CHAPTER 1

A Historical Perspective
on the Field of Biofeedback
and Applied Psychophysiology

MARK S. SCHWARTZ
R. PAUL OLSON'

This chapter conveys a rich appreciation of the converging trends that have influenced the
development and journey of applied biofeedback, and the evolution of the broader field of
applied psychophysiology. This historical perspective helps readers to understand nor only
the origi IlS of biofeedback, but also some factors shaping its future . It also helps to illuminate
the broader concept of appl ied psychophysiology, and to gi vc perspective to the name changes
of the primary professiona l membership organization and its journa l.
Applied biofeedback began in the United States WiTh rhccollvcrgcncc of many disciplines
in the late 1950s. The major antcccdenrs and fields from which it developed include the fol-
lowing. (Both in this list and in subsequent texT, italics on first use of a teTm indicate that the
term is included in the glossary at the end of this chapter.)

1. Instrumenta l conditioning of autonomic Jlervous system (ANS) responses.

2. Psychophysiology.
3. Hehavior therapy and behavioral medicine.
4. Stress research and Stress managcment stratcgies .
5. Hiomedical engineering.
6. Surfacc electromyography (EMG), diagnostic EMG, and control of sillglc motor units.
7. Consciousness, altered states of consciousness, and electroencephalography (EEG).
8. Cybcmetics.
9. Cu ltural factors.
10. Professional devclopmems .2

T he order of the items in this list reflects neither historical sequcnce nor importance. Other
classifications and historical perspecti ves on biofeedback applications can be found in Gaarder
and Momgomery ( 1977, 198 1), Gatchel and Price (1979), Anchor, Beck, Sieveking, and Adkins
(I 982}, and Basmajian (1989).

]
1. l-listoric.ll I'crs pccti,'c 19

Nowlis, D_ P., & Kamiya, J. (1970). The control of ekctroenceph<llographic alph<l rhythm s through allditory
feedback <lnd the associated mental acti,'ity. PsydJOph)'siolog)', 6, 476--484 .
Ochs, L. (992). E£G tre<ltmen! of aililictions. Biofeedb,,~k, lOP), S-16.
Orne, :-'1. T. (1979). The efficacy of biofee.:lback th erapy. A"'w.~1 Reuiew of Medici"e, 30, 489---503.
O""win, R. E. (1972). The psydJO/ogy of comcious"ess. San Francisco: Fr~,*,man.
Paul, G. L. (1966). /usigh/ ,'",sus desellsi/i1:Mion i" psychology. Stanford, CI\: St<lnford Universitt, Press.
Pelletier, K. R., & Garfidd, C. (1976). Collscious"ess: Eas/.~"d west. New York: Ilarp~r & Row (I-Iarper Co[o-
phon Books ).
Peniston, E. G., & Ku[kosky, 1'.1- (1989). Alph<l-Theta bra inw<lve training <lnd endorphin levels of <llcoholies_
Akoholism: Clinic,,1 ""d Experimell/.~I Rese."ch, 13(2),271-279.
Peniston, E. G., & Kllikosky, P.). (1990 ). Akoholie personaliTY and <I[pha-theta brainwave training. Met/ic.~1
PsydJO/her.~py, 3, 37-55.
Pi-S uner, A. (1955). The whole IIwl ils p.1,/S ill biology. New York: Philosophical Library.
Progoff, I. (1980). The pr.H/ice of process medi/.1Iion. New York: Dia[ogue Hou:;e Library.
Rosenfeld, J. P. (l992a). ~EEG~ treatment of addictions: Commentary On Ochs, Peniston, and Ku[kosky . Bio-
feedb.~ck, 10(2),12-17.
Rusenfdd, J. P. (l992b). N,'W directions in app[i~'<[ psychophysiology. Biofeedb<ICk ,md Self-Regul.1Iio", 17, n-87.
Rosenthal, T. L., & Zimmerman, B. J. (1978). Soci~/le.1mi'lg mul COg'lili"'l. New York: Academic Press.
Schw,\ftz, G. E., & Beatty, J. (Eds.). (1977). BiofudlMck : Theory Imd research. New York: Academic Press.
Schwartz, G_ E., & Weiss, S_ M. (1978). Wh<lt is behavioral mcxlkine) Psycb050/1/.1ric Medici"e, 39(6), 377-381 _
Schwartz, i\-l. S. (1988). The biofeedback odrssey: Nearing one score and countin g (Presidential address). 8io-
feedv .1Ck tIIul Self·Regul.lIio", 13(1),1-7.
Schwam., M. S. (1999a). What is applied psychophysiology?: Toward a definition. Applied I's)'dJOph)'siology
m,d niofeedb.~~k, 14, 3-10.
Schwartz, M . S. (I999b). Responses to comments and clo~er to a definition of applied l'sychophpiologr? Ap-
plied 1'5ydH>p/J)'siolog)' and /Jiofeedv.1Ck, 24, 43-54.
Sclye, H. (19 71 ). Th e evolution of the suess concept: Stress <lnd cardio"ascu[ar disease. [n L. Levi (Ed.), Sociely.
stress, ~",I dise.1st (Vol. l). New York: Oxford University Press.
Sclye, H. (1974). SI,ess u,jl/H>"I disl.ess. Philadelphia: Lippincott.
Sclye, H. (1976). The Slress of life (rev. ed. ). New York: McGraw-Hi lI.
ScI)"e, H. (Ed. ). (1983). Selye's g"ide 10 Sl,ess ,eseMd, (Vol. II ). New York: Scientific and Academic Editions.
Shealy, C. N. (1977). Ni"el), d"ys 10 self-be,~llh. New York: Dial Press.
Sh tark , M. E., & Kall, R. (199 8). Biofeedback·3: Theory a",1 praaice. Nomsibirsk, Russia: CERIS.
Shtark, M. B., & Schwart7., M. S. (2002 ). 8iofeedbck-4: Theory a",[ p.ae/icc. Novosibirsk, RlIssia: CERIS.
Si[,'a, J. (1977). Sil,·.~ mi",1 co,,'ral melhod. New York: Simon & Schu,ter.
Smith, J. C. (1989). ReI.1X,lIiOl' dy"'lmi~s. Champaign, 1L: Research Press.
Smith, J. C. (1990). Cog"i/i!'e be/'a!'ioml , eiaxalion Ir.~ini"g. New York: Springer.
Smith, O. C. (1934). Action potentials from si ngle mutor un its in vo[unt.uy contraction. Americ.m jO"''''11 of
""),si%gy, 108,629-638 _
Sokhadze, E. ;"'1., & Shtar k, M. B. (1991 ). Scientific and clinical biofeedback in the USSR. Biofeedb.lck .md Sclf-
Regu/Mioll, 16(3), 253- 260_
Sterman, M. Jl. (1982). EEG biofeedback in the treatment of epilepsy: An OR'1"vieweirca 1980. In L. W. White &
B. Tllrskr (Eds.), CIi"ical biofeedb.1Ck: Effic",y a"d mech.1I1isms. New York: Gui[ford Press.
Striefcl , S. (1998). Creating the future for applied psychophpio[ogr and biofeedback: From fantasy to reality.
Applied PsydJophY5i%gy .,,,d Jjiofeedb.~ck, 23, 93-106.
Stroebel, C. (1982). The quieling ref/ex. New York: Putnam.
Tarlar ·Il.e,,[o[o, L. (1978). The role of relaxation in biofeedback training: A critical re,';ew of the [itcrature. I'sy-
chologiclIl B"I/elin, 85, 127-755 .
Tart, C. T. (E<I.). (1969). AI/ered s/.~/es of co"sciousness: A hook of ,e.1<1i"gs. New York: Wiley.
U[ lm<lnn, L, & Krasner, L. (l~d s.). (1965) . G.1se sl"dies ill beli,1<'io, mot/ific,1Iio'l. New York: Ho[t, Rinehart, &
Winston.
Wickramasekcra, I. E. (Ed.). (1976). Biofeed"-Ick, veh.1,·ior Ihe"W)' ,wd hypnosis: POlenti-1lillg Ihe "".V.1/ COl/-
1m/ of bcb"l'ior for c/i"icians. Chicago: Nelson Hall.
Wickramasekern, I. E. (1988). Clinical beh""ioml medicine: Some COl"",,/S a"d procedures. N~>w York: Plenum Pn'SS.
Wolf, S. L., & Bindcr-M"cLeod, S. A. (! 983). FJcctromyosmphic biofeedb>"I.: in the phrsic<ll Thcr<lpr dinic. In J. V.
&.smajian (Ed. ), IJiofeedb<lck: I'ri"ciples "nd pmc/ice for di"icitll,.. (2nd Cil.). &~[timore: Williams & Wilkins.
Wo[pc, J. (1973). T/le p,.1Clice of beh.1";o r IheMpy (2nd Cil.). New York: Pergamon Press.
Wuttke,.vl. (1992). Addiction, awakening, and EEG biofeedback. Biofeedb.lck, 10(2), 18-22 .
4 L H ISTORY, ENTER ING, AND DHI NIT IONS

