When biofeedback came upon the scene in the early 1970s, many people were excited by its potential for facilitating developmental changes in people, but the simple instrumentation and clinical technique then available stood in the way of this potential being realized. In the meantime, partly due to the economic necessity of translating biofeedback into a practical therapeutic model, many practitioners lost sight of biofeedback's deeper applications and instead emphasized its usefulness as part of the established medical paradigm.
This paradigm, based as it is on a fractionated, mechanistic view of the human being, channeled biofeedback into a limited application geared toward "treating" malfunctioning body systems without examining how these systems interrelate--we began to separate psyche from physiology--mind from body--and bill accordingly. The work I have been pursuing over the past several years at the Bio Research Institute has been an attempt to explore and develop biofeedback's therapeutic and developmental potential.
This following study illustrates how advanced mind/body training and research can reveal deeply ingrained psychophysiological patterns and shows that these patterns can be changed, leading to corresponding changes in the client's psychophysiology and quality of life. In this study, the client not only learned how to self-regulate multiple body systems by recognizing and working with these patterns, he realized as a result of self-regulation that alternative ways of being existed, and began the process of making more "appropriate choices" that led to an increased satisfaction with life.
This article does not attempt to fully explain the many aspects of the training and research model presented here or of the psychological process experienced by the client as he moved toward greater development. Rather, it provides an overview that challenges current practices in biofeedback training and the education of practitioners. I have chosen to present the following information in a research study format, but I encourage the reader to examine the effects of advanced mind/body training in the context of the changes in the client's life.
The charts presented here represent 75 sessions of advanced mind/body training in five modalities. Learning how to create and interpret this kind of longitudinal data has been a challenge and has yielded powerful implications for the way biofeedback is taught and practiced.
Most biofeedback training series (including personal training undergone by practitioners) extend for eight to twelve sessions and are limited to one or two modalities, typically temperature and EMG. The reasons for this include:
Financial constraints due to insurance limitations on the number of sessions and specific modalities that can be billed; Acceptance of the medical model that encourages a fragmented approach to disease and illness; and Practitioners' lack of experience with long-term multimodal biofeedback training and familiarity with its benefits.
Long-term advanced mind/body training and research conducted at BRI has revealed a physiological periodicity in some individuals that suggests practice and reinforcement of problematic behaviors on a cellular level. This implies that the physiology of the individual, as well as his or her cognitive patterns, may help to generate and maintain behavior.
The following study illustrates how advanced mind/body training provides a larger perspective that reveals cyclical patterns which surface at different levels within physiological systems and across modalities. A client's specific problem may not be what it seems--that is, the presenting complaint may be an indicator of a deeper psychological process in motion, a struggle between the self attempting to actualize and the older psychophysiological shell resisting this development. The pain produced by this struggle is often what leads the client to seek help and may lead the clinician away from the larger issue at hand--the self-perpetuating cycles of psychophysiological activity that have come to define and limit the individual's experience of the world.
The client, M.A., was a forty five-year-old man with two adult children who presented with a "mind that was never quiet" associated with diagnosed manic depression, and insomnia associated with sleep onset and late-night sleep disturbance. In addition, he complained of chronic fatigue and a great deal of "stress" in his life. He found his quality of life to be unacceptable due to his inability to cease analyzing everything that he experienced. He was unable to relax sufficiently to enjoy even recreational activities such as going to the movies or leaving town on vacation. He was self-employed as an attorney, and stated that he found it impossible stop thinking about work-related issues. When training began, he was taking Lithium (900 mg./day), Librium (from 75 to 150 mg/day) and Xanax (from 2 to 4 mg/day) as prescribed by his doctor, and frequently self-medicated with marijuana.
