in partnership with the

Behavioral Medicine Research & Training Foundation

Non-profit Scientific & Educational Organization 91-1948669

operating under Section 501c3 of the US Internal Revenue Code 

6576 Blue Mountain Road, Port Angeles, WA 98362

Course Description and outline for:

Introduction to Behavioral Interventions for Pelvic Floor Disorders 

45 Hours of CE Credit / Course Fee $750 

 Presented by Richard A. Sherman, Ph.D.

Concept and Objectives:

 

This course is set at the level of a typical 3 credit post-licensure, introductory level 

course. The course is targeted to licensed / certified clinicians such as psychologists, counselors, 
physical therapists, social workers, nurses, and physicians as well as to graduate students. 
Students learn by watching audiovisual lectures provided on the course web site, watching 
movies demonstrating recording techniques and interviews, reading assignments both from 
materials provided on the web site and standard texts, and interacting with their instructor via e-
mail. They answer short essay questions after each lecture rather than taking exams. Previous 
students have found that this course takes between 45 and 95 hours of work to perform.
               

This course provides a basic understanding of pelvic floor functions and structures along 

with clinical etiologies of pelvic floor disorders treated by behavioral interventions. It provides 
sufficient information on research supporting behavioral interventions, and clinical protocols for 
behavioral interventions to bring health care providers to the point where they have the 
knowledge base needed to provide these interventions to their clients within their scopes of 
practice and expertise after the providers gain hands-on experience by working with experienced 
practitioners. You may wish to contact the Foundation for information about hands-on training.

Learning objectives: The course objective is to provide the depth of knowledge in pelvic area 

A&P, psychophysiology, biofeedback equipment, and training techniques which clinicians 
require to perform psychophysiologically oriented assessments and biofeedback and other 
behaviorally based interventions for pelvic floor disorders. This information is crucial to 
effectively adding these techniques to a clinician’s practice. 

This course is designed to help you (the student):

1. Summarize the psychophysiological processes and anatomy underlying each 

1

pelvic floor condition covered in the course.

2. Use psychophysiological recording and biofeedback devices record and

 display psychophysiological information about musculoskeletal functioning
 of the pelvic floor. 

3.  Control the biofeedback display to optimize learning to correct patterns of muscle

 tension in the pelvic floor.

4.  Use psychophysiological recording equipment to assess patients with pelvic floor

 musculoskeletal dysfunctions.

5.  Use biofeedback equipment to apply specific interventions tailored to each
 

muscle related pelvic floor condition covered in the course.

6. Use behavioral techniques learned in the course to assist patients in controlling 

muscle related dysfunction patterns causing specific pelvic floor problems.

DISCLAIMER: Completion of this continuing education course is strictly for educational / 
informational purposes and does not imply competency, proficiency, and/or experience. The 
course completion certificate is not a clinical certification nor a license to practice. 

Format: Home study supported by e-mail chats after each unit is completed. The lecture 
portion of the course is presented through a series of audiovisual lectures profusely 
illustrated by power-point slides and movies. The course is accessed from the course web 
site. The audiovisual lectures are on power point slides. You will hear the instructor’s 
voice while viewing the power point sides. The lectures are between 1 ½ and 2 ½ hours 
in length. Reading assignments parallel the lectures. After watching the lecture and 
reading the assigned supporting files, you will answer a brief series of short essay review 
questions (which are in the review questions file on the course web site). The answered 
questions are then e-mailed to the instructor. You and the instructor will discuss each unit 
via e-mail chat after your answers are assessed. There is no need to complete the 
discussion with the instructor before proceeding to the succeeding lecture & chapters. It 
is expected that all review questions will be answered correctly and completely by the 
student. Any questions answered incorrectly or incompletely must be discussed and/or 
corrected. You will have at least one real-time meeting with the instructor via a web 
based program such as “go to meeting” during which you will interact around your new 
skills.

Accessibility: Hearing impaired people can view the slides only as virtually all of 

the material presented in the lectures is typed onto the slides. Visually impaired people 
can concentrate on the verbal lectures as the slide material is repeated in the lecture 
accompanying each slide. 

Accessing course materials: All course materials are available on the course web site. When 
you purchase the course, you will be given instructions for accessing the course web site 
immediately. 

