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An Overview of the world of Biofeedback

An Overview of the world of Biofeedback:

copyright Rob Kall 1999, 2005
-an overview of biofeedback-
some basic definitions:
self regulation

-history and evolution of the field in the context of health care, peak performance, education, etc.,

-eastern approaches: yoga, meditation

-early pioneers (Jacobson, Basmajian, Kamiya, Brown, Green, Taub, Budzynski, Stoyva
-Legal and related issues:
-FDA Device Registration
-insurance billing and re-imbursement

Information Resources:

AAPB Website: The Association for Applied Psychophysiology and Biofeedback some good basic biofeedback info, some articles, conference info.

EEG Spectrum a private company, specializing in EEG biofeedback, with excellent web info resources. A good possible source for part of the biofeedback package.
Futurehealth My website. Lots of info on different biofeedback and other topics of interest, including:
Positivity Central optimal functioning, positive experience training, smile anatomy, more on positive approaches
Neurofeedback Central dedicated to EEG biofeedback, neurofeedback, neurotherapy and QEEG information, software, computer systems, instruments, meetings, workshops, articles, abstracts, tapes
Stress/Relax Central articles, tips, info, products for stess management and relaxation
Pain Central information, tapes, articles, products for pain self care
QEEG Central Brain mapping, imaging, assessment
sEMG/ Muscle electromyography for measuring muscle activity, training for relaxation and tension reduction

ADD Central information, tapes, articles, products on ADD/ADHD
Meeting Abstracts on neurofeedback, Optimal Functioning and sEMG meetings
The Ghost in the box a very important,. short book on what makes biofeedback work, and common misconceptions. Must reading for someone entering biofeedback. This is downloadable as a "shareware" book from this website.

SNR Society for Neuronal Regulation lots of articles on neurofeedback, though about half are somewhat obscure or technical, some cover interesting topics, including some peak performance applications.


-clinical applications:

stress disorders, headache, pain, hypertension, habits, substance abuse, ADD/HD, chronic disorders

- non-clinical applications
optimal performance in work, sports, life
consciousness exploration
spiritual exploration


- background theory,
operant conditioning

behavioral medicine
-applications, physiology and technology of the different modalities:
-EEG (brainwaves)
-EMG (muscle)
-thermal (skin temp based on stress nervous system/autonomic arousal)
-respiration (stretch, RSA, nasal temp, trapezius EMG)
-cardio signal (ECG, PPG).

-Skin (GSR, EDG, SCL)

Biofeedback hardware and software
-Professional systems
Stand-alone Biofeedback Instruments (a good way to make the technology more accessible to more people at less cost.)
-consumer home trainers very low cost simple tools to aid in home practice, used to speed up the learnijng curve.

-technologies for group stress and peak performance training

-ancillary "megabrain" technologies-
-sound/light mind machines
-acoustic/vibration chairs, pads, tables
-electrical and magnetic brain stim

-Applied psychophysiology:
-what it is
-applications (pain, stress assessment, muscle scanning, stress profiling)

-Mind-Body-Spirit wellness and achievement programs
three and ten week turn-key programs health club/spa staff can be trained to implement

