Biofeedback: An Introduction

1. Biofeedback:An Introduction Lindsay M. Havlicek, M.S. School Psychologist April, 2007

2. Hans Selye’s Model: General Adaptation Syndrome • Stage 1: Alarm Stage • Physiological changes prepare the body • fight, flee, resist the stressor. • Stage 2: Adaptation Stage • Energy must be expelled to resist stressor. • Hormonal changes linger. • Stage 3: Exhaustion Stage • alarm reaction returns • no more energy to resist; physically break down. • Stage 4: Termination • No relief death

3. Disruption of Homeostasis (the body's internal balance) processes • Regain its normal equilibrium once the stress has passed • Become stuck in an over aroused state. • Become stuck in an under aroused state • How a person copes with stress -- by reaching for a beer or cigarette as opposed to heading to the gym -- also plays a big role in the impact stress will have on our bodies. (Bruce McEwen and Dean Krahn) (From AAPB’s stress ppt)

4. Allostasis and Allostatic Load • Allostasis are the adaptive responses which means maintaining stability, or homeostasis, through change. • Allostatic load is the price the body has to pay for either doing its job less efficiently or simply being overwhelmed by too many challenges. (Bruce McEwen and Dean Krahn) (From AAPB’s stress ppt)

5. Changes, Purposes, and Long-term Consequences During Stress (borrowed from AAPB’s stress PowerPoint)

6. How do we know? • How do we know when we have a cold? • Runny/stuffed nose • Sore throat • Coughing • Achy and tired. • So how do we know when we have stress/anxiety or heightened arousal? What does our body tell us? • Biofeedback helps us identify.

7. Dysregulation • What leads to dysregulation? • Denial of emotions • Lack of exercise • Fatigue • Stress • Substitutes: Illegal drugs; Alcohol; Cigarettes; Caffeine • Not paying attention to the cues our body gives us to tell us • Leads to dysregulation habit/rut.

8. Dysregulation • The dysregulated state the new homeostatic level. • People do not know they’re dysregulated (not paying attention to body). • Loss of cues. • It’s easy to dysregulate easy to adopt an abnormal new homeostasis. • Biofeedback can aid us in identifying our cues. • Helps us pay attention. • Aids in regulation!

9. You’ve Done Biofeedback and You Don’t Even Know It! • Feedback on your body’s condition: • Have you ever… • Looked in a mirror? • Feedback on your appearance. • Taken your temperature? • Feedback whether you’re running a fever. • Stepped on a scale? • Feedback on your body’s weight.

10. What is Biofeedback? • “…a group of therapeutic procedures that uses electronic or electromechanical instruments to accurately measure, process, and feedback, to persons and their therapists, information with educational and reinforcing properties about their neuromuscular and autonomic activity, both normal and abnormal in the form of analog or binary, auditory, and/or visual feedback signals…” (Schwartz & Andrasik, 2003)

11. What is Biofeedback? • The goal is • to help a person develop bodily awareness, self-confidence, and control over physiological processes. • A person learns to identify and control external signals (physical feelings and cues) (“symptoms”). • With practice, the person learns how to control these “symptoms” via cognitions. • Psychophysiology: • Scientific study of the interrelationships between physiological and cognitive processes.

12. What is Applied Psychophysiology?“Clinical Biofeedback” • The scientific discipline of understanding and modifying the relationship between behavior and physiological functions via noninvasive physiological measures. • Evaluation, Diagnosis, Education, Treatment, Performance enhancement. • Clinical Biofeedback: alter behaviors with feedback from their physiology. • Clinical Psychophysiologists.

13. Behavioral Medicine • An outgrowth of learning theory, psychophysiology, and behavior therapy. • “Behavioral medicine focuses on applications of learning theories to medical disorders and other health-related topics. It does not focus on psychopathology or mental disorders… Behavioral medicine places much emphasis on the patient’s role in prevention of and recovery from organic diseases and conditions.” (Schwartz & Andrasik, 2003)

14. Cybernetics • The idea: “one cannot control a variable unless information about the variable (feedback) is available to the controller.” (Schwartz & Andrasik, 2003) • Feedback allows us to learn. • Think of operant conditioning and cybernetics— • Positive or negative reinforcement provide information (feedback) about our behavior.

