Whole Health

Guidance on Standards for Community Care Network Providers of Biofeedback/Neurofeedback

Introduction 

“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.“  (Association for Applied Psychophysiology and Biofeedback, the Biofeedback Certification International Alliance, and International Society for Neurofeedback and Research 2007 Task Force)  

Neurofeedback is a specific type of biofeedback that is used to improve brainwave activity. 

There are many types of biofeedback being offered in the community. Not all types are considered appropriate for referrals from the VA, and not all people who have been trained in biofeedback may be allowed to use this modality in their job at the VA or as community care network providers for VA referrals. 

The VA supports the use of Biofeedback/Neurofeedback modalities in the treatment of Veterans if these modalities are supported by the research and recognized by the major professional organizations in the field. 

Supported modalities for community care network referrals include: 

Biofeedback: Electromyography (EMG), Temperature, Galvanic Skin Response (GSR) or electrodermal activity (EDA), Heart Rate Variability (HRV), Respiration, Capnometer, Blood Volume Pulse (BVP) Photoplethysmography, Hemoencephalography (HEG), and Pelvic Floor EMG. 

Neurofeedback: Electroencephalography (EEG) biofeedback, HEG, Infra-low frequency, Low Energy Neurofeedback System (LENS)™, QEEG-based neurofeedback, Low Resolution Electromagnetic Tomographic Analysis (LORETA), z-Score EEG, and Slow Cortical Potential neurofeedback (SCP). 

Unsupported biofeedback modalities include: 

1. Any forms of “biofeedback” not utilizing the methodologies/technologies listed above or “biofeedback” modalities utilizing sensors to measure physiological signals such as sound or energy, which are not medically understood or supported as a source of treatment (click here and here for additional information); 
2. Any biofeedback which does not have all 3 of the following present in either a face-to-face or video telehealth format: a device that measures and provides information on physiological signals, a biofeedback trainer that uses the information provided by that device to guide the learning process of becoming aware of unconscious unhealthy patterns and training to consciously change them, a biofeedback trainee; 
3. Any form of “biofeedback” which purports to diagnosis medical conditions 

Recommended Standards for Community Care Network Providers of Biofeedback/Neurofeedback: 

Professional Minimum Proficiencies: 

All community care network biofeedback providers external to the VA must be licensed healthcare professionals in their field of practice. These include (but are not limited to): Medical providers, mental health providers, physical and occupational therapist, psychologists, social workers, licensed professional counselors, marriage and family therapists, and advanced practice nurses. 

1. Providers must hold a current, active license for their field in the state they provide the services.
2. The license must allow the provision of clinical services without supervision. 

Biofeedback/Neurofeedback Minimum Proficiencies (for Community Providers): 

Provider must: 

• Have biofeedback/neurofeedback within scope of practice and follow any guidelines endorsed by their state board 

AND the following, depending on area requested: 

Heart Rate Variability (HRV) 

Provider must meet one of the following: 

1. Have a Certificate of Completion in HRV from a professional certifying body with a minimum of 16 didactic hours and 10 supervised contact hours, including one case study 

or

Attest to all the following: 

1. Completion of 25 hours continuing education in HRV Biofeedback
2. Completion of a minimum of 50 patient or client sessions
3. Completion of 10 supervised contact hours
4. Completion of one supervised case study 

 General Biofeedback (EMG, surface skin temperature, electrodermal response, etc.)  

Provider must meet one of the following:  

1. Certified in General Biofeedback by a certifying body with a minimum of 42 didactic hours and 10 supervised contact hours, including one case study. 

or 

Attest to one of the following: 

1. Completion of a 3 semester-hour college course in biofeedback and/or applied psychophysiology, and completion of 10 supervised contact hours and supervised review of 50 sessions.or
2. Completion of 20 hours continuing education on relevant biofeedback topics, and completion of 10 supervised contact hours and supervised review of 50 sessions. 

Neurofeedback 

Provider must meet one of the following: 

1. Certified in Neurofeedback by an accrediting body with a minimum of 36 didactic hours and 25 supervised contact hours.

or

Certified in General Biofeedback by an accrediting body with specialization in neurofeedback to include the following:

1. 100 sessions of patient or client neurofeedback and 
2. 25 supervised contact hours in neurofeedback. 

or 

Attest to the following: 

1. 36 hours of training in neurofeedback and
2. 100 sessions of patient or client neurofeedback, with 25 supervised contact hours or
3. 400 sessions of patient or client neurofeedback, with 10 supervised contact hours 

Pelvic Muscle Dysfunction Biofeedback 

Provider must meet one of the following: 

1. Certified in Pelvic Muscle Dysfunction Biofeedback by a professional certifying body 

or 

Attest to the following: 

1. Completion of 22 hours of education in Pelvic Muscle Dysfunction Biofeedback by a professional certifying body or
2. Completion of a 3 semester-hour modalities course with Pelvic Muscle Dysfunction Biofeedback training and a clinical practicum or residency rotation with pelvic health specialty

Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government, and shall not be used for advertising or product endorsement purposes. 

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