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Introductory Clinical Biofeedback

– Table of Contents –

Introduction
Frequently Asked Questions
Perspective
Biofeedback and Stress Science
Coaching
Timing and Sessions Structure
Three Concepts Underlying Successful Neurofeedback Learning
Summary
Glossary
Introduction

This free online e-learning course should take about one to two hours to complete, and we believe provides a solid introduction to biofeedback and the information you need to continue your learning in this extraordinary field, and to learn in the most time and cost effective ways possible.

We can recommend many books to supplement your learning. Two that are especially useful would include: Biofeedback, A Practitioner's Guide, Schwartz, Mark S. and Associates, Guilford Press, 1995; Biofeedback and Somatics,Criswell, Eleanor, Ed.D., Freeperson Press 1995. These and other relevant books can be ordered from our website or by calling our toll free number.

Having been deeply devoted to biofeedback and applied psychophysiology for over thirty years I must confess that it is no easier for me to be objective about this amazing field than it would be for an astrophysicist to be completely objective about the majesty and mysteriousness of the universe. Nonetheless we will do our best to assist you in understanding this 'technology of self knowledge' the way it actually is so that you can efficiently put it to work for you. Maybe the astrophysics analogy is fairly apt, because in a sense biofeedback deals with the challenges of 'inner space'. In fact I at least some of the astronauts and many scientists believe that achieving success in outer space is critically linked to our achieving major successes within our own inner space.

We think that the best way to provide information and insights for you is by the use of a series of Frequently Asked Questions derived from hundreds of practitioners over decades. Some of the answers will be longer than the FAQ's you are probably used to. We invite your comments and suggestions as to how we might continue to improve this free e-learning biofeedback course.

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Frequently Asked Questions

Following are 31 FAQ's from the certification training section of our website. Some of the information may be redundant.

  1. When and where is professional training available?
  2. What is Biofeedback, Neurofeedback and Applied Psychophysiology?
  3. Who can practice Biofeedback and Neurofeedback professionally?
  4. Is Certification necessary in order to become a practitioner?
  5. What is the minimum of training I need in order to get started?
  6. Why Biofeedback Certification Institute of America (BCIA) Certification?
  7. What Certification is available?
  8. What training does Health Training Seminars Offer?
  9. What is the content of the clinical training and certification programs?
  10. What is the National Registry of Neurofeedback Providers (NRNP)?
  11. Why choose this program?
  12. What will I learn?
  13. How well established is Biofeedback in traditional and integrative medicine?
  14. What consulting services do you offer?
  15. Why do you differentiate between traditional Biofeedback and Neurofeedback?
  16. Who is on the Health Training Seminars faculty?
  17. How do I build a successful Biofeedback practice?
  18. How do I select the right equipment for me?
  19. What do others say about Health Training Seminar's ability to help you achieve your goals?
  20. How is my timing for entering this field?
  21. Is the technology difficult to master?
  22. Do you offer internships?
  23. Do third party payor's reimburse for Biofeedback?
  24. What are the educational objectives?
  25. Do you offer online training?
  26. What are BCIA certification requirements and how do I fulfill them?
  27. What are the Qualifications for BCIA EEG Certification?
  28. How much will it cost me to get started?
  29. What is the Biofeedback Certification Institute of America?
  30. What do I do if I cannot qualify for certification?
  31. What are the benefits of Certification in EEG Biofeedback?
What is Biofeedback? The Technology of Self Knowledge

Biofeedback; bio means living. Feedback is a term coined by the mathematician, Norbert Weiner, to mean a method of controlling a system by reinserting into it the results of past performance. Without feedback systems, for example, controlled rocket flight would be impossible. Biofeedback itself came out of the field of cybernetics in the 1960's. It means the method of controlling a biological system by reinserting the results of its past performance. Most clinical grade instruments feedback information within fractions of a second. Biofeedback uses instrumentation to collect data and present it as a reinforcement to alter behaviors of the biological system. A good example is the use of a blood pressure system to give visual and auditory signals and information to the subject who then uses that information to change his blood pressure.

Although the term biofeedback was chosen by the founders of the Biofeedback Society of America about 1969, biofeedback itself is many thousands of years old, since its practical meaning is the use of technology to reflect information back to the user for the purposes of enhancing control of the mind and body. A mirror, weight scales or a target are examples of ancient biofeedback 'instruments'. Biofeedback is a technology of self-knowledge, and it is among the most widely accepted of the holistic, alternative medical modalities. In fact, most health care practitioners knowledgeable about biofeedback probably consider it to be a main stream medical form of therapy, especially, when applied to stress related disorders and rehabilitation etc. Biofeedback training implies a high order of heuristic learning. It is of that deeply creative kind of learning whereby the learning and the doing are one.

Heuristic, that method of learning whereby the learner is encouraged to learn with as little dependence on outside authority or past experience as wisdom deems appropriate.

The skillful biofeedback practitioner is constantly developing better ways of assisting the client in strengthening his or her own capacity to self-teach the most practical and powerful of all skills - enhancement of mind/body performance. In theory anything learned with the assistance of biofeedback instruments could be learned without them. However, most find that they can learn many valuable skills much faster and more simply by using biofeedback instrumentation. For example, Viet Nam veterans in the mid sixties who had been disabled learned to regain control of injured muscles often in one tenth the time that learning the same level of control would require using traditional rehabilitation therapy without biofeedback.

How does biofeedback work?

