Specific versus placebo effects in biofeedback training: A critical lay perspective

Recent interchanges on the question of how to evaluate biofeedback have been cast in terms of a researcher versus clinician dichotomy. This tends to make the arguments ad hominem and focuses attention on minutiae that are of limited general interest. Accordingly, one purpose of the present paper is to state the specific-effects approach to biofeedback evaluation from a critical lay, rather than a research, perspective. The logic of the specific-effects approach to treatment evaluation is first illustrated by a hypothetical example (the Minefield Parable), and it is then suggested that the approach is appropriate for the evaluation of any treatment, be it physical, psychological, or some complex combination. The other purpose of the paper is to further clarify the specific-effects position by responding to some difficulties that have been raised by critics of the position. Some of these difficulties are based on misrepresentations of the position, while others are genuine. However, even for the genuine difficulties, practical solutions are available. The paper concludes that the question of whether a particular class of treatments works is one that is properly raised by the intelligent consumer, and that, for the answer to that question, only the facts, based on adequately controlled clinical studies, will do.The preparation of this paper was supported by a grant from the National Science and Engineering Research Council of Canada. I am indebted to Hal Scher and Donna Shulhan for comments on an earlier draft.