Download a free copy of the 2004 Yucha and Gilbert review of biofeedback efficacy as an E-Book from AAPB.
Efficacy vs. Clinical Effectiveness:
Efficacy is determined by evaluating formal studies done on each disorder. When a study is done, the treatment is very carefully standardized, the people doing the interventions should have great expertise in the treatment and the disorder, and patients are very carefully selected. In the real clinical environment, the patients may have many problems in addition to the one they are being treated for (which would affect the chances of the treatment doing well), may be given many overlapping treatments at once (so you can't tell how much help any one treatment was), and the therapist may not be as experienced as the people running the research study. Thus, a treatment's efficacy may be greater or lesser than its effectiveness in the real clinical world.
The Association for Applied Psychophysiology and Biofeedback (AAPB) has developed the following criteria for setting the level of evidence for efficacy (Moss and Gunkelman 2002, LaVaque et al 2002): It is very similar to the rating schemes developed by other organizations such as the American Psychological Association. Please note that the efficacy ratings made based on these criteria are from formal studies. Please see these citations for an explanation of how the ratings were arrived at and a discussion of the weaknesses of double blind studies for several of the techniques evaluated.
LaVaque, T., Hammond, D., Trudeau, D., Monastra, V., Perry, J., Lehrer, P., Matheson, D., & Sherman, R. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological evaluations. Applied Psychophysiology and Biofeedback, 27(4), 273-281.
Level 1: Not empirically supported:
Level 2: Possibly Efficacious:
Level 3: Probably Efficacious:
Level 4: Efficacious:
Level 5: Efficacious and specific: The investigational treatment has been shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings.
Efficacy ratings for biofeedback based treatments:
Please see Yucha and Gilbert's 2004 review of efficacy ratings for most of the disorders biofeedback is used to treat. (Yucha, C. & Gilbert, C. (2004) Evidence-Based Practice in Biofeedback and Neurofeedback. Association for Applied Psychophysiology and Biofeedback. Colorado Springs, CO.
The following efficacy ratings are taken from the Yucha and Gilbert's text. Additional references are available in the text.
Efficacious and specific (Fifth level):
Efficacious (Fourth Level):
Probably Efficacious (Third level):
Possibly Efficacious (Second level):
Not empirically supported (First level of evidence):