Computer and Computer Knowledge Requirements:  Anybody with a modern computer and 
a bit of basic understanding of computer operation (at the level of being able to send e-mails) can 
play this course with minimal problems. You must have a computer (a) capable of connecting to 
the internet and running a typical internet program, (b) containing/running a modern word 

2

processor such as Microsoft word or Word Perfect, (c) the capability to play sounds such as 
music (has speakers and appropriate software which normally come with any modern computer), 
and (d) a slide viewing program such as Power Point (you can probably get a slide viewing 
program free off the internet if you don’t have one). Any modern (e.g., built within the last ten 
years), IBM style computer running Windows 98 and more recent platforms (e.g., XP or 
Windows 8) should be able to do this. Speed, hard disk size, and RAM are not factors for 
computers in the above category.

 Dozens of students have used recent Apple products (MACs etc.) for the course however 

they frequently have more difficulty playing the course materials than PC users do.
If you are using a MAC type of computer, you must have a current version of “quicktime”. If 
you do not have it, you can download it for free from the web.

Prerequisites & professional training requirements: You should have had undergraduate 
courses in general biology and general psychology prior to taking this course. If you haven’t had 
them, contact us before registering. You will do much better in the course if you have already 
taken our “introduction to psychophysiology” and “Anatomy and Physiology for Behavioral 
Clinicians” courses. This course is intended for licensed / certified clinicians. None of the 
instructional material offered will provide you with the clinical skills needed to apply the  
psychophysiological assessment and interventional techniques you will learn in the clinical  
environment unless you are already a trained clinician.  

Reading:

      Required: (Cost of the texts is not included in the course fee.)

a. Schwartz M and Andraskik F: Biofeedback a Practitioner’s Guide. All of section VIII 

(elimination disorders), Guilford Press, New York, 2003. ISBN 1-57230-845-1

b.  Laycock J and Haslam J: Therapeutic Management of Incontinence and Pelvic Pain. 

Springer, New York, 2002. ISBN 1852332247 (soft cover).

c.  Compendium of articles and protocols provided on the course CD. 

    Optional:

a. Dorey G: Conservative treatment of male urinary incontinence and erectile 

dysfunction. Whurr Publishers, Phhiladelphia & London, 2001.  ISBN 1-86156-302-7.
(Note: If you work with males, it is very worth your while to get this small book!)

b. Newman D: Managing and treating urinary incontinence. Health Professions Press, 

Maryland, 2002.  ISBN 1-878812-82-3 (Very good book but you can get similar material from 
the two required texts.)

c. Brubaker L and Saclarides T: The female pelvic floor. F.A. Davis, Philadelphia, 1996. 

ISBN 0-8036-0075-5  (Excellent book but you can get similar material from the two required 
texts.)

3

Faculty:

 

The course is given by Dr. Richard Sherman, Ph.D.  He is certified by BCIA, approved 

by BCIA to teach the general biofeedback certification course, and currently teaches A&P, 
Pelvic floor disorders, pain, and other courses. He is a professional psychophysiologist with 
extensive training (his Ph.D. is in biology & psychology), has nearly 30 years of experience in 
the field, and has published over 130 books, chapters, and articles (mostly in peer reviewed 
journals). Dr. Sherman is Director of the psychophysiology doctoral specialization at Saybrook 
University and has held many positions within the Association for Applied Psychophysiology 
and Biofeedback including president. Full CV available upon request and on the course web site.

Practicum and mentored biofeedback training: 

This course covers only the didactic 

portion of the material required to be competent in performing behavioral interventions for 
pelvic floor disorders. It is crucial that everybody intending to perform behavioral interventions 
for pelvic floor dysfunctions (1) hands on training in use of the biofeedback devices, (2) observe 
patients being treated for those dysfunctions of interest, and (3) receive mentoring while 
performing initial interventions. For BCIA 

(Biofeedback Certification Institute of America) 

certification in 

“pelvic muscle dysfunction biofeedback” in addition to a course in anatomy and 

physiology, 4 hours of practicum training in use of biofeedback equipment and observation of patient 
treatment are required along with 48 hours of mentored biofeedback. The mentoring consists of 30 hours 
of clinical training in EMG and behavioral interventions, 12 hours of direct clinical supervision, and 6 
hours of case conference. 

You may want to contact us for information about getting this crucial training and mentoring.

