Controlled group designs in biofeedback research: Ask, "what does the control group control for?"

The extant literature on the specific role of biofeedback in promoting skeletal muscular relaxation is reviewed and found deficient with respect to the use of properly controlled group outcome research. The review emphasizes the failure of commonly used control procedures to adequately control a number of potentially confounding variables. Strengths and weaknesses of three types of controlled group design (attention placebo, pseudofeedback, and altered contingency) are discussed with respect to their relative usefulness in controlling certain nonspecific or placebo effects in biofeedback research. Many published biofeedback studies failed to measure the credibility of control procedures or the subject's ability to discriminate different feedback contingencies. The studies reviewed suggest that the various control procedures used are not inert and are not equivalent with respect to their effects on control group behavior. The suggestion is made that the controlled group outcome design be accepted as the minimum requirement for testing the specific effects of biofeedback, and possible methods for improving control procedures are discussed.