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Biofeedback has been around for over 30 years, with a history which stetches back, when you include its roots in yoga and meditation, for millenia. The more recent history of biofeedback reflects the development of each of the different physiological modalities most often measured:
John Basmajian pioneered EMG electromyography for muscle activity measurement in fifties and sixties, with articles in Science magazine. He showed how people could learn to voluntarily control the firing of single cells in the spinal cord. That’s fine motor control! He used fine wire electrodes placed in muscles in his steps towrd developing the EMG rehabilitation model of biofeedback.
Elmer Green and Ed Taub both were involved in developing thermal or temperature biofeedback. Elmer was at the Menninger foundation, studying Shultz and Luthe’s Autogenic Training. They discovered that a migraine patient’s headache went away when she warmed her hands during autogenic training. They figured out how to use temperature biofeedback to teach hand warming to prevent and abort migraine headaches.
Ed Taub, at the Institute for Behavioral Research reseached the use of thermal feedback for raynauds, a disorder in which sufferers experience painful cold, blanching hands when exposed to cold, even air conditioning.
Joe Kamiya pioneereed the use of EEG electroencephalographic or brainwave biofeedback. His early colleague, Jim Hardt, published essential research in Science Magazine, proving that people could voluntarily control alpha brain waves with eyes closed. More recently, Kamiya is retired, Hardt operates the Biocybernaut institute (with a history of multiple unhappy terminations of partnerships with different groups, including Canyon Ranch.) But every person I’ve spoken to whohas gone through his program (5 days, $20,000) says itis extraordinary and life changing.
Other early pioneers in the EEG field include Max Cade, who worked with people with "Awakened Minds" such as yogis, gurus, executives and athletes. Cade is no longer living, but he trained Anna Wise, who wrote The High Performance Mind.
Barry Sterman developed, with NIH and military funding, the use of EEG biofeeback with intractable epilepsy cases.
Joel Lubar took Sterman’s model and developed EEG biofeedback for Attention Deficit Disorder
Elmer Green and his wife Alyce, at the Menninger Foundation, developed alpha theta training. Green has described it as "instrumental Vipassana" which enables the individual to access the planetary consciousness. He’s told me how he’s used this approach to ask questions of the planetary or universal intelligence. And he gets useful answers he could not have come up with on his own.
Gene Penniston developed an alpha-theta protocol used to treat alcoholism and substance abuse.
Tom Budzynski, Johann Stoyva and Charles Adler first reported the use of EMG biofeedback for relaxation training, and first developed audio biofeedback. Budzynski now often presents on the use of biofeedback to enhance mental functioning, particularly in the aging.

Biofeedback treatment or training?
Biofeedback uses technology. It’s a tool, basically, just a screw driver or wrench. Yet biofeedback is used primarily for teaching or coaching, so it would be more appropriate to consider it to be a tool like a stopwatch.
There are no stopwatch associations composed of coaches who use stopwatches, nor stopwatch professions. Yet, there are coaches and sports psychologists who all use the technology of the stopwatch to help enable people, from 7th grade budding track stars to world class marathon and olympic runners and professional football league ends, to reach the further limits of their potential.
That’s what biofeedback is about too- but instead of speed, it’s about helping people reach the further limits of their potential to know theirselves and develop self mastery of their minds, bodies, emotions and the ways these all interact.

Biofeedback organizations, licensing, meetings, Certification

There are several biofeedback societies, AAPB, SSNR, and the Winter Brain Meeting specializing in biofeedback and the beginnings of a movement to establish a biofeedback profession. There is also the Biofeedback Certification Institute of America, with a general and an EEG Certification.
Biofeedback as it is used or practiced is a blend of psychology and technology, of teaching and coaching, learning and or stretching to reach new levels of personal potential .

There are sociopolitical/economic differences in the ways biofeedback is conceptualized. At one end of the spectrum it is defined by some health care providers as a medical treatment, just like an injection or respiratory therapy. Applications at this end of the spectrum include neuromuscular rehabilitation of spinal cord injuries, stroke victims, headache relief, amelioration of hypertension, diminution of diabetic intermittent claudication... and many more.

At the other end of the biofeedback concept spectrum, it is considered a transformational process used to enable people to reach their full potential and peak performance, not only emotionally, mentally and physically-- reaching the awakened mind state, new levels of concentration, focus, creativity, patience, equanimity and inner peace, achieving new athletic performance milestones, raising IQ-- but also spiritually and even psychically, enabling enhanced telepathic ability, out of body experiences, multiple orgasms, connections with the planetary consciousness and deep spiritual unions with God/higher powers.

Certification and Licensure
The issue of licensure and certification can be an important one in planning a facility. It’s not always easy to find a licensed and or certified biofeedback provider. And, this can add considerable expense to staffing costs. On the other hand, depending upon the model your facility is working with, it may be necessary to meet the guidelines of the facility.
Some providers, mostly some of the licensed ones, say that people should be licensed in a profession to offer biofeedback. They say you should be an MD, licensed psychologist, physical therapist, RN, etc. in order to be allowed to "practice" biofeedback. Most of the licensed practitioners of biofeedback are NOT certified in biofeedback. The certification process involved meeting certain educational criteria, required course work, experience, supervision and the personal experience of being trained in biofeedback. Certificants must take a written exam and maintain an acceptable level of continuing education credits.