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There are several sophisticated psychophysiological theories that are often used to explain the effectiveness of using biofeedback instrumentation. Most traditional psychologists explain biofeedback's effectiveness in terms of operant conditioning and behavioral modification. Some scientists feel that the traditional explanations only partly explain the effectiveness of biofeedback over the wide range of disorders and learning strategies to which it is being applied. However, in keeping with our belief that biofeedback can be understood through fairly simple explanations we offer the following concepts:

    1. The scientific, medical, and educational communities take biofeedback to generally mean the use of extremely sensitive scientific (usually electronic and computer assisted) instruments which can feed back information to the user which would normally be too subtle for the learner to be aware of in normal consciousness. Biofeedback could be compared to a telephone to one's insides or a magnifying glass. By massively amplifying these internal signals or cues the user can learn to gain control over mind/body functions that were previously not controllable due to insufficient sensitivity on the part of the learner.

One of the peculiar characteristics of increased mind/body control acquired through the use of biofeedback is that the individual eventually learns to exercise the same level of control without the biofeedback instruments that they achieved with the use of the instruments. It is believed that using the instruments allows the learner to increase his internal awareness so much that (s)he 'awakened' to the natural biofeedback instruments within the body. Another interesting aspect of biofeedback training is that the skill once learned is usually not easily forgotten.

  1. Revelatory, often inspirational insight. When used skillfully biofeedback instrumentation can dramatically magnify and make clear the connection between the mind and body and the way they effect each other. Most of us pay lip service to the notion that the mind and the body are one. However, the inescapable reality of the integration of mind and body often hits the biofeedback beginner like a thunderbolt. Most immediately see that they can bring major beneficial changes to the mind through careful changes in the body and vice versa. This practical, real world insight seems to fill most people with a sense of inspiration and the desire to work hard to bring these many benefits to themselves (and often their loved ones as well).

In fact this concept is expressed by the mind/body principle first made famous by Elmer Green Ph.D. in the late sixties as he and others were essentially inventing the scientific art form we now call biofeedback.

"For every physiological event, conscious or unconscious, there is the appropriate and corresponding mental-emotional event, conscious or unconscious; and conversely for every mental-emotional event, conscious or unconscious, there is the appropriate and corresponding physiological event, conscious or unconscious."

MAJOR BIOFEEDBACK INSTRUMENTS

The three major nervous systems of the human being are instrumented in biofeedback making it possible to work in a classic way - from the easy to the more difficult - from the outside in.

Voluntary Nervous System (VNS)

ELECTROMYOGRAPH (EMG)

The EMG measures the electrical activity of the muscles (primarily the firing of motor neurons).

Autonomic Nervous System (ANS)

TEMPERATURE

Very sensitive electronic thermometers measure temperature of the skin (usually of the hands and feet). Blood increases or decreases to these areas depending on increasing or decreasing fight or flight arousal.

SKIN CONDUCTANCE (SCR)

The SCR measures relative flow of electrons across the surface of the skin (primarily the hands). This flow increases or decreases depending on the amount of conducting fluids on the surface of the skin (primarily sweat). These fluids tend to increase or decrease depending on arousal of the ANS.

BLOOD PRESSURE AND HEART RATE

Blood pressure and heart rate modification strategies can be learned when the precise information from these cardiovascular activities are fed back quickly enough and in small enough increments.

Central Nervous System (CNS)

ELECTROENCEPHALOGRAPH (EEG)

Probably the most glamorous of the biofeedback modalities. Measures brain waves enabling the user to modify brain electrical activity to a remarkable degree.

There are many other kinds of instruments which may be used for biofeedback (a bathroom scale, or mirror for example), but the instruments described above are by far the most widely used both in health care and education.

What is Biofeedback Certification?

There are several organizations which offer practitioners the opportunity to become board certified. We are accredited to do certification training by all of them. You can obtain further detail on certification at the Certification Training FAQ section on our website.

Is this course for the interested layman as well as the professional?

Yes, why not? The value of this kind of training for health care practitioners is obvious. However, it is clearer than ever that we all individually must take responsibility for our own health care. And the medical industrial establishment has been tragically delinquent in educating the lay public as to the benefits of biofeedback and other relatively low cost holistic health strategies. Biofeedback is an extremely powerful preventative strategy which leads to less dependency on more expensive forms of health care including medications etc.

Many excellent biofeedback practitioners were once lay persons who received outstanding benefits from biofeedback therapy, and were inspired to get trained and enter this part of the health care field. In the 90's, health care and education accounted for about 13% of the GNP. Within 15 years the two fields combined are expected to account for about 20% of a far larger GNP. So with all the problems facing the American health care and educational revolutions, health care still offers high growth and great career opportunities.

Is biofeedback applicable to Peak Performance, Super Learning and Life Enhancement?

There is a rapidly growing interest in what we call MindFitness (Life and Performance Enhancement Learning). We believe this kind of education of relatively functional people who want to maximize the quality of their lives will eventually exceed even the clinical market. In its essence biofeedback is an educational super tool. We believe most people can substantially increase the learning curves of many valuable skills by undergoing skillfully administered biofeedback training. In fact, a growing number of educators and scientists believe biofeedback training is one of the greatest technological breakthroughs in both medical and educational history. To increase your understanding of our approach to MindFitness Training® we invite you to take our free e-learning training program. The book MindFitness Training: Neurofeedback and the Process by Adam Crane and Richard Soutar Ph.D. is available from Amazon.com, our website and other online booksellers.

What does it take to get started as a biofeedback practitioner?

The short answer is to get proper training and quality equipment and get started. The doing is the learning. There are many details as to costs, qualifications etc. available on our website. Even simpler call or email us.

What is Applied Psychophysiology?