This man's psychological background provides some insight into the physiological manifestation of his stress. He grew up in New York, and when training began was not on speaking terms with his parents. He had been a police officer from 1966 to 1975, and suffered a stress-related disability in 1975 precipitated by a psychotic break which required a brief hospitalization. At this time he began taking Lithium. From 1964 to 1969 he had been attending school as a business major at San Jose State, and he started attending night school studying law in 1969 while working full-time for the police department. He graduated with honors in 1973, passing the bar immediately thereafter. He also went through a divorce in 1973, and continued working for the police department through 1975. From 1976 to 1977 he worked as a legal aide on a part-time basis, and from 1977-1978 he practiced law part-time on his own. From 1979 to 1980 he traveled extensively in Central America and the South Pacific, and from 1980-1982 experimented with several start-up businesses. From 1983 to 1991 he practiced personal injury law part-time in San Jose and Santa Rosa, moving to Santa Rosa in 1987 and continuing his law practice through 1991. In 1992 he moved to a small cattle ranch in Arizona and is currently living in New Mexico. He is now considering a part-time business venture other than law. He remarried in 1982 and was subsequently divorced and remarried to this wife twice.
The client came to BRI at the recommendation of a chiropractor he knew professionally through his law practice, who had had personal experience with biofeedback. However, M.A. was highly skeptical of the efficacy of biofeedback; in fact, for the first 20 sessions he continued to profess skepticism about the value of the training process. At no time during training did he appeared depressed or "down" in any way; he was consistently "on" and energetic. He was highly verbal, known to fatigue people with his verbosity and intensity. After conducting the initial comprehensive evaluation at BRI, I elected to schedule his training at 11 a.m. on Wednesdays so as to give myself time during lunch to recover from his intense communication style.
Following the comprehensive evaluation, the data strongly indicated EEG to be the training measure of choice for this client, due to chronic excessive beta activity . However, as will become clear, EMG played a dramatic role, not only as a training measure, but as a reflection of the struggle this client experienced during the process of change.
1. Custom-built computerized physiological monitoring and feedback instrument from BRI. Eight physical channels configured as follows:
2. 16-channel digital oscilloscope with FFT analysis, wave form scrolling and recording capabilities.
3. Primary analysis was performed on a 486 with 16 megabytes of RAM, a 660 megabyte hard drive and 1.2 gigabyte magneto optical drive.
Data were analyzed and stored in two- and three-dimensional spread sheets along with custom-written programs for data manipulation. The data set for this client was as follows:
Meaningful mind/body training involves an important educational component, in which clients learn that they have developed psychophysiological strategies for survival that involve specialized patterns of EEG activity and chronic tensing. We have learned these patterns in response to various life situations. Through mind/body training, we can unlearn them, to reverse many of their negative effects and develop more positive strategies for survival and self-development. This is done in part through a training process that involves achieving or reestablishing global homeostasis as reflected in the following psychophysiological levels. These levels are appropriate for the modalities and placements used in this protocol, and reflect appropriate activity for clients in a restful seated position from upright to reclining.
Different psychophysiological conditions may call for variations on the protocol. The training ranges stated above apply to those individuals who exhibit system-wide sympathetic outflow. The procedures used in this study, and with all clients at BRI, have been consciously designed to foster a feeling of partnership between trainer and client. This involves a process of education that begins when the client enters the door of the institute and continues throughout each session.
The application of seventeen sensors has the potential of creating anxiety in some clients, so I have over the years developed a relatively elegant and gentle protocol for sensor application. I check that the sensors are transmitting information accurately and reliably by turning on the biosystem and the audio amplifier to make a raw audio and oscilloscopic check of the appropriate signals. I make a third check by observing the numeric data displayed on the biosystem screen.
The initial session is composed of a comprehensive psychophysiological evaluation and a thorough intake. The psychophysiological evaluation is composed of four baselines: five minutes eyes closed, no talking; five minutes eyes open, no talking; fifteen minutes discussing stress-related issues; and seven minutes eyes closed, no talking, self-soothing response.
Training prioritization depends on three factors: (1) the presenting complaint, which suggests one or more physiologies to be prioritized; (2) the results of the comprehensive evaluation; and (3) the ability of the client to learn to control specific psychophysiological systems. At this point, the multimodality approach to training is particularly significant, in that the client usually exhibits inappropriate activity in multiple systems, and it is important to recognize that successful training involves regulation of the organism as a whole.
