News

International certification is now within reach!

BCIA is now the Biofeedback Certification International Alliance

The Biofeedback Certification Institute of America (BCIA) was created in 1981 with the primary mission to certify individuals who meet education and training standards in biofeedback and progressively re-certify those who advance their knowledge through continuing education. To reflect our global identity, the new name - Biofeedback Certification International Alliance - was adopted in March, 2010.

BCIA is an autonomous nonprofit corporation. BCIA policies and procedures are set by an independent board of directors, comprised of a rotating group of distinguished biofeedback clinicians, researchers, and educators.

Board certification is the mark of distinction for providers of bio and neurofeedback services. Certification is valid for four years for providers who carry the credential in Biofeedback and Neurofeedback, and three years for those who are certified in Pelvic Muscle Dysfunction Biofeedback. Recertification indicates continuous peer review of ethical practice and the acquisition of advanced knowledge of recent developments in the field through required continuing education. Names of certified practitioners may be found on the BCIA Web site in our Find a Practitioner search function.

Board certification establishes that the individual has met entry-level requirements for the clinical practice of biofeedback; however, BCIA certification is not a substitute for a state sanctioned license or other credential to practice one's profession. Candidates for certification who do not hold a professional license or its equivalent must stipulate that they practice under the supervision of a licensed provider when treating a medical or psychological disorder.

Professional certification is the voluntary process by which a non-governmental entity grants a time-limited recognition to an individual after verifying that predetermined and standardized criteria have been met. Because biofeedback is an unregulated field, certification is crucial for providing standards of care. To be viable as a professional service, standards of competence and clinical practice must be defined and measured. Since 1981, BCIA has taken on this task. Through the BCIA recertification program, each certificant is held accountable to a code of ethics, obtains specified continuing education, and maintains proper credentialing appropriate for clinical practice.

To become a Board certified practitioner, one must:

  • hold an appropriate degree in a BCIA approved clinical health care field
  • meet strict didactic education and clinical training requirements
  • pass a written certification exam
  • adhere to an ethical code of conduct which states that when working with a medical or psychological disorder, unlicensed providers must work under the supervision of an appropriately credentialed provider.
  • The American Psychological Association (APA) has recognized biofeedback as a proficiency in professional psychology because of the petition filed with them by BCIA.
  • BCIA certification is recognized as the standard in the field by The Association for Applied Psychophysiology & Biofeedback (AAPB) and The International Society for Neurofeedback and Research (ISNR), the premier biofeedback and neurofeedback membership associations.
  • The Centers for Medicare and Medicaid Services (CMS) and the private insurance industry have each determined criteria for recognition and reimbursement pertaining to biofeedback interventions.
  • The American Medical Association has revised and assigned specific CPT codes to be utilized for biofeedback clinical intervention.
  • BCIA is a member of the Institute for Credentialing Excellence, formerly the National Organization for Competency Assurance (NOCA).

For further information visit: www.bcia.org

Tim's own biofeedback team specializing in Optimal Sports Performance is Bruno De Michelis (AC Milan) and the MindRoom concept. The MindRoom was envisioned and developed by Thought Technology's enthusiastic Larry Klein!

by Nick Iliev

Sun, May 09 2010: Chelsea are crowned champions of England for the third time after demolishing Wigan on May 9. The destruction extinguished any forlorn hopes harboured from Manchester United and their supporters for a miracle in the eleventh hour that would have seen them leapfrog their rivals at the top of the table. But with the blistering form of the Blues, it was hard to imagine just how a struggling Wigan side would extract anything worth mentioning from the Bridge in the first place.

Not seven minutes into the fray and the hosts went one nil up as a Didier Drogba free-kick got slightly deflected from the Wigan wall but was subsequently scored by Nicolas Anelka who got the ball in the scramble and drilled it in from close range.

With the initial pressure instantly dissipated, Chelsea proceeded to dominate comfortably and enjoy their game on this last day of the season. The second goal came when Didier Drogba stormed into the penalty area and was brought down by Gary Caldwell. Frank Lampard then stepped in and gave a two nil lead from the spot on 30 minutes.

With the second half under way, the Blues went relentlessly forward and Anelka scored a stunning fourth to a jubilant Stamford Bridge, volleying a right wing cross from Branislav Ivanovic. The inevitable fifth and the club's 100th goal in the Premiership this season was scored by Drogba. But only four minutes later Chelsea made it 6-0 as Drogba, again was on the score-sheet from the penalty spot.

But Chelsea were not going to call it a day there, and Drogba scored his hat-trick on the afternoon with only four minutes to go, making it 7-0. The final, eight goal of the match was scored by Ashley Cole.

Meanwhile Manchester United had no problem dismantling Stoke City in their own right at Old Trafford, in a match which was hardly going to go any other way. With little pressure for the Red Devils, they simply had to play their game - and play for pride as the title was all Chelsea's to lose.

Darren Fletcher and Ryan Giggs were on target for the hosts in the first half while Stoke's Danny Higginbotham scored an own goal in the 55th minute. Korean international Ji-Sung Park wrapped it up for 4-0 before the end of the match.

