Biofeedback Training: An
Interactive Tripartite
Learning Process
afbmk@uaa.alaska.edu
Learning Models ~ Methods for
Effective Biofeedback Training
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
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Treatment
Therapy
Training
Techniques
Instruction
Skills
Loop
Strategy
Learning
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Process
Program
Regime
Education
Approach
Experience
Application
Routine
Session
Research & Clinical Variability:
Biofeedback Nomenclature Ambiguity
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Technology
Response
Intervention
Systems
Patterns
Measures
Components
Methods
Modalities
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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)
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multiple consequences
physiological
cognitive
perception
emotional
behavioral
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multiple consequences
physiological
Biofeedback
cognitive
perception
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
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Stimulus - Response
Passive
Reflexive
Association
Unconscious
Classical
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Stimulus - Response
Passive
Reflexive
Association
Unconscious
Operant
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Response – Stimulus
Active
Instrumental
Environment
Conscious
Classical
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Stimulus - Response
Passive
Reflexive
Association
Unconscious
Concurrent
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Attention - Intention
Perceptual Learning
Awareness
Experiential Learning
Conscious
Operant
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Response – Stimulus
Active
Instrumental
Environment
Conscious
Classical
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Stimulus - Response
Passive
Reflexive
Association
Unconscious
Operant
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Concurrent
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Attention - Intention
Perceptual Learning
Awareness
Experiential Learning
Conscious
Response – Stimulus
Active
Instrumental
Environment
Conscious
Cognitive
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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
 Neuromuscular
 Neurovascular
 Neurohumeral
 Interneuronal
What kind of Responder
are you?
Stereotypical Stress Pathways
 Neuromuscular EMG
muscles prepare for fight or flight
muscle pain
tension headaches
fatigued muscles
low back pain
muscle
weakness
tension
arthritis
Stereotypical Stress Pathways
 Neurovascular TEMP
increased heart-rate
blood flows to big muscles & brain
fainting
migraines
high blood pressure
cold
heart disease
hands & feet
stroke
Stereotypical Stress Pathways
 Neurohumeral SC
immunosuppression
lowered sexual functioning
decreased appetite
infections
autoimmune diseases
GI disorders
hypertension
sweating
Stereotypical Stress Pathways
 Interneuronal EEG
obsessive thoughts and feelings
racing thoughts
confusion, ruminations
sleep disturbances
emotional burnout
cognitive
depression & mania
& emotional
drug 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)
 Unconscious Incompetence
• Acquisition (Concurrent)
 Conscious Incompetence
• Discrimination (Operant)
 Conscious Competence
• Self-Efficacy (Social
 Unconscious Competence
Learning)
Biofeedback Training Process
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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
Learning 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
Learning 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
Learning 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
Learning 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
Learning 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