INS'lll..UMENTAt CONDITI ONING 01; AUTONOMIC

NERVOUS SYSTEM HESI'ONSES

Learning theory developed wiThin experimenta l psychology as a means of undersTanding,

predicting, and connolling variations in animal and human behavior. [n contrast with those
who emphasize heredity as the major determinant of behavior, learning theorists emphasize
the importance of one's environment-specifically, of environmental contingencies, includ-
ing Teil/forcers, which lead ro acquisition and maintenance of learned behavior.
" Learning" means a change in behavior as the direct result of experience. Rcinforccmcllt
is necessary for OIJerant cO llditiolling or illstrumcllfal cOllditiol1illg TO take place. From This
perspective, both overt behaviors and coven behaviors, such as thoughts, feelings, and physi-
ological responses, arc functions of the antecedents and consequences of such behaviors . This
model describes the learning of responses instrumenta l to obtaining or avoiding positive or
negative consequences.
The prevailing scientific \,iewpoint for several decades was that only the volun tary muscu-
loskeletal system, mediated by the cClltralllervous system (eNS), was responsive to operant
conditioning. T his view held that the autOllomic nervous system (ANS) functioned automati-
cally beyond conscious awareness, and hence beyond voluntary control. Most scientists thought
that the internal, homeostatic controls for such functions as circulation and digestion were in-
nate aJld unaffected by self-regulatory leaming. Most scientists assumed that ANS functioning
or visceralleamillg was modifiable only via classict/I cOllditiollillg, if subject to learning at all.
In this view, responses are a utomatic after conditioning occurs. In classical conditioning, thoughts
can even become conditioned stimuli (CSs) and elicit physiological responses .
T he srrong biases aga inst instrumental conditioning of the ANS and the visceral responses
it controls limited the amount of ex perimental work in this area until ahout three decades
ago (M iller, 1978). Later studies with humans alld animals showed that instrumemal traill-
ing could produce increases and dereases in several body responses. T hese included vasomo·
tor responses, blood pressure, salivation, galvallic skill respOIlse (CSR), and ca rdiac rates and
rhythms (see reviews by Kimmel, 1979, and Harris & Hrady, 1974).
Research indicated that individuals could gain volitional comrol over severa l differem
ANS functions without learning that could be attributed to cognitive factors. Many scientists
and professionals were very skeptical of these findings . T here was much disagreement con -
cerning whether the research really demonstrated cortical control over ANS activity. As re-
search advanced, it became clear that to show operant learning effects in the ANS, research -
ers needed more sophisticated designs. T hey had to rule out skeletally mediated mechanical
artifacts and visceral ref/exes.
By the I 970s, researchers began studying CNS-controlled, imegrated skeletal-visceral
responses and panerns. They also studied specificity and patterning of learned visceral re-
sponses and cognitive1y mediated strategies for producing visceral changes (M iller, 1978).
The curarized animal stud ies of Miller and his associates (Miller & DiCara, 196 7) countered
the argument that ske1era l muscle activity was mediating some visceral changes. The skeletal
muscles were temporarily paralyzed .
0 f1le ( 1979), a cautious but supportive conscience of the biofeedback field, reminded us
that, in terms of animal st udies,
It would be misleading, however ... not to point out that the important studies with cu rarized
animals ... while initially replicated, cannot now be reproduced. Though there is no difficulty in
demonstrating statistically sign ificant changes in visceral function as a result of instrumenta l
conditioning in curarized animals- Iea"ing no doubt about the phenomenon--obtaining effects
sufficicntly large to be clinically significant cludes the present techniques. (p. 495 )
1. l-listoric.ll "crs pccti,'c 5