Psychophysiology is the study of the interrelationship of physiological systems, cognition, social and environmental parameters, and health. Applied psychophysiology is the application of the results of information derived from the study of psychophysiology. The equipment used in biofeedback is derived from and applicable to scientific psychophysiological studies.

How can I learn about and acquire best equipment at best values for my needs?

There is a great deal of information on our website. You can call, email or fax us your questions. Naturally we want to be your biofeedback company, and one strategy we use to make it more comfortable for you is to handle virtually all of the equipment available that satisfies our standards. There is a wide variety of equipment available. We can usually ask you a few questions and quickly recommend the equipment that is most appropriate for your applications. Leasing and credit card financing strategies are available. Of course, the BCI Certification seminars offer the fastest way to train, as well as hands on experience with different kinds of biofeedback systems and modalities.

What will I learn in the next modules of this course?

The next modules are designed to provide you with most of the competency based didactic training that we currently provide in our live seminars. This course is based on the Biofeedback Certification Institute of America's blue print for certification training.

 

Certification Requirements

As of 2004, all General Biofeedback BCIA Certification candidates are required to complete a minimum 92 hour training program, and BCIA EEG Certification candidates are required to complete a minimum 105 hour training program as described herein.

 

 

Blueprint for General Biofeedback

Hours

Orientation to Biofeedback 4

Stress, Coping & Illness 4

Psychophysiological Recording 8

SEMG Applications 8

Autonomic Nervous System Applications 8

EEG Applications 4

Adjunctive Intervention 8

Professional Conduct 4

Total Hours 48


Mentoring Requirements

Personal Feedback : 10 sessions(minimum 20 min. each)

Patient/Client Contact: 50 sessions, 25 each of EMG & Thermal (minimum 20 min. each)

Direct Mentoring Contact: 20 hours with 2 hours face to face contact

Case Presentations: 10 case Presentations

Blueprint for EEG Biofeedback

Hours

Orientation to EEG Biofeedback 4

Basic Neurophysiology and Neuroanatomy4

Instrumentation & Electronics 8

Research 2

Psychopharmacology Considerations 2

Treatment Planning 12

Professional Conduct 4

Total Hours 36


Mentoring Requirements

Personal Feedback: 10 sessions(minimum 20 min. each)

Patient/Client Contact: 100 sessions(minimum 20 min. each)

Direct Mentoring Contact: 25 hours with 2 hours face to face contact

Case Presentations: 10 case Presentations

 


 

What are the clinical applications of biofeedback?

Biofeedback should always by thought of as adjunctive. That is, it is always combined with other therapeutic or educational strategies. It is theoretically possible for a highly motivated person to simply acquire instrumentation and train themselves by themselves; however, we think this would almost always be a mistake. The assistance of a properly trained professional will yield a much greater chance of success. Furthermore, the only reason to experiment by yourself would be to save money; however, assistance from a qualified professional will almost certainly yield a much better return on the total investment because of the integration with appropriate training techniques and the value of your time.

After all, the biofeedback instrumentation is designed to assist the user in learning how to achieve the same degree of psychophysiological control without the instrumentation as they can with it. We are particularly referring to clinical biofeedback applications. Performance enhancement applications of biofeedback are often learned without the assistance of a professional. However, we believe that the right kind of professional coaching can lead to superior results and a better cost/benefit ratio as well for most people learning biofeedback assisted performance enhancement. That is why we developed the Mindfitness training program and Life and Performance enhancement coaching services.

There are over 400 disorders for which biofeedback is adjunctively used. In addition there are performance enhancement and other learning applications. Some of the most common follow:

AREAS OF REFERRAL FOR BIOFEEDBACK TREATMENT
anxiety disorders, behavioral control - drug / alcohol / smoking / weight, bruxism, cardiovascular disorders, chronic pain, diabetes, educational applications, epilepsy, incontinence (fecal & urinary), ob/gyn, pain, psychotherapy, sexual disorders, sleep disorders, speech disorders, sport applications, stress management, special services to children (hyperkinesis, learning disabilities).

AREAS OF REFERRAL FOR BIOFEEDBACK TREATMENT IN STRESS RELATED (PSYCHOSOMATIC) DISORDERS
asthma, blepharospasm, dermatitis, dysmenorrhea, essential hypertension, migraine & tension headaches, hyperhidrosis, insomnia, irritable bowel syndrome, myofascial pain, psychogenic emesis, raynaud's disease, tinnitus, writer's cramp, performance anxiety.

AREAS OF REFERRAL FOR BIOFEEDBACK TREATMENT IN REHAB MEDICINE
causalgia, cerebral palsy, esophageal motility disorders, dysphagia, guillian barre syndrome, hemiplegia, multiple sclerosis, neuromuscular reeducation, orthopedic recovery enhancement, paretic muscles, parkinson's disease, post-cva rehabilitation, reduction of spasticity and hypertonicity, respiratory disorders, spinal cord injuries, stress management, stroke, tendon transfer, tic, torticollis.

ADDITIONAL AREAS OF REFERRAL FOR BIOFEEDBACK
anger states, backache/neck pain, balance disorders, cardiac arrthymias, carpal tunnel syndrome, chronic fatigue syndrome, depression, frigidity, impotence, balance disorders, postural dysfunction, scoliosis, sinus tachychardia, neurodermatitus/eczema, hyperventilation and performance and life enhancement applications.

How can I find out about biofeedback research?

Much of the most important research is covered in our seminar courses. On our website you can acquire professional textbooks which contain thousands of research citations. We estimate that there are over 10,000 biofeedback and applied psychophysiological studies which are relevant to this field and more coming out all the time. One of the objectives of our training is to assist you in finding those studies which are most relevant to your needs.