Bulgarian international Dimitar Berbatov was subbed in the 61st minute by the Italian super sub Federico Macheda.

Previously, Chelsea had won the old English championship for the first time in the distant 1954/55 season. The Blues then won their first Premiership title in 2004/5, followed by another title back-to-back the following season.

Originally published under the title: Chelsea FC are crowned English champions on www.sofiaecho.com

Canada's top secret initiative -OWN THE PODIUM - involved the use of the latest in high-tech training.

The biggest secret was the use of Biofeedback and Neurofeedback to train athletes to develop the ability to rapidly switch between a relaxed state and a super-focused state without wasting any physiological resources. Marge Dupee from the University of Ottawa discusses how effective this training was in enabling Alexandre Bilodeau, Jennifer Heil and others to win gold, silver and bronze medals. The equipment they used was from Thought Technology of Montreal, the same equipment used in professional sports clubs such as AC Milan, Real Madrid, Chelsea and the Vancouver Canucks, where the systems are called Mindrooms (mindroomsportscience.com)

By Loren Anthony, February 2010

At forty-two I'm supposed to be supremely female. I'm supposed to run with the wolves. But how's a girl to run with the wild pack if she leaks pee when she does. I'm supposed to be peaking, not leaking! I should be in control, not bloody incontinent. The very term evokes images of my beloved nana who, at 97, could quote Keats at the drop of a hat, but who always had a vague smell of pee about her. Not an alluring scent.

And I am not alone. You can spot us a mile off. We're self-assured and sanguine but we need to cross our legs when we sneeze. Yet this leg-crossing code remains largely ignored in our culture. Living in the post-Vagina Monologues epoch, we're surprisingly coy about our privates. And if we're not coy, we're just completely clueless. Our nether regions are terra incognito, a mysterious bundle of orifices that we don't fully understand.

I wouldn't be quite so clueless if I had paid attention in pre-natal classes over a decade ago. Instead, I had gazed dreamily into the middle distance, lovingly stroking my burgeoning belly like a benevolent Buddha. And so I came away from the classes thinking that pelvic flaws were - what?! - battleship hips, the perineum was an indigenous plant, and Kegels were surely German pastries. And so, three pregnancies later, I leak when I laugh. Or cough or run.

Things came to a head recently at my daughter's athletic meet. It was the Mom's Race, a perverse little event tagged on to the program to punish mothers. There was no way I was going to do the 100metre dash at the risk of a leak. But, oh, the anguish in my daughter's eyes as the other moms lined up at the starting line and I cowered behind the grandstand. And so I resolved to fix the problem.

It turns out that my occasional "accidents" are the result of slack pelvic floor muscles, caused mainly by pregnancy and natural childbirth, and brought on by pressure, such as jumping, sneezing and laughing uproariously. It's clinically known as "stress incontinence." Not a sexy term but very descriptive of what happens when sudden pressure (stress) is put on a pathetically slack pelvic floor.

"Most women," says gynaecologist Dr Shaw, "have stress incontinence to some degree. Very few women can jump on a trampoline without problems after they've had children." Oh, the things we put up with for our offspring! I had to be a bloody hero and have three natural births. But before I could seriously envy my friends who've had elective c-sections, Dr Shaw explained that while a normal vaginal delivery does affect the pelvic floor most, women who've had caesars also have stress incontinence. It's apparently not so much the way you birth but the weight of your beloved baby on the pelvic floor that puts strain on it.

The pelvic floor muscles are a network of muscles, ligaments and tissues, shaped like a hammock, that subtends and supports the pelvic organs - your uterus, lower intestine and rectum - and like any muscle, they need regular toning. Pelvic floor slackness can lead to lousy sex and leaks. Thankfully there's heaps of help at hand. My first port of call was Lizelle Grundell, an Applied Psychophysiological and Biofeedback practitioner who is passionate about priming pelvic floors. Lizelle laments the fact that we're full of bad habits. "Did you know that the best position to pee in is a squat? Failing that, the brace position works well- lean slightly forward, with your elbows on your knees and relax. Most of us sit incorrectly on the loo, or, if we're sharing public loos in an office or mall, we tend to perch above the loo without sitting comfortably. By doing this, we're already using our muscles incorrectly and undermining control."

I asked Lizelle to help me locate my pelvic floor muscles. I tried twitching everything I could twitch down below, but really had no clue what I was doing. Why is it so easy to flex a bicep but so utterly frustrating to tweak a pelvic muscle? Again, it's this sense of basic ignorance we have about our bodies. Lizelle uses biofeedback technology to help women locate and work these hidden muscles, and retrain the brain to do it naturally.

Lizelle gave me a probe to insert and hooked me up to a monitor. She put me through a series of exercises, ranging from short twitches, to long, sustained contractions of between 10 to 60 seconds. Oh my word, there it was, graphically clear on a graph. While the average pelvic squeeze registers 37.5 on the graph, I scored a whopping 6! Did I even have a pelvic floor, I wondered?