15. Culture • Merging of Eastern and Western traditions • Rise in meditation • Yoga and Zen (altering physical states through meditation) • Health and prevention • Holistic health, physical well-being. • Is biofeedback “Yoga of the West” or “Electronic Zen?” • ***Quiet the body down allows awareness.

16. Examples of When Biofeedback May Help… • Relaxation • Headache • Hypertension • Neuromuscular applications • Musculoskeletal therapy • Sport Psychology • Elimination Disorders • Including Irritable Bowel Syndrome • Tinnitus • Raynaud’s Disease (spasms of small arteries in hands and feet) • Heart Disease

17. Examples of When Biofeedback May Help… • Substance abuse/alcoholism • Asthma • Chronic Pain • Eating Disorders • Insomnia • Post-Traumatic Stress Disorder • Temporomandibular Disorders (TMJ) (Popping in jaw, jaw locking, difficulty opening the mouth, grinding teeth) • Hyperactivity • Attention/Concentration difficulties • Cancer • Chronic Fatigue Syndrome

18. How Biofeedback Works • From AAPB Website: • (1) monitor, (2) measure, (3) present information meaningfully/interestingly

19. How Biofeedback Works • The three most common physiological processes that biofeedback relies upon: • Skeletal muscle tension • Peripheral vasoconstriction • Electrodermal activity • We cannot measure these directly through noninvasive ways. • We must gain access indirectly through monitoring correlates we are interested in.

20. EMG: Electrical Correlate of Muscle Contraction • We are not able to directly measure muscle contraction. • Biofeedback utilizes the electrical aspect of muscle contraction. • Surface electrodes on the skin can sense weakened electrical signals in the muscle fibers beneath. • Monitors the electrical component of muscle contraction.

21. Peripheral Temperature: A Correlate of Peripheral Vasoconstriction • We cannot directly measure the constriction or dilation of peripheral blood vessels. • However, dilated blood vessels pass more warm blood than constricted blood vessels. • The surrounding tissue warms and cools accordingly (especially in the fingers and toes). • Temperature is a practical indicator.

22. Skin Conductance Activity:A Correlate of Sweat Gland Activity • Cannot tell if a sweat gland is “on,” or how much sweat it is producing. • Sweat contains electrically conductive salts that makes sweaty skin able to conduct electricity better than non-sweaty skin. • Skin conductance measures the amount of electrical current that the skin passes.

23. Focusing on Temperature and Skin Conductance • Self-calming by cognitive means will often raise temperature and lower skin conductance. • Negative emotions will lower temperature and raise skin conductance • Fear, worry, anger… • Relaxation techniques such as breathing, imagery, or meditation can lead to calm emotions.

24. Evidence-Based Practice • In the past, many biofeedback applications have not been well-documented (Yucha & Gilbert, 2004). • Not all studies and biofeedback practices have been shown to have efficacy. • We need more studies!

25. Relaxation with Biofeedback vs. Relaxation Alone? • Studies have been mixed. • Some well-controlled, randomized studies have shown biofeedback to be superior to other relaxation and self-control methods for reducing anxiety (Yucha & Gilbert, 2004). • My impression it is also about regulating the body.

26. TYPING MOUSING EMOTION TYPING STEP 1 2 3 4 5 6 7 8 9 10 11 12 Forearm Scal/trap Thorax Abdom Temp EDA

27. Conclusion • Biofeedback can be used in conjunction with other therapies. • Why not include it into CBT? • Could it be practical in a school-based setting? • Yes!

28. Conclusion • Biofeedback is a “hands on” experience. • Self-control • Empowering • Awareness • Aids in Regulating the body • Helps us read our body’s cues. • Can see how you have the ability to change. • Overall wellness and health?

29. Recommended Readings and Websites to Check Out • Schwartz, M.S. & Andrasik, F. (2003). Biofeedback: A practitioner’s guide (3rd Ed.). New York: Guilford. • Yucha, C., & Gilbert, C. (2004). Evidence-Based Practice in Biofeedback and Neurofeedback. • Available from AAPB’s website (free download!) • Applied Psychophysiology & Biofeedback (AAPB). • www.aapb.org • Biofeedback Certification Institute of America • www.bcia.org • Society of Behavioral Medicine • www.sbm.org