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Guidance on Supported Biofeedback/Neurofeedback Modalities for VA Facilities

Guidance on Supported Biofeedback/Neurofeedback Modalities for VA Facilities 

Updated 2020-09-29 

Prepared by Integrative Health Coordinating Center (IHCC), VHA Office of Patient Centered Care & Cultural Transformation (OPCC&CT) 

Please be aware there are 2 different recommended standards utilized by the VA for Biofeedback/Neurofeedback:   

  • Recommended Standards for VA employees practicing biofeedback or neurofeedback as part of their VA position.
  • Recommended Standards for Community providers participating in Choice or Community Referral programs.

Questions or issues around the implementation of biofeedback/neurofeedback in the VA can be directed to the IHCC (vhaopccintegrativehealth@va.gov).

Introduction: The VA only supports specific types of biofeedback/neurofeedback 

There are many types of biofeedback being offered in our communities. Not all of them are considered appropriate for referrals from the VA, and not all people who have been trained in biofeedback may be allowed to use this modality in their job at the VA. 

The VA supports the use of Biofeedback/Neurofeedback modalities in the treatment of Veterans if these modalities are supported by the research and recognized by the major professional organizations in the field. 

  • Supported biofeedback modalities: Feedback driven self-regulation training (e.g. HeartMath™, Elite HRV™, or Freespira™), Electromyography (EMG), Temperature, Galvanic Skin Response (GSR) or electrodermal activity (EDA), Heart Rate Variability (HRV), Respiration, Capnometer, Blood Volume Pulse (BVP) Photoplethysmography, Hemoencephalography (HEG), and Pelvic Floor EMG. 
  • Supported neurofeedback modalities: Electroencephalography (EEG) biofeedback, HEG, Infra-low frequency, Low Energy Neurofeedback System (LENS)™, QEEG-based neurofeedback, Low Resolution Electromagnetic Tomographic Analysis (LORETA), z-Score EEG, and Slow Cortical Potential neurofeedback (SCP). 
  • Unsupported biofeedback modalities:  
    1. Any forms of “biofeedback” not utilizing the methodologies/technologies listed in “1” above or “biofeedback” modalities utilizing sensors to measure physiological signals such as sound or energy, which are not medically understood or supported as a source of treatment (click here and here for additional information); 

    2. Any biofeedback which does not have all 3 of the following present in either a face-to-face or virtual video connect format: a device that measures and provides information on physiological signals, a biofeedback trainer that uses the information provided by that device to guide the learning process of becoming aware of unconscious unhealthy patterns and training to consciously change them, a biofeedback trainee;
    3. Any form of “biofeedback” which purports to be able to diagnosis medical conditions 

Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government, and shall not be used for advertising or product endorsement purposes. 

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