So Lizelle put me to work. I took home a U-Control biofeedback device. You insert it, and have to squeeze to keep the bar-lightin the orange, and release it again into the green. It's so graphic and responsive that you can really see (if not quite feel) what you're doing. In four months, Lizelle encouraged, you'll be sixteen again. Well, at least down below.

In the interests of research and achieving Olympian pf muscles, I decided to try all the products that were available on the market. A pile of pelvic floor improvers landed on my desk. There's the Kegelmaster which helps you to "hold on to your femininity." I loved that promise. It's a really robust, muscular workout; there are sleek LadySystem vaginal cones that you can clench while you shop or have tea with your mum-in-law. We've come a long way, baby. At the time of Hippocrates (about 400 BC) women had to insert half a pomegranate up their fannies to tauten their muscles. There's the Cefar Peristim Pro, designed for lazy daisies like me, which sends a pulse to the muscle, causing it to contract.

My husband, catching a glimpse of my recently acquired pelvic products, chirped happily, "Oh, sex toys. Kinky!" Well, he'd hit on something there. Toning your pf muscles can lead to quantum leaps in love-making. The blissful by-product of pelvic floor toning is tantric sex. I have to say that all that twitching and holding and releasing was not only leading to marvelous muscle tone but it also made me feel so much more libidinous.

Which is why the pf muscles are also called the love muscles. Corina Avni, a physiotherapist and pelvic floor specialist, avers. For her it's all about awareness. Know thyself; love thyself, and the benefits flow from there. "Try to lie quietly, notice your breathing and then very gently switch your pelvic floor on and off. Say hi to yourself. If you own your body, its movement and function, you simply have to get back to yourself after each trauma (such as pregnancy)." Simply embracing this part of your body restores dignity (no more leaks) and enhances your love-making.

Through sensory motor integration, Corina teaches her clients to feel the muscles, so they can use them. "Rather feel more, then, when you have a neat little perfect contraction, work on increasing it. Don't increase poor initial function. Train for length, not strength (long and loose, not short and tight contractions). It's as important to let go and relax as it is to squeeze. Kegel exercises and pelvic floor exercises should be renamed relaxes. You should squeeze then relax. Then squeeze again and relax." Unsurprisingly, for an untoned wimp like me, the relaxing part was a challenge. It's easy to twitch, but harder to hold, and then release properly. And it's such a head thing. You really have to reconnect your brain to your body to get those mysterious muscles to do what you want.

Joanne Enslin, a physiotherapist who practices pilates, does visceral manipulation, a gentle technique developed by Jean-Pierre Barral. Joanne says that it begins with our posture and the way we hold our bodies. "Pelvic floor activation is hugely influenced by the alignment of the Sacroiliac Joint and the balance in the pelvic organs. Pilates has a huge influence in maintaining the correct alignment of the pelvis and balancing our musculoskeletal system." As I'm a sloucher and have shockingly bad posture - decades of holding a baby on my hip - I knew I would benefit.

But if all else fails, if all the tweaking and relaxing and breathing and aligning doesn't work, then there are other options. Dr Frans Van Wijk, a leading urologist, is quick to calm. "Prevention, of course, is always better than cure. Women should be doing their toning long before they have children, but, even after the fact, there is so much we can do. There are drugs and many non-invasive surgical options. Surgery is now a routine, risk-free and highly successful option."

I resolved to go it the natural way and at the end of three months I swear I had my Kegelmaster in a death grip. Also, judging by the perpetually smug look on my husband's face, my pelvic floor muscles are now perfectly primed.

And so I found myself back at the mom's race at my preschooler's mini-olympics. I am proud to report that I sailed to the finish line, pure poetry in motion, and my polka dot La Senzas remained nicely dry. And it wasn't so much about crossing the line as about the journey it took to get there. Yes, I had gained tautened pelvic floor muscles, and tantric sex but, more importantly, I had gained an empowering knowledge of my body which I hadn't had before.

A word of caution
As with any condition, you need to see a specialist before you begin treatment. Says Lizelle, "unsupervised treatment can be dangerous. For example, if you simply strengthen the muscles without learning how to relax them, you may make your incontinence worse by making the chronic pelvic tension better at cutting off blood flow."

The famous Kegels
Kegels should be done in three positions- lying down, seated and standing

Elevator Kegels
Visualize the muscles of your vagina as a building, with the base of your pelvic floor as the "lobby" and the top floor at your belly button. Raise the elevator slowly (tighten the muscles) from the bottom floor to the top, give a slight hold and bring the elevator back down, slowly relaxing your muscles from top to bottom.

Sustained Kegels
Contract the pelvic floor muscles and hold for a count of 10. Repeat 10 times. If you cannot hold them this long initially, hold them as long as you can. Eventually, you will be able to do 10-second holds.

