1. 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

2. 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

3. University of AlaskaDepartment 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

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

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

15. What is Biofeedback?

16. Theory or Rationale for Biofeedback

17. Define Biofeedback for Patients

18. 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)

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

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

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

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

23. 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.

24. Fundamental Principles SENSATION - Unconscious PERCEPTION - Conscious

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

26. Classical • Stimulus - Response • Passive • Reflexive • Association • Unconscious

27. ClassicalOperant • Stimulus - Response • Passive • Reflexive • Association • Unconscious • Response – Stimulus • Active • Instrumental • Environment • Conscious

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

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

30. Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

31. 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

32. Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

33. 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 (77-79), Schwartz (78-79) Stereotypic Pathways: Wilson (82)

34. Stereotypical Stress Pathways • Neuromuscular • Neurovascular • Neurohumeral • Interneuronal What kind of Responder are you?

35. Stereotypical Stress Pathways • Neuromuscular EMG • muscles prepare for fight or flight • muscle pain • tension headaches • fatigued muscles • low back pain • weakness • arthritis muscle tension

36. Stereotypical Stress Pathways • Neurovascular TEMP • increased heart-rate • blood flows to big muscles & brain • fainting • migraines • high blood pressure • heart disease • stroke cold hands & feet

37. Stereotypical Stress Pathways • Neurohumeral SC • immunosuppression • lowered sexual functioning • decreased appetite • infections • autoimmune diseases • GI disorders • hypertension sweating

38. Stereotypical Stress Pathways • Interneuronal EEG • obsessive thoughts and feelings • racing thoughts • confusion, ruminations • sleep disturbances • emotional burnout • depression & mania • drug addiction cognitive & emotional changes

39. Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

40. 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)

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

42. 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

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

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

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

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

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

48. Biofeedback Models Physiological Emphasis Learning Emphasis Interactive Emphasis

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

50. Triadic Feedback ProcessKappes (10) Performance Feedback Patient Influence Instrument Influence TFP Therapeutic Feedback Physiological Feedback Therapist Influence