The Alternative Medicine Blog

Biofeedback, part 6

Conclusion: Training and Credentials of Biofeedback Therapists

The increasing popularity of biofeedback in dealing with disorders resulted in an increasing number of entities providing this service. Biofeedback "specialists" can be found in mental health clinics, universities, medical schools, hospitals, private practice etc. These persons hold degrees in psychology, social work, medicine, physical therapy, nursing and other associated fields.

Professionals themselves would like to see a move closer to formal training and testing in the area. Training, as of now is achieved in one of the few training programs or home-study courses. As insurance agencies are starting to reimburse for biofeedback services, they will require certification of the individual providing the service in the area of treatment.

Anyone can purchase biofeedback software and equipment. It is tremendously important, that the provider you are seeking is properly credentialed. BCIA, mentioned in a previous post, provides accreditation and educational programs that are not stemming from universities. They offer certification in General Biofeedback and for EEG Biofeedback.

Remember, these credentials are not always required to offer biofeedback, seeking a practitioner with these credentials could only enhance a clinicians knowledge. Here are the guidelines for general certification:

1. Introduction to biofeedback, 2. Stress and illness, 3. Psychophysiologic recording, 4. Neuromuscular applications, 5. ANS (Autonomous Nervous System), 6. EEG applications, 7. Adjunctive techniques and applications, Professional conduct.

EEG certification requires:
1. Introduction to biofeedback, 2. Research, 3. Basic neurophysiology and neuroanatomy, 4. EEG and electrophysiology, 5. Instrumentation, 6. Psycho-pharmacology considerations, 7. Treatment planning, 8. Other therapeutic techniques, 9. Professional conduct.

All certifications require training and an internship supervised by a certified member, followed by a written examination. The practitioner must participate in continued educational seminars or courses in order to stay certified. Certification is reviewed every 4 years.

Questions to ask a prospective biofeedback provider:

What are your credentials? Have you received extended training at workshops, seminars, or professional biofeedback training? Do you teach courses on the topic? Do you commit yourself to lifelong learning on the subject? Are you licensed in your specific field? Are you familiar with the application of biofeedback I am seeking treatment for? These questions are always a good start.

I hope I was able to shed some light on the very legitimate practice of biofeedback. Please feel free to comment or ask questions right here or contact:

Association for Applied Psychophysiology and Biofeedback (AAPB)
10200 West 44th Avenue
Suite 304
Wheat Ridge, CO 80033
1-800-477-8892 303-422-8436
http://www.aapb.org/i4a/pages/index.cfm?pageid=1.

Biofeedback Certification Institute of America (BCIA)
10200 W. 44th Ave, Ste 310
Wheat Ridge, CO 80033-2840
Phone:303-420-2902 • FAX 303-422-8894 
http://www.bcia.org/

Beste Gesundheit,

Werner

Biofeedback, part 5

Electrocardiology and Heart Rate Variability Feedback (HRV) The electrocardiogram (ECG) records the electric impulses of the heart. In biofeedback those are rarely used what is used however is the HRV (Heart Rate Variability). What is it? HRV is calculated by the elapsed time in between heart beats. It is directly related to the sinoatrial node (or the pacemaker) of the heart. It joins the sympathetic and the parasympathetic branches of the autonomous nervous system. A lack of variation could signal an imbalance between these two, and a sign of poor cardiac health. Decrease one (parasympathetic) or increase the other (sympathetic) and there is an increase occurrence of arrhythmias. Low levels of HRV are related to mortality, myocardial infarction, coronary heart disease, and congestive heart failure. Yes you guessed right, people who exercise or endurance athletes have higher HRV. How can we achieve this in the untrained individual, increasing HRV? This is possible by showing them how to become calm and relaxed and to concentrate on breathing. People are just now beginning to get a grasp of this interesting application. Tomorrow: the conclusion: Training and Credentials of Biofeedback Therapists Beste Gesundheit, Werner PS: Further reading on HRV would be: Lown and Verrier, 1976 Tsuji, Vendetti, Manders, 1994 Tsuji, Larson, Vendetti, 1996 Boutcher et al, 1997 Gevirtz, Lehrer, 2003

Biofeedback, part 4:

Descriptions of Biofeedback Modalities

The most common biofeedback modalities are EMG (Electromyography), SCR (skin conductance response and temperature response), and sweat gland activity. But there are more particular procedures emerging like EEG (electroencephalograph or neurotherapy), HRV (heart rate variability) , and BVPI (blood volume pulse). We already covered the three "workhorses" of biofeedback (EMG, SCR, and sweat gland activity) in previous posts. Lets move on to the more specialized forms of biofeedback.