Progressive Kegels
Squeeze briefly and hold for five seconds. Then squeeze harder and hold for five seconds. Squeeze as hard as possible and hold for five seconds. Release a little, hold for five. Release a little more, hold for five. Release completely

Bipedal blunder
Interestingly, our pelvic floor is weakest when we're standing. This, apparently, is yet another evolutionary blunder (along with post-nasal drip) as a result of being bipedal. Most other big mammals walk around on all fours and so the pelvic floor doesn't carry all the weight.

The culprits
what causes slack pelvic floor muscles? Pregnancy, childbirth, tearing during delivery, episiotomy, Caesarean section, smoking and the associated chronic cough, frequent straining during bowel movements, eg. constipation, IBS. Obesity, diets high in processed foods, menopause, woman doing heavy weight lifting, hysterectomy. Simple inactivity can lead to decreased pelvic floor muscle tone, strength and endurance. Source: Lizelle Grundell

Movement is key
"Our bodies are meant to move," says Corina Avni. "This is where any form of exercise that encourages appropriate use of the core and breathing can add value - Pilates, Yoga, Tai Chi, Feldenkrais, Alexandre Technique, Gyro, Nia, etc." Source: Corina Avni at www.pelvicfunction.co.za

Too toned?
If you leak, have pain or discomfort during sex or when inserting a tampon, and frequently "need to go", you may have over-taut rather than slack pelvic muscles (clinically known as vaginismus or vulvodynia). You need to see a urologist before you embark on any treatment. All the exercises mentioned in this feature will worsen and not alleviate your problem.

What is Biofeedback?
Essentially it's retraining your brain to perform certain functions which have fallen into misuse or disuse. Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. It's a non-invasive form of treatment. Precise instruments measure physiological activity and rapidly and accurately "feed back" information to the user. The presentation of this information - often in conjunction with changes in thinking, emotions, and behaviour - supports desired physiological changes. Over time, these changes can endure without continued use of an instrument. Voila, you've trained your brain.

The love muscles
The vagina and clitoris are surrounded by the pelvic floor muscle and contribute to a woman's sexual function and satisfaction. Pelvic floor muscle strength increase a woman's stimulation during intercourse due to increased blood flow and nerve sensitivity and circulation to the area, which result in an intense heightened sensitivity to touch. Woman with strong vaginal muscles achieve better, longer and multiple orgasm as well as increased ability to control the timing of their orgasm. Source: Lizelle Grundell

The Power of Infiniti India's Olympic Gold Breakthrough

"I used the Infiniti System to train Abhinav for the air rifle competition in Beijing - India's first ever Olympic Gold.Shooting is a unique sport due to the lack of movement, and air rifle is the most precise and exacting of the shooting sports. I chose the FlexComp because it allowed me to move seamlessly between training modalities, and the BioGraph software because of it's ability to measure and provide accurate biofeedback." Timothy Harkness - South African Sports Psychologist


Italy's World Cup Winner - AC Milan

"Thought Technology's FlexComp Infiniti and BioGraph Infiniti are an essential component of the sports science in AC Milan's Milan Lab. Our ability to monitor muscle fatigue, as well as th psychological and physiological preparedness of our athletes in the Mindroom have allowed them to perform at their peak, and enabled them to decrease injuris by 90%."Bruno De Michelis Ph.D - Milan Lab AC Milan


NASA's Underwater Nemo Nine Project

"Our Project was called Nemo Nine. It was 22 days long, with 2 astronauts participating. They wore the FlexComp Infiniti system for three of the mission days. What we were looking for was the effect of isolation, workload and fatigue on the individuals. We're using the Nemo Nine environment as an analog of space. Because of the extremes in the research environment, which included air pressure at 65 feet below sea level, there were questions as to whether the instrument would function - it did flawlessly."Bill Toscano - NASA Ames Research

August 21, 2008
Linda Young - AHN Editor
Beijing, China (AHN)

It turns ut that Abhinav Bindra had a secret weapon when he took the gold medal in the 10 meter air rifle event at the Beijing Olympics becoming the first athlete from India to ever earn an individual gold medal in that Olympic sport. Bindra trained for his event using biofeedback training to master control over the other skills, besides dead aim, that a shooter needs to excel in the 10 meter event.

Bindra, is a 25-year-old businessman and the world champion in the sport. He trained with sport psychologist Timothy Harkness using biofeedback training to help him master a controlled breathing and heart rate, eliminate excess tension in his muscles, silence interior monologue, and develop sharp focus and good reactions for him to trigger at the moment when the sight image was correct for him to fire his winning shots.

Harkness was one of a team of shooting coaches that helped Bindra prepare for the 2008 competition, other team members included a physician, chiropractor, dietitian and physiotherapist, David Stumph, executive director of the Association for Applied Psychophysiology & Biofeedback, said in an emailed statement on Wednesday.

"Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance,' according to a statement on the website of the Association for Applied Psychophysiology and Biofeedback.

This is done by using instruments that measure physiological activity such as brain waves, heart function, breathing, muscle activity, and skin temperature and then "rapidly and accurately 'feed back' information to the user," the AAPB says.

Over time, the presentation of this information, in conjunction with changes in thinking, emotions, and behavior, supports desired physiological changes and can endure without the use of an instrument, the association says.

