Biofeedback Training An Interactive Tripartite Learning Process Bruno

Biofeedback Training: An Interactive Tripartite Learning Process Bruno M. Kappes, Ph. D. Professor of Psychology & Health Science University of Alaska Anchorage afbmk@uaa. alaska. edu

Learning Models ~ Methods for Effective Biofeedback Training Bruno M. Kappes, Ph. D. Professor of Psychology & Health Science University of Alaska Anchorage afbmk@uaa. alaska. edu

University of Alaska Department of Psychology Licensed Psychologist Certified Biofeedback Therapist Certified Medical Psychotherapist Professor of Psychology & Health Science General Psychology Abnormal Psychology Stress Management Forensic Psychology Health Psychology Trauma Psychology

Research & Clinical Variability: Biofeedback Nomenclature Ambiguity • • • Treatment Therapy Training Techniques Instruction Skills Loop Strategy Learning • • • Process Program Regime Education Approach Experience Application Routine Session

Research & Clinical Variability: Biofeedback Nomenclature Ambiguity • • • Technology Response Intervention Systems Patterns Measures Components Methods Modalities • • • Condition Procedure Control Mechanism Principles Performance Package Factors Practice

What is Biofeedback?

Theory or Rationale for Biofeedback

Define Biofeedback for Patients

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)

S T R E S S O R multiple consequences physiological perception cognitive emotional behavioral

S T R E S S O R multiple consequences physiological Biofeedback perception cognitive Cognitive Therapy emotional Humanist Therapy behavioral Behavior Therapy

Biofeedback Process • Biofeedback • Biological (physiological) Information • Biofeedback Training • Psychophysiological Association • Goal of Biofeedback • Voluntary Self-Regulation

Biofeedback Process • Biological Information • Unconscious to Conscious • Biofeedback Training • Discrimination Training • Voluntary Self-Regulation • Self-Efficacy

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.

Fundamental Principles SENSATION - Unconscious PERCEPTION - Conscious

Learning Definition: A relatively permanent change in behavior based on experience.

Classical • • • Stimulus - Response Passive Reflexive Association Unconscious

Classical Operant • • • Stimulus - Response Passive Reflexive Association Unconscious • • • Response – Stimulus Active Instrumental Environment Conscious

Classical Operant • • • Stimulus - Response Passive Reflexive Association Unconscious Concurrent • • • Attention - Intention Perceptual Learning Awareness Experiential Learning Conscious • • • Response – Stimulus Active Instrumental Environment Conscious

Classical Operant • • • Stimulus - Response Passive Reflexive Association Unconscious • • • Response – Stimulus Active Instrumental Environment Conscious Concurrent Cognitive • • • Attention - Intention Perceptual Learning Awareness Experiential Learning Conscious Internalization Locus of Control Self-Efficacy Expectancy Unconscious/Conscious

Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

Biofeedback Models 1) Physiological Emphasis: Motor Skills ~ Anti-Stress Relaxation ~ Autonomic ~ Cybernetic ~ Pathways 2) Learning Emphasis: Operant ~ Self-Regulation ~ Cognitive ~ Multiple Learning Stages 3) Interactive Emphasis: Mastery ~ Coaching ~ Triadic Feedback

Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

Physiological Emphasis Motor Skills Acquisition: Lang (74), Lang & Twentyman (74), Johnson (77) Anti-stress / Relaxation: Stoyva & Budzynski (74), Stoyva (77), Silver & Blanchard (78) Autonomic Discrimination: Brener (74, 77), Roberts (77) Cybernetic / Systems: Anliker (77), Gaarder & Montgomery (77), Mulholland (77), Sargeant (7779), Schwartz (78 -79) Stereotypic Pathways: Wilson (82)

Stereotypical Stress Pathways v Neuromuscular v Neurovascular v Neurohumeral v Interneuronal What kind of Responder are you?

Stereotypical Stress Pathways v Neuromuscular EMG ümuscles prepare for fight or flight ümuscle pain ütension headaches üfatigued muscles ülow back pain muscle üweakness tension üarthritis

Stereotypical Stress Pathways v Neurovascular TEMP üincreased heart-rate üblood flows to big muscles & brain üfainting ümigraines ühigh blood pressure cold üheart disease hands & feet üstroke

Stereotypical Stress Pathways v Neurohumeral SC üimmunosuppression ülowered sexual functioning üdecreased appetite üinfections üautoimmune diseases üGI disorders ühypertension sweating

Stereotypical Stress Pathways v Interneuronal EEG üobsessive thoughts and feelings üracing thoughts üconfusion, ruminations üsleep disturbances üemotional burnout cognitive üdepression & mania & emotional üdrug addiction changes

Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

Learning Emphasis Operant Learning: Black, Cott & Pavloski (77), Miller (78) Self-Regulation: Blanchard & Epstein (78) Cognitive: Lazarus (75), Meichenbaum (76) Multiple Learning Stages: Dreyfus (80), Brenner (84), Kappes (96)

Biofeedback Training Process • Education (Classical) v Unconscious Incompetence • Acquisition (Concurrent) v Conscious Incompetence • Discrimination (Operant) v Conscious Competence • Self-Efficacy (Social Learning) v Unconscious Competence

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 Learning Self Technique 11: Home Training Program Self Technique 12: Summary

Theories of Learning: The Developmental Progression of Self-Regulatory Skills education acquisition discrimination self-efficacy Prevailing Theoretical Process Classical Concurrent Operant Learning Cognitive Learning

Theories of Learning: The Developmental Progression of Self-Regulatory Skills education acquisition discrimination self-efficacy Prevailing Theoretical Process Classical Concurrent Operant Learning Cognitive Learning

Theories of Learning: The Developmental Progression of Self-Regulatory Skills education acquisition discrimination self-efficacy Prevailing Theoretical Process Classical Concurrent Operant Learning Cognitive Learning

Theories of Learning: The Developmental Progression of Self-Regulatory Skills education acquisition discrimination self-efficacy Prevailing Theoretical Process Classical Concurrent Operant Learning Cognitive Learning

Theories of Learning: The Developmental Progression of Self-Regulatory Skills education acquisition discrimination self-efficacy Prevailing Theoretical Process Classical Concurrent Operant Learning Cognitive Learning

Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

Interactive Emphasis Mastery: Stoyva & Budzynski (74), Peper (08) Coaching Mastery: Shellenberger & Green (86) Triadic Feedback Process: Kappes (10)

Triadic Feedback Process Kappes (10) Performance Feedback Patient Influence Instrument Influence TFP Therapeutic Feedback Physiological Feedback Therapist Influence

Triadic Feedback Process Patient Variables Motivation Self-Efficacy Learning Readiness

Triadic Feedback Process Instrument Variables Analog / Digital Real Time Accuracy

Triadic Feedback Process Therapist Variables Certified / Trained Communication Skills Therapeutic Competencies

Integrative Biofeedback Model Physiological Emphasis Stereotypic Pathways Learning Emphasis Interactive Emphasis Multiple Learning Stages Triadic Feedback Process