacy for a particular problem, therapists cannot ethically charge for the intervention.

    Failure to adequately evaluate support for an intervention can lead to a therapist losing credibility with clients, third party payers, employers, and colleagues. It may result in loss of license, legal action and/or FDA confiscation of equipment.

    The FDA does not approve specific treatments as such but it does provide “labels” indicating that the device has been shown to be safe and effective for a particular use. While many biofeedback devices are now registered with the FDA, very few disorders have received labels. Most are only labeled for stress and incontinence. It is the professional’s responsibility to understand what the device has been labeled for.

    Before using any biofeedback device for clinical purposes, the provider must be certain that it is registered with the FDA. An FDA registered device may not be labeled for the application the therapist intends to use it for. If the device is not labeled for the disorder to be treated, the provider is must inform the client – in writing - that the provider proposes to use the device “off label” and the client must agree in writing.

    There is nothing unethical about using a device off label as long as there is a strong rationale for doing so and there is strong empirical support from  research and scientific organizations. On the other hand, many biofeedback techniques are considered "non-validated" or "off-label" because they have not met any profession’s criteria for demonstrated efficacy. Therefore, the therapist must decide whether to charge for the suggested off-label treatment based on the extent to which it will address the client's needs. Therapists cannot legally or ethically charge for a treatment for which there is no factual basis to conclude the treatment will succeed (Belmont Report, 1988).

    Requirements for informed consent for therapy and/or training:

    It is important to distinguish between actual, knowledgeable, informed consent to a treatment or intervention vs. therapist/trainer influenced compliance. This distinction is important because it is difficult to obtain true, informed consent from clients, as they typically do not possess the therapist's concepts, specialized vocabulary and understanding of the problem.

    Therapists and performance specialists are ethically required to provide a brief, clear description of the intervention they propose and permit the client. A reading level at the sixth grade will cover most populations.  The description must set out the limitations and strengths of the treatment openly, simply and completely. The client must have a verbal explanation, including key aspects of treatment, and have an opportunity to ask questions. The client should be able to summarize key points of the explanation.

    Key aspects of treatment/training to be covered include:

    * Any risks of biofeedback and associated techniques (e.g., reactions to sensor tape, abreactions during training, etc.)
    * Relative risk to benefit ratios of biofeedback techniques
    * Alternative interventions (e.g., performing progressive muscle relaxation training without biofeedback for tension headaches)
    * Limits of  confidentiality

    A provider must work with a client to establish objective, mutually agreed upon goals for the intervention. The client must indicate not only an understanding of the proposed therapeutic approach but  also acknowledge the possibility that the intervention may not achieve the desired goals. The client needs to be informed and demonstrate an understanding of the importance of informing the practitioner of any changes in medications, symptoms, or behaviors.

    Providers are ethically required to take special care to insure that the following groups understand the proposed intervention to the best of their abilities and can decline if they truly wish to:

    (1) Children must be informed within the limits of their ability to understand. Practitioners must obtain their assent as well as the parents' or guardians’ consent.

    (2) Prisoners, because they may not be free to decline therapy – especially if it is court ordered.

    (3) Individuals who are mentally or intellectually compromised. Practitioners must exert special effort to inform such persons within the limits of their ability to understand and assent. People who may believe that machines control them or have other delusions need special attention.

    If data gathered during a biofeedback-based intervention are to be used for research or educational purposes, the client must consent to this use in writing.

    Client Abandonment and Duty to Protect

    If a client can no longer pay for a treatment that is progressing (e.g., when insurance is no longer available), the therapist cannot abandon the client.  Rather, the therapist must make every effort to find a viable alternative for the client or continue to work with the client for a reduced fee or at no charge.

    The duty to protect is a legal concept that exists in most states. If a therapist has any reason to think that a client may be a danger to someone, an organization, or property, the therapist must warn that person or organization as well as the police and anyone else who may be concerned. This law takes precedence over privacy considerations.

    Many states also have laws that require practitioners to report suspicion of abuse being perpetrated upon children, elders or disabled people. Practitioners are expected to know and follow ethics and regulations related to these issues.

  2. Issues in Advertising Biofeedback Based Services

    Advertising is not restricted to paid advertising, brochures distributed or left in waiting rooms, or posters in public places. Any way potential clients find out about the therapist and the services the therapist offers is a form of advertising. This includes, but may not be limited to,  telephone directory listings, letterheads, business cards, items posted on the Internet, public statements about the therapist (relative to clinical practice), media presentations, testimonials, and in-person solicitations.

    In any advertising or publicity, providers must clearly distinguish the difference between their state license and biofeedback certification. As space permits, providers must also accurately state the efficacy of the treatment for the disorder or issue being addressed.

    Additionally, therapists, researchers, educators, coaches and other providers must be accurate about their professional backgrounds and training. Failure to do so is a breach of ethical practice.

    Testimonials are generally discouraged as they tend to be biased. Paid testimonials are generally considered to be unethical. It is also unethical to pay referral sources, including giving free sessions to persons who refer others.

    Advertising claims need to either match the biofeedback equipment’s FDA label or the therapist needs to present solid research from peer-reviewed published literature demonstrating a reasonable level of efficacy.

  3. Considerations for Client Privacy and Dignity
    1. Touch

      State practice guidelines for several professions (e.g., psychologists, social workers, marriage and family therapists, counselors) may prohibit their practitioners from touching clients in any way, even though biofeedback is considered within the professional's scope of practice. When practitioners are prohibited from touching their clients, they must explore how sensors can ethically and appropriately be applied to a client or trainee.