For Bindra, the training resulted in more than a gold medal, he reportedly received monetary awards from various organizations back home, which include:

  • The Sports Authority of India gave him $71,000.
  • The Board of Control for Cricket in India plans to give him cash award of about $60,000.
  • The Minister of Railways gave him and a companion a free, lifetime rail pass to travel
  • first-class in an air-conditioned compartment.
  • Steel tycoon Lakshmi Mittal announced a $357,000 award from his London-based Mittal Champions Trust.

Understanding what the FIRST individual Olympic GOLD medal in 112 years means to 1.2 Billion people is hard to imagine. Tim Harkness and FlexComp Infiniti's role in this is part of Thought Technology's unique Sports history.

Mark Golin If you're like me, then you've probably flirted briefly with some sort of meditation or guided-imagery technique in an attempt to give stress the slip.

Unfortunately, I always ran into the same problem. After wrapping myself up into a reasonable facsimile of the lotus position, I'd close my eyes and set sail for inner peace. About 10 minutes into my journey, I'd start wondering if I was doing it right.

Am I relaxed now? I'd ask myself. That little voice of doubt always managed to be just loud enough to disrupt any attempt at achieving relaxation.

The end result of all my endeavors was always the same: a sigh of defeat and a couple more instruction books relegated to the bottom of a closet.

But a couple of months ago, hope came to me through the mail in a package from a company called Thought Technology. Inside was a hand-sized piece of machinery with the enigmatic label GSR 2. It was a biofeedback unit. I vaguely recalled biofeedback as a sort of 70's self-improvement fad that somewhere along the line was quietly forgotten. But since I was about due for another adventure in stress control, it couldn't hurt to give biofeedback its turn.

Being inherently suspicious of anything I don't understand that promises to do me good, the first order of business was a call to John A. Corson, PhD., professor of psychiatry at Dartmouth Medical School and an expert in the field of biofeedback.

"Basically, what a biofeedback unit does is monitor a biological process that would be otherwise difficult or impossible for the subject to detect," Dr. Corson says. "Changes in body function are then transformed into an easily understood signal, such as a tone or meter reading, so that the subject can see exactly what a certain part of his body is doing from moment to moment."

'THE FIRE IN THE BOILER'

One reason for spying on your body's workings is that they often times change as your emotional state changes. The autonomic nervous system is a perfect example of this, says Dr. Corson. I call this system the emotional fire in the boiler because it initiates many physical and chemical changes as components of heightened emotional states, such as fear or excitement.

Perspiration is one of those functions controlled by the autonomic nervous system. You may have noticed yourself sweating a bit the last time you gave a recital at Carnegie Hall or were chased by a Siberian tiger. This is the autonomic system working at its best. On a subtler level, the size of your pores as well as the level of perspiration production are constantly changing in reaction to everyday stimuli and stress.

"These changes are very small and are measured in units called micromhos," says Dr. Corson. The GSR 2 biofeedback unit monitors the skin's micro-mho level and emits a tone, which rises in pitch as more moisture is produced or drops as the skin becomes drier.

The end product is a direct line of communication with how you're really feeling. So it seemed as if biofeedback was the answer to my meditation struggles with the voice of doubt. Now I'd know for sure if I was relaxing correctly because the tone would tell me. It was time for some experimentation.

MASTERING THE PITCH

The actual unit fit easily in my hand and had a small elastic band that held my fingers snugly against two smooth metal plates. Upon contact, a small earphone began humming softly in my ear. I closed my eyes and started purposefully thinking about a stressful situation: my next article deadline. Sure enough, within three seconds, the tone started climbing the scale until it resembled the high-pitched whine of a mosquito. No doubt about it, I was definitely worked up.

'Soon I had the unit humming a low tone - virtually one-note hymn to relaxation.'

Bringing the tone back down took a little more work. Over the next two weeks, I practiced regularly with the unit while listening to a tape of relaxation exercises that came with the package. Soon I had the unit humming a low complacent tone that was a virtual one-note hymn to relaxation. If I heard the tone rise, I stopped and examined my thoughts to see what was bothering me. In this way, I not only learned correct relaxation techniques, I also discovered hidden stressors that I never realized were upsetting me.

As I was lying on my living room floor totally calm after a half hour of feedback, I wondered why such a great technique had been a mere fad 15 years ago. "The instrumentation and training techniques for clients were less sophisticated back then," says Dr. Corson. "People bought biofeedback units with the idea that they could just plug themselves in and rewire their emotions for relaxation."

If regeneration is high on your priority list, biofeedback may be just the ticket.

That's not the case at all. If you're thinking of giving biofeedback a try, be prepared for some serious work. To start, you've got to find a good relaxation technique and really concentrate on making it work. "The unit itself only tells you how you're doing, not what to do," cautions Dr. Corson. A good analogy is that of a maze. At one end is you, at the other is relaxation. Biofeedback can tell you when you're on the right path and can also let you know when you're taking false turns.

