1. The Biofeedback Certification International Alliance
(formerly the Biofeedback Certification Institute of America)
Blueprint of Knowledge Statements for
Board Certification in Biofeedback
The provider certified in Biofeedback will have knowledge of:
I. ORIENTATION TO BIOFEEDBACK – 4 hours
A. Definitions of biofeedback 2. Traumatic stress and posttraumatic stress
disorder
B. History of biofeedback
1. Pioneers in biofeedback C. Psychophysiological reactions to stressful
2. Forces leading to the emergence of events
biofeedback (e.g., operant conditioning, 1. Negative affect, e.g., anxiety, anger,
self-regulation, cybernetics, miniaturization, hopelessness, depression
computerization, founding of the 2. Acute stress: Cannon’s fight-or-flight
Biofeedback Society of America) response
a. Sympathetic-adrenomedullary
C. Concepts of feedback and control in biological activation
systems b. Relationship to panic disorder and
somatization
D. Overview of principles of human learning as 3. Chronic stress: Selye’s general adaptation
they apply to biofeedback syndrome
1. Learning theory (e.g., habituation, a. Hypothalamic-pituitary Adrenocortical
classical and operant conditioning, activation
discrimination, generalization, extinction) b. Stages of the general adaptation
2. Application of learning principles to syndrome
biofeedback training (e.g., reinforcement, c. Health consequences of chronic
discrimination training, length and number stress
of sessions, massed vs. spaced practice, 4. Immune system disruption
generalization to the life situation) a. Psychoneuroimmunology (PNI)
b. Implications of PNI for immune-related
E. Research methodology illness
1. Differences between correlational and
randomized controlled outcome studies D. Psychosocial mediators of stress
2. Threats to internal validity 1. Cognitive appraisals of stress and coping
3. Specific and nonspecific treatment resources
effects 2. Personality dispositions, e.g. optimism-
4. Control group designs pessimism, self-efficacy
5. Case study designs 3. Social support
6. Small-N designs
7. Meta-analysis III. PSYCHOPHYSIOLOGICAL RECORDING – 8
8. Criteria for clinical efficacy hours
II. STRESS, COPING, AND ILLNESS – 4 hours A. Descriptions of most commonly employed
biofeedback modalities: SEMG, skin
A. Stress and the biopsychosocial model of temperature, electrodermal activity, EKG and
illness heart rate variability, respiration, EEG
1. Sensors and sensor placements
B. Stressful life events and risk of illness 2. Characteristic signals
1. Assessing stressful life events 3. Signal processing and feedback displays

2. B. Sources of artifact accident, cerebral palsy, spinal cord injury,
1. How to identify and eliminate peripheral nerve injury, and chronic pain
environmental noise, including 60 Hz,
radio frequency, and electrostatic C. Chronic neuromuscular pain
interference 1. Ascending and descending pain
2. How to evaluate instrument noise levels pathways
3. How to perform a continuity check on 2. Gate control theory
electrodes and cables 3. Neuromatrix theory
4. How to identify and correct electrical short 2. Trigger point mechanisms
circuits 3. SEMG differences between chronic pain
5. How to identify and correct extraneous subjects and normal subjects
biologic activity in recordings
6. The relationship of skin impedance to D. General treatment considerations
amplifier input impedance; effects on 1. SEMG assessment strategies
physiological recordings
2. SEMG down-training strategies
3. SEMG up-training strategies
C. Identification and elimination of electrical
shock hazards
E. Target muscles, typical electrode placements,
and SEMG treatment protocols for specific
D. Essential electronic terms and concepts for
neuromuscular conditions
biofeedback applications, including:
1. Tension-type headache
1. Conduction and insulation
2. Temporomandibular disorders
2. Voltage (E)
3. Posterior neck and upper back pain
3. Current (I)
4. Low back pain
4. Resistance (R)
5. Urinary and fecal incontinence
5. Ohm’s Law (E=IR)
6. Power 6. Paresis and spasticity secondary to
7. Impedance central nervous system disorders and
8. Electrode impedance injuries
9. Input impedance 7. Worksite ergonomic applications
10. Signal-to-noise ratio
11. Amplifiers: single-ended and differential V. AUTONOMIC NERVOUS SYSTEM (ANS)
amplifiers APPLICATIONS – 8 hours
12. Common mode rejection
13. Artifact A. Structure and function of the autonomic
14. Amplitude nervous system
15. Integration methods: integral average 1. Sympathetic and parasympathetic
voltage, peak voltage, peak-to-peak divisions
voltage, and root mean square voltage 2. Anatomy and autonomic innervation of the
16. Bandpass cardiovascular, GI, and respiratory
17. Frequency response curve systems
18. Volume conduction 3. Physiological mechanisms underlying
19. Time constant commonly employed biofeedback
20. Power spectrum modalities, including electrodermal
21. Optical isolation activity, skin temperature, heart rate,
22. Telemetry respiration, heart rate variability
4. Homeostasis, disregulation, and self-
IV. SURFACE ELECTROMYOGRAPHIC (SEMG) regulation of ANS activity
APPLICATIONS – 8 hours 5. The effects of commonly employed
medications on autonomic activity
A. Muscle anatomy and physiology; antagonistic
and synergistic muscle groups B. Psychophysiological Concepts
1. Tonic and phasic activity
B. Central nervous system 2. Orienting, arousal, and habituation
Neuroanatomy, neurophysiology, and 3. Situational specificity of physiological
pathology relevant to cerebral vascular response

