Donald C.E. Ferguson, Ph.D., MPH
Research Professor, Department of Psychiatry
Uniformed Services University
Bethesda, Maryland

HYPERLINK "mailto:dferguson@usuhs.mil"
dferguson@usuhs.mil

Licensure in a health care field does not imply a health care provider has been trained or is competent to practice biofeedback. Qualified practitioners may have one or more original disciplinary backgrounds; however, physicians (M.D.), licensed clinical psychologists (Ph.D.), clinical social workers (M.S.W.), nurses (R.N.), and physical therapists (RPT) do NOT routinely receive training in biofeedback while earning their professional degree. Currently medical students and other health professionals in training students now learn about biofeedback, and what such treatment consists of and something about its benefits. They are not trained to use it in treatment themselves however.

Biofeedback may be employed as an alternative to pharmaceutical treatment for a number of conditions, but it is a mainstream treatment rather than alternative medicine per se. It is a scientifically derived, laboratory and research based treatment approach. 

Only a few physicians obtain post-graduate biofeedback training. The majority of qualified  biofeedback practitioners are clinical psychologists, nurses, physical therapists, social workers, chiropractors, or dentists. Small numbers of other health professionals may also have received training as biofeedback specialists.

Information Regarding the Training of Qualified Biofeedback Practitioners

In order to qualify to effectively and competently practice biofeedback, health professionals obtain specific biofeedback training as well as supervised clinical experience with it after completing training in a basic health discipline, whatever that may have been. There are a few exceptions to this general rule. 

After completing training in a health profession, at some later point an individual adds post-graduate study, training and supervised experience in clinical biofeedback to his educational qualifications.  

Since many conditions treated using biofeedback and neurofeedback involve medical illnesses, conditions, or stress related disorders, prior training in anatomy, physiology, and previous supervised experience in a clinical discipline and treating patients is a decided asset. Individuals trained this way are better able to understand the need for, and value of referring problems beyond the scope of their practice, and the desirability of actively collaborating with physicians and other health professionals as appropriate or as a matter of routine in the case of some types of illnesses.

To repeat, prior training and experience as a health professional is valuable preparation for subsequent biofeedback training and for later work as a biofeedback professional. Familiarity with physical, affective, and behavioral aspects of medical and psychological problems treated with biofeedback is highly useful. No single physician, medical specialty or health discipline is uniquely qualified to deal with all aspects of the 25,000 plus medical diagnoses and ailments (see the International Classification of Diseases) humans may experience, nor is any single professional ordinarily equipped to deal with all aspects of certain single or multi-problem patients. Wishing or pretending otherwise does not make it so.  It is for this reason that specialties have come into existence. 

Willing, intelligent cooperation with other health and medical specialists, when needed, is both desirable and necessary in many instances. Patients should beware the “omniologist” - a health professional professing competency in all health and medical matters and specialties. No one knows everything.

As a non-invasive, non-pharmacologic method of treatment, biofeedback is particularly useful for those who prefer non-pharmacologic interventions, or who do not wish to use medication, are allergic or hypersensitive to drugs used to treat their conditions, who suffer unpleasant or intolerable side effects from medications used, or who are aware of the medical literature which demonstrates that for many conditions, biofeedback treatment leads to longer periods of relief than do drugs which palliate but do not cure an underlying problem. In a number of cases biofeedback and medication together are useful or necessary to obtain the best result. Patients are ordinarily best served working with practitioners with a track record of working comfortably with other specialists and/or physicians. To repeat, no one knows everything. A partial list of conditions, disorders, and illnesses for which biofeedback has been found useful will be found on the Biofeedback and Neurofeedback Page of this Web site.  

Neurofeedback: A Biofeedback Specialty

Clinical neurofeedback, also known as neurotherapy and EEG biofeedback, is an additional sub-specialty of biofeedback. Clinical neurofeedback skills require additional training, additional equipment, and additional supervised experience. 

With few exceptions, practitioners of neurofeedback or neurotherapy were also first trained as professionals in a health or medical discipline. Subsequently, following graduation, they received training as biofeedback practitioners.  Following biofeedback training, a number of health professionals seek, and go on to study and obtain additional training in neurofeedback thereby adding to their existing professional qualifications. Some health professionals offer services in all fields they have ever been trained in. Some limit their practice to biofeedback or neurofeedback only.   