How is biofeedback applied to performance and life enhancement?

All of the biofeedback instruments mentioned, and more, have been applied to performance enhancement. One of the reasons is that all biofeedback learning leads to reduction of the maladaptive stress response, and that leads to enhanced learning curves and increased energy. Currently, the most popular form of biofeedback for performance and life enhancement applications is neurofeedback (EEG). We refer you to our free e-learning MindFitness and professional EEG courses for additional insight into EEG (brain wave) biofeedback.

Is it possible to learn enough about biofeedback to become a practitioner without coming to a professional seminar?

As they say, almost anything is possible. It is obviously easier to learn by attending live training events. However, our goal with e-learning is to make it possible for people all over the world to learn enough about biofeedback over the Internet so they can deliver quality biofeedback training no matter how remote. The goal is also to bring the cost of biofeedback professional training down.

How do I learn more about biofeedback online?

Take our two additional free courses and our Biofeedback Bootcamp and then take advantage of our advanced e-learning courses as they are developed. By all means read our back newsletters archived on our website and subscribe to our free email newsletter.

Do you have to know a lot about technology and computers?

No. The fact is that many of the health care professionals and educators who go through our programs are excellent therapists and teachers, and have spent their lives learning how to be 'people' people. They have not had the need to learn a lot about technology or computers. For decades we have made it our business to teach them what they need to know in order to be excellent biofeedback practitioners. Sometimes the learner is even a little techno or computer phobic. They are usually delighted to realize that learning the technical side of biofeedback is not that difficult.

It is like driving a car. It is possible to become an excellent driver without knowing everything about cars and engines etc. Of course, there are some technical things which must be learned but they are not that difficult. What is more difficult is to find the best therapy and educational strategies to go along with the instrument work. Most people interested in this field consider the therapy and educational part to be relatively easy because it is simply an extension of what they have been doing all along.

Do insurance companies pay for biofeedback services?

Of course. However, biofeedback is subject to the same third party payment restrictions that apply to the rest of the health care system. As is the case with virtually all medical and psychological modalities biofeedback practitioners use many billing strategies depending on diagnoses, credentials, insurance carriers, HMO or managed care requirements etc. As is the case with everything in health care we are aware of the more the practitioner learns about best billing strategies for his or her situation the more profitable the practice will be. It takes sustained ongoing research to maximize profitability.

It is also important to keep in mind that well over 50% of all moneys made in the health care business are derived from private pay and self insurance. Many of the most successful practitioners are careful to integrate these kinds of patients into their practices because they are often the most profitable. They are trend setters, and others frequently ask them to recommend health care services. We devote a good deal of our training to this subject. Also, we provide consulting services for those who want to increase their biofeedback business skills.

How much can I make?

Biofeedback practitioners generally bill between $75 and $150 per therapy hour (some considerably more). However, the same equipment which is used for biofeedback can also be used for assessments and tests which are often billed at higher rates from a time perspective. We encourage practitioners to think of their practices as small businesses. This can lead to additional strategies for increasing practice revenues. For example, a substantial amount of biofeedback therapy and education can be conducted in groups. Depending on the credentials and/or licensing and management skills of the practitioner, supervision of other practitioners can lead to additional revenues.

How difficult is it to earn a living in biofeedback?

The way I usually handle this question is as follows: First learn enough about biofeedback to determine whether you really want to do it. If you do, especially if you love it as many of us do, then come on in. You should do fine. If you are not really attracted to it after you have learned about it in depth, but are only considering it as a way to earn a living we do not encourage you (unless you already have a job and this is a necessary part of it) because biofeedback takes commitment and is to some degree an art. You need to love an art to be really good at it. Also, we believe that our economy is so diverse that it should be possible for most of us to find work that we really like, if not love.

Perspective

When I teach training seminars I try to put myself in the place of the seminar participants. So that usually means doing my best to make the art - science of biofeedback assisted self-regulation as simple, understandable, and fun as possible. The best way I know to do this is to just tell the story while showing the participants the basics in a logical, traditional learning structure, which gently leads from the gross to the subtle, from the easy to the more difficult.

To me the story of biofeedback is one of the most exciting and beautiful of our time. From its humble beginnings to the incredible drama and glamour associated with advanced applications, the promise of biofeedback substantially enhancing self-regulation of the body and qualities of consciousness is capturing the imagination of some of the best thinkers, scientists and philosophers we have. The thing to keep in mind about biofeedback is that its essence implies substantially greater learning curves, enhanced qualities of consciousness and virtually unlimited growth in terms of self-knowledge.

I entered the biofeedback field 30 years ago because it is a technology of self-knowledge, and self-knowledge leads to healing for the individual and the culture as a whole. Like millions of others, I believed it should be possible to learn how to be an artist of living. So I set about searching for the best ways I could find to learn. Recently, I began to call this relatively unorganized collection of insights, perennial principles, strategies, methods and techniques The Process® of achieving Mindfitness®.

There is a growing consensus that fear and wrong conditioning lie at the root of human suffering and ecological irresponsibility. Many scientists believe we already know how to solve most of the worst problems we face worldwide; however, political and other factors that are based on inappropriate conditioning and fear are preventing the implementation of potential solutions, which in some cases were worked out long ago. We assert that skillfully applied biofeedback assisted self-regulation learning can reduce maladaptive stress, fear, and unhealthy conditioning more effectively for most people than virtually any other method we are aware of (with the exception of spontaneous explosions of intelligence, creativity and mystical insights).