Limits to the depth of information provided by this course:

Anatomy and Physiology Course:

 

Anyone intending to perform behavioral treatments 

of pelvic floor dysfunctions needs to know the basic elements of human anatomy and physiology 
(A&P). For example, the effects of stress, hormones, bone remodeling, bone disorders, etc on the 
dysfunctions to be treated can’t be covered in sufficient depth in this course. BCIA requires an 
undergraduate A&P course for certification. We offer a BCIA approved, distance based A&P 
course which emphasizes the material you need to know to enhance you competence in 
providing behavioral interventions. Information about the course can be found on our web site.

General Biofeedback Course: This is not a course in general biofeedback. Thus, 

although you will learn all you need to about the correct application of muscle tension and 
pneumatic biofeedback to the pelvic floor. But you will not learn (a) how to perform other types 
of biofeedback such as temperature and breath control training which may be needed if the 
person is vasoconstricting so much or breathing so incorrectly they can’t attend to what you are 
trying to do due to anxiety, etc. or (2)  associated behavioral techniques such as relaxation 
training which may be needed to reduce levels of anxiety so high the patient can’t learn the skills 
you are trying to teach or may be so tense all over they may not be able to control the pelvic 
floor. Thus, if you haven’t had a general biofeedback course, you may want to take one..
 

Pain Course: This is not a general course on pain assessment and intervention from a 

psychophysiological perspective. This course provides an overview of psychophysiological pain 
assessment and intervention sufficient for you to do a competent job assessing and providing 
interventions for simple pelvic floor related pain problems but it doesn’t have the depth to give 

4

you an overall picture of how pain in other parts of the body relates to the pelvic floor, etc. This 
means you won’t know enough at the end of this course to competently assess pain problems 
referring to or influencing the pelvic floor. Nor will you know the overall elements of pain 
assessment and intervention. If you are going to work with pain in the pelvic floor, you should 
consider taking a course in pain psychophysiology.

Detailed Contents of each topic with associated audiovisual talks and readings

Note that in accordance with BCIA requirements, this course includes at least the following 
number of hours of education in the following topics scattered through all of the lectures: 
Applied Psychophysiology & Biofeedback 6 hours; Pelvic Floor Anatomy 6 hours, Surface 
EMG Assessment of Pelvic Floor Musculature 6, Clinical Practice Procedures 6 hours; Clinical 
Disorders I, Bladder Dysfunction 6 hours; Clinical Disorders II, Bowel Dysfunction 6 hours; 
Clinical Disorders III, Chronic Pelvic Pain Syndromes 6 hours, Ethical considerations 3 hours.

1. Overview of behavioral assessment and intervention for pelvic floor disorders:

(About three hours of instruction including interaction with the instructor.)
Elimination disorders treated with biofeedback assisted behavioral therapy, history of 

biofeedback and behavioral modalities used for pelvic floor disorders, assessing credibility of 
behavioral interventions for pelvic floor disorders, etc.

Audiovisual Lectures 1.1 and 1.2 – Introduction
Audiovisual Lecture 1.3 – Assessing Credibility

(Note that people who have taken the Behavioral Medicine R&T Foundation or UNM’s 
 courses in either pain assessment or general biofeedback are exempt from lecture 1.3)

Laycock & Haslam 1
Optional Newman 1 and 2
PFD biofeedback chapter file on CD 1

2. Anatomy and Physiology of the Pelvic Floor

(About six hours of instruction including interaction with the instructor.)

Audiovisual Lectures 2.1 and 2.2

a. Anatomy and physiology of pelvic floor structures (pelvic floor muscle, bones, 

diaphragms, sphincters, smooth vs. striated muscle)

Laycock & Haslam 2, 5, 28 - 30

A&P of the male lower urinary tract

Optional Newman 2 and 3
Optional Dorey ch 2 

Anatomy of the penis / physiology of erections

b. Urological A&P (urine storage and maturation, bladder anatomy, normal bladder 

storage and emptying, somatic and autonomic enervation)

types of urinary incontinence, dyssynergia

Laycock & Haslam 3

differences between male and female urinary incontinence

Optional Dorey Chapter 5

5

c. Prostate conditions

Optional Dorey ch 4

d A&P of digestive structures and processes, stool continence, defecation, somatic and 

autonomic enervation.

Laycock & Haslam 20 - 22
Optional Newman 5

3. Principles of applied psychophysiology biofeedback as applied to the pelvic floor

(About six hours of instruction including interaction with the instructor.)

