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Biofeedback Training: An Interactive Tripartite
Learning Process
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Learning Models ~ Methods for Effective Biofeedback Training
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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
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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
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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
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What is Biofeedback?
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Theory or Rationale for Biofeedback
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Define Biofeedback for Patients
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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)
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SSTTRREESSSSOORR
physiologicalphysiological
cognitivecognitive
emotionalemotional
behavioralbehavioral
multiple consequencesmultiple consequences
perceptionperception
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SSTTRREESSSSOORR
physiologicalphysiological
cognitivecognitive
emotionalemotional
behavioralbehavioral
multiple consequencesmultiple consequences
perceptionperception
Biofeedback
Cognitive Therapy
Humanist Therapy
Behavior Therapy
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Biofeedback Process
• BiofeedbackBiofeedback• Biological (physiological) InformationBiological (physiological) Information
• Biofeedback TrainingBiofeedback Training• Psychophysiological AssociationPsychophysiological Association
• Goal of BiofeedbackGoal of Biofeedback• Voluntary Self-RegulationVoluntary Self-Regulation
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Biofeedback Process
• Biological InformationBiological Information• Unconscious to ConsciousUnconscious to Conscious
• Biofeedback TrainingBiofeedback Training• Discrimination TrainingDiscrimination Training
• Voluntary Self-RegulationVoluntary Self-Regulation• Self-EfficacySelf-Efficacy
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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.
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Fundamental Principles Fundamental Principles
SENSATION - SENSATION - UnconsciousUnconsciousPERCEPTION - PERCEPTION - ConsciousConscious
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LearningLearningDefinition: Definition:
A relatively permanent A relatively permanent change in behavior based change in behavior based on experience.on experience.
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ClassicalClassical • Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious
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ClassicalClassical OperantOperant• Stimulus - ResponseStimulus - Response• PassivePassive• ReflexiveReflexive• AssociationAssociation• UnconsciousUnconscious
• Response – StimulusResponse – Stimulus• ActiveActive• InstrumentalInstrumental• EnvironmentEnvironment• ConsciousConscious
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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
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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
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Biofeedback Models
Learning Emphasis
Physiological Emphasis
Interactive Emphasis
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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
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Biofeedback Models
Learning Emphasis
Physiological Emphasis
Interactive Emphasis
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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)
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Stereotypical Stress Pathways
NeuromuscularNeuromuscular NeurovascularNeurovascular NeurohumeralNeurohumeral InterneuronalInterneuronal
What kind of Responder are you?
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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
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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
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immunosuppressionimmunosuppressionlowered sexual functioninglowered sexual functioningdecreased appetitedecreased appetiteinfectionsinfectionsautoimmune diseasesautoimmune diseasesGI disordersGI disordershypertensionhypertension
Stereotypical Stress Pathways Neurohumeral SCNeurohumeral SC
sweatingsweating
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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
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Biofeedback Models
Learning Emphasis
Physiological Emphasis
Interactive Emphasis
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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)
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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
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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
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Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
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Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
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Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
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Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
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Theories of Learning:The Developmental Progression of
Self-Regulatory Skills
PrevailingPrevailingTheoreticalTheoretical
ProcessProcess
ClassicalClassicalLearningLearning
ConcurrentConcurrentLearningLearning
OperantOperantLearningLearning
CognitiveCognitiveLearningLearning
education acquisition discrimination self-efficacy
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Biofeedback Models
Learning Emphasis
Physiological Emphasis
Interactive Emphasis
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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)
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Triadic Feedback ProcessTriadic Feedback ProcessKappes (10) Kappes (10)
Physiological Feedback
TherapeuticFeedback
TFP
Performance FeedbackPatient Influence Instrument Influence
Therapist Influence
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Triadic Feedback Process Triadic Feedback Process Patient Variables
Motivation
Self-Efficacy
Learning Readiness
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Triadic Feedback Process Triadic Feedback Process Instrument Variables
Analog / Digital
Real Time
Accuracy
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Triadic Feedback Process Triadic Feedback Process Therapist Variables
Certified / Trained
Communication Skills
Therapeutic Competencies
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Integrative Biofeedback Model
Learning EmphasisMultiple Learning Stages
Physiological EmphasisStereotypic Pathways
Interactive EmphasisTriadic Feedback Process
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