However practitioners report that biofeedback seems to facilitate even these mysterious altered states in some people. It seems clear that biofeedback can substantially increase the learning curve of those individuals eager to teach themselves the art and science of attending more profoundly, of going deeply into the mind and activating latent orders of exceptionally high intelligence (some call this meditation).

To us the logic is compelling. We assert this kind of heuristic learning can make a substantial contribution to society because:

  1. We have long had the resources and the know how to transform this earth and our societies.
  2. However, we have prevented ourselves from achieving much greater collective success because of the aforementioned conditioning and fear and lack of the exercise of deep attention to the actual fact of 'what is'.
  3. Once we develop ways to assist some reasonable percentage of the population in reducing this fear and unhealthy conditioning we will relatively quickly make the changes that begin to solve the immense problems we are facing.
  4. The same creativity that transforms the quality of our own lives will naturally extend into society as a whole.

Finally, we have a full blown economic crisis in our health care system, and so do most other countries as well. In the US we are inventing extraordinary new therapies at an exponential rate. However, fewer and fewer of us can afford quality medical care (50 million in the US alone are uninsured or seriously underinsured). Joseph Califano urgently warned us of this impending crisis in his 1986 book entitled America's Healthcare Revolution: Who Lives, Who Dies, Who Pays. Long ago it was clearly demonstrated that appropriate psychological (self-regulation) training would reduce over all health care costs more than any other single health care strategy. We believe many of those same self-regulation strategies can be made far more effective when skillful biofeedback training is added.

My arithmetic tells me that nothing in common practice today or on the scientific horizon beats the cost saving capability of skillful integration of biofeedback assisted self-regulation training into our entire health care system. We are looking at this from a hard nosed accounting perspective, and that means we take into account those for whom biofeedback is contraindicated for whatever reason. We are simply looking at the cost benefit numbers from the perspective of how much does it cost to render quality biofeedback services to those for whom it is indicated, and how much will be saved as a result over the life of that patient. This potential for biofeedback to bring about major efficiencies within our system has been a strong motivation for many of us devoted to this 'Technology of Self Knowledge'.

It is good to meditate on these concepts, because when challenges emerge it will empower you to know that you are sowing and harvesting in a field that has the potential to bring almost unimaginable benefits to humanity and indeed all of the natural world.

Biofeedback and Stress Science

Although biofeedback has hundreds of applications, practically all clinical and educational applications begin with reduction of unhealthy stress so that healthy stress can increase (yes, there is healthy stress). Stress is an engineering term which simply means change. So stress science implies learning how to reduce unhealthy change so that we can have more healthy change. Therefore, any biofeedback practitioner worthy of the title must be skilled at stress management. This implies walking the talk. The easiest, and I believe most successful way to teach stress management, is to begin with relaxation of certain key muscles. Consequently, the first instrument which is used in most biofeedback protocols is the electromyograph (EMG). By placing electrodes (biofeedback practitioners prefer to call them sensors) on particular muscle groups it is possible to teach a person how to produce exceptionally deep relaxation of the muscles (voluntary nervous system (VNS). From there the practitioner will usually use other instruments and other strategies to increase the clients stress science learning curve.

THE PSYCHOPHYSIOLOGICAL STRESS PROFILE (PSP)

Actually, we have gotten a little ahead of ourselves because the most effective strategy to employ with most clients is to do a psychophysiological stress profile before you begin biofeedback training. A PSP is simply the measurement of physical responses to mild stressors. The same instrumentation used to do biofeedback is used for the PSP and many other assessments. Although a skilled practitioner can do a PSP using stand alone instruments, PSPs are usually done using computerized equipment because you can get much better information. The time savings and enhanced quality of information makes computerized systems more cost and time effective while delivering enhanced quality of training to the client. The computerized systems we recommend make it easy to measure muscle, temperature, skin conductance, blood pressure and heart rate. Even EEG can be added.

The PSP protocol we like takes about 20 minutes and it is divided into five four minute trials. The first four minutes is a base line and the client is requested to simply sit normally and relax. At the beginning of the next four minute period the client is asked to count backwards out loud using serial sevens from 2197 as fast and accurately as he can. The next four minutes (s)he is asked to simply relax. The next four minutes the client is asked to talk about a real life stressor. This takes some skill on the part of the practitioner since the client may try to evade the real stressor by substituting a fake or very mild stressor. The final four minutes the client is instructed to simply relax. In this way the clinician can gather valuable information about what the client's base line physical levels of arousal are, how high the arousal goes up when mildly stressed and how quickly the system returns to homeostasis (balance).

It is a good idea to do a PSP before the first intake interview, again about half way through the total training program and finally when the patient is released. By the way, PSP's are usually billed separately as assessments and not as biofeedback therapy. It is important to do the PSP before you start training and even before the intake interview because once you start training the client will begin learning how to manipulate the instruments, eliminating the opportunity to get a quality assessment of pre-treatment stress levels and recovery skills.

With very little exception, relaxing the voluntary nervous system causes the autonomic and central nervous systems to relax and move towards homeostasis (balance). It is usually easier to learn to deeply relax the muscle system than it is to gain similar control over the other nervous systems. This is why we usually begin with EMG. Most traditional biofeedback protocols will begin temperature training once the EMG training goals are achieved. Temperature training is usually considerably more difficult, but the rewards of success can be even greater for most people. One out of five adults will be able to warm their hands to criteria ( 5 degrees above baseline) the first time they try. Note: four out of five children can warm their hands first time they try while only one out of five adults can. Let that be a powerful clue. Biofeedback assisted self-regulation training has much in common with a childlike, playful state of mind. Most people miss their 'lost' childhood. So in a way, one of the benefits of this kind of learning is that we come back, in some sense, to what we have lost. It is widely believed that anyone can learn to warm their hands at will, although it might take some of us a couple of months and many practice sessions.

