Why do you need training to effectively incorporate psychophysiological assessments and biofeedback-based interventions into your practice...
and how you do choose which course is best for you?*
By Richard A. Sherman, Ph.D.
Everyone planning to include psychophysiological assessments and biofeedback interventions in his or her practice needs, at the very least, to take a basic course in biofeedback. A good course will help you understand the relationships between the feedback display, the physiology being recorded, and the disorder being assessed and then treated. Misunderstanding these relationships along with ignorance of how to incorporate biofeedback into a treatment has resulted in numerous failures of otherwise efficacious biofeedback-based interventions.
Many people feel that basic courses are unnecessary because they think the devices are so sophisticated they can practically work themselves. Others think that because their licensing boards include biofeedback as a technique within their scopes of practice, the minimal exposure to biofeedback they received in typical graduate programs (perhaps augmented by a few hours of training by a manufacturer) provides all the information they need. This simply isn't the case as the time required to address many crucial concepts in sufficient depth isn't there. Courses provided by instrument manufacturers frequently do a fine job teaching people how to use of a specific device but not how to competently incorporate the device into a psychophysiological assessment or biofeedback based intervention within a multimodal treatment regime.
Sadly, many people who have never had an adequate biofeedback education waste their own and their patients' time. Studies by myself and, unfortunately, insurance companies show that many clinicians, regardless of their clinical degree, who are undereducated in biofeedback get results no better than the placebo effect, but think they are doing a great job.
Another problem is that people practicing biofeedback who have not had a basic course in it are unaware of the strengths and weaknesses of biofeedback applications for specific disorders. They can apply the wrong type of biofeedback, use it incorrectly, or use and charge for treatments that have not been shown to work for the disorder they are treating. This information can only come from a course or review of the literature by an expert.
So what should you look for in a basic biofeedback course?
Five key factors to consider include (a) depth of material presented, (b) demonstration of many types of equipment and software used for a wide variety of problems, (c) availability of a skilled professional to answer your questions during and after the course, (d) whether the course has been independently evaluated and approved by a variety of well recognized professional organizations, and (e) your actual costs to take the course relative to your motivation to study on your own.
The course you are considering needs to allot sufficient time and depth to cover the material. You can't cover basic general biofeedback in much less than 40 hours. No course much shorter than that will give you the depth you need. Some courses teach you how use biofeedback devices appropriately but don't teach you to how to incorporate psychophysiological assessments and biofeedback-based interventions into typical clinical, coaching, and educational practices. A good course will include movies or extensive demonstrations showing a variety of assessments and interventions being performed with real patients.
Look for a course that demonstrates the use of many types of hardware and software so you can make your own comparisons of the devices and their software. There are a great many devices available which have different degrees of flexibility and tremendous differences in cost. You could easily spend a fortune buying a device with far more capabilities than you need or with software you can't easily use. Some courses concentrate on teaching participants how to use the hardware and software for one particular device. This means you won't have a good idea what alternatives are available when it comes time to purchase equipment.
Most biofeedback courses are set at one of three levels: (a) general/basic, (b) basic with technique-based subspecialty emphasis, and (c) disorder-based specialized/advanced. For most people, the way to begin learning about biofeedback is with a general biofeedback course to get an overview of what the field is all about and how biofeedback is incorporated into treatments.
However, if you have seen an introductory slide show and have sufficient knowledge of biofeedback to know that you are only likely to perform a specialized type of biofeedback using one main technique, such as EEG or pelvic floor muscle tension, then you can begin with a basic course concentrating on these techniques. Be sure that the course still includes a good overview of biofeedback, so you can understand where it fits into the field.
If you work primarily with one particular class of disorders (such as ADHD or chronic pain) and only want to use biofeedback for that single class of disorder, you should take an advanced course after you take a good basic course. Advanced courses cover many biofeedback techniques as applied to a single class of disorders. This is where you learn the detailed physiology of the disorder and many behavioral approaches to them in relation to other techniques.
Regardless of whether the course is given in a classroom or in a distance education setting, it should include extensive personal interaction with an instructor who is actually an expert in the field. Look for peer-reviewed publications by the instructor in the area in which the course is given. If you are considering a distance education course, be sure to find out if there is an actual instructor with appropriate credentials. Ask if extensive interaction with the instructor is an integral part of the course and if you can easily contact the instructor with questions. Also see if the instructor is prepared to provide extra material to meet your particular interests and needs. Get a clear idea of whether the course will offer audiovisual lectures or just a series of readings. Some distance education courses are still the old pamphlet based readings with multiple choice exams scored by a secretary without support from an actual instructor.
Look at the organization providing the course. Is the organization established and in good standing with the professional community? Most good CE groups will have program approval by state and national boards such as the American Psychological Association, California's Boards of Behavioral Sciences and Psychology, or the National Board of Certified Counselors. Colleges should have regional accreditation or, at the very least, state approval. Find out if the organization appears to be biased toward one viewpoint or product. You also need to ask if you can get CE credit for the course toward license renewal, etc.; if there are student, hardship, and/or developing nation scholarships; and if you can take only the parts of the course you need. Any biofeedback course you consider should be approved by the Biofeedback Certification International Alliance (BCIA which used to be called the Biofeedback Certification Institute of America). The BCIA sets criteria for the contents of each basic and technique specialty course (but not advanced courses) based on what panels of experts feel people utilizing a particular type of biofeedback need to know. They evaluate each course to ensure it provides the minimum material required in a usable format. Without BCIA approval, you can't know whether a course covers crucial material you need to know.