Training speed depends on (1) the client's ability to overcome the philosophical belief that "trying" (expending conscious or unconscious sympathetic nervous system effort) is the only path to achievement; (2) how long the physiological condition has existed, which corresponds with how much practice the client has had reinforcing the condition on the psychocellular level; (3) client motivation; and (4) clinician's experience and equipment he or she uses. Client motivation can depend significantly on how well the trainer has educated the client, how many sessions the client has had (how familiar the client is with what can be done through biofeedback training), and how willing the client is to practice at home and integrate his or her learning into everyday life.
To demonstrate the client's potential for psychophysiological change, I provide an on-screen review of other clients' longitudinal mind/body charts drawn from the BRI library at some point during the early sessions. These charts powerfully demonstrate the effect of training over time and encourage clients to persist in training when they have reached apparent plateaus in ability to control various systems.
One of the procedural goals of training is for the client to develop sufficient skill in understanding the feedback process so that he or she can work with increasing independence, resulting in reduced verbal interaction during actual training. A research benefit of this protocol is that the data tend to reflect the client's general levels without the physiological responses and artifacts produced by active verbal interaction.
The data presented here reflect the psychophysiological changes recorded over 75 sessions. With the exception of the first session, all means in all modalities represent an average of 25 minutes of physiological data.
As will be shown, this kind of advanced mind/body training and research can provide crucial information regarding the potential for self-regulation and psychophysiological patterns that is not available to the practitioner/researcher who monitors and trains in only one or two modalities for eight or twelve sessions.
For the first 20 sessions, this client was so psychophysiologically active that we were unable to include any training besides EMG; EEG training was out of the question because A.M. was unable to settle down long enough to discern or appreciate the nature of his brain wave activity and potential ability to use EEG training as a means of "quieting his mind." Instead, we focused on EMG, using this more "tangible" modality as a means of educating the client about his own patterns of muscle tensing and relating them to mental stress. Simultaneously, the client's other measurements were being recorded, but his attention was only peripherally drawn to them.
In examining the following charts (which will be coming to this web site) I would like to draw the reader's attention to overall level changes and repeating periodic patterns within specific physiologies and across physiologies. The charts represent longitudinal data, with each point being the average of the entire data set for one session (25 minutes). It should be noted that this client faithfully attended training sessions on a weekly basis on Wednesdays at 11 a.m., without interruption, for 55 weeks. It is highly unusual to achieve data of this regularity, and as will be shown, it reliably reveals patterns within patterns that were generally imperceptible on a subjective level.
Chart 1 indicates the mean measurement of EMG activity of the temporalis, a.k.a. scalp and jaw (solid line) and the average of right and left trapezius (dashed line) for each of the sessions. The bandwidth of the EMG amplifier was 90-400 Hz .
When the client began training, the mean reading for the first session for the scalp and jaw was just under 16 microvolts; the mean reading for the trapezius was 13.5 microvolts. These readings are considerably elevated (the goal zone for mean-data EMG is 2-3 microvolts). In the second session, these readings dropped dramatically for both channels, and this downward trend continued until the fifth session. At this point, the readings rose again and began the M-shaped pattern that repeated itself in increasing intensity over the next 26 sessions.
To this point in training, it appeared that M.A. was getting both better and worse in terms of his EMG activation - it is possible to draw two lines heading in opposite directions uniting the instances where his EMG levels were elevated and where they had come down. It was difficult to state that biofeedback training was helping him control his activation levels, since they showed a tendency to improve and get worse to progressively greater extents.
Sessions 31 through 36 followed the tendency to exhibit weeks of progressively increased system activation followed by weeks of decreased activation; however, the 37th through 41st week showed a dramatic alteration in this pattern. During this time, the overall activation levels dropped significantly, and a general trend toward lower and lower levels was established. From the 49th session through the 75th, M.A. consistently achieved activation levels lower than those shown in the first half of training, eventually remaining at or near the goal zone of 2 to 3 microvolts.
