Regulation of neurofeedback is minimal; professionals seek tougher rules

Tuesday, December 15, 2009

Neurofeedback is marketed as a powerful therapy, capable of temporarily or even permanently changing your brain. Yet throughout the United States, manicurists are more strictly regulated than neurofeedback therapists.

In contrast to fingernail professionals, neurofeedback technicians don't need special licenses to operate their equipment. This may help explain why only 500 of the estimated 6,000 people who practice neurofeedback throughout the United States have gone through the 136 hours of classroom training, mentoring and supervised practice required by the Biofeedback Certification Institute of America, according to the institute's director of certification, Judy Crawford.

The equipment itself is also in a gray zone. The Food and Drug Administration approves biofeedback devices only for relaxation training, meaning that the hardware isn't cleared for treating autism, ADHD or other brain disorders, according to FDA spokeswoman Karen Riley. Licensed mental health therapists are free to practice as they see fit, but the manufacturers may not advertise such off-label uses.

Professional groups, such as the International Society of Neurofeedback and Research, are lobbying for more regulation to help protect their industry's reputation from quacks. For now, however, the burden is on potential clients to take care before letting just anyone hook up their brain to a computer.

Mental health professionals are required to have licenses, so your first question should be whether the would-be practitioner is a licensed psychologist, psychiatrist, doctor, nurse or social worker. Beyond that, it's wise to insist they also have some specific neurofeedback training and experience.

"The analogy I use is there's a difference between a butcher and a neurosurgeon," says D. Corydon Hammond, a psychologist, professor and neurofeedback practitioner at the University of Utah School of Medicine. "The butcher has a few rudimentary skills, but to know what to do and what not to do with the brain requires diagnostic and more-advanced skills."

The risks of bad treatment may extend beyond a mere waste of time and money, as Hammond and co-author Lynda Kirk reported in a 2008 article in the Journal of Neurotherapy. The article chronicled cases in which an autistic child reportedly regressed following treatment, while another child's facial tics worsened, and a third patient wet his bed. Such effects are usually brief and temporary, says Hammond, but he warns that, if administered by people with the wrong kind of training, others can be more serious. His article describes one client who drove through a red light after leaving a therapist's office and another who crashed into a light pole just a block from the therapist's office. "Imagine the potential liability!" wrote the authors. Hammond predicts such mishaps will be greatly reduced as practitioners become better-qualified and trained -- and as the field matures, with standardization and objective guidelines replacing the guessworkso prevalent today.

Industry watchdogs are similarly concerned with biofeedback gadgets being sold directly to consumers -- a separate issue from licensed practitioners' using the machines for off-label purposes. Canada's CBC News recently featured an exposé of a $20,000 biofeedback machine called the Electro Physiological Feedback Xrroid, a.k.a. the Scientific Consciousness Interface Operating System, being purchased by people with such ailments as AIDS and cancer.

"An increasing number of companies seem to be seeking to fly under the FDA's radar by failing to register their equipment and selling it directly to the public," Hammond wrote me in an e-mail. "Putting electrodes on the head and then seeking to modify how the brain is functioning without appropriate licensure and training . . . is something fraught with potential risks."

-- Katherine Ellison

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