2 Why You Need to take Biofeedback Courses, equipment training by akgame


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									What you need to know to perform biofeedback effectively Article 2: Why you need to take biofeedback courses, equipment training, and mentoring By Richard A. Sherman, Ph.D. This is the second of four articles in the series on “What you need to know to perform biofeedback effectively”. The series contains talks on why: 1. You need to know how the body works in order to use biofeedback effectively to change physical and mental functioning. Otherwise, you may try to do training which can’t work well or can’t be done at all (A&P / Human Biology). 2. Every practitioner needs a basic biofeedback course before doing biofeedback. You need to know when an introductory level general biofeedback or neurofeedback course doesn’t provide the depth you need to effectively incorporate biofeedback into interventions for the kinds of disorders you treat (e.g. chronic pain, incontinence, muscle rehabilitation, etc.). 3. You need to know how biofeedback devices actually record physiology and how to set the devices to produce useful recordings (Biofeedback Instrumentation). 4. You need to be able to tell if there is enough solid evidence supporting the use of a technique for you to even try it, let alone charge for it, and to tell whether the results you see or hear about are due to placebo or treatment effects (Basics of clinical research). This discussion is intended to give you an idea of why you need to take (a) biofeedback courses, (b) individual training with equipment, and (c) mentoring through your first few clients to do an effective job at biofeedback. Everyone planning to include biofeedback in his or her practice needs to, at the very lease, take a basic course in biofeedback. A good course, such as those approved by BCIA, will help you understand the relationships between the feedback display, the physiology being recorded, and the disorder being treated. Misunderstanding these relationships along with ignorance of how to incorporate biofeedback into a treatment results in numerous failures of efficacious biofeedback-based interventions.

However, 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 that they are allowed to use, 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 this approach does not allow adequate time to address the many crucial concepts in sufficient depth. 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 biofeedback based intervention within a multimodal treatment regime. Often practitioners don’t see the point of learning the basics or they think they can pick up the information they need by reading a device manual. 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? Foremost is approval of the course by the Biofeedback Certification Institute of America (BCIA). 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. Don’t hesitate to go to BCIA’s web site www.bcia.org to look at their requirements for what you need to know, mentoring, etc. It’s also very important that the course you are considering allots 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. Look for a course that is not based mainly


on teaching participants how to use the hardware and software for one particular device. This eats up too much time and doesn’t permit comparisons between devices. 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 peerreviewed 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. 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 California’s Board of 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. How do you decide which is best for you, in-person instruction or distance education? First consider how you learn best. If you aren’t selfdirected and able to sit down and do a distance course on your own, then it is not for you. If you like to have others around to bounce ideas off of and you like to have the instructor there with you, then, obviously, in-person classroom learning is the way to go. If you are sufficiently self-directed and like to be able to initially learn and then review the lectures and materials at your convenience, a distance course should work for you. Unfortunately, many people never complete their distance courses. Also consider your economic circumstances. In-person courses can be a week long, and unless one happens to be given in your town, they require travel expenses, meals, hotel, etc. If you are in private practice, you also give up your income for the week. If you live very far away from the course, and have an exchange rate problem, language barriers, etc., then a distance course would be recommended. Another point is that many distance


education courses can be divided into segments, so you may only purchase and take the parts you need. What level of course and sub-specialization do you need? 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, such as the one on this site, and you 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. If you work primarily with one particular class of disorders (such as ADHD or chronic pain) or want to use biofeedback for that one class, then 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. Individual training with biofeedback devices and mentoring through your first few clients: Even taking a solid lecture course in biofeedback can’t really prepare you to incorporate biofeedback techniques into your practice. Once you learn the basic information and protocols from the course, you need to thoroughly learn to use the biofeedback device you chose. Most people have great difficulty learning to use devices in a large group setting because they are nervous and hesitant to ask questions. The one size fits all method dictated by classroom settings means that more restrained participants tend to be the subjects to whom instruments are attached rather than those working the devices themselves. Information may come in so quickly that it can’t be readily absorbed nor remembered. There is also little time to actually learn to use biofeedback techniques to actually control your own functioning.


On the other hand, sitting alone in your office with a novel device and only a manual to guide you through its intricacies leaves most people trembling. Think of the last time you had to learn to use a new electronic gizmo for your home. If you are like most people, you don’t really care about all the apparently myriad of capabilities and intricacies of specialized programming. All you want it to do is its primary function so that is all you learn. Because of these problems, BCIA requires that practitioners spend time individually learning to use their equipment under the supervision of somebody who has experience with it. Once you know the basics and are comfortable with the equipment, you need to actually use the stuff with a real client. As you well know, nothing ever goes quite according to plan and there are always complications integrating a new system into your practice. So, its is handy to have somebody to guide you through your first few clients to insure that you can integrate the equipment into real practice appropriately and truly understand how to provide biofeedback to real people. This is why BCIA requires mentoring as part of the certification process. Both individual training and mentoring are available from local biofeedback practitioners and on-line via the web. Regardless of whether you are getting your training and experience through web cams or in a neighboring practitioner’s office, you need to insure that the person has solid training in biofeedback (preferably BCIA credentials) and has expertise in working with the kinds of patients you intend to see.

This article has provided a rationale in support of taking a basic and/or technique-oriented course before getting started in biofeedback, and taking an advanced course before using biofeedback for specific classes of disorders. A listing of courses can be found within the AAPB and BCIA websites. The author, Richard Sherman, Ph.D. is a Past President of AAPB and teaches basic science and biofeedback training courses. He can be reached at rsherman@nwinet.com.


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