Chart 2 is a record of brain wave measurements of left and right hemisphere activity in microvolts per second (amplitude density). It reveals dramatic activation in the beta bandwidth and low levels of alpha. Over the course of the first 53 sessions, beta levels continued to be elevated, although alpha levels began a rising trend after the 47th session. Again, gauging from the pattern presented in the first two-thirds of the course of training, biofeedback training did not appear to have a beneficial effect on M.A.'s elevated levels of EEG activity; and again, like EMG, this modality showed a striking alteration in which beta levels sank and alpha levels rose during the final third of training.
Chart 3 represents the synchrony between the two channels of EEG.. Synchrony is defined as occurring when the EEG measures from two channels fall within 12.5% frequency similarity and are no more than 45 degrees out of phase. The Y-axis represents the percent of synchrony achieved. Typically, increased synchrony is viewed as a positive training goal.
However, analysis of these data suggests that desynchronization may be a step in a positive direction for some individuals.. M.A. exhibited unusually high synchrony in the bandwidths beta and gamma (as relative to the institute's data base). Review of the longitudinal data reveals a general trend upward in beta synchrony through session 38, after which a clear decline may be noted. I theorize that the decrease in synchrony in beta and gamma bandwidths suggests a reorganization of neuronal activity. When viewed in relation to the other measures and in light of the subjective and observed positive changes that occurred in M.A., this desynchronization may be seen as a positive step in the restructuring of the psychophysiological self. I suspect that if training had continued, we would have seen increased synchrony in alpha and beta reflecting the new personality matrix.
These charts reveal several disconcerting and exciting aspects of biofeedback training, particularly EEG training, as it is currently practiced:
They show that patterns of system activation exhibit periodicity, even when an individual is deliberately seeking to change them through regular and extensive training. These patterns appear to be embedded within the psychophysiological makeup of the individual, and their resistance to change is remarkable (as illustrated by the tendency of M.A.'s EMG readings to follow a clear multi-week pattern that exacerbated over time as he sought to gain control over that system).
They reveal the possibility of breaking these embedded patterns and establishing consistently lower levels of system activation and more comfortable and rewarding activity patterns of EEG through long-term training geared to the individual's unique needs. In M.A.'s case, this was only possible after spending many, many sessions during which the patterns became increasingly exaggerated and it appeared that the situation was actually getting worse in terms of the individual experiencing both lower and higher levels of activation as the weeks progressed.
They imply that psychophysiological states of individuals that we formerly accepted as characteristic, immutable, and controllable only through the use of drugs are indeed client to being dramatically altered by long-term biofeedback training. In other words, certain uncomfortable and inappropriate ways of being in the world that we have considered permanent, that is, unamenable to change through counseling or psychotherapy, can be addressed through biofeedback so that the individual learns sufficient self-regulation to break unrewarding patterns and establish new ones.
These notions suggest a new understanding of the human personality, in which personality traits are recognized as specialized states of consciousness, associated with special psychophysiological patterns habitually experienced by the individual. This means looking at human development in a different way, one in which the individual, rather than being dealt a hand at birth that he or she must play throughout life in terms of personality type and psychophysiological characteristics, can deliberately evaluate the usefulness of certain characteristics and change them with the assistance of biofeedback training. Certainly this client reported after the 30th session that his subjective experience of life was qualitatively different; in his words, "I realize that I can do a lot of what I'm learning in training in my day-to-day life." Previous to this point, M.A. had shown minimal ability to integrate the skills he was acquiring into his life. From this point on, however, his progress was remarkable and was supported by the differences he perceived in his daily existence that reinforced the power of the training. He was assisted in this process by his wife, who aided him in interpreting the graphical documentation he received after each session and supported his efforts to "change his ways."