This model often uses hired certified technicians or biofeedback certificants to to provide the actual service, which is supervised by licensed providers. In reality, most of the supervisors are not certified, and know much less, often very little about biofeeedback. This situation usually exploints the non-licensed certificants, paying them between $8 per hour and half of the fee billed for the service-- up to $60. Some will work for a salary ranging from $24,000 to $60,000, most often averaging between $28,000 and $38,000.

Another way of looking at biofeedback, one I support, proposes that biofeedback is a teaching or coaching process, enabling CLIENTS to move towards higher levels of functioning in health, mind, body, work, play and life. This model does not require licensure. But it does encourage ethical levels of competence-- so that the user of the instrumentation can operate the equipment and understand the principles, techniques and approaches of biofeedback in an informed, effective way. This model leaves room for participation of teachers, athletic coaches and exercise physiologists and others as providers. But they should be adequately trained, have personal experience with biofeedback traiing, having gone through it themselves, and should begin seeing clients with a supervisor to discuss their work with.
There are a vast number of applications which can be broken into a more limited number of categories:

arousal reduction for stress/anxiety disorders (anxiety, panic attack, phobia, post-traumatic stress disorder, anger) and disorders stress aggravates, such as cancer, Raynaud’s, Tinnitus, irritable bowel, hyperhydrosis (excessive sweating),
Pain management: headache, back pain, raynauds, phantom limb pain, arthritis, RSD, TMJ
by arousal reduction
by muscle pattern analysis (sEMG aided kinesiology)
homeostatic balancing of psychophysiology to minimize symptoms and stress effects of chronic illness such as cancer, arthritis, diabetes, high blood pressure,
Respiratory function amelioration/enhancement: asthma, panic disorder (shortness of breath,) respiratory therapy for emphysema/COPD (chronic obstrcutive pulmonary disease,) hypertension.
neuromuscular rehabilitation (post injury, surgery, spinal cord rehab (Bernie Brucker in Miami is world renowned for his work with spinal cord injuries)
Incontinence: urinary and fecal-- affects over 20% of women over 60. It’s a multi-billion dollar problem with more adult diapers sold each year than babies’.
ergonomic assessment and training. Identify high risk individuals and work-site ergonomic designs by use of multiple site muscle (sEMG) evaluation of muscle activation/inhibition patterns. This is used to prevent and treat disorders such as carpal tunnel syndrome, thoracic outlet syndrome, back injuries, etc.
Brain or central nervous system related function enhancement:
ADD/HD teaching children and adults to pay attention, focus, sit still
closed head injury
lymes disease
chronic fatigue syndrome
the "Ponce DeLeon Effect" enhancing mental functioning in the elderly
ADD/HD teaching children and adults to pay attention, focus, sit still, also preventing childen from needing to become labeled as disability children.
stress management training in schools, business, health facilities to prevent stress problems, enhance wellness
teaching mind body awareness and self regulation as an element of the Intra personal and Body/kinesthetic elements of Gardner’s Multiple Intelligences model.

Optimal Functioning/Peak Performance
athletic performance
concentration and focus
muscle pattern optimization
muscle balancing to optimize movement patterns
muscle relaxation to maximize strength and energy resources
physiological balancing to optimize performance (for example, shooting in the decathlon between heart-beats)
executive and worker performance enhancement
enhancing personal functioning and happiness
enhancing mental functioning such as IQ and the psychophysiological characteristics associated with higher intelligence.
relaxation training to create an ideal mental state or equanimity and peace
creativity enhancement
stress reduction to enhance mental clarity, improve memory
Expanding or stretching the capacity to experience and express the full spectrum, range and depth of emotions.

Mind/Body Consciousness Exploration, Toys for Big Boys and Girls, Psychic Development
consciousness exploration
achieving transcendant, transformational states
brainwave or muscle controlled music
relaxation training for the sake of feeling calm
Reaching meditative states much faster, with a shorter learning curve than eastern techniques such as yoga, TM, living in a cave, etc.
quick "chilling out"
enhancing psychic abilities
out of body experiences
vipassana meditation via biofeedback to enable contact with planetary/universal consciousness for the purpose of getting answers to questions

Part 2 Mind Machines and Sensory Environments