EEG or Electroencephalograph Biofeedback or Neurotherapy

I hope I am not getting to technical with that but I need to mention some terms in order to make this concept understandable, or show why it works. Brain activity, like most other functions of the body, can be monitored. What is measured is the electric activity between the synapses of neurons. (look for future posts under the heading psychoneuroimmunology for a detailed explanation how this works.) This activity shows the exchange of information between pre- and post-synaptic space. It is termed post-synaptic potential (PSP). The tally of the PSPs is the EEG.

EEG is separated into different incidence of bands. Each incidence of band has a matching behavior. The biggest application of EEG is being the treatment of attention deficit disorder (ADD). Here is a case study:

Jack 15:(1)

Diagnosed with ADHD, inattentive type.

Children with this diagnosis have different brain-wave activity then kids who do not have this problem. ADD and ADHD patients have normally excessive slow brain-wave activity or THETA, which causes them not to pay attention. In addition, they have not enough fast brain wave activity termed BETA. Stimulant medication gets these kids hyped up, with all kinds of side effects. Below, this case study will show how the same result is achieved without medication, and of course the nasty side effects.

After observing Jacks brain wave activity during various conditions simulating the school environment it was found that Jack had a ratio of approximately 3:2. The treatment sought to reduce this ratio to 1:1.

After being "hooked up" to the equipment, Jack was asked to increase beta waves and reduce theta without instrumentation. The thresholds were set so that Jack received a "point" 80% (eighty-percent) of the time. As Jack improved, thresholds were set to a more difficult level, hence shaping his response.

In addition to his task, he was asked to listen to, and read different types of material, to again, simulate school conditions. At first lessons lasted 20 to 25 minutes, however as Jack gained more control over his EEG, sessions sometimes exceeded one hour.

Interestingly enough, at the time Jacks parents reported unbelievable changes in his behavior, this time could be exactly pinpointed on the EEG and it's first occurrence of Jack's beta waves being higher than his theta waves. His parents reported that Jack had maintained his ability to concentrate following the treatment. Several months after treatment Jack was still able to produce the desired response and was doing very well in school.

I hope this will shed some light on the fact that there are other, more suitable modalities, then mere medication for problems like ADD and ADHD.

If you would like to start a dialog about this or any other topics feel free to click on the comment link below this article. Your comments are always welcome.

Tomorrow: Electrocardiology and HRV (heart rate variability) Biofeedback

Beste Gesundheit,

Werner

(1) Complemetary & Alternative Medicine, A Research Based Approach. (2004) Mosby, St. Louis, Missouri, p. 220

Biofeedback, part 3

Clinical Practice

Biofeedback has two basic approaches. The general approach is designed for people who are stuck in a continuous mode of heightened arousal or the fight or flight mode. This condition exists when the organism's physiology prepares it to escape (flight) or engage (fight). The muscles are tense, pulse is elevated, perspiration increase, blood flow to the extremities decreased, pupils widen, etc.

Biofeedback teaches people to prevent this constant state of alert in the first place and shows how to reduce it when it occurs.

There are three basic modalities, the "Workhorses" of biofeedback. Here they are:

Muscle Tension Biofeedback (Electromyography [EMG]),
Thermal or Temperature Biofeedback,
Sweat gland Activity or Skin Conductance Biofeedback.

For general relaxation, EMG biofeedback is done from the forehead. Being able to relax the muscles there is thought to have a state of muscle relaxation throughout the body.

Relaxation can also be induced by learning how to warm ones hand, via an attached sensor to a finger. The important part is not the hand warming, but for the hand-warming to be achieved, nervous system activity needs to be slowed, which in turn allows blood vessel in the hand to be opened and for increased blood flow to the extremities.

Skin conductance, or sweat gland activity are often indicators for heightened arousal. We all experienced sweaty palms at one point or another in our lives. The fight-flight response causes the sweat glands of the hand to become over active. By paying close attention to this activity people can learn strategies how to decrease that arousal.

Of course there are a myriad of other stress relaxation options (yoga, meditation, progressive muscle relaxation, breathing, imagery etc.). I will be touching on each of them individually in later posts.

What can be treated?

Any condition related to heightened arousal of the SNS (Sympathetic Nervous System) or anxiety and stress. For example, anxiety disorders, headaches, elevated blood-pressure, IBS or irritable bowel syndrome.

Tomorrow: Biofeedback Modalities

Beste Gesundheit,

Werner

Ps: Don't forget about our "Food for the Ear" seminar on April, 13. For more info go to Upcoming Events.

