One Modality Does Not Fit All

23 January 2008
– a BioFeedBack Resources International email newsletter –
written & edited by Harry L. Campbell, President
technical editing and production by Edwin Johnson

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  1. One Modality Does Not Fit All – by Harry Campbell
  2. Announcements
  3. Biofeedback and Neurofeedback Training 2008 Schedule
  4. New Brain Training Software


  1. One Modality Does Not Fit All – by Harry Campbell

    Many practitioners get stuck on using a single modality. This can happened for many different reasons. The practitioner may only have equipment that allows one modality. They may have produced good results using one modality and become convinced that it was good for all applications or clients. Sometimes new practitioners are initially taught to use a particular modality. They follow the teaching, never expanding their knowledge of the usefulness of other modalities. Each modality has peculiar properties and applications. They work on different systems of the physiology. Learning regulation of one modality does not mean regulation of every other modality. I have worked with professional biofeedback practitioners who have used one or two biofeedback modalities for a long time who find it challenging to reach criteria on a modality that they have not used before. The same would be even more significant for their clients. There can be additional benefits gained by learning regulation of other modalities.

    Following is a basic review of the major biofeedback modalities:

    ===EMG (Elecromyograph)===

    Measures the electrical activity coming from the skeletal muscles. It works on the voluntary nervous system. The voluntary motor cortex initiates skeletal muscle control.

    In stress management EMG is used to help a person to become more aware of excess muscle contraction. We use the EMG to help people learn to relax their muscles. This can be useful in general stress reduction, tension headaches, muscle spasms, muscle pain, anger management, and other applications. EMG can also be used in an opposite way to help people increase muscle contraction. Some of the applications for teaching muscle contraction are muscle rehabilitation, stroke, physical therapy, strength training, and pelvic muscle disorders including incontinence.

    I like to use EMG biofeedback as the first modality that I demonstrate to people because I find that it is the easiest for people to learn to control. It seems to respond the fastest and it is relatively easy for a person to know what they have to do to make the level improve.

    ===Skin Temperature===

    Changes in skin temperature are caused by the constriction or dilation of blood vessels in the hands or feet. Sympathetic nervous system activation causes constriction of the blood vessels due to contraction of the smooth muscles in the walls of the blood vessels. When a person is able to decrease their sympathetic nervous system activation, the smooth muscles in the blood vessels relax and the blood vessels dilate. This causes more blood to circulate and increases the hand or foot skin temperature. Applications of temperature training include: Migraine headaches, hypertension, asthma, and Raynaud’s Disease.

    ===Skin Conductance/Electrodermal===

    Affected by the sympathetic nervous system. Measures conductance on the fingers or palm between two sensors. Changes in the amount of sweat on the skin affects the level of conductance. When there is less sweat the conductance is lower. When there is more sweat the conductance is higher. Emotional reactivity or arousal causes an increase in the conductance level. Some of the standard applications for Skin Conductance are anxiety, phobias, PTSD, and looking for and dealing with reactivity during psychotherapy.


    There are several types of respiration biofeedback devices. The most popular type is called a strain gauge. It uses a sensor band that is placed around the abdomen, chest or both. It includes a flexible sensor that stretches as the subject inhales. It gives feedback about the relative expansion of the abdomen or chest and the rate of breathing. Respiration is under both voluntary and involuntary control. We breathe when we are not thinking about it, even while sleeping. When we are focused on our breathing we can control how deeply and at what rate we breathe. The respiration sensor feedback can help a person learn this control more effectively than verbal instructions alone.

    EMG sensors can be used instead of strain gauge sensors. They can be placed in the abdomen area to measure the contraction of the muscles used to breath abdominally. Another set of sensors can be placed on the upper trapezius (upper back area) muscles and scalene (front-neck/throat area) muscles to help reduce thoracic (upper body) breathing.

    Another device called an incentive inspirometer uses a piston in a cylinder that has volume markers. It has a mouthpiece and tube connected to it. As a subject breathes in through the mouthpiece the cylinder rises to indicate the amount of air the person is breathing in. This can be used to help a person learn how to increase the amount of air they breathe in. It can also be used in combination with an EMG instrument to keep the breathing abdominal and not thoracic.

    The last device called a capnometer measures and gives feedback for end-tidal CO2. It uses a tube that goes into the nostril of the subject to measure the CO2 in their breath. It can also measure breaths per minute. Some people consider this type of respiration feedback the most effective and exact but it is not as widely used.

    Respiration should be used with almost all stress reduction applications. It is one of the easiest ways to help a person learn to initiate the relaxation response. It is notably helpful with asthma, anxiety, phobias, and hypertension. It can also be helpful in teaching a person to warm their hands when using temperature biofeedback.