3. 4. Individual response stereotypy 2. Psychophysiology and biofeedback
5. Physiological differentiation of emotional principles used in explaining treatment
states rationale, setting expectations, and
motivating compliance
C. General applications of autonomic 3. Recognition of secondary gains the
biofeedback client may obtain from symptoms
1. Psychophysiological stress profiling 4. Development of a treatment plan based
2. Biofeedback-assisted relaxation on knowledge of relevant research and
3. Psychotherapy process monitoring established criteria for treatment
selection
D. Pathophysiology, biofeedback modalities, and
treatment protocols for specific ANS B. Relaxation methods: Procedures, indications
biofeedback applications and
1. Migraine headache contraindications
2. Raynaud’s disease 1. Progressive muscle relaxation
3. Hypertension 2. Autogenic training
4. Cardiac arrhythmias 3. Guided imagery
5. Hyperventilation syndrome 4. Hypnosis
5. Meditation
VI. ELECTROENCEPHALOGRAPHIC (EEG) C. Psychotherapeutic techniques
APPLICATIONS – 4 hours 1. Empathy and rapport
2. Strategic use of verbal and non-verbal
A. Specific central nervous system structures behavior
and neurotransmitter pathways subserving 3. Optimizing nonspecific (placebo) effects
important psychological states and activities,
including sleep-wakefulness, affect and D. Cognitive interventions
emotion, pain, motor function, and executive 1. The effect of cognitions (e.g., appraisals,
function. schemas, self-talk) on stress levels,
presenting complaints, and treatment
B. Neuronal sources of scalp EEG activity outcomes
2. Methods of cognitive intervention, e.g.,
C. EEG patterns and their behavioral correlates, reframing, cognitive restructuring, stress
including delta, theta, alpha, low beta, high inoculation, modification of automatic
beta, and SMR frequency ranges thoughts
D. Clinical uses and efficacy of EEG E. Nutritional considerations pertinent to stress-
biofeedback in the treatment of attention related disorders
deficit disorder, mild closed head injuries,
substance abuse, epilepsy, migraine, F. The effects of exercise on mood, physiological
insomnia, anxiety and affective disorders, functioning, and presenting symptoms
including the specific EEG parameters and
recording sites used for feedback training VIII. PROFESSIONAL CONDUCT – 4 hours
E. Potential effects of prescribed and A. Responsibility and competence
nonprescribed drugs on clinical presentation, 1. Responsibilities and liability in provision of
EEG measures, and EEG biofeedback services
learning tasks 2. Demonstrated competence in all aspects
of service provided
VII. ADJUNCTIVE INTERVENTIONS – 8 hours 3. Limiting scope of practice to areas of
professional training and qualifications
A. Intake procedures 4. Experimental vs. commonly accepted
1. Interview techniques for charting of biofeedback treatment
presenting problems, medical and 5. Contraindications to treatment
personal history, psychopathology, and
coping resources

4. 6. Familiarity with the ethical principles of D. Professional relationships
BCIA and one’s primary profession 1. Dual relationships
7. Advertising, marketing of services, and 2. Conflicts of interest and exploitation of
public statements clients
8. Continuing education and training 3. Consultation, referral, and relationships
with other professionals
4. Medical and medication monitoring
B. Client rights 5. Procedures for dealing with unethical
1. Privacy, confidentiality, and privileged behavior of colleagues
communication E. Record keeping
2. Informed consent to assessment and 1. Technical and legal records
treatment 2. Legally required records and retention
3. Accepting clients, abandonment, and
appropriate referral 3. Documentation of medical history
4. Universal precautions in biofeedback 4. Security of records to ensure
5. Equal access to health care confidentiality
C. Supervision and Consultation
1. Appropriate consultation and supervision
in biofeedback
2. Purposes of supervision and consultation
3. The process of supervision
4. Guidelines for seeking supervision
©2006 by the Biofeedback Certification International Alliance, (formerly the Biofeedback Certification Institute of
America (BCIA). No portion of this document may be reproduced in any form without the permission in writing of
BCIA.