Biofeedback Training: An Interactive Tripartite Learning Process

Biofeedback Training: An Interactive Tripartite

Learning Process

Learning Models ~ Methods for Effective Biofeedback Training

University of AlaskaDepartment of Psychology

Licensed Psychologist Licensed Psychologist Certified Biofeedback TherapistCertified Biofeedback Therapist

Certified Medical PsychotherapistCertified Medical PsychotherapistProfessor of Psychology & Health ScienceProfessor of Psychology & Health Science

General Psychology Abnormal Psychology General Psychology Abnormal Psychology Stress Management Forensic Psychology Stress Management Forensic Psychology Health Psychology Trauma Psychology Health Psychology Trauma Psychology

Research & Clinical Variability: Research & Clinical Variability: Biofeedback Nomenclature Ambiguity Biofeedback Nomenclature Ambiguity

• TreatmentTreatment• Therapy Therapy • TrainingTraining• TechniquesTechniques• InstructionInstruction• SkillsSkills• LoopLoop• StrategyStrategy• LearningLearning

• ProcessProcess• ProgramProgram• RegimeRegime• EducationEducation• ApproachApproach• ExperienceExperience• ApplicationApplication• RoutineRoutine• SessionSession

Research & Clinical Variability: Research & Clinical Variability: Biofeedback Nomenclature Ambiguity Biofeedback Nomenclature Ambiguity

• TechnologyTechnology• ResponseResponse• Intervention Intervention • SystemsSystems• PatternsPatterns• MeasuresMeasures• ComponentsComponents• MethodsMethods• ModalitiesModalities

• ConditionCondition• ProcedureProcedure• ControlControl• MechanismMechanism• PrinciplesPrinciples• PerformancePerformance• PackagePackage• FactorsFactors• PracticePractice

What is Biofeedback?

Theory or Rationale for Biofeedback

Define Biofeedback for Patients

What is Biofeedback?“Biofeedback is a process that enables an individual to learn how

to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately "feed back" information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.

Approved 5/18/2008 by ( AAPB ~ BCIA ~ ISNR)

SSTTRREESSSSOORR

physiologicalphysiological

cognitivecognitive

emotionalemotional

behavioralbehavioral

multiple consequencesmultiple consequences

perceptionperception

SSTTRREESSSSOORR

physiologicalphysiological

cognitivecognitive

emotionalemotional

behavioralbehavioral

multiple consequencesmultiple consequences

perceptionperception

Biofeedback

Cognitive Therapy

Humanist Therapy

Behavior Therapy

Biofeedback Process

• BiofeedbackBiofeedback• Biological (physiological) InformationBiological (physiological) Information

• Biofeedback TrainingBiofeedback Training• Psychophysiological AssociationPsychophysiological Association

• Goal of BiofeedbackGoal of Biofeedback• Voluntary Self-RegulationVoluntary Self-Regulation

Biofeedback Process

• Biological InformationBiological Information• Unconscious to ConsciousUnconscious to Conscious

• Biofeedback TrainingBiofeedback Training• Discrimination TrainingDiscrimination Training

• Voluntary Self-RegulationVoluntary Self-Regulation• Self-EfficacySelf-Efficacy

Biofeedback Training

BFT is a systematic process using electronic sensing instruments to reveal and amplify specific physiological responses in real time so an individual may consciously recognize, influence and learn to self-regulate normally unconscious psychophysiological processes.

Fundamental Principles Fundamental Principles

SENSATION - SENSATION - UnconsciousUnconsciousPERCEPTION - PERCEPTION - ConsciousConscious

LearningLearningDefinition: Definition:

A relatively permanent A relatively permanent change in behavior based change in behavior based on experience.on experience.

ClassicalClassical • Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious

ClassicalClassical OperantOperant• Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious

• Response – StimulusResponse – Stimulus• ActiveActive• InstrumentalInstrumental• EnvironmentEnvironment• ConsciousConscious

ClassicalClassical OperantOperant• Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious

ConcurrentConcurrent• Attention - IntentionAttention - Intention• Perceptual LearningPerceptual Learning• AwarenessAwareness• Experiential LearningExperiential Learning• ConsciousConscious

• Response – StimulusResponse – Stimulus• ActiveActive• InstrumentalInstrumental• EnvironmentEnvironment• ConsciousConscious

ClassicalClassical OperantOperant• Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious

ConcurrentConcurrent• Attention - IntentionAttention - Intention• Perceptual LearningPerceptual Learning• AwarenessAwareness• Experiential LearningExperiential Learning• ConsciousConscious