I put in a good half hour a day at feedback. But Dr. Corson says even 10 to 20 minutes daily, done regularly, can have a beneficial effect. "Besides the promise of daily relaxation, I've found that biofeedback in conjunction with stress-management training often delivers other bonuses, such as better sleep and relief from stress-relaxed high blood pressure," he says.

Eventually, when you've learned proper relaxation techniques, you can wean yourself from the feedback unit. But again, to make it work, you still must practice your exercises regularly. Otherwise your body will forget everything you taught it. "Occasionally it's a good idea to go back to the biofeedback unit to make sure your skills are in good order," says Dr. Corson.

If regeneration is high on your priority list, biofeedback may be just the ticket. It helps you gain control of your body and mind so that you can realize some of your latent potential. And it does this by rechanneling your own attention rather than by depending on external resources. If you just want to calm down a bit, biofeedback can show you how to do it faster and better.

Thought Technology is a leading manufacturer of quality, home biofeedback units. If you're interested in learning a little more about the GSR 2, drop them a line.

Hasselt - "The reason why I invited this Japanese yogi is that I wanted to know how much pain he feels and how he can do these things without screaming of pain", says Dr. Peper, president of the Biofeedback Foundation of Europe . Ten minutes later Mitsumasa Kawakami wets the iron skewer with his tongue and pierces it through the skin of his throat. His respiration rate does not increase, his heart rhythm remains stable. "Health is control over your body", concludes Dr. Peper.

Biofeedback is a relatively new field within medicine. The method is monitored closely by the pharmaceutical industry, because if Dr. Peper could influence medicine , patients in Western society would need a lot less pills to control pain. A computer with screen would be all that is needed to control pain. Through biofeedback people can see on a computer screen how their body reacts. These reactions are monitored using sensors. The sensors measure muscle tension, skin temperature and blood pressure, analyze these data and show them on the screen in an understandable way. For the patient the computer screen is like a mirror to his inner body. He can see how his muscles react to inner (stress) and outer (workload) stimuli. Working with the physician the patient can figure out how his physical complaints are related to his psychological state. Then he can learn how to react in order to suppress the physical complaint, for example by adapting his respiration rate. "Biofeedback has proven to diminish incontinence in women by 80%", says Dr. Peper, who is the coordinator of the scientific program at the 9th Annual Meeting of the BFE in Hasselt .

Respiration

"Biofeedback makes it easier to understand your body", says Dr. Peper. Often people are unaware that they work in a certain posture that can cause severe complaints in the future. It is common for journalists to work on the computer with tensed shoulders. This causes , after a period of time , a cramped posture, which leads to pain, faster breathing and the beginning of a vicious circle. While a relaxed posture and slower breathing can reduce pain by a large extent. By using biofeedback you can make this visible in an easy way.

Health

The use of Biofeedback, biological monitoring, and stress management principles in Psychotherapy.

Donald Moss, Ph.D., Saybrook Graduate School , San Francisco , CA USA - Correspondence should be addressed to: dmoss@saybrook.edu

Sigmund Freud described the interpretation of dreams as the "royal road to the unconscious" for psychotherapy (1900). Today psychophysiology can provide that royal road for psychotherapists. This program introduces fifteen principles guiding the use of psychophysiology in psychotherapy, including specific techniques and case examples, showing the use of biofeedback instrumentation to augment the work of psychotherapy. The author also cites the work of pioneers such as Sandor Ferenczi, Wilhelm Reich, Marjorie and Hershel Toomim, and Ian Wickramasekera, who contributed to understanding the potential role of the body in psychotherapy.

Principle 1.

Cultivating physiological relaxed states facilitates psychotherapy. Freud began his psychoanalytic practice initially with hypnosis, and after he abandoned hypnosis continued to invite the patient to recline on a couch. The early psychoanalyst Sandor Ferenczi advised the use of relaxation exercises to overcome inhibitions to free association (1925). Commencing a psychotherapy session with a brief relaxation exercise increases the patient's awareness and expression of emotion, and eases those inhibitions which impede therapeutic awareness (Moss & Lehrer, 1998). When patients either block or struggle with emotional pain, a return to relaxation reduces the intensity of distress and enables acceptance.

Principle 2.

Observing changes in the body leads to detection of defensive and inhibitory operations. Therapist observations of movement, posture, and changes in non-verbal expression provide keys to current emotional and cognitive processes in the patient. Sudden changes in the body often reveal current moves to block emerging thoughts, feelings and impulses. Patterns of bracing and tension in the musculature support the defensive operations of the mind. The repetitive and chronic suppression of emotions and impulses creates an "armoring" in the musculature (Wilhelm Reich, 1927, 1933). Anna Freud (1936) commented that the "defenses meet our eyes in a state of petrifaction when we analyze the permanent 'armor plating of character'."

Principle 3 .

Electronic monitoring of physiology enhances this recognition of mind-body linkages. Biofeedback instrumentation detects subtle physiological changes and processes not evident to the observer, providing a signal to therapist and patient alike of emotionally significant internal responses. The display of the biological signal reduces therapeutic tensions around "resistance." The patient perceives the biological signal as "objective" and accepts its image more readily than therapist-initiated interpretations.