      In many cases, practitioners can instruct clients in appropriate sensor application without the need to touch their clients. Alternately, they may ask a significant other to place the sensor under supervision, or have an appropriately licensed health care professional assist in placement. Most state organizations have guidelines about touching clients for innocuous purposes, as long as the therapist is appropriately trained and can identify the need to do so for a specific, accepted, therapeutic reason.

      Those engaged in sports and performance interventions may need to touch clients to apply sensors, but touch should never involve areas of the body that would be considered sensitive. Practitioners must ask for and receive permission prior to applying sensors.

      Practitioners who have specific concerns regarding touch are advised to discuss their situation with the appropriate state professional organizations.

    2. Chaperones

      Some therapists mistake their comfort with a client for the client’s comfort with them. Clients can be very uncomfortable in many situations but not be willing to verbalize their feelings. This can potentially disrupt the client-provider relationship and can even result in the individual terminating therapy prematurely.

      Sensors sometimes need to be attached to the low back, which may mean that parts of the upper buttocks have to be exposed. Other times, sensors need to be placed on the very low abdomen below the normal level of the undergarments. For treatment of fecal incontinence and male urinary incontinence, a rectal probe has to be placed and held in position by an individual trained to do so.

      Therapists should not assume that a client of either gender is comfortable having a therapist of either gender see or touch private areas during the sensor application process. Before placing sensors in sensitive areas, the therapist must be certain that the client actually understands why this needs to be done. Clients should place their own sensors when possible.

      When sensors must be placed by the client in sensitive areas -- as in a woman inserting a vaginal probe, private dressing areas or facilities must be provided. Further, clinicians facilitating these interventions must be specially certified to address these disorders.

      In biofeedback applications involving sensitive anatomical areas, a chaperone must be utilized under all circumstances. Some examples would include the following:

      1) Sensors attached to the low back at L4, which may mean that parts of the upper buttocks have to be exposed depending on how the client is configured.

      2) Sensors that need to be placed on the very low abdomen below the normal level of the underwear.

      3) Rectal or vaginal sensors that must be held in place by the clinician, as in treatment of fecal incontinence and male urinary incontinence.

      Therapists must always have a chaperone of the same gender as the client in the room when applying and removing sensors placed in sensitive areas. This applies even if the therapist and the client are the same gender. It is unethical not to have a chaperone present under these circumstances.

  4. Hygiene

  5. Providing Distance Interventions

    Coaching can be provided throughout a distance based biofeedback session through the use of software providing real time audiovisual communication between the client and provider. If practitioners are providing biofeedback-based services via distance communications such as the Internet, they must follow the requirements of their professional organizations as well as state licensure / certification boards. Being licensed in one state does not necessarily mean the provider can provide services requiring a license / certification in another state. Persons providing treatment recommendations to providers who are unlicensed and are treating medical or psychological conditions are being unethical and can incur liability.

  6. Coaching Clients During a Biofeedback Session

    Clients do not learn to control their physiologies by merely observing a biofeedback display. Rather, clients must be coached throughout a biofeedback session using the principles of operant conditioning and other training techniques. Clients must not be left alone to attempt changes for significant periods of time unless this is a specific goal for the client.

  7. Medications and Other Co-occurring Therapies

    Medications can alter the physiological signal, the client’s ability to regulate the signal, and may even contribute to the problem being addressed with biofeedback. Conversely, biofeedback training can alter the dosage of medication needed. Clinicians must be aware of what medications the client is taking and know which medications dosages are likely to change during the course of biofeedback. Clinicians may need to monitor medication side effects. If clinicians are not the prescribers of medications, they must communicate with the prescriber regarding any concerns pertaining to current medication levels or indications suggesting changes may be needed.

    Non-prescribers must not recommend that trainees / clients change prescribed medications. Rather, they must discuss the potential need for changes with the provider who prescribed the medication. If the prescriber will not co-ordinate with the biofeedback provider, the provider may have to cease treating the client rather than risk negative effects.

VII. Use of Biofeedback within the Research Environment

Biofeedback devices are used for both human and non-human studies. Five of the most common uses are (a) delineating the limits of psychophysiological self control, (b) exerting voluntary control over some aspect of physiology to determine the effect on a disorder or some performance element, (c) evaluating the effectiveness of various training techniques for establishing psychophysiological self-control, (d) monitoring people’s reactions as they respond to simulated events such as advertisements, and (e) establishing the efficacy of biofeedback techniques for controlling a disorder.

Many researchers have no formal training in teaching, coaching or conducting clinical work. While it is appropriate for scientists and academicians to conduct research utilizing biofeedback devices, they must meet BCIA’s requirements for knowing how to use biofeedback devices of the type they are working with and collaborate with appropriately trained and licensed clinicians, educators, and coaches when disorders are being explored.

Individuals conducting research using biofeedback devices must work within all relevant federal, state, and institutional standards including approval by the relevant institutional review and animal use committees.

Some organizations and practitioners refer to non-validated techniques as being in the “research” stage of development. This does not imply that actual studies are being conducted to determine the efficacy of the technique. Some practitioners who regularly provide and charge for non-validated techniques refer to these techniques as being “research.” This could lead clients to believe that research is being conducted on the technique. It must be emphasized that providing non-validated interventions outside of a properly delineated and approved study does not constitute research and must not be referred to as such.

Citations:

The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research.  OPRR Reports, US Government Printing Office 2010778-80319, 1988.

VIII. Appendix

Ethical principles promulgated by AAPB and BCIA that cover practitioners providing biofeedback:

Every person providing biofeedback services is required to follow the ethical principles stated by AAPB and BCIA. The AAPB and BCIA ethical principles are equally applied to all non-clinical applications of biofeedback by educators, trainings, and coaches. These ethics documents are provided below. Providers must also follow the ethical standards of their professional organizations.

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