• Response – StimulusResponse – Stimulus• ActiveActive• InstrumentalInstrumental• EnvironmentEnvironment• ConsciousConscious

CognitiveCognitive• InternalizationInternalization• Locus of ControlLocus of Control• Self-EfficacySelf-Efficacy• ExpectancyExpectancy• Unconscious/ConsciousUnconscious/Conscious

Biofeedback Models

Learning Emphasis

Physiological Emphasis

Interactive Emphasis

Biofeedback ModelsBiofeedback Models1)1) Physiological EmphasisPhysiological Emphasis::

Motor Skills ~ Anti-Stress RelaxationMotor Skills ~ Anti-Stress Relaxation~ Autonomic ~ Cybernetic ~ Pathways~ Autonomic ~ Cybernetic ~ Pathways

2)2) Learning EmphasisLearning Emphasis: : Operant ~ Self-Regulation ~ Cognitive Operant ~ Self-Regulation ~ Cognitive ~ Multiple Learning Stages~ Multiple Learning Stages

3)3) Interactive EmphasisInteractive Emphasis: : Mastery ~ Coaching ~ Triadic FeedbackMastery ~ Coaching ~ Triadic Feedback

Biofeedback Models

Learning Emphasis

Physiological Emphasis

Interactive Emphasis

Physiological EmphasisPhysiological EmphasisMotor Skills AcquisitionMotor Skills Acquisition: : Lang (74), Lang & Lang (74), Lang &

Twentyman (74), Johnson (77) Twentyman (74), Johnson (77) Anti-stress / RelaxationAnti-stress / Relaxation: : Stoyva & Budzynski (74),Stoyva & Budzynski (74),

Stoyva (77), Silver & Blanchard (78) Stoyva (77), Silver & Blanchard (78) Autonomic DiscriminationAutonomic Discrimination: : Brener (74, 77), Brener (74, 77),

Roberts (77)Roberts (77)Cybernetic / SystemsCybernetic / Systems: : Anliker (77), Gaarder &Anliker (77), Gaarder & Montgomery (77), Mulholland (77), Sargeant (77-Montgomery (77), Mulholland (77), Sargeant (77-

79), Schwartz (78-79) 79), Schwartz (78-79) Stereotypic Pathways:Stereotypic Pathways: Wilson (82) Wilson (82)

Stereotypical Stress Pathways

NeuromuscularNeuromuscular NeurovascularNeurovascular NeurohumeralNeurohumeral InterneuronalInterneuronal

What kind of Responder are you?

muscles prepare for fight or flightmuscles prepare for fight or flightmuscle painmuscle paintension headachestension headachesfatigued musclesfatigued muscleslow back painlow back painweaknessweaknessarthritisarthritis

Stereotypical Stress Pathways Neuromuscular EMGNeuromuscular EMG

muscle muscle tensiontension

increased heart-rateincreased heart-rateblood flows to big muscles & brainblood flows to big muscles & brainfaintingfaintingmigrainesmigraineshigh blood pressurehigh blood pressureheart diseaseheart diseasestrokestroke

Stereotypical Stress Pathways Neurovascular TEMPNeurovascular TEMP

coldcoldhands & feethands & feet

immunosuppressionimmunosuppressionlowered sexual functioninglowered sexual functioningdecreased appetitedecreased appetiteinfectionsinfectionsautoimmune diseasesautoimmune diseasesGI disordersGI disordershypertensionhypertension

Stereotypical Stress Pathways Neurohumeral SCNeurohumeral SC

sweatingsweating

obsessive thoughts and feelingsobsessive thoughts and feelingsracing thoughtsracing thoughtsconfusion, ruminationsconfusion, ruminationssleep disturbancessleep disturbancesemotional burnoutemotional burnoutdepression & maniadepression & maniadrug addictiondrug addiction

Stereotypical Stress Pathways Interneuronal EEGInterneuronal EEG

cognitive cognitive & emotional& emotional

changeschanges

Biofeedback Models

Learning Emphasis

Physiological Emphasis

Interactive Emphasis

Learning EmphasisLearning Emphasis Operant LearningOperant Learning: : Black, Cott & Pavloski Black, Cott & Pavloski

(77), Miller (78)(77), Miller (78)

Self-RegulationSelf-Regulation: : Blanchard & Epstein (78)Blanchard & Epstein (78)