Principle 4.

Biofeedback instrumentation identifies maladaptive physiological responding: Maladaptive responses are disproportionate to the triggering situation, either exaggerated or minimized.

In addition, the individual may fail to recover in a timely manner when the triggering stimulus passes.Once maladaptive physiological response patterns are recognized, the biofeedback instrumentation enables a retraining and modification of the maladaptive elements. Toomim and Toomim (1975) introduced a framework utilizing electrodermal biofeedback to identify patterns of over-reactors and under-reactors, and showed how biofeedback training could facilitate a more optimal pattern of responding for each group.

Principle 5.

Recognizing the mind-body linkage facilitates psychotherapeutic progress. The psychophysiological principle is that: "Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state" (Green, Green, and Walters, 1970, p. 3). When the patient directly experiences this reciprocal integrity of body and mind, it facilitates an awareness and ownership of many previously unrecognized emotional and motivational elements in everyday living.

Principle 6.

When the patient is verbally stuck, turning to physiological pathways moves psychotherapy forward. Exploration of body posture and tensions often serves to move therapy forward, when verbal processing is at an impasse. Direct physical interventions, such as breath training, postural re-alignment, and therapeutic massage, also can facilitate renewed movement toward awareness and health. In general, "body-work" enables expanded subjective awareness.

Principle 7.

When the patient is physiologically stuck, turning to psychological exploration moves the process forward. Body-work such as breath training or biofeedback can also get stuck, and when this happens, discussing the emotional accompaniments of the physical impasse often clears the way for renewed bodily learning. Wilhelm Reich introduced these classical strategies of mind-body therapies, expressed in principles 6 and 7, in the following comment: "When a characteristic inhibition would fail to respond to psychic influencing, I would work at the corresponding somatic attitude. Conversely, when a disturbing muscular attitude proved difficult of access, I would work on its characterological expression and thus loosen it up" (Reich W., 1927/1942, p. 241).

Principle 8.

The human being can push negative emotion out of the mind, but not out of the body (Wickramasekera I., 1988, 1998). Individuals can deny many emotions and desires to themselves cognitively, yet the body will disclose undeniable physical reactions when the subject is discussed. Increases in skin conductance, changes in rate and manner of breathing, and increases in muscle tension may all be a warning of such unrecognized emotional distress or conflict.

Case Example: Larry illustrates this principle that negative emotion can be pushed out of mind, but not out of body. Larry presented himself adamantly as happy and content with his marriage and family. He appeared to be an angry, resentful man, but resisted any discussion contrary to his rigid self-perception. His psychotherapist monitored electrodermal and heart-rate variability biofeedback to monitor Larry's physiology during therapy sessions. His electrodermal response elevated noticeably, and his Very Low Frequency range in his heart rate variability spiked in activity each time the topic of his marriage and wife was mentioned. The physiology was more convincing for him than the therapist's perceptions. He became receptive to this "objective" witness to his unrecognized feelings. The physiological display opened a psychotherapeutic window over time in his therapy

Principle 9.

Observing the physiological display can convince the patient of the reality and significance of subjective cognitive and emotional changes. The patient often is surprised by simple recognitions: "You mean that just because I am upset about my spouse, my breathing becomes erratic, my heart rhythms change, and my brain wave patterns are different?" The physiological display can also show patients the power of relaxation skills or a hypnotic induction to bring about dramatic physical changes, and convince the patient to continue to cooperate with such therapies.

Case Example: Nora provides an illustration of how the display of physiological data can enhance the patient's confidence in the therapy process. Nora, a 43-year-old EMT and fire fighter, was presented with repeated trauma in the line of duty, and classic symptoms of PTSD. Her symptoms included nightmares, daytime flashbacks, baseline vigilance and a heightened startle response. She also showed a loss of emotional spontaneity and social withdrawal which contributed to the breakdown of her marriage. Nora was repeatedly referred by her employer for psychological services. Each time she initially made some progress, but continued to experience intermittent flashbacks. She became discouraged by setbacks and quit psychotherapy several times. Monitored with EEG during a therapy session, Nora showed a dramatic spike of cortical activity at 28 Hz. This EEG feature was interpreted to her as a ruminative reliving of a trauma scene. During a hypnotic induction, the spectral display flattened across entire spectrum, completely erasing the 28 Hz spike. Nora was shocked: "I knew I felt better but I didn't think it really made any difference." Seeing the change in her brain convinced her that the therapy might have lasting impact.

Principle 10.

A variety of biofeedback modalities can usefully disclose information relevant for psychotherapy. Some patients are muscular responders, others are cardiovascular responders, others gastrointestinal responders, and others cognitive responders. Access to a wide range of physiological instrumentation allows the therapist to choose specific modalities for monitoring during psychotherapy.