The research with instrumenta l conditioning of visceral responses media ted by the ANS
gave a major impeTUs to thc development of clinical biofeedback . It appeared to resolvc thc
controversy concerning whether such condi tioning was a legitimate phenomenon. An assump-
tion of clinical biofeedback is that it can help persons improve the accuracy of their percep-
tions of their visceral events. These perceptions allow them TO gain greater self-regulation of
these processes. Indeed , some professionals view some biofeedback as instrumemal condi-
tioning of visceral responses.
This operam model of biofeedback has significam heuristic va lue. One can apply prill-
ciples of instrumental con ditioning to physiological self- regulation. These principles include
schedules of reinforcclllellf, shaf)il/g, extinction, and fadil/g.
Although it is helpful TO view biofeedback primarily as instrumental conditioning of vis-
ceral responses, this model is seriously limiting. Leanl1ng theory has developed far beyond
the more traditional views of operant conditioning. Other professionals believe that human
1car1l111g 11lcludes major cognitive dimensions as well as environmemal reinforcers. Examples
include thinking, expecta tion, visualization and imagery, foresight and planning, and prob-
lem-sol\'ing strategies.
One can include cognitive faCTOrs within the operant conditioning model. However, pro-
fessionals adhering to more Strillgem imerpretations of the model consider cognitive faCTOrs
inadmissible, because one cannot observe or objectively measure them . Nevertheless, studies
of mOTOr skill learning (Blumenthal, 1977) show that humalls develop menta l models
("motor programs") of what a skilled movement should be like. Furthermore, research shows
that Olle may acqui re beh a vior without obvious practice or even rein forcement. Th is evidence
comes from latent learning experiments (Harlow & Harlow, 1962 ), studies of discovery learn-
ing (Bruner, 1966), and STUdies of obserllatiollalleamillg involving imitation of a model
(Rosemhal & Zimmerman , 1978).
Increased acceptance (or the role of mental processes in learning led TO cognitive-behavioral
thcrapies and studies of cognitively mediated strategies in the changes occurring during bio-
feedback therapies. The emphasis on cognitive learning also supported the applications of
cybemetics to biofeedback.

PSYC HOPHYSIOLOGY

David Shapiro offered the first academic course in psychophysiology at Harvard University
in 1965 . Th e Handbook of PsychOf) hysiology, a major publication, appeared 7 years later
(Greenfield & Stern back, 1972 ).
Psychophysiology involves the scientific study of thc imcrrelationships of physiologi-
cal and cogni tive processes. Some consider it a special branch of physiology. Some also
consider it an offspring of psychobiology, which ill turn is the child of the marriage be-
tween the physica l and social sciences (Hassett, 1978 ). Physiological psychologists often
manipulate physiology and observe behavior. [n contrast, psychophysiologisrs often facili-
tate, manage, guide, hinder, or obstruct human psychological variables and observe the
physiological effects.
As a form of "applied psychophysiology,"J clinical biofeedback helps people alter their
behaviors with feedback from their physiology. These include muscle activity, peripheral blood
flow, cardiac activity, sweat gland acti vity, brain electrical activity, and blood pressure. Some
providers of clillica l biofeedback call themselves "clillical psychophysiologists." This name
emphasizes the applied nature of their professional activities and their involvement with this
scientific specialty.
6 L H ISTORY, ENTER ING, AND DHI NIT IONS

rmHAVIOR THrnAPY AND BEHAVIORAL M[DI C INIJ

Related outgrowths of both learning theory and psychophysiology are the fields of behav-
ior therapy and behavioral medicine. "Bcha vior therapy" developed in the 19505 as an alterna-
tive to insight-oriented psychodYllamic theories find therapies for meIltal disorders. Early pro-
ponents of behavior therapies included Wolpc (1973), Paul ( 1966), Bandura and Walters (1963),
and Ullman and Krasner (1965), T he roots of behavior therapy include the llotion that one learns
maladaptive behaviors, and thus in mOST cases, 011C can unlearn them . T he model is largely
educational rather Than medical as such. It applies the principles of operant and respondcnr
conditioning, as well as of cognitive learning, to change a wide range of behaviors. Many pro-
fessionals view some biofeedback applications as a form of operant learning. O thers view bio-
feedback more cognitively within all information-processillg model.
" Ikhavioral medicine" is another outgrowth of learning theory, psychophysiology, and
behavior therapy. This specialty developed within behavior therapy alld psychosomatic medi-
cine . It appeared as a distinct entity ill the late 1970s. Behavioral medicine focuses on appli-
cations of learnillg theories to medica l disorders alld other health-related topics . It does nor
focus on psychopathology or mental disorders. G . E. Schwartz and Weiss ([ 978) reported a
definition of behaviora l medicine proposed at the Yale Conference held ill 1977:

lkhavioral medicine is the field concerned with the development of behavior science knowledge
and techniques relevant TO the understanding of physica I health and illness and the application of
this knowledge and these techniques to diagnosis, prevention, treatment, and rehabilitation. Psy-
chosis, neurosis, and substance abuse arc included only insofar as they contribuTe TO physica l
disorders as an end point. (1'. 379 )

Behavioral medicine also developed because traditional medical approaches were insu f-
ficiellt for managing and treating many chronic diseases, conditions, and health-damaging or
maladaptive behaviors . This new specia lty goes beyond the traditiollal germ theory of the
etiology and progression of diseases. It recognizes the imporrallt roles of stress, lifestyle, hab-
its, and environmental va r iables in the development, mainrenallce, and treatment of medical
and dental diseases and conditions.4
Behaviora l medicine places much emphasis on the patient's role in prevention of and
recovery from organic diseases and conditions. The same emphases are clear in ap plied or
clinica l biofeedback . In fa ct, some professionals consider clillical biofeedback to be a major
specialty within the broader field of behavioral medicine.
T he contributions of behavior therapy and behavioral medicine to the development and
applications of applied biofeedback and applied psychophysiology arc clear. The in teractions
among professionals from all of these fields will continue to be emich ing.