As the psychophysiology of the person is developed and reinforced throughout life, it supports a matrix of mind/body activity that maintains a particular stasis for the individual. I suggest three interconnecting conditions that maintain this stasis:
This matrix of psychophysiological activity sustained by the individual is in part characterized by a complex electromagnetic field. The ability to measure this field makes it possible to feed back information about it to the person; this information, coupled with training goals, provides a clear path for beneficial change and self-knowledge. Biofeedback instrumentation measures aspects of this field in specific physiological systems, e.g., brainwave activity (EEG), heart activity (EKG), as well as direct and indirect electromagnetic activity in other body systems.
This activity reflects a number of things, including the genetic and hereditary design of the individual, and the individual's specialized organization of that genetic and hereditary design in response to life experiences (psychophysiological strategies for survival).
The remaining charts reflect the profound changes made by this client in his overall psychophysiology during the course of training, and support the observation that A.M. literally redefined himself in terms of psychophysiological arousal patterns, which were in turn associated with his experience of an interaction with the world in day-to-day living.
The client's psychological condition showed changes as dramatic as those exhibited in his psychophysiological systems over the training period.
M.A. went from being an individual with an "overactive mind" who felt himself to be "stressed out" to the point of being "at the end of his rope, to an individual who exhibited gentleness, calmness and very substantial awareness of himself and his journey to relaxation and clarity.
Three years after training, M.A. continues to do very well. His doctor has said that since M.A. appears to suffer no ill effects from Lithium, he should continue taking it; he now takes Librium only occasionally and has been off Xanax for three years. The client no longer experiences the chronic sleep disturbance or uncontrollable thought patterns of years past. M.A. credits his current state to the mixture of EEG, EMG, and respiration training he received at BRI. He continues to practice his skills and is confident that he will be able to do so for the rest of his life.
These three charts illustrate the potential of long-term psychophysiological training to create dramatic and lasting changes. Not only do these changes occur in more than one system, they reflect patterns in the client's psychophysiological strategies for survival that appear both within and between systems and occur over a matter of minutes and months.
Conclusions about this client based on the traditional eight or twelve sessions of training would be startlingly different from those implied by advanced training.
The common misunderstanding of biofeedback's potential for making profound and enduring changes in chronic conditions has been shaped by the accepted practice of limiting training to eight or twelve hours and expecting clients to be able to take what they learn in those sessions and apply it to the rest of their lives. As this study demonstrates, much of what a client can achieve is never even approached in the first 10 to 15 sessions, and the client may not receive more than a hint of what he or she can gain in terms of multi-system self-regulation.
The current practice of limiting biofeedback training to eight or twelve sessions exemplifies a thin application of a very powerful discipline. We know that short-term training can be useful in symptom and pain reduction, which is valuable in itself. But to stop because the discomfort is alleviated or for other reasons may mean missing a chance to do far more than this, to make lasting changes that involve the whole person.
However, using biofeedback to make these changes requires a philosophic shift from seeing the human being as a collection of discrete physiologies to an understanding that the whole is greater than the sum of its parts. This process has implications that extend beyond symptom relief to the reorganization of personality.
Unfortunately, current biofeedback practice virtually ignores this potential, partly because of financial concerns, but also because practitioners themselves have not been exposed to the kind of research and education that would help to change the way biofeedback is popularly understood.
Practitioners who have received only ten hours of training before certification develop a limited personal understanding of the discipline. In addition, when they are unfamiliar with the possibilities and rewards of long-term training, they are less able to promote lasting and far-reaching change in clients. Advanced mind/body training is more than simply extending training beyond the usual number of sessions. It involves a new attitude toward training and research, and the design of more powerful data sets and graphics, so that the information can be presented meaningfully to clients and other researchers.
Advanced mind/body training is more likely to be effective in alleviating symptoms, in that its results tend to be enduring. But it is important to note that the results endure because the client has had time to reduce the patterns that caused the symptoms and is empowered through self-awareness that is unavailable through standard training involving fewer sessions and modalities. This self-awareness extends beyond symptom relief and implies a human capacity for changing aspects of the self that have previously been seen as permanent.