Believe it or not many practitioners stop with those two instruments. And they can get very good results using only EMG and temperature feedback. However, we try to persuade the practitioners we train to go the extra distance and learn to use EDR, blood pressure, heart rate, and sooner or later even EEG (for those ready for considerably more learning, and what we believe is a whole new dimension of health care and education).

Electrodermal (EDR -Skin Conductance) is a powerfully effective biofeedback instrument when used skillfully. It is very sensitive to even small autonomic (emotional) changes which is why it is the most important measure used in polygraphs ('lie detectors'). One of the most valuable applications of EDR is to demonstrate the powerful effect of thoughts and feelings on the physical body. Most are amazed to see how simply thinking about something stressful can cause the EDR to go flying off scale. By the same token the instrument is equally effective in assisting the client in learning strategies which restore homeostasis and relaxation, thereby reducing unhealthy stress. Because of its sensitivity to temperature, humidity and variances in sensor pressure, skin calluses and other factors it takes a little training to be able to use the EDR in the most effective ways. However, the training results are very much worth the effort.

Blood pressure biofeedback research began in the late sixties. Obviously, in order to do blood pressure biofeedback there must be an instrument for measuring blood pressure. For over a decade most practitioners doing biofeedback assisted blood pressure treatment simply used the old standard hand pump sphygmomanometer. However, by the mid 1970's doctors Jim Lynch and David Paskowitz at the University of Maryland Medical Center had computerized modified ICU fully automatic blood pressure units and beautifully adapted them to biofeedback. This led to many improved biofeedback training techniques for modifying blood pressure. Integration of biofeedback blood pressure training strategies yields excellent results with most well motivated patients. However, it takes focus, dedication and patience. Usually temperature training is also used. Dr. Steve Fahrion developed a widely accepted technique which among other behavioral strategies, calls for warming the feet as well as the hands.

Heart rate biofeedback is adjunctively used in the treatment of tachychardia and sinus arrhythmia.

EEG Brain wave biofeedback (NFB - Neurofeedback) is one of the fastest growing, most glamorous forms of biofeedback. It has caught the imagination of a growing public, and several books written for the layman are already available. Although NFB is just another form of biofeedback, clinical NFB is sufficiently subtle and sophisticated as to require its own in-depth training program. Rather than duplicating information here we suggest you look at our free neurofeedback e-learning program.

 

Coaching

So far it may sound like all the practitioner does is connect the patient to the instrument and everything gets better. It takes a bit more than that. In fact, the ideal biofeedback style of training is more like a coaching or mentoring model than it is an academic model. The best practitioners have usually personally benefited from biofeedback learning, and have achieved considerable personal skill at the same strategies that they are teaching their clients. In fact, one of the techniques we recommend to professionals coming into this field is that they train themselves for at least forty hours on each instrument that they plan to use with their clients. This is one of the fastest techniques for understanding how to integrate biofeedback with the practitioner's existing therapy style. Not only that, it is also remarkably effective at teaching the practitioner how to coach the client to biofeedback assisted self-regulation successes.

Timing and Sessions Structure

Constructing a treatment plan is a highly individualistic process because there are so many different therapy styles and healing philosophies. However, the following thoughts should help you get an understanding of how you can adapt biofeedback to your way of working. First, it is possible to construct sample flow charts, and we use them in our training seminars and as hand out materials. On the other hand, if you understand some of the basic principles it should be easy to construct your own custom treatment plans and flow charts relatively easily. It is actually fairly simple and straightforward.

The first timing issue most are concerned with is how many sessions are required in order to achieve best results. Obviously, this varies considerably depending on the goals to be achieved. For example, some neuromuscular rehabilitation patients can still be receiving benefits from doing biofeedback training years after their first sessions. Also, performance enhancement clients using biofeedback (especially neurofeedback) often report that refresher sessions continue to produce improvement even though they may come years after the initial training. This is actually logical since the nature of performance enhancement learning tends to be progressive, cyclical in nature, and continues throughout life.

The practical side of the timing issues relates to economics more than it does to what is ideal for the patient. Depending on the way the billing is handled some third party payors may limit the practitioner to, say ten sessions. In that case, one does the best one can during that time, and happily the patient can often achieve a great deal of benefit by undergoing even a few well designed and inspirational sessions. However, when you ask biofeedback 'master class' and expert practitioners, they will usually encourage training for substantially longer periods. For example, we suggest that most protocols for psychosomatic and stress related disorders should be accomplished over about a six month period. One session per week or about thirty sessions is close to ideal. This allows the patient to go through a number of symptom cycles and learn how the steady application of the skills learned in the office gradually produces the desired improvement in symptoms. Of course, sometimes training the same number of sessions everyday (as in the case of in patient treatment) can also bring excellent results. Neurofeedback training protocols can vary substantially from this standard. We recommend that you take our free e-learning clinical neurofeedback course to gain insight into the differences.

In fact, the ideal treatment protocol will usually cover a two year period: once per week for about six months, then one session per month for about three months, then one session per quarter for the balance of two years. This allows the patients to continue to grow and strengthen their self-regulation skills way beyond just clinically satisfactory symptom relief. Getting paid for this amount of training is not always easy for the beginner; however, as the practitioner grows in understanding, so does his or her ability to persuade third party payors and, or the clients themselves to fund what is needed to do high quality work. It is fairly easy to show anyone substantial cost/benefit ratios for this kind of 'super learning'.