S·l·RESS HESEAHCH, HELAXATION THERAPIES,

ANI) OTHHt snwss MANAGEMIJNT 'ITCHNIQUrS

An important area of beha \'ioral medicine is resea rch on the effects of stress on causing physical
symptoms and alterillg the immune system . However, resea rch on stress began long before
the development of behavioral medicine or biofeedback; in fact, both fields have their roots
partly in stress research . Sclye's ( 1974) repOrt of more than 130,000 emries on stress showed
the eXTellt of stress research.
Pioneering research was condUCTed by the physicians Claude Bernard and Walter B.
CaTlllon and by Hans Selye. Pi-Suner (1955) observed tha t Ikrnard developed the concept of
1. l-listoric.ll "crs pccti,'c 7

physiological "homeostasis" as the major process by which the body mainta ins itself. As
Langley ( 1965) noted, the concept became integral to the discipline of physiology. Ph ysical
and mental disease are thought to occur because some homeostatic feedback me<:hanism is
malfunctioning. One of the major effects of such homeostatic imbalance is stress.
In hi s book The Wisdom of the Body, Cann on (1932 ) indicated the natural causes and
results o f the inna te stress response. He named this response fight or flight . Selye's (1974 ,
1976, 1983) extensive research led to a triphasic conceprualization of the nature ofthe physi-
ological stress response: 1t includes stages of alarm, resistance, and exhaustion . One first
experiences stressful even ts as hardship; then one gets used to them; and finally one canTlot
stand them any 1011ger (Selye, 1971).
The brilliant and pioneering work of Cannon and Selye contributed significantly to the
development o f the field of psychosomatic medici11e. Their work i11creased a wareness of the
role of stress in physical and mental diseases. This awareness nurtured applied biofeedback,
and many of these applications focused on stress-related disorders. Furthermore, as noted by
M iller (1978 ), the emphasis of biofeedback on measurement and producing changes in bodily
processes contributes to other behaviora l techniques for relieving stress effects .
M any stress managemcnt systems evolved with the awareness of the effects of stress on
health a11d disease. Included amo11g these are mallY relaxation therapies, and some observers
perceive biofeedback as a specific treatment modality within this group. In practice, the ef-
feCTS of relaxatioll have a major role in achieving the therapeutic effects with biofeedback.
A very early form of physical rela xation is "hatha yoga," a technique adopted from the
Far East and populariled in Westem countries in the 1960s. In the United States ill the 1930s,
Edmund Jacobson ( 1938, 1978) developed "progressive relaxation training," which is a se-
ries o f muscle acti vities designed to teach people ways to distingui sh degrees of tenSiOll and
relaxation, and to reduce specific and general muscle tension . It also reduces or stops many
symptoms and some causes and effects of stress .

Muscle relaxation has long been noted as an important treatment for a variety of psychophysi-
ological and stress·rclated disorders. The value of taking time to relax is bl"<:oming increasingly
rcrognized in Western society, and we arc borrowing techniques from those Eastern cu ltures where
relaxation proce(iures ... have been practiced for centuries. (T<"Irlar·&l1 lolo, 1978, pp. 727- 728 )

Lehrer and Woolfolk ( 1984 ) reviewed empirical and comparative studies through the
early 1980s involving progressive relaxa tion and versions of it. Lichstein (1988) provided one
of the mOSt thorough reviews o f relaxation stratcgics and research results. Other very useful
resources are two books by Smith ( 1989, 1990). Modi ficat ions of progressive rela xation have
been developed by Wolpe ( 1973), Bernstein and Borkovec ( 1973), and Jacobson and McGuigan
( 1982). A related technique developed in England by Laura Mitchell (1977, 1987) involves
stretch-release procedures.
In addition to the physiological relaxation procedures, there has been a proliferation of
primarily mCllTal techniques, mOSt of which arc some form of meditation . Islamic Su fis, Hindu
yogis, Christi an contemplatives, and Hasidic Jews have practiced religious medi tation for
centuries. Howevcr, meditation was not (and still is not) a popular practice in the U11 ited States
except among a very small minori ty.
M ed itation became popularized in the Ullitcd States in the 1960s as a result of the devel-
opment of Transcendental Meditation (TM), practiced and promoted by a teacher from
India named Maharishi M ahesh Yogi (Forem, 1974 ). More Westernized variations of TM
were subsequentl y developed as "clinica ll y standardized medi tation" (CarringTOn, 1977) and
the "relaxation response" (Bemon, 1975). A modification of a meditation technique com-
bined with physiological rela xation is Strobel's (1982) "quieting reflex."
8 L H ISTO RY, ENT ERI NG, AND DHIN IT IONS

