Regarding Mari Swingle's Editorial on Neurofeedback Practice

Abstract

It was encouraging to read Dr. Swingle's article, “Neurofeedback, Where Are We and Where Are We Going?” (2021, Biofeedback, Vol. 49, No. 3, pp. 59–70). Dr. Swingle believes that well-trained and well-informed providers are necessary in order to provide appropriate neurofeedback services. She notes that providers should be well informed about research, presumably applied research. We would like to elaborate that providers should be skilled in the critical assessment of research, including why different research designs are necessary to draw valid conclusions.One disappointment in Dr. Swingle's otherwise excellent article is that she implies that double-blind randomized controlled trials are not necessary. She suggests that there are imperatives to perform double-blind controlled research that are spurred by the pharmaceutical industry, and she additionally discounts the use of placebo controls. She does not consider that research designs are not imperatives or laws, they are ways to reduce threats to validity, especially in cases of biofeedback and neurofeedback study, where nonspecific factors can play a huge role in outcomes. In addition, treatment providers can subtly (and not so subtly) influence the outcome of an experiment if they know which condition a subject received. Applied psychophysiology is already thriving in neurology and psychiatry in the form of electroencelphogram assessments for seizure disorders and polysomnography for sleep staging and sleep disorders. In the area of treatment, electroconvulsive therapy and repetitive transcranial magnetic stimulation (rTMS) have thousands of controlled research articles accessible in PubMed. The question is whether people who want to have a meaningful role in behavioral healthcare and optimal functioning would be interested in including neurofeedback among their efforts.Consider the following: (a) people will not believe that neurofeedback works simply because we believe it does; (b) getting meaningful funding for studies that do not contain control, and especially blinded ones, is very difficult; (c) many nascent fields such as contact thermography have died on the vine or become vestigial due to a lack of convincing evidence supporting their assertions or were dropped because properly performed studies showed their techniques were ineffective; and (d) many fields such as rTMS have become widely accepted because they provide adequate evidence of efficacy using accepted techniques such as placebo-controlled studies or longitudinal studies with objective outcome measures. Such techniques are not tools of the pharmacological industry nor were they developed by it. Rather, the pharmacological industry has adopted placebo-controlled studies because they are the best designs to show that a technique, process, medication, and so forth may work better than placebo factors alone.Graduate programs, such as the Applied Psychophysiology program at Saybrook University, the Applied Psychophysiology program at the College of Certified Psychophysiologsts, or the Clinical Psychophysiology elective diploma program at the Advance Education Institute and Research Center (AEIRC), would be major vehicles for accomplishing the objectives of developing clinicians and trainers who are broadly knowledgeable in anatomy and physiology and the fundamentals of psychophysiology, as well as what research designs are available and why they are important. Students are expected to demonstrate their critical reasoning and research skills in papers, theses, and dissertations. With this rich background providing tools for critical thinking, students proceed to master skills at applying psychophysiology for assessment, stimulation, and biofeedback/neurofeedback training. In that light, Dr. Swingle's article seems to be making a good case for graduate-level education as the next step in the applied science of neurofeedback.