There are some protocols which will usually yield substantial symptom relief in as little as four or five session (bruxism and trapezius co-contractions are examples). And if that is all we can be paid for then we sometimes must settle for modest symptom relief and 4 or 5 sessions. However, these kinds of symptoms usually have underlying causes which take more time than just retraining the muscles enough to reduce the pain. Without attention to the underlying causes the symptoms may return. We assert that a careful cost/benefit analysis would easily show that it will cost the health care system (and the patient) far less over the long term if the underlying symptoms are treated as well as the pain.

There is another way to think about timing, and that relates to how sessions should be divided up. Once the practitioner has achieved even intermediate skill, the integration of biofeedback with other strategies happens automatically. However, in the beginning it may help to think about a particular session or all of the sessions being structured according to the following ratios: about one third of the time simply training on the biofeedback instruments, about another third education and the final third therapy. We differentiate between education and therapy.

Education is learning about mind/body specifics that are necessary in order to achieve the result. For example, the client must understand at least the basics of stress science, and this understanding must be in his idiom, not necessarily the practitioner's or teacher's. I do not think that any of the clients I've been successful with in terms of stress management and self-regulation could have achieved that same level of success if they had not had a practical understanding of the dynamics, facts and science involved. That is what we mean by education. In addition to that, there is a great deal of education which relates to the science of biofeedback, nutrition, exercise, cognitive science, meditation etc., which is necessary with many patients (maybe most) and can have the additional benefit of being highly motivational.

Therapy is also considered by many to be educational, and certainly it is but we think of therapy as different from educational in the sense most use that term. You know, most clients who come through the door already know what they should do or not do in order to reduce their symptoms and move on to an improved life. However, they have discovered that they cannot do or not do those things they should. That is where the art, the 'magic' of therapy comes in. Really good therapists can assist the patient in doing or not doing those things they are having trouble self-regulating. One of the most important characteristics of any self-regulation, self-knowledge teacher (whether biofeedback tools are used or not) is the ability to inspire the client to make a strong effort to comply with the training and therapy regimen. For many decades biofeedback has attracted professionals and healers of all kinds precisely because it is so effective in motivating the patient or client to vigorously participate in their own healing. Biofeedback is also profoundly effective in showing patients how to maximize their in-built, natural healing abilities.

Three Concepts Underlying Successful Neurofeedback Learning

(and indeed all Biofeedback learning)

In the course of my life I have had a number of teachers whom I would describe as 'masters'. I noticed that they shared certain characteristics which most of us would find intriguing and extremely useful. For example, they will usually give of themselves without reservation if they perceive the student is deeply interested and committed. Another characteristic is how quickly and easily great teachers will use the term, 'I don't know'. Then they usually follow it up with something like, 'So since we don't know let's go exploring and see what we may find out'. Another intriguing strategy is simplification and the ability to point the mind of the learner to basic principles which will serve him well. They will often say something like, "You know, it is true that this subject can be incredibly complicated; however, if you will just understand these two or three basic principles and ponder them deeply you will do very well". And then these 'master class' teachers explain the principles in ways you can understand and practically apply.

It seems to us that there are three fundamental principles which when understood and applied will almost guarantee success, as well as steadily increasing understanding and growth in skillfulness. We urge you to do all you can to understand these three things to the best of your ability. They are: Attention, The Breathwork, and Sleep.

In our seminars we spend a great deal of time on these three basic concepts. However, for introductory purposes we might add the following:

Attention Most people believe at least superficially that they can change whenever they want (especially when young). But then when the time comes to institute significant change it becomes clear that it is much more difficult than was believed. This then leads to discouragement and even depression. Yet there is at least one aspect of the human mind that can be substantially changed in most of us. That is the quality of our attention. We believe that substantially enhancing the quality of one's attention is a kind of 'end point' for human beings. The reason is that high quality attention brings about profound and complex mind body benefits to all of us.

High frequency training is believed to enhance the kind of attention needed to think more clearly (especially for people who have ADD symptoms and other similar problems). Low frequency protocols are related to 'Deep States' kind of attention. In fact, we have coined the term 'Profound Attention' (as in meditation and creative states) to indicate the kind of attention that is believed to be enhanced by low frequency training protocols in most clients.

The Breathwork refers to the importance of breath retraining for most clients. Most people, especially those suffering from stress related clinical disorders, are breathing paradoxically (thoraxically - in the upper chest). Beyond that there is a strong relationship between the electronic activity of the brain and quality of breathing. In our experience, even stress management professionals overestimate their knowledge and skill at implementing healthy, 'easy breathing' strategies for themselves and their patients. Those who approach the breathwork humbly and with an open mind can usually learn how to bring about extraordinary benefits for themselves personally, as well as their clients.

Sleep is another dynamic that is poorly understood by most health care professionals and even less understood by the lay public. A great way to gain insight into the enormous opportunities for health and healing benefits that can be gained by restoring relatively normal sleep is to read William Dement's book, The Promise of Sleep. It is common for biofeedback professionals to notice that one of the least talked about benefits of learning effective self-regulation strategies is that sleep improves. Since most of the population is sleep deprived, and since that sleep deprivation is further complicated by a poor quality of sleep, even modest improvement in quality of sleep can produce disproportionately large improvements in health and mental clarity.