Another meditation approach is "open focus," developed by Fehmi and Fritl, ( 1980). Thi s
intends TO promOte an open, relaxed, and integrated mind-body STaTe. It is closer to Soro Zen
meditation in its goal of a content-free and quiet mind, by contrast with the focused concen-
tration of yoga and TM. Th e emigration of Zen BuddhisT teachers to the United States begin-
ning in the 1940s was yet another factor contributing to the meditation movement.
There are still other approaches involving relaxation/meditation: Ira Progoff's ( 1980 )
"process meditation," Jose Silva's (1977) "Silva mind control," and C. Norman Shealy's (1977)
"biogenics." Practitioners often usc relaxation/meditation techniques with biofeedback ill-
strumentation to enhance the learning of psychophysiological self-regulation .
Hypnosis is yet another approach developed to aid persons to control pain and stress. In
the 1700s, Franz Mesmer first postula ted "animal magnetism" to explain persons' responses
to suggestion . Hypnosis developed slowly until the 20th century. O ver the past few decades,
it has become more sophisticated and empirically grounded as a set of therapeutic techniques.
Liebeault, Charcot, and Freud were among the first to apply the techniques to patients (M oss,
1965) . Contemporary researchers, such as narber, Hilgard, Weit7.enhoffer, and Erickson, ha ve
comiucted seri ous investigations into the parameters of hypnosis.
In Germany ea rl y in the 20th century, J. H . Schultz devcloped a form o f physiologically
directed, self-generated th erapy ca lied "'autogenic tra ill ing." Wolgang Luthe (1969) reported
thc cxtensivc rcsearch and thcrapeutic applications of this popular techniquc, variations of
which arc now also ill common practice. Some, like Wickramasckara (1976, 1988), have
repoTted integrations of hypnosis and biofecdback .
There are numerous other stress management techniques. Many of these ha\'e been sum-
marized by Davis, Eshelman, and McKay ( 1980), Mc Kay, Davis, and Fanning (198 1),
Charlesworth and Nathan (1985 ), mId Lehrer and Woolfolk (1993).

BIOMEDICAL ENGINEERI NG

Withour high-quality insTIumentatioll for measuring physiological events accurately and re-
liabl y, there would be no biofeedback. As T arlar- Iknlolo ( 19 78) reminds us, "prior to World
War II , available equ ipmem was not sufficiemly sensitive for measuring most of the body's
intcmally gcncrated electric impulscs" (p. 728) . Progrcss occurrcd a ft cr thc war, and

technology had advanced far ... making feasible the task of design ing and constructing instru-
ments that could ac<.""Urately detect and record minute electrica l discharges, integrate and amplify
these responses, and produce a corresponding signal thar could be interpreted by the person
being monitored. {po 728 l

])iomcdical cnginccrs ha\'c devcloped technology tha t is both noninvasivc and sophis-
ticated . Surface recordings used for biofeedback measurement provide feedback for many
differcnr physiologica l activitics. Feedback can also be provided for angles of limbs and thc
force of muscles and limbs. In struments continuously monitor, amplify, alld rrallsform
clectronic and electromechallical signa ls into audio and visual feedback-understandable
ill formation.
Now multiple and simultaneous rccordings of several channels of physiological infor-
matiOll are available with instrumenratioll lillked to compurers. Computers allow greater
storagc capabilitics, rapid signal an d statistical analyses, simultancous recording and intc-
gr:ltion of mu ltiple chall11els, and displays impossible only a few ycars ago.
1. l-listoric.ll "crs pccti , 'c 9

EI.I:CTROMYOGRAPHY, DIAGNOSTI C H .ECTROMYOGRAPHY,

AND SINGLE-MOTOR-UNIT CONTROL

T he workhorse of the biofeedback field is surface electromyography or simply electromyo-

graphy (abbreviated here as fMC, though sEMG is also used). According to Basmajian (1983),
EMC instrumentation grew Out of the studies of neuromuscular and spinal cord functions .
He reminds us that "it began with the classic paper in 1929 by Adrian and Bronk, who showed
that the electrical responses in individ ual muscles provided an accurate reflection of the ac-
tual functional activity of the muscles" (p. 2).
Physicians' use of EMG III diagnosing neuromuscular disorders is many decades old. As
early as 1934, reports indicated that voluntary, conscious control over the EMG potentials of
sillgle motor ullits was possi ble (Smith, 1934 ). M arinacci and Horande (1960) added case re-
ports of the potential value of displaying £\1G signals to assist patients in neuromuscular re-
education . lhsmajian (1963, 1978) also reported 0 11 the comro! o f single motor units.
Severa l investigators reported EMC feedback in the rehabil itation of patients after stroke
(Andrews, 1964; Brudny. 1982; Basmajian, Kukulka, Naraya n, & Takebe, 1975; Wolf &
Binder-M acLeod, 1983; Hinder-Mac Leod, 198 3). Such research was important in the devel-
opment of applied biofeed back, especially for the field of neuromuscular rehabilitatioll. Thus
EM C biofeedback gained solid support among researchers and clinicians.
Practitioners ha ve also used EMG feedback for treating such symptoms and disorders as
tension headaches and tension myalgias, and, more recently, incontinence.

CONSC IOUSNESS, ALTERED STATES OF CONSC IOU SNESS,

AND ELECTROl:NCEI'HALOGRAI'HIC fEEDBACK

Some observers prior to the late 1960s viewed psychology as a discipline that lost its mind
when it stopped studying human consciousness and lost irs soul when it discarded a phenom -
enology of the self. Since then, however, these trends have been reversed. Humanistic psy-
chology has reestablished the human self as a legitimate source of inquiry, and scientists in
transpersonal psychology and neurophysiol ogy ha ve renewed the study of human conscious-
ness. Such theorists as Ta n ( 1969), Krippner ( 1972), O rnstein (1972), Pelletier and Ga rfield
( 1976), G. E. Schwartz and Beatty ( l 977), and Jacobson ( 1982) are among those who have
made significant contributions to our understanding of human consciousness.
M any studies of altered states of consciousness induced by drugs, hypnosis, or medita-
tion ha ve added to our knowledge of the relationsh ips between brain func tioning and human
behavior . Such research helped stimulate the usc of electroellcephalography (EEC) in bio-
feedback, which also foc uses on the functional rela tionships between brain and behavior.
In the ea rl y 1960s, studies began appearing on the relatio nships between EEG al,)ha wave
activity (8- 12 hertz) on the one hand, and emorional states and certain states of conscious-
ness on the other . Alpha biofeedback, commonly reported as associated with a rela xed but
alert state, received its most attention in the late 1960s . Clinical applications were mostly for
genera l rela xation .
Kamiya (1969) reported that one could voluntarily control alpha waves-a feat that was
previously believed impossible. Support for these and related findings came from Brown (1977),
Nowlis and Kamiya (1970 ), and Hart (1968). "T hough these studies tended to lack system-
atic controls, they no netheless caught the imagination of many serious scientists as well as
the media" (Orne, 1979, p. 493). Some investiga tors and practitioners continued to advo-
cate the value o f alpha biofeedback th rough the early 1980s (e.g., Gaarder & Montgomery,
10 L H ISTORY, ENTER ING, AND DHI NIT IONS