Biofeedback, part 2

Defining Biofeedback:

Bio is commonly referred to as self or pertaining to self. Feedback pertains to components that have a result were these components are modified, corrected, or enhanced by the result. Biofeedback then is a method in which information about the self is used to modify, correct or strengthen activity within the self. In other words, biofeedback is used therapeutically that involves measuring a persons physiologic modus operandi such as heart rate, muscular contractions, then this measurements are "fed back" to the person in an understandable way so that he/ she can modify this process. In clinical settings the goal is to help individuals alter their physiology to obtain a more robust state of health.

Here is an example:

Overactivity of muscles can cause severe pain. Such as slouching over a laptop for hours researching and composing a post to ones blog. This is of course not the only cause and there are others stressors which can be psychological, physical, or both. A physician might prescribe a muscle relaxant, a physical therapist might use heat, massage or exercise. A biofeedback therapist on the other hand would begin by monitoring the muscles thought to be involved. Once these muscles are singled out, the biofeedback therapist would teach the person how to prevent the levels of muscular tension from elevating and when threshold levels are exceeded an expeditious reduction.

Applied biofeedback, a term coined by Olson (1995), contains ten components as further defined by Schwartz and Schwartz (1995, 2003) (1):

1. a group of therapeutic procedures that
2. uses electronic or electromechanical instruments,
3. to accurately measure, process, and feedback to persons and their therapists,
4. information with educational and reinforcing properties
5. about neuromuscular and autonomic activity, both normal and abnormal,
6. in the form of analog or binary, auditory, and or visual feedback signals.
7. Best achieved with competent biofeedback professional,
8. the objectives are to help persons develop greater awareness of, confidence in, and increase in voluntary control over their physiological processes that are otherwise outside awareness and/ or under less voluntary control,
9. by first controlling the external signal,
10 and then by using "cognitions, sensations, or other cues to prevent, stop, or reduce symptoms." (Scwartz and Schwartz, 2003, p.35)

1 through 7 describe key procedural elements and 8 through 10 key goals of biofeedback.

Tomorrow: Biofeedback in Clinical Settings.

Beste Gesundheit,

Werner

(1) Complemetary & Alternative Medicine, A Research Based Approach. (2004) Mosby, St. Louis, Missouri, p. 212

Biofeedback, part 1:

Dear Reader,

this week the posts shall educate about biofeedback. What is biofeedback? It's history? It's applications? How could it be applied in larger settings? How could it contribute to the reduction or flat out discontinuation of medication? Biofeedback is a form of medicine truly establishing and enforcing the mind-body connection. Let's get to it.

History:

Back in the 60's there were a few brave man working on a project to disproof the conventional wisdom of the time, which held, that only the voluntary systems in the control of the CNS (central nervous system) could be controlled by learning. The players were Dr. Miller, then a psychologist at Yale University. Lee Birk, a psychiatry resident working with David Shapiro, David Shapiro himself, Bernard Tursky.

The problem:

Subtle movements of muscles could alter heart rate, blood pressure, hand temperature. What needed to be achieved was a way to eliminate such possibilities so researchers could claim "purely learned visceral" control. They thought this could be accomplished by giving curare, an agent that eliminates muscle movement, hence completely paralyzing the subject. Where to find a subject to risk an experiment which could lead to death? Birk, insisted that it was not so dangerous and volunteered himself.

The experiment worked. The conditioned responses were autonomic, because Birk was totally paralyzed. Birk also wrote the first medical book on biofeedback entitled Biofeedback: Behavioral Medicine (1973).

Other factors contributing to the establishment of biofeedback: Altered states of consciousness, behavioral therapy and medicine, biomedical engineering, consciousness, cultural factors, cybernetics, electroencephalogram, advances of electromyography devices, instrumental conditioning, professional development, psychophysiology, stress management and research.

Providing credibility to the field of biofeedback was the formation of the Biofeedback Society of America in 1968. Now called the:

Association for Applied Psychophysiology and Biofeedback (AAPB)
10200 West 44th Avenue
Suite 304
Wheat Ridge, CO 80033
1-800-477-8892 303-422-8436
http://www.aapb.org/i4a/pages/index.cfm?pageid=1.

They cosponsor the periodical Applied Psychophysiology and Biofeedback, publishing a lot of research in biofeedback.

And then there is the:

Biofeedback Certification Institute of America (BCIA)
10200 W. 44th Ave, Ste 310
Wheat Ridge, CO 80033-2840
Phone:303-420-2902 • FAX 303-422-8894 
http://www.bcia.org/which oversees the certification of biofeedback practitioners.

Tomorrow: Biofeedback defined

Thank you for reading.

Beste Gesundheit,

Werner