    ===Heart Rate/Heart Rate Variability===

    Heart Rate is affected by both Sympathetic and Parasympathetic systems. Twenty years ago I only remember hearing about people in biofeedback working with heart rate. The goal was to decrease elevated heart rates to a normal level. In recent years heart rate variability has become the new hot modality. Heart rate is supposed to increase when a person inhales and decrease while they exhale. This is called the respiratory sinus arrhythmia (RSA). The RSA shows the heart’s ability to adapt to changing demands. Heart Rate Variability is often combined with respiration training. When this is done the goal is to get the heart rate and respiration to be perfectly in-phase. The peaks and valleys of both the heart rate and breathing should match. Other goals are to train the subject to breathe between 5 and 7 breaths per minute and to maximize the amplitude of the heart rate oscillations at 0.1 Hz in the low frequency range. Many people are using HRV training for almost all applications. Some of the applications that I am most comfortable with are anxiety, hypertension, asthma, general stress reduction, and performance enhancement.

    ===Electroencephalograph (EEG)===

    EEG biofeedback is associated with the Central Nervous system. EEG measures the electrical activity given off by brain activity. The raw electrical signal is broken down into various frequency bands from the lowest Delta to the Highest Beta and Gamma. The different frequencies are associated with different mind states like sleep, relaxation, or focused attention. EEG can be measured from various parts of the brain. The expected amplitude of the various frequency bands varies with the location since different parts of the brain have different functions. EEG feedback helps a subject learn how to increase or decrease the amplitude of a frequency band to normalize brain activity. There are many applications of EEG biofeedback since the brain controls so many functions. Some of the applications include ADD/ADHD, learning disorders, head injuries, stroke, substance abuse, insomnia, anxiety, and performance enhancement and even pain.

    I hope that this might stimulate your interest in any of the modalities that you have not been using. For more detailed information on each modality I suggest the following resources:

    “Biofeedback, A Practitioner’s Guide”, Mark S. Schwartz, Frank Andrasik (book)click here

    “Biofeedback and Somatics”, Eleanor Criswell, Ed.D. (book)click here

    “Biofeedback Tutor”, Fred Shaffer, Ph.D, (a CD) click here

    “Biofeedback Bootcamp”, Fred Shaffer, Ph.D, (an Online Course)click here

  2. Announcements

    Thought Technology announces its new BioGraph Infiniti version 4.0
    BioGraph Infiniti version 4.0 is compatible with Windows Vista, and comes with over 100 exciting new features and new functions . The upgrade cost is US$150. If bundled with the purchase of one EEG Suite or Physiology Suite, it will only be $50. Please contact us about your upgrade options.
    Major new features of 4.0 version:

    • Z-score neurofeedback (5 new screens added to the EEG Suite)
    • Dual Threshold Feedback (useful for coherence, phase, z-score, etc.)
    • Built-in Programmable Respiration Pacer (6 new screens added to the Physiology Suite)
    • Heart Rate Variability (HRV) Resonant Frequency Detection (6 new screens added to the Physiology Suite)
    • Pulse transit time feedback (delay between EKG R-spike and finger pulse) (3 new screens)

    The hardware devices and basic software functions for Slow Cortical Potentials (SCP), Evoked and Event-Related Potentials (EP/ERP), Reaction Time Testing and Joint Time Frequency Analysis (JTFA) are also be available with 4.0 version. However, the specialized application Suites are still under development, and are expected to be released in 2008.
    For details go to:
    Biograph Infiniti 4.0

    EEG Suite
    Physiology Suite:

    Or call 877-669-6463 or 914-762-4646

  3. Biofeedback and Neurofeedback Training 2008 Schedule

    Apr 5-9, 2008 – Hawthorne, NY
    Aug 2-6, 2008 – Chicago, IL
    Oct 25-29, 2008 – San Francisco, CA

    May 2-5, 2008 – Hawthorne, NY
    Jul 11-12, 2008 – Hawthorne, NY (Advanced)
    Nov 7-10, 2008 – Hawthorne, NY

    For details go to: click here
    Or call 877-669-6463/914-762-4646

  4. New Brain Training Software

    MindFit is a computer program that has been specifically designed for adults who wish to actively maintain a vital, agile and vigorous mind. The program is designed for use on a Microsoft Windows based computer; it is easy to use and requires minimal computer knowledge. MindFit is based on scientific studies of the adaptability of the adult human brain which have shown that training can bring about an improvement in mental abilities. The software is geared to the adult population and instructions are given both as written directions and verbally. There is a self-assessment section followed by a training section with varied, challenging tasks.

    The self-assessment takes about one hour and is divided into three sittings. The results of the assessment are compared to norms to determine the strengths and weakness of the user. It must be emphasized that the whole process is anonymous for maximum protection of the individual’s privacy.

    For details go to:click here

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