\ 98 1), despite recoglliJ;ing that " there was no clear-cUT and concrete rationale to explain why
iT should help patients" (p. 155), Interested readers can review Gaarder and Montgomery's
informative discussion. [n contrasT, Basmajian (\ 983) noted that

alpha feedback ... has virnlally dried up as a scienrifically defensible clinical tool ... it has
returned TO the research laboratory from which it proba bly should not have emerged prematurely.
Through the next generation of scientific investigation, it may return as a useful applied tech -
nique. (p. 3)

Other investigators studied special izcd learning processes and other EEG parameters, such
as theta waves, evoked cortical responses, and EEG phase synchrony of mu ltiple areas of the
correx (Beatty, Greenberg, Deibler, & O'Hanlon, 1974; Fehmi & Selzer, 1980; Fox & Rudell,
1968). A few investigators continue this experimental work.
Specialized EEG bio feedback from selected brain areas, and selecTed fEG parameTers
(e.g., sensorimotor rhythlll and slow-wave activity), became The focus of well-controlled STud-
ies . T hese emerged as effective Therapeutic approaches for very carefull y selected paTiellTs WiTh
CNS disorders such as epilepsy (Lubar, 1982, 1983; Sterman, 1982; see also Strehl, Chap-
ter 20, This volume), as well as for some patients WiTh aTTention-deficiT/hyperacTivi TYdisorder
{Lu bar, 199 1; see also Lubar, Chapter 18, This volume}.
M ore recently, combined alpha-theta EEG feedback procedures purport to be success-
ful in treating patients' addicti ve behaviors, such as alcoholism (O chs, 1992; Rosen feld, 1992a;
Wuttke, 1992; PenistOll & Kulkosky, 1989, 1990; sec also Monasrra, Chapter 19, this vol-
ume). Clinical applications, as well as debate and research on them, continue.

CYBr:H.NFl·ICS

The term "biofeedback" is a shorthand term for external psychophysiological feedback, physiological
feedback, and sometimes allgJllenred proprioception. Th e basic idea is to provide illdividuals with
increased information about what is going on inside their bodies, including their brains.
T he field that deals most directly with information processing alld feedback is called
cybemetics. A basic principle of cybernetics is that one cannot control a variable unless infor-
mation about the variable is available to the controller. The information provided is called
"feedback" (Ashby, 1963; Mayr, 1970).
Another principle o f <:yberlletics is that feedback makes learning possible. Annett ( 1969)
reviewed the evidence for this principle. In applied biofeedback, individua Is recei ve di rect and
clear feedback about thei r physiology. This helps them learn to control such functions. For
example, from an EMG instrument, persons receive informaTion concerning their muscle
activity. This helps Them learn to reduce, increase, or otherwise regulaTc thc muscle Tension .
From a cyberneTic perspecTive, operam conditioning is one form of feedback. It is feed-
back provided in the form of positive or negative results of a particular bchavior. T he point
is that another sign ificallT contribution to the development o f applied biofeedback is an
information-processing model derived from cybernetic theory and research. Proponents of
this model ill The field of biofeedback include Brown (1977), Anliker (1977), M ulholland
( 1977), and Gaarder and MOllTgomery ( 198 1).

CULTURAL I' ACTOHS

Several cultural factors have comributed to the development of applied biofeedback. Th e

gradual merging of the traditions and techniques of the East and West is one major factor.
1. l-l isto r ic.ll "crs pccti , 'c
"
The rise in popularity of schools of meditation was an expression of a cu ltural change pro-
viding a context in which applied biofeedback developed . Yogis and Zen masters reportedly
alter their physiological sta tes significan tl y through medi tation. Related phenomena presum-
ably occur in some forms of biofeedback experiences . T herefore, some have referred to bio-
feedback as the "yoga of the West" and "electronic Zen."
Within the Un ited States, there are other cultural factOrs adding to a Zeitgeist encourag-
ing biofeedback applications. T hese are the heightened COSTS of health care and the resulting
need for more efficacious and cost-effective treatments. [n addition, it is commoll ly recog-
nil.ed that pharmacotherapy, with all its benefits, is o f limited value for many patients. Some
patients cannOt take medica Tions because of untoward side effects; many patients a \'oid com-
pliance; and some physicians deemphasize pharmacotherapy.
Perhaps evell more significant is the current popular public health emphasis 011 prevention.
The movement toward well ness has COlltinued to grow since the 1960s. Practitioners of holistic
health also emphasize sel f-regulation and self-control. The result of these emphases is that more
people are involving themselves in lifestyle changes to regulate their health. These changes in-
clude enhancillg physical fitness, avoiding caffeine alld nicotine, reducillg or stOpping alcohol
use, and pursuing better weight control . More people arc thus assuming increased responsibility
for their physical, as well a s their mental and spiricual, well-being. [11 addition, more people arc
accepting responsibility for their recovery from illness. Many believe that biofeedback therapies
facilitate and fit well into these efforts at greater self-regulation, well ness, and growth.

PHO f ESS IONA L DEV EI.O I'M ENT S

Also adding to the development of ap plied biofeedback afe the organizations of profession-
als engaged in both research and clinical/educltional applications. [ssucs considered here
include the professional organizations themselves (and the various names the primary one
has used); the status o f the literature in this field; the professional journal of the primary or-
ganization (and the journa l's name); and, fina ll y, the scope of the field .

Pro fessio nal O rg ani 7..<1 tio n s

Homer's epic poem The Odyssey can serve as a metaphor for the past, present, and future of
biofeedback and applied psychophysiology.s From the title of this epic, an "odyssey" has come
to mean any long series o f wanderings, especially when filled with notable experiences, hard-
shi ps, and the exploration of new terrain . Just as Homer's Odysseus experienced setbacks but
was ultimately successful in his joutlley to reach home, the joutlley of psychophysiological sel f-
regulation with biofeedback has experienced and will C01l(inue to experience setbacks and suc-
cesses. The Biofeedback Society o f America (BSA) was emering its 20th year, thus completing
one full generation of devc1opmenr, when similar words were firs t delivered (M. S. Schwa ro,
1988). T wenry years constitute one generation, or the average period between the birth of par-
ents and the birth of their offspring. Thi rteen years then remained until the year 200 I, the dare
of the famous book and mMie 2001 ; A S,1flce Odyssl-'Y' However, our field docs not seck the
universality of something 3S monolithic as Arthur C. Clarke's and Stanley Kubrick's odyssey.

