The most significant criticism of biofeedback involves the limited amount of empirical data supporting its widespread clinical application. In some cases, the application of biofeedback to certain clinical problems has progressed with even limited theoretical rationale, let alone empirical support.
Biofeedback by definition can involve a variety of physiological indicators, making its application highly variable. Thus, regardless of empirical findings, treatment using biofeedback is not well standardized. In some settings, biofeedback is equated with relaxation treatment and/or variations occur in the specificity and sophistication of the physiological data provided to the individual (e.g., using computerized versus noncomputerized information; real-time versus lag-time data).
A related problem is that biofeedback is used by clinicians with varying training backgrounds. There is board certification available but it is not required in order to practice. This problem is exacerbated by the limited number of trained professionals available. Also, those referring are not often knowledgeable about the appropriate uses of biofeedback or the benefits of the approach in the face of lagging empirical studies. It is not uncommon for referrals to request biofeedback either for problems for which it has limited support, or to address biobehavioral problems when other primary problems exist (e.g., mood disorders). The technological appeal of biofeedback tends to perpetuate referral in the absence of understanding. This highlights the need for more trained clinicians and for those clinicians to appropriately screen referrals, while continuing to educate referral sources and the general public.
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