Audiovisual Lectures 3.1 – 3.6
Movie 1 on CD 2

(Note: Anyone who took the pain or general biofeedback course given by either the Behavioral 
Medicine R&T Foundation of the UNM is exempt from this section.)

PFD muscle tension exercise file on CD 1

a. Introduction to biofeedback (definitions, history, overview of modalities, concepts of 

feedback and control in biological systems, principles of human learning as applied to 
biofeedback)

b. Surface EMG Instrumentation (terms and concepts, sources of artifact, sensor 

placement including skin preparation, distance between sensors and typical sites, EMG factors 
affecting assessment and interpretation such as fat, posture, etc., signal processing and feedback 
displays)

c. Biofeedback and distress (stress and the biopsychosocial model of illness, stressful life 

events and the risk of illness, psychophysiological reactions to stressful events)

d. Neuromuscular relaxation training (techniques assisted by EMG biofeedback such as 

autogenic training, hypnosis, meditation, etc., integrating relaxation into daily life, overview of 
other psychophysiological modalities used for neuromuscular relaxation such as heart rate 
variability, thermal biofeedback, EEG, GSR, etc.)

4. Know what is normal before you try to fix it

(About two hours of instruction including interaction with the instructor.)

Lack of understanding normal levels and patterns of muscle function, patters and rates of 

urination, defecation, lubrication, erection etc. has led many people to think they are abnormal 
and many therapists to try changing a normal system resulting in abnormal functioning and pain.

Audiovisual Lecture 4

5. Assessments and interventions for urinary incontinence

(About six hours of instruction including interaction with the instructor.)

Audiovisual Lectures 5.1, 5.2, 5.4, 5.6, and 5.8
Protocols and patient handouts on CD 1
Movies 2 and 3 on CD 2

a. Overview of physiological basis for and testing for urinary disorders (varieties of 

bladder disorders such as stress and urge incontinence dyssynergia, etc., overview of medical 
diagnostic procedures, urodynamics)

Schwartz & Andrasik 26
Laycock & Haslam 4, 6, and 16
Optional Newman 6

6

b. Physical assessments
c. Urodynamics

d. Surface EMG pelvic floor muscle assessment (vaginal and rectal surface EMG 

placements, infection control, protocols for evaluation, baselines, phasic and tonic muscle 
testing, endurance, dyssynergia testing, data interpretation)

e. Exercise and Surface EMG based pelvic floor training 

f. Treatment options not involving biofeedback

Laycock & Haslam 8 , 9, 11 – 15, 17 - 19
Optional Newman 7, 8, 9, and 10
Optional Dorey chapter 8

Exercises, Cones / weights, Electrical stimulation, Lifestyle changes, Bladder 

training for urge incontinence, Medications for urge incontinence, Pads, Appliances, Penile 
clamps, Prosthetic devices, inserts, Plugs, Surgery, Fluid Control, Skin care for incontinence 
dermatitis, Intermittent self-catheterization, and Artificial urinary sphincter (d 83/4)

g. EMG instrumentation options (sensors, SEMG instruments, home training devices)

Laycock & Haslam 10

 

h. Preparation for clinical practice (patient education in biofeedback and relevant A&P, 

patient intake, communication with other health care providers)

i.  Medical and behavioral treatment modalities – urologic (neuromuscular reeducation 

and exercise assisted by vaginal/rectal SEMG and other SEMG placements for bladder disorders 
– uptraining, downtraining, coordination training), other behavioral techniques including urge 
suppression techniques, bladder retraining, electrical stimulation, etc., non-behavioral techniques 
including drugs, surgery, electrical, physical interventions, etc.)

6. Assessments and interventions for bowel dysfunctions

(About six hours of instruction including interaction with the instructor.)

Audiovisual Lectures 6.1 and 6.2
Schwartz & Andrasik 27 & 29
Laycock & Haslam 20 - 22

a. Physiological basis for and testing for GI disorders (GI disorders including fecal 

incontinence, constipation, dyssynergia, irritable bowel syndrome, and colonic inertia, medical 
diagnostic procedures including manometric and defocograraphic evaluation and transit time 
studies)

b. GI Medical and behavioral treatment modalities (neuromuscular reeducation and 

therapeutic exercise assisted by vaginal/rectal surface EMG and other EMG placements for 
bowel disorders including uptraining, downtraining, coordination training, and bowel sensory 
awareness training, other behavioral methods specific to bowel disorders, non-behavioral 
interventions including surgery medications, physical interventions)

7. Principles of pain assessment and intervention from a psychophysiological perspective

7

(About six hours of instruction including interaction with the instructor.)