The An'ociulion Jor AppJic' I PsycllOp hy.~iolo9Y alJ(I Biifeedha ck,

(ltld l IS V(J ri ous Nu mes

H ow the jOl4mey BegaJl. T he Biofeedback Research Society (BRS) was formed in 1969,
largely by a handful of research psychophysiologists. After 6 years the BRS became the BSA,
12 L H ISTO RY, ENT ER ING, AN D DH INIT IONS

with both an experimenta l and an applied division. Age 6 is about the age at which ch ildren
go through the transition from home to school; similarly, The scope of The organization and
the field broadened into applied arenas. This change in name reflected the growth and im-
portance of the applied area.

How the ]OUnley Co mil1ued. At age 19 , as a result of the field's expanding scope, the
HSA wenT through its second Transformation-inTO the Association for Applied Psychophysi-
ology and Biofeedback (AA PI3). T his is about the age at which many studCllTs graduate to
institutions of higher learning. This organization returned to some of its roOTS in psychoph ysi-
ology at the same imcrval. Th e consisTency with the journey metaphor first struck M. S.
Schwartz (1988 ) theil, as O dysseus also took 20 years to return ho me.
As later reponed by M. S. Schwanz ( 1999a, p. 3),

the name ... change was a hotl y debated topic. Many argued for a need to expand the implied
scope of The organization. One factor was that most practitioners uTililed a wider array of the rap)'
methods than biofeedback . Presenrations at the annual meetings of the BSA encompassed much
more than biofeedback. Researchers at universities were saying th at the term biofeedback was
too limiting. They maintained that the term biok-edback alone was not viewed as sufficiently
credible by some ind ividuals and that this hampered their abilities to publish their research in
some qual it)' journa Is a nd TO obtain extcrna I research funding. The researchers further comended
that the tenn "biofeedback" was insufficient for them to obtain the kind of recognition they needed
in their academic departments. Thus, both applied practitioners and researchers were contend-
ing that a name change was needed.
Ps)'choph)'siology was the birthplace of the field of biofeedback, and so it was time to return
to these roots. The emphasis was placed on the term applied to distinguish it from lits] grandpar-
ent organization and field, the Society for Psychophysiological Research .
Many members of thc I~SA ... argued for dropping the term biofeedback but the supporters of
the term successfully argued for the preservation of the tenn .... The term "applied psychophysi-
ology" reflected the evolution of science and clinical practice .

The AAI'H contin ues to be a productive, intellectually stimulating, cl inically useful, scientifi-
cally sound, and vibrant organization .
Disagreement has continued, howe\'er, about the mOSt approp ri ate name for berh the
membership organization and its journal (sec below ). Some argue for only "Associatio n
for Applied Psychophysiology." Others argue for maintain ing the terms "Biofeedback" and
"Self- Regu lation ." Th ere is good reasoning on both sides. Those supporting "Association
fo r Applied Psychophysiology" as sufficien t emphasize a broader scope. Th is is more ac-
ceptable conceptually and politically to many psychophysiologically oriented researchers
with close tics to biofeedback . Those who advocate keeping the term "Hiofeedback " in the
names of the organization and journal focus on the establi shed place of this term in the
m inds o f professionals and the lay public, as well as on its history, brevi ty, and case of
communication . Wh y change horses III midsTrcam, they argue, especially from a fami li ar
one that is doing so well?

Other Mem bership Ora o n niza rions

Another national membership organi~.ation, the American Association of n iofeedback Clini-
cians, started in 1975 but wcnt ou t o f exi stence ill the late 1980s. Th is left the BSA, now the
AAPI), as the only organiza tion with a major emphasis on biofeedback. H owever, many other
profcssional and scicmific societies also devote space ill their publications and time at their
meetings to biofeedback and applied psychophysiological research .
1. l-listoric.ll "crs pccti , 'c 13

Th e Biofeedback Certification Institute of America

A professional organization that influenced the cominued developmellT of the field is the Bio-
feedback Certification Institute of America (BCI A). As its name indicates, the BCIA maintains
a credible credemialillg program. Before 1979, credentialing was in the hands of a few state
biofeedback societies. These societies, well·meaning as they were, suffered from the understand-
able problems of small gro ups of professionals who typically had little or no training and expe-
ricnce with the complexities of credential ing. T hus there was considerable variability in the
credemialing across states . In most states, there was 110 credemialing at all or the hope of any.
Ed Taub, then president-eleCT of the BSA, had the foresight and wisdom to inspire the
development of an independent, credible, nationwide credemia ling program. T he BSA spon -
sored and suppo rted the official establishment of the BClA (named by Bernard Engel, later
the first chair of the BO A boa rd) in January 198 \. Three months later, when Engel became
President of the BSA, he graciously relinquished the chair of BO A to Schwartz. T he BCIA
evolved with more stringent criteria for educa tion, tra ining, experience, and rece rtification.
Professionals continue to seek and earn the BCIA's credential as the only one of its kind .
Although the I)C IA holds primacy in credemialing, educational opportunities exist in many
undergraduate and graduate courses in biofeedback. Private training programs and work-
shops are offered by national, state, and regional professional o rganizations. There are also
many companies manufacturing biofeedback instrumelltation, and several companies selling
and servicing a variety of instruments from di fferent manufacturers.

Th e J ou rn ey of a Family or Separate J ourneys?

All professionals in this field share some join t responsibility and custody for the yo ung adult
we call ·'biofeedback and applied psychophysiology." So me individual professionals proceed
on their own journeys; they seek their o wn destinations, their own lthacas, instead of com-
mon ones . However, the AAPB continues as the leading administrative, facilitative, educa-
tional, and coordinating organization dedicated to integrating professional disciplines and
conceptual frame wor ks that involve varied scientific and applied areas of psychophysiology
and biofeedback. It is the nuclear fami ly for biofeedback.