Widely used biofeedback instruments for monitoring during psychotherapy include:

  • Surface electromyography (SEMG) to detect muscle tension.
  • Thermal biofeedback (TEMP) to monitor peripheral skin temperature.
  • Electrodermal biofeedback (EDR) to detect changes in skin electrical conductance or skin electrical resistance.
  • Respiratory biofeedback (RESP) to monitor rate of breathing, amplitude of breaths, and the "architecture" of breaths.
  • The electrocardiogram (EKG) or photoplethysmograph (PPG) to detect current heart rate, blood pulse volume, as well as patterns in heart rate variability.
  • EEG biofeedback to detect brain wave patterns, areas of over-activation or under-activation.
  • Alternatively, a therapist may use a multi-line graph, monitoring several modalities at once, to detect the patient's personal stress response, physiological activation and recovery patterns.

Principle 11.

The boundary blurs between psychophysiological training and psychotherapy. Ancient Chinese medicine tells us about the value of regulated breathing in mental calming: ". the tranquility of the mind regulates the breathing naturally and, in turn, regulated breathing brings on concentration of the mind naturally" ( Questions and Answers of Meisha , Yue Yanggui, Qing Dynasty, cited by Xiangcai, 2000, p. 7). Today, breath training is included as an adjunctive component within anxiety treatment. This simple skill often provides so much mastery over anxiety that patients proceed to use their new breath skills independently, recovering their self-confidence with little or no additional psychotherapy. Similarly, EEG biofeedback training to reduce a left/right frontal asymmetry in cortical activation often improves mood so rapidly, that patients proceed on their own to accomplish typical therapeutic goals, such as self-affirmation, assertion with peers, and cognitive reframing of problems.

Case Example: Susan provides an illustration of how physiological training sometimes cancels the need for psychotherapy. Susan was a 34-year-old high achiever, rapidly piercing the glass ceiling at a mid-sized corporation. She requested evaluation for a panic disorder with agoraphobia.

Her psychophysiological Stress Profile (PSP) showed a baseline of shallow, irregular rapid breathing (22-30 breaths/minute). A hyperventilation trial produced a full-fledged panic attack. In two sessions of respiration training, she showed excellent mastery of smooth, full diaphragmatic breathing. Susan returned the next session, and reported how she had used alternating hyperventilation and relaxed breathing trials to prepare herself to enter anxiogenic situations. For example, Susan sat in her car in a parking lot, first hyperventilated to the point of anxiety, then calmed herself with effortless full breathing, and then entered a supermarket without any incidence of anxiety. Her sense of mastery increased rapidly, she increased the range of situations she was able to master, and no "therapy" phase was needed.

Principle 12.

A stress management model and stress management skills facilitate symptom management in psychotherapy. The use of biofeedback instruments assists the therapist in teaching the patient a stress management paradigm. The patient can distinguish in a practical way between the provoking stressor and his/her own stress response to that stressor. Biofeedback training also models for the patient a modified and more adaptive response to that same stressor in the future.

Principle 13.

A variety of basic mind-body principles transfer readily to psychophysiological psychotherapy. For example, consider the principle of response mechanism stereotypy (Sternbach, 1966). When individuals encounter stress their physiological responding is often recurrent and unchanging over a variety of situations. This stereotypy decrees the types of stress-related medical symptoms an individual is likely to develop. The more consistent this stereotypic activation is, the greater is the likelihood of stress-related disease. Re-training a novel, non-stereotypic and more strategic response aids in restoring adaptive functioning.

Principle 14.

Psychophysiological monitoring supports a variety of behavior therapies and specialized interventions. Physiological indices can guide the course of behavior therapeutic interventions, such as systematic desensitization. Electrodermal feedback, peripheral temperature, respiration, or heart rate variability can each serve to indicate when the patient is calming his/her anxiety, and when the patient's anxiety is persisting or increasing. In addition, biofeedback assisted relaxation can facilitate recovery following each behavioral exposure trial.

Principle 15.

Psychophysiology provides a Trojan horse to open the individual's gates to psychotherapy (Wickramasekera I., 1988, 2003). This is especially true for somatizers, individuals who present physical complaints without any measurable pathophysiology. These patients represent 50 % or more of patient visits in primary care clinics; they often resent and resist referrals to mental health professionals. Biofeedback emphasizes physiological mechanisms, biomedical instrumentation and measurement of bodily processes, affirms the patient's somatic focus, and reduces the patient's defensive resistance against an inferred psychological understanding of their complaints. Once the patient has accepted biofeedback, relaxed defenses, and achieved physiological relaxation, emotional awareness and self-recognitions often unfold spontaneously.

Conclusion

In conclusion, biofeedback and biological monitoring are useful in creating readiness for selfexploration, reducing therapeutic resistance, and enabling the patient to recognize mind-body linkages.

Display of physiological signals enables therapist and patient alike to identify maladaptive and stereotypic responses to stress, and to retrain more flexible and adaptive responding. Biological monitoring during the course of psychotherapy can provide a "window into the soul" - alerting both patient and therapist to attune to specific topics and life situations which activate somatic threat and distress reactions.

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