The cover of this issue of Biofeedback shows Canadian Mark de Jonge, K1 200-m bronze medalist at the summer 2012 Olympic Games in London and World Champion in 2015 in the sport of CanoeKayak (credit to Jeff Cooke for the photo).

The Biofeedback Certification International Alliance (BCIA) has certificants in 32 countries. The author chronicles the development of BCIA's international outreach, reviews the challenges that had to be overcome, and explains why BCIA's shift to ethics education and online testing were crucial to this process. This article concludes with a discussion of BCIA's international affiliate program, recognition of its Australian and Mexican affiliates, and discussion of exciting developments in Canada.

This study was designed to explore the relationship between elite athletes' self-regulation ability and their ranking at the world level using psychophysiological stress assessment profiling. Fifteen elite level athletes' psychophysiological stress response patterns were recorded during a nine-stage stress assessment. Respiration rate, heart rate, heart rate variability, skin conductance, peripheral body temperature, and electromyograph (trapezius and frontalis) were monitored. There was a significant correlation between elite athletes' overall self-regulation ability and their ranking at the world level, meaning that the better the overall self-regulation ability of the athlete, the better the world ranking. In addition, a multiple regression analysis indicated that self-regulation accounted for 76% of the variance in world ranking. Our results suggest the existence of a relationship between elite athletes' overall self-regulation ability and their ranking at the world level. Therefore, the results of this study have important implications for training of optimal psychophysiological self-regulation in athletes.

There has been a recent interest in the use of neurofeedback to enhance sports performance. Our goal is to report the effects of performance brain training (a specific neurofeedback training paradigm with protocols based on the NeuroPerformance Assessment) on specific measures of golf performance in a group of Division I National Collegiate Athletic Association (NCAA) golfers. Participants included 16 golfers. Baseline performance data was collected prior to grouping athletes (Time Point 1). Initially, both groups continued as normal with team practice, tournament play, and sport-related coaching, while only Group 1 completed performance brain training (Time Point 2) due to limited athlete availability. Subsequently, only Group 2 completed while both groups maintained normal team activities (time point 3). Performance data was collected at each time point. Paired t-test analyses were completed for five performance variables from Time Point 1 to Time Point 2 and from Time Point 2 to Time Point 3 for each group. When comparing Time Point 1 to 2, Group 1 showed significant improvements in several golf performance indices: with increases in greens in regulation, decreases in the putting average, and decreases in the average number of three putts per round. Between Time Points 2 and 3, Group 2 demonstrated statistically significant improvements in greens in regulation, fairways in regulation, putting average, and average of three putts per round. It appears that Performance Brain Training may contribute to improvement in sport measures. Broadly, these findings lend support to previous studies illustrating that brain training improves performance outcomes, yet replication in a large sample size is required for further conclusions to be drawn.

The difference between success and failure in 200-m canoe and kayak events is measured in milliseconds. The gold medal for the 200-m kayak in the Summer 2012 Olympic Games in London was won by a margin of 294 milliseconds, and the difference between winning a bronze medal and not reaching the podium was merely 31 milliseconds. In addition to physical fitness, strength, and technique, the ability to focus effectively and manage arousal is crucial to the ability to react quickly off the start. Conversely, the inability to manage arousal and focus has been shown to reduce reaction time (RT) and, in extreme cases, lead to “choking.” Research in sport psychology and psychophysiology has identified multiple psychological, physiological, and neurological characteristics that underlie peak performance. Although many of the skills and characteristics identified in the research are common to most peak performers, it is also well known that each athlete's optimal performance zone for competition is unique. For athletes, identifying these individual zones of optimal physical, psychological, physiological, and neurological functioning can be elusive and difficult to quantify. Existing technology in bio- and neurofeedback presents a unique opportunity for athletes and researchers to explore what individual peak performance looks like both physiologically and neurologically. Thus, the purpose of this case analysis was to explore the psychophysiological differences of a 200-m canoe athlete between his best and worst reaction times.

The aim of the study was to investigate the possible effects on the performance of a skilled shooter of the delivery of transcranial random noise stimulation (tRNS) to the right parietal and left frontal areas of the brain. An athlete (35-year-old male) with 16 years of shooting experience was involved in the study. The participant performed 40 shots in two different sessions (sham and tRNS) during which his performance was assessed using the SCATT shooter training system, while physiological and postural data were collected. Findings showed that tRNS stimulation can improve shooting performance. Considering heart rate as an index of arousal, it is evident that its increase during the tRNS is consistent with the hypothesis that arousal plays an important role in modulating selective attention. Probably this is caused by the increase of cognitive resources devoted to help, maintain, and sustain attention for the time necessary to perform the visual–spatial–motor task.

Seventeen 9th-grade students at a charter school were selected to participate in a 3-week stress management/peak performance training program that integrated biofeedback into the overall educational schedule. The training program included a weekly visit by the facilitator, who discussed with the students the psychophysiology of stress and neuropsychology of attention, as well as the beneficial aspects of relaxation on the mind and body. These factors have been studied with peripheral biofeedback and EEG biofeedback for over 30 years and are known to facilitate peak performance during tests, social interaction, and various other performance scenarios, such as general academic performance, sports, and music. Students were guided through relaxation exercises and were then asked to think about how and why these exercises fit in to their own personal goals as students and performers. They were instructed to practice at home with an audio CD and worked with the emWave PC®, a heart rate variability biofeedback instrument. The Test Anxiety Quiz was administered pre- and posttraining, and the Behavioral Change Survey was administered posttraining. The students showed mild to moderate improvement on test anxiety and behavioral measures. Overall, significant gains were made in reduction of test anxiety and other behavioral measures. This study suggests that, consistent with the peak performance literature, integration of relaxation techniques into a secondary school setting can improve important measures of students' scholastic achievement.

Millions of women experience substantial pain and suffering from vulvodynia, which is pain around the entrance to the vagina (vulva). A common treatment is surgical removal of the tissue (vestibulectomy). This case report describes the detailed process of a holistic biofeedback-based intervention that successfully resolved the vulvodynia in a 23-year-old woman. The four-session treatment interventions included teaching diaphragmatic breathing to transform shallow thoracic breathing into slower diaphragmatic breathing. Treatment transformed her feeling of powerlessness, a belief that there was nothing she could do, into empowerment and a hope that she could reduce her symptoms and optimize her health. She also practiced self-healing imagery and learned to change her posture from collapsed to erect/empowered. Each time she felt discomfort or was fearful, her lower abdomen tended to tighten. After treatment, she used this sensation as a reminder to breathe lower and slower and sit or stand erect. After 6 weeks, she once again could initiate and enjoy intercourse and has been symptom free during the 8 month follow-up.