Many biofeedback practitioners do NOT offer neurofeedback treatment. A few practitioners are trained in, and offer neurofeedback services only. Neurofeedback training requires additional study of brain anatomy and physiology, EEG training, and methods of brain wave training which utilize an electroencephalograph or EEG, special biofeedback equipment and hardware, a specially configured microcomputer, and purpose designed computer software. This is not ordinarily a do-it-yourself activity.

Neurofeedback is not usually used for conditions and disorders which can be treated using other biofeedback modalities. In a number of situations both a combination of both biofeedback and neurofeedback are utilized in order to obtain the optimal or probable best outcome for the patient.

Who May Legally Practice Biofeedback?

In the District of Columbia, Maryland, and Virginia, as in most U.S. jurisdictions, there is no law specifically regulating who can and cannot provide biofeedback or neurofeedback services. This means that just about anyone is free to offer biofeedback services regardless of their background. Some individuals who offer biofeedback services may not even have had previous training as health professionals. Because of this it is important for each consumer or prospective patient to check to insure that a biofeedback therapist has been trained and has appropriate credentials and experience in providing the treatment being sought. This is not difficult to accomplish.

The Mid-Atlantic Society for Biofeedback and Behavioral Medicine can assist through recommending their Member practitioners that are trained, skilled and experienced in treatment of particular conditions. This information is found on other pages of this Web site. Other on-line resources to help identify qualified practitioners in other geographical regions are also listed there.  

Listing in the practitioner roster of The Mid-Atlantic Society for Biofeedback and Behavioral Medicine does not constitute a guarantee as to the specific quality of care for a given condition provided by those listed. Membership in the Society does not indicate competency within the field of biofeedback, but does signify active affiliation with professional colleagues and health professionals in the region interested in improving and maintaining competence through participation in, and exposure to professional affairs and continuing education in their chosen field.  

It is self-evident in today’s complex and fast moving world that “keeping up” is important in any health profession. Treatment methods, the underlying basic science, new approaches and new protocols are being improved continuously. Patients and clients will benefit from receiving treatment from practitioners motivated to keep abreast of current developments in their chosen field, and who are known to their professional peers.  This precept applies to all health and medical specialties. 

What About Certification?

The Biofeedback Certification Institute of America (BCIA) was developed to establish certification in biofeedback and uphold minimum Membership standards for providers who wish to be credentialed. Certification by the BCIA provides one indication of at least a minimum level of skills in biofeedback. Keep in mind, however, that certification in biofeedback is not a license, and thus is not regulated by law. Also please note that membership in our own Biofeedback Society (MASBBM) does not automatically mean a provider is BCIA certified. 

Requirements to become BCIA certified in biofeedback include: a bachelors degree in an approved health field, 200 hours of specific training in biofeedback and counseling, and passing a written and practicum exam administered by the BCIA. Typically, the letters "BCIA" appearing after the practitioner’s name and professional degree denotes biofeedback certification 

Many highly skilled and well regarded biofeedback practitioners are not BCIA certified. The American Board of Clinical Biofeedback certified some early providers, but is no longer in operation. Others, usually older, more senior practitioners, began practice in this field long before the BCIA came into existence. These persons have established both reputations and a track record in their communities, and are readily identified by professional organizations or within the wider professional community at large.  

The Mid-Atlantic Society for Biofeedback and Behavioral Medicine can assist those seeking to assess Member qualifications, credentials and experience in treating a given condition. A telephone call to any of the Society Officers listed on the Society’s Home Page at our Web Site may prove helpful in this regard. Those living outside our geographic area will. find references to other resources listed on other pages of this Web site which may prove helpful.

What About Neurofeedback Certification?

The Neurotherapy and Biofeedback Certification Board (NBCB) certifies Neurotherapists (neurofeedback specialists), Peak Performance Specialists and Certified Neurofeedback Therapists. Go to www.nbcb.org.

In addition to “General” Biofeedback Certification, the Biofeedback certification Institute of America (BCIA) has an EEG Certification (Neurofeedback), as well as certification for Pelvic Muscle Dysfunction. Visit their site at www.bcia.org.

Since Neurofeedback (Neurotherapy) certification is recent, many excellent, well trained and experienced neurofeedback specialists have not yet sought or obtained certification. We suggest readers contact MASBBM Society Officers listed on the Society’s Home Page at this Web Site for information concerning neurofeedback practitioners in our region. For information on neurofeedback practitioners in other states, inquiries made through using the www.biofeedback.net or the Society for Neuronal Regulation Web site may prove useful.