Status o f th e Lit erature in th e Held

The number of publications is one barometer of the history, growth, and possibly the future of
a fi eld. T he firs t bibliography of the biofeedback lirerature (Hurler & Stoyva, 1973) contained
about 850 references . T he next edition,S years later, listed a bout 2300 references (Butler, 1978).
Thousands more have appeared since 1978 (Hatch & Riley, 1985; Hatch & SaiTO, 1990). There
wasa downward trend in journal publications in English from 1985 through 199 1 (Hatch, 1993).
However, about 150 per year continue appea ring with no decline between the yea rs 1987 through
199 1. (Sec M. S. Sch war["L & Andrasi k, Chapter 39, this volume, for more discussion.)
Note there are dozens of papers published each year in non-English-speaking countries.
For example, the important Japanese literature was still III its early stages in 1979, but ra p-
id ly increased in the 1980s (Hatch & Saito, 1990). T here is also a rich history of resea rch
publications and clinical appl ications in Russia and other countries that were formerly part
of the USS R (Sokhadze & Shta rk, 199 1; Shtark & Kall, 1998; Shtark & Schwartz, 2002).
T his foreign literature is not well known ill the Ull ited States.
A perspective on the issues o f history, publications, and past and current interest, and a
full appreciation fo r roOtS, research, and applicatio ns, all require awarelless of and access to
foreign publication databases .
14 L H ISTO RY, ENT ERI NG, AND DHIN IT IONS

Th e Primary J ournal , and It s Name

A measure of the maturity of a field is the existence o f and quality of its primary professional
journa l. The journal Biofeedback (ln d Self-Reglllatioll, published by Plenum Press, was started
ill 1976. T he journal's name was changed to Af,plied Psychophysiology and Biofeedback as
of Volume 22, 1997. The editors, board, and publisher noted that "the journal has long had
a broader focus than the ririe implied, and this new name more accurately reflects its expanded
scope" (Andrasik, [997, p. I ).

Defining "Appli(:d Psyc hophysio logy"

Defining the term ';applicd psychophysiology" still remained a need, goal , and challenge as
of 1998, several years after the AAPWs and the journal's name changes. As llOted by M. S.
Schwartz (1999a, p. 4 ), "One can only surmise that everyone apparently kllew what applied
psychophysiology meam .... What everyone apparemly knew, no one had wrinen. What
everyone apparently knew, was unclear."
J. Peter Rosenfeld, in his AAPg presidemial address (Rosenfeld, 1992 b), was the first w
address a definition of "applied psychophysiology." He identified some of irs clements, "and
wuched on elements of a definition" (.\II. S. Schwanz, 1999a, p. 4 ). Sebastian Striefel, a later
president of AAPB, again raised the question of a definition of applied psychophysiology in
his 1998 presidential address (Striefel, 1998) . At the same meeting, "Paul Lehrer, chairperson
of the AA PB Publication Conun ittee, convened an ad hoc commirree to deal with a wide array
of topics .... One of these wpics was ... the lack o f a formal ... definition of 'appl ied psy-
chophysiology'" (M. S. Schwartz, 1999a, p. 4 ). The committee assigned the task of establish-
ing an operationa l definition for the term. The initial paper by M. S. Schwartz ( 1999a),
responses and critiques by an array of notable professionals, and the response by Schwartz
( 1999b) are all eontained in the journal (1999, Vol. 24, pp. 1-54). (See N. M. Schwartz &
Schwartz, Chaprer 3, th is volume, for the definition and selected comments .)
The development o f a definition that is acceptable to e\'eryone is unlikely. J ust as there
were broader and narrower definitions for "biofeedback," there probably will remain broader
and narrower definitions for "appl ied psychophysiology." T his is not a problem, as long as
one considers definitions as operational entities developed for specific purposes . Perhaps the
AAP]) will adopt an official definition even tually.

SUMMARY

The field of biofeedback has a very rich history with multiple roots. Awareness of this back-
ground can be helpful in understanding the beginnings of biofeedback, its status, and salient
factors shaping its fUT ure. From feedback research and applications of the past, one may find
inspiration and momentum for a creative future in this exciting field . Th e scope and contri-
butions of biofeedback encompass many professional fields . For some professionals, biofeed-
back remains a field in itself. For many other professionals, biofeedback is pa rt of the broader
fi eld of "applied psychophysiology"-now the term that is part of the primary national
organization'S name and the title of the primary journal. However, it is still too early to fore-
caSt how the applied psychophysiology concept and term will affect the metamorphosis of
the broader field and the biofeedback component. "Biofeedback" remains a viable and en-
during term with a rich and complex history, present status, and future. This is true whether,
by implication or design, it is independen t of, linked TO, or subsumed by broader terms and
conceptual models.
1. l-l isto r ic.ll "crs pccti l.-·c IS

GLOSSARy6

ALPHA WAVE ACTIVITY. Electroencephalographic (EECj activity ( 8~12 hertz) commonly, but not al-
ways, thought to be associa ted with an alert but relaxed state.
AUTONOMIC NERVOUS SYSTE:-.1 (ANS ). The part of the nervous system that is connected to all organs
and blood vessels, and transmits signals that control their function ing. It consists of two branches, the
sympathetic and parasympathetic, which usually produce opposite responses. Once thought to be totally
involunrary, it is now known to be under some significanr volunrary control, although less so than the
CNS.
CENTRAL NERVOUS SYSTE-\1 (CNS). The part of the nervous system including human thought, sense
organs, and conrrol of skclefal muscles. Once belie\'cd to be totally separate from the ANS, it is now
known to inreract with the ANS.
CLASSICAl. CONDITIONING. O riginating with Pa vlov, the type of conditioning or learning that assumes
that certain stimuli (unconditioned stimuli, or UCSs ) evoke unconditioned or unlearned responses
(UCRs ) (e .g., acute pain evokes crying, withdrawa I, and fear