CognitiveCognitive: : Lazarus (75), Meichenbaum (76)Lazarus (75), Meichenbaum (76)

Multiple Learning StagesMultiple Learning Stages: : Dreyfus (80), Dreyfus (80), Brenner (84), Kappes (96)Brenner (84), Kappes (96)

Biofeedback Training ProcessBiofeedback Training Process• EducationEducation ( (ClassicalClassical))

Unconscious IncompetenceUnconscious Incompetence• Acquisition Acquisition ((ConcurrentConcurrent))

Conscious Incompetence Conscious Incompetence • Discrimination (Discrimination (OperantOperant))

Conscious CompetenceConscious Competence• Self-Efficacy (Self-Efficacy (Social LearningSocial Learning))

Unconscious CompetenceUnconscious Competence

Biofeedback Training Process – Edu Technique 1: Classical Learning– Edu Technique 2: Education of Patient– Edu Technique 3: Psychophysiological Assessment– Acq Technique 4: Concurrent Learning– Acq Technique 5: Sensation and Perception– Acq Technique 6: Conscious Observation– Dis Technique 7: Initiate Operant Training– Dis Technique 8: Establish Specific Goals– Dis Technique 9: Assess Performance Skills– Self Technique 10: Social Cognitive LearningSelf Technique 10: Social Cognitive Learning– Self Technique 11: Home Training ProgramSelf Technique 11: Home Training Program– Self Technique 12: SummarySelf Technique 12: Summary

Theories of Learning:The Developmental Progression of

Self-Regulatory Skills

PrevailingPrevailingTheoreticalTheoretical

ProcessProcess

ClassicalClassicalLearningLearning

ConcurrentConcurrentLearningLearning

OperantOperantLearningLearning

CognitiveCognitiveLearningLearning

education acquisition discrimination self-efficacy

Theories of Learning:The Developmental Progression of

Self-Regulatory Skills

PrevailingPrevailingTheoreticalTheoretical

ProcessProcess

ClassicalClassicalLearningLearning

ConcurrentConcurrentLearningLearning

OperantOperantLearningLearning

CognitiveCognitiveLearningLearning

education acquisition discrimination self-efficacy

Theories of Learning:The Developmental Progression of

Self-Regulatory Skills

PrevailingPrevailingTheoreticalTheoretical

ProcessProcess

ClassicalClassicalLearningLearning

ConcurrentConcurrentLearningLearning

OperantOperantLearningLearning

CognitiveCognitiveLearningLearning

education acquisition discrimination self-efficacy

Theories of Learning:The Developmental Progression of

Self-Regulatory Skills

PrevailingPrevailingTheoreticalTheoretical

ProcessProcess

ClassicalClassicalLearningLearning

ConcurrentConcurrentLearningLearning

OperantOperantLearningLearning

CognitiveCognitiveLearningLearning

education acquisition discrimination self-efficacy

Theories of Learning:The Developmental Progression of

Self-Regulatory Skills

PrevailingPrevailingTheoreticalTheoretical

ProcessProcess

ClassicalClassicalLearningLearning

ConcurrentConcurrentLearningLearning

OperantOperantLearningLearning

CognitiveCognitiveLearningLearning

education acquisition discrimination self-efficacy

Biofeedback Models

Learning Emphasis

Physiological Emphasis

Interactive Emphasis

Interactive EmphasisInteractive Emphasis MasteryMastery: : Stoyva & Budzynski (74), Peper (08)Stoyva & Budzynski (74), Peper (08)

Coaching MasteryCoaching Mastery: : Shellenberger & Green (86)Shellenberger & Green (86)

Triadic Feedback ProcessTriadic Feedback Process: : Kappes (10)Kappes (10)

Triadic Feedback ProcessTriadic Feedback ProcessKappes (10) Kappes (10)

Physiological Feedback

TherapeuticFeedback

TFP

Performance FeedbackPatient Influence Instrument Influence

Therapist Influence

Triadic Feedback Process Triadic Feedback Process Patient Variables

Motivation

Self-Efficacy

Learning Readiness

Triadic Feedback Process Triadic Feedback Process Instrument Variables

Analog / Digital

Real Time

Accuracy

Triadic Feedback Process Triadic Feedback Process Therapist Variables

Certified / Trained

Communication Skills

Therapeutic Competencies

Integrative Biofeedback Model

Learning EmphasisMultiple Learning Stages

Physiological EmphasisStereotypic Pathways

Interactive EmphasisTriadic Feedback Process