The cover of this special issue of Biofeedback illustrates the widespread problem of incontinence discussed in the lead article by Debbie Callif. According to Callif, more than 25 million Americans suffer with bladder bowel incontinence (thanks to Shutterstock for the image).
Biofeedback for pelvic floor muscle dysfunction provides a practical and effective intervention for elimination disorders. Dysfunction in the pelvic floor muscles can affect bladder and bowel function and can cause pelvic pain. According to the National Association of Continence, there are 25 million Americans affected by bladder or bowel incontinence. Surface electromyographic (sEMG) sensors monitor the electrical activity of the pelvic floor muscles. Additional muscle co-contractions of the obturator internus, hip adductors, and transverse abdominis can facilitate improvements in symptoms affected by pelvic floor dysfunction. Pelvic floor therapy incorporates urge reduction techniques and functional control strategies. Dietary and lifestyle recommendations are also provided. The Biofeedback Certification International Alliance (BCIA) is the primary certifying body in the fields of biofeedback and neurofeedback. BCIA has a Blueprint of Knowledge specific for certification in pelvic muscle dysfunction biofeedback (PMDB). The Blueprint outlines the fundamental science, history, and theory of sEMG biofeedback as used for elimination disorders and chronic pelvic pain. You can find more information on PMDB at www.bcia.org.
Most work done in areas such as counseling, therapy, leadership, and coaching involves some aspect of decision making. New electroencephalographic (EEG) electromagnetic tomographic analysis (ETA) imaging techniques provide a mechanism for exploring decisions, while the individual is directly engaged in everyday choice making, by exposing our precognitive emotional responses to identified thoughts, feelings, and actions. This article discusses gamma wave activity research, at the precognitive level, and its use for describing approach-avoidance decision making. Armed with these new insights, an individual can better understand the emotional triggers that affect our daily decisions.
Body postures can project nonverbally how a human being feels. Postural changes affect thoughts, emotions, and energy levels, and conversely, energy levels, emotions, and thoughts affect posture. The purpose of this study was to explore how changes in erect or standing body posture affect positive energy levels, emotions, and thoughts. For example, increases in perceived arm muscle strength as well as recall of positive emotional memories due to posture changes will positively affect client beliefs about coping with difficult life circumstances. In this study, 33 participants paired up as “testers” or “subjects” and took turns standing either in an erect or collapsed/slouched posture. All subjects proceeded through a manual muscle testing procedure by raising their arms and attempting to resist the steady downward pressure applied by the tester to their forearm near their wrists. All but one (98%) of the subjects perceived greater arm strength as they resisted the downward pressure when they stood in an erect posture compared with when they stood in a collapsed/slouched posture. Similarly, testers observed that the subject were much stronger in their ability to resist the downward pressure in the erect versus slouched position (p < .01). The somatic feedback of muscle strength and the guided practice of how body position may affect recall of memories can be used to demonstrate the mind/emotion and body interactions. This study points out that psychology and bioneurofeedback training needs to understand how important body posture, movement, and somatic feedback are as part of the therapeutic and teaching process. Somatic awareness can be used as a tool to change behavior because changing the posture affects strength and recall of memories, which are important parts of the mind-body equation that underlies health and illness.
Systemic lupus erythematosus (SLE) is a complex and typically chronic illness, producing a wide variety of symptoms and an unpredictable course. SLE is an autoimmune condition, commonly affecting the skin, joints, kidneys, brain, and other organs. This article describes the application of a multilevel integrative care plan, following the pathways model, to assist a patient with SLE in managing and moderating symptoms and improving quality of life. The patient, Mary Anne, was a 33-year-old female nurse with a 14-year history of SLE. Her initial response to lupus was biomedical, with a passive reliance on a wide range of medications and an increasingly inactive, sedentary lifestyle. Along with lupus she developed obesity, hypertension, migraine, sleep disturbance, depression, and anxiety. Her rheumatologist referred her for behavioral health interventions to help her to learn nonpharmacologic forms of pain management and motivate her for illness self-management for her various chronic conditions. The interventions were organized into the three levels of the pathways model and included Level 1, movement, sleep hygiene, and mindful eating; Level 2, aquatherapy, an illness self-management support group, and a mindfulness class; and Level 3, heart rate variability (HRV) biofeedback, self-hypnosis training with healing imagery, a nutrition consultation, and a sleep medicine clinic. This patient mastered excellent skills with self-hypnosis, paced breathing, and HRV biofeedback. She sustained increased physical activity and a modified diet. At the 3-year point, she reported less frequent pain and joint swelling, less nausea and sick feeling, moderate improvement in sleep, and less frequent and less severe Lupus flares.
A method of nonprescriptive neurofeedback is described that is based on the brain interacting with its own tonic slow cortical potential. In the absence of any explicit guidance by the clinician, the training depends entirely on the brain's response to the unfolding signal. When this training is performed under optimal conditions in terms of placement and target frequency, there is a bias toward optimal functioning. The brain uses the information for its own benefit. The outcomes of the training are either comparable to or exceed expectations based on conventional electroencelphalogram band-based neurofeedback. Results are shown for a cognitive skills test for an unselected clinical population.
Valid electrodermal measurements ensure the integrity of client assessment and biofeedback training. Accurate measurements require understanding of the signal and potential artifacts (sources of contamination) and developing “bulletproof procedures.” Peper, Shaffer, and Lin have recommended the following guidelines for ensuring accurate psychophysiological monitoring: (a) understand the physiological mechanisms that generate the signal, (b) always record and inspect the raw signal because this will allow you to identify artifact, (c) question whether displayed values make sense (e.g., skin conductance levels that rapidly fluctuate, exceed 40 μS/cm2, or fall below 1 μS/cm2 should be suspect in a client who is sitting quietly), (d) recognize the appearance of common artifacts and how they alter derived measurements, and (e) intentionally create artifacts so that you can better recognize them (e.g., rhythmically move the fingers attached to a skin sensor, loosening or tightening the sensors if they are attached with the Velcro® finger straps, and review both the raw signal and calculated skin conductance values). This article reviews the anatomy and physiology, measurement procedures, sources of common artifacts and their control, tracking test for recording electrodermal activity, and common response patterns.
How can you be sure that a larger abdominal waveform, as compared with a smaller chest waveform, means that a client is breathing more abdominally than thoracically? Could this difference be due to discrepancies in the sensitivity of the sensors? This article describes a procedure for measuring the sensitivity of respiratory strain gauges and provides practical recommendations for accurate measurement and display of the relative expansion and contraction of the chest and abdomen.
The book Foundations of Heart Rate Variability Biofeedback: A Book of Readings, edited by Donald Moss and Fredric Shaffer, is an excellent collection of valuable articles relating to heart rate variability biofeedback (HRVB) demonstrating the advantages of self-regulation and the resulting impact of autonomic dysregulation on human functioning. The book readings highlight both the many leading authors in the field of heart rate variability (HRV)—published between 2008 and 2015—and the knowledge base that has developed related to a broad range of applications with promising therapeutic effects from asthma, depression, hypertension, fibromyalgia, to posttraumatic stress disorder (PTSD). TheIntroduction