Audiovisual Lecture 7.1 – 7.7 

(Note: Anyone who took the pain course given by either the Behavioral Medicine R&T 
Foundation of the UNM is exempt from this section.)

Physiological basis of pelvic pain disorders (psychophysiological basis of pain, basic pain 

mechanisms related to pelvic pain, pain – stress – muscle tension relationships, trauma)

8. Assessments and interventions for pelvic pain syndromes

(About five hours of instruction including interaction with the instructor.)

Audiovisual Lecture 8.1, 8.2, & 8.3
Schwartz & Andrasik 28
Laycock & Haslam 23 - 27

a. Physiological basis of pain syndromes related to pelvic floor dysfunction (chronic 

pelvic pain syndromes including vulvodinia, proctalgia fugax, levator ani; co-morbidities 
including irritable bowel syndrome, fibromyalgia, interstitial cystitis)

b. Pelvic pain syndromes unique (mostly) to males: (prostatitis, orchialgia, penile pain, 

prostatodynia, perineal pain, testicular cancer related pain, proctalgia fugax)

Optional Dorey ch 6

c. Medical and behavioral treatment modalities for pelvic area pain (neuromuscular 

reeducation, posture, dietary counseling, drugs, surgery, physical interventions, sexual history 
taking and counseling)

9. Assessments and interventions for erectile dysfunction: Audiovisual Lecture 9

(About two hours of instruction including interaction with the instructor.)
a. Overview of erectile dysfunction
b. Assessment
c. treatment

(1) alternative (electrical stimulation, herbs, acupuncture)
(2) drug based (antianxiety, vasodilators)
(3) surgical (repair or replace)
(4) behavioral (education, counseling, fantasizing, exercises, biofeedback, life

 style)

10. Ethical considerations in performing behavioral assessments and interventions for pelvic 
floor disorders

(About three hours of instruction including interaction with the instructor.)

Overview of ethical principles of biofeedback as well as practice limitations and referral 
guidelines. 

Audiovisual lectures 10.1 and 10.2
Read files on CD entitled “PFD BCIA ethics document” and “additions”.

11. You aren’t quite done yet.
Please fill out the Foundation’s course and instructor evaluations.

8

When all requirements have been successfully completed, your course completion certificate will 
be e-mailed to you and BCIA will be informed that you completed the course. 

Administrative Information

Schedule:

 You can start the course whenever wish to within six months of the purchase date 

and work at your own pace as long as you complete the course within one year of purchase.

Duration of course validity: You must begin the course within six months of the purchase 

date and complete it within one year of the purchase date. Courses not completed by that time are 
void and must be repurchased if still available. No refunds are provided for courses not 
completed within one year of purchase. 

CE Credit

:

 Saybrook University is regionally accredited and approved by the state of California to grant 

degrees. These are continuing education, not university accredited, courses. CE credits are given through 
(1) the state of California’s Board of Behavioral Sciences (Approval # PCE1895); (2) The National Board 
of Certified Counselors (Provider # 6270), and (3) the Behavioral Medicine R&T Foundation is approved 
by the American Psychological Association to sponsor continuing education for psychologists. The 
Foundation maintains responsibility for this program and its content.
Saybrook University is regionally accredited and approved to grant degrees by the state of California.

BCIA:

 

This course is accepted by the Biofeedback Certification International Alliance for both 

certification and recertification.

Purchasing courses: Courses can be purchased from Biofeedback International Resources

by clicking the Buy Me button for the specific course HERE.

Full refund will be made until the students are given access to the course website.

After getting access to the course website, there is no refund at all, as Saybrook University and the

Foundation have committed their resources to you and you have access to all of the course materials.

A course would only be cancelled due to an extreme emergency on the part of the course instructor or

the Foundation. In the highly unlikely event a course is cancelled, you would receive a full refund.

Scholarships:  Saybrook University and the Foundation give 

scholarships 

consisting of 

25% off the cost of the course(s) to (a) students and professionals (e.g. clinicians, coaches, teachers) 
from emerging nations and (b) full time graduate students in developed nations.

Course updates: Updates to all courses are placed on the course web site as they are made. 
Students are informed when updates are available. 

9