Summary

We hope this introduction to traditional, mainstream clinical biofeedback has been fun. Real learning should be. We have done our best to give you the information you need in order to take the next action steps which will bring you closer to achieving your goals. For some of you that will mean acquiring equipment as quickly as you can and getting started training yourself and 'easy' clients. For others it will mean coming to one or more of our certification seminars and getting more clinical and hands-on instrument training. As you realize there are two other free e-learning courses on our website. You can also, sign up for our free e-newsletters and review old ones on our website. We invite you to call or email us with your questions and allow us to assist you in achieving your goals. Thank you for your attention. e-learning staff: Adam Crane BCIA Senior Fellow, BCIA EEG, NRNP Diplomate; Harry Campbell BCIA, NRNP; Marilyn Wexler, administration; Edwin Johnson, webmaster.

Please take a moment and give us some feedback in the form of comments, evaluation, thoughts for improvement for this course:

Glossary

Arcane from the Latin, hidden or secrete, relating to arcanum, arcana, meaning secret, mystery; a secret remedy; elixir.

Archetype the original pattern or model after which a thing is made.

Art to join, to fit together, making or doing of things that have form and beauty. A subjective definition that makes sense to me is - putting things in their right place.

Ascetic one who practices extreme self denial, especially for religious reasons.

Attention The act of applying the mind to anything; consideration or regard for any person or thing (dictionary). We suggest attention is a condition of relative neural silence in which perception and sensitivity (intelligence) are enhanced.

Attention learning enhancing and nurturing the ability to attend deeply to what is.

Biofeedback life (bio) feedback. Information which comes back to an organism about itself. See FAQ What is biofeedback?

Cohere to stick together; be united, hold fast, as parts of the same mass. In physics, to be united within a body by the action of molecular forces. To be naturally or logically connected.

Coherence the act or state of cohering. Natural or logical connection. Correspondence, harmony, agreement, rationality.

Coherence theory The theory of truth that every true statement, insofar as it is true, describes its subject in the totality of its relationship with all other things. Pragmatic theory.

Consciousness the state of being aware especially of what is happening around and within one. Having a feeling or knowledge of one's sensations, feelings, etc. Being able to feel and think, awake. Aware of oneself as a thinking being.

Dysponesis from the Greek meaning inappropriate and, or unnecessary use of energy.

Empyrean the highest heaven, among the ancients the sphere of pure light or fire, the abode of God,

Epistemology Theory or science of knowledge, treating of its origin, validity, and relation to human experience.

Heuristic the method of learning in which the student is encouraged to learn for him or herself with as little dependence on past experience or outside authority as wisdom deems appropriate.

Hypnogogic hypnopopic imagery refers to that imagery which emerges as one shifts toward sleep (hypnopopic) or comes back from sleep to consciousness (hypnogogic).

Hypothesis from the Greek hypothesis meaning groundwork, foundation, supposition. Literally 'to place under' (hypotithenai). An unproved theory, proposition, supposition, etc. tentatively accepted to explain certain facts or (working hypothesis) to provide a basis for further investigation, argument, etc.

Intelligence from the Latin intelligere - to see between the threads finely woven. therefore we suggest sensitivity is intelligence. From the dictionary - the ability to apply the mind effectively to any situation, study or problem; clear thinking plus good judgment.

Liminal a moment of equilibrium, charged with promise, when the old has not quite passed and the new is just being born. The border, or at the threshold of which, in psychology and physiology implies the least degree of stimulation that produces a response.

Meditation the art and science of evoking the highest orders of intelligence and wisdom possible for a human being.

Mutation an alteration or change. Any heritable alteration of an organism.

Mysticism the belief in a direct, intimate union of the soul with God through contemplation and love.

Profound Attention is a term (inspired by Edwards Deming's concept of profound knowledge) I coined in order to indicate there are extremely high orders of attention which are not usually recognized in traditional psychology. Also, psychology recognizes a variety of consciousness phenomena as attention (such as Molholland's 'data-capture-and-hold' type of attention. Some of these consciousness phenomena we view as orders of thinking rather than attention. Profound attention includes feelings and leads to the unfoldment of what has come to be known as emotional intelligence (EQ). There is the sense that the heart enters into the brain. I believe that neurophysiologically the brain must be extremely quiet and in this quietness it can observe thought thereby increasing the quality of thought. Such deep attention 'draws' the potential out of the moment. It might be said that this quality of attention nurtures, or causes the implicit to unfold itself becoming explicit and it does so in true real time. Meditation and love require this Profound Attention as well as evoke it. Profound attention, meditation and love may actually be the same phenomena, quality or force (similar to the space - time continuum). I believe Profound Attention can be developed, nurtured, enhanced in most human beings.

Profound Knowledge As taught by Edwards Deming it meant the capacity to see the whole (business, organization, person, a life, ecological system, etc.) system as a system. This enables the right questions to be asked. Profound Knowledge carries the notion that one must invest one's energy and resources in solving those problems which really count as opposed to wasting one's energy and resources solving problems which do not matter much or are even irrelevant. One of the best ways (perhaps the only way) to gain Profound Knowledge is through the exercise of Profound Attention.

Ontology a branch of metaphysics which studies the nature and meaning of existence.

Philosophy the serene wisdom that comes from calm contemplation of life and the universe (Webster's second definition).

Psychology the science dealing with the mind and mental processes, feelings, desires etc. learning, the acquiring of knowledge or skill.

Renaissance to be born, to be born anew, rebirth, revival.

Science from the Latin sciens, to know. The state or fact of knowing. Systematized knowledge derived from observation, study, and experimentation carried on in order to determine the nature of principles of what is being studied.

Transform to change the external form or the inner nature, to change the personality or character of.

Synchronous moving at the same rate and exactly together.

Ubiquitous being everywhere, especially at the same time.