N Exclusions

When considering clinical biofeedback for an individual, the following basic requirements must be met: The individual must be able to tolerate the application of the sensors; the individual must be able to under stand the instructions regarding the relationship between his or her physiology and the feedback signal; the individual must be motivated to change physiology, using the feedback signal to facilitate this process; and finally, the individual must be motivated to practice what he or she has leaned in the clinic in his or her everyday world.

There are also cautions and contraindications for the use of clinical biofeedback. First, a determination must be made that a more appropriate intervention, such as an immediate medical treatment rather than biofeedback therapy, is not warranted. An example of this is that an individual may be suffering from the recent onset of headaches caused by an aneurysm. In this situation, providing biofeedback as the only treatment would not be sensible, as a surgical intervention may be needed. Although there is little literature on contraindications for psychological states, logic indicates that in certain psychological conditions, biofeedback should not be considered the treatment of choice. These conditions include psychological states such as severe depression, uncontrolled schizophrenia, delirium, and depersonalization. Caution or special considerations should be employed when the client has the following conditions: impaired attention, dementia, mental retardation, or if the client is taking medications, as the medications may need to be adjusted as therapy progresses.

Therapists should also be aware that some individuals might experience what is being referred to as relaxation induced anxiety (RIA). Although little systematic information is available on the incidence of this in clinical practice, it is of concern as some individuals feel a strong sense of apprehension when a deep state of relaxation is induced. These individuals often report disturbing cognitions, feelings of loss of control, depersonalization, and strange body sensations. For these individuals, it is necessary to gradually train them in moderate levels of relaxation until they can tolerate and enjoy the benefits from deep states of relaxation. For further information on cautions and contraindications see Standards and Guidelines for Biofeedback Applications published by AAPB in 1992, and Schwartz's 1995 work.

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