biofeedback training: an interactive tripartite learning process bruno m. kappes, ph.d. professor of...
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Biofeedback Training: An Interactive Tripartite
Learning Process
Biofeedback Training: An Interactive Tripartite
Learning Process
Learning Models ~ Methods for Effective Biofeedback Training Learning Models ~ Methods for Effective Biofeedback Training
University of AlaskaDepartment of Psychology
University of AlaskaDepartment of Psychology
Licensed Psychologist Licensed Psychologist
Certified Biofeedback TherapistCertified Biofeedback Therapist
Certified Medical PsychotherapistCertified Medical Psychotherapist
Professor 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
Licensed Psychologist Licensed Psychologist
Certified Biofeedback TherapistCertified Biofeedback Therapist
Certified Medical PsychotherapistCertified Medical Psychotherapist
Professor 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?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)
“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 ProcessBiofeedback Process
• BiofeedbackBiofeedback• Biological (physiological) InformationBiological (physiological) Information
• Biofeedback TrainingBiofeedback Training• Psychophysiological AssociationPsychophysiological Association
• Goal of BiofeedbackGoal of Biofeedback• Voluntary Self-RegulationVoluntary Self-Regulation
Biofeedback ProcessBiofeedback Process
• Biological InformationBiological Information• Unconscious to ConsciousUnconscious to Conscious
• Biofeedback TrainingBiofeedback Training• Discrimination TrainingDiscrimination Training
• Voluntary Self-RegulationVoluntary Self-Regulation• Self-EfficacySelf-Efficacy
Biofeedback TrainingBiofeedback 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 Fundamental Principles Fundamental Principles
SENSATION - SENSATION - UnconsciousUnconscious
PERCEPTION - PERCEPTION - ConsciousConscious
SENSATION - SENSATION - UnconsciousUnconscious
PERCEPTION - PERCEPTION - ConsciousConscious
LearningLearningLearningLearning
Definition: Definition:
A relatively permanent A relatively permanent change in behavior based change in behavior based on experience.on experience.
Definition: 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 ModelsBiofeedback Models 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
1)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
Physiological EmphasisPhysiological 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)
Motor 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 PathwaysStereotypical Stress Pathways
NeuromuscularNeuromuscular NeurovascularNeurovascular NeurohumeralNeurohumeral InterneuronalInterneuronal
What kind of Responder are you?
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 PathwaysStereotypical Stress Pathways
Neuromuscular EMGNeuromuscular EMG
muscle muscle tensiontensionmuscle 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 PathwaysStereotypical Stress Pathways
Neurovascular TEMPNeurovascular TEMP
coldcoldhands & feethands & feet
coldcoldhands & feethands & feet
immunosuppressionimmunosuppressionlowered sexual functioninglowered sexual functioningdecreased appetitedecreased appetiteinfectionsinfectionsautoimmune diseasesautoimmune diseasesGI disordersGI disordershypertensionhypertension
Stereotypical Stress PathwaysStereotypical Stress Pathways
Neurohumeral SCNeurohumeral SC
sweatingsweatingsweatingsweating
obsessive thoughts and feelingsobsessive thoughts and feelingsracing thoughtsracing thoughtsconfusion, ruminationsconfusion, ruminationssleep disturbancessleep disturbancesemotional burnoutemotional burnoutdepression & maniadepression & maniadrug addictiondrug addiction
Stereotypical Stress PathwaysStereotypical Stress Pathways
Interneuronal EEGInterneuronal EEG
cognitive cognitive & emotional& emotional
changeschanges
cognitive cognitive & emotional& emotional
changeschanges
Learning EmphasisLearning 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)
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 ProcessBiofeedback 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
• 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 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
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
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
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
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
Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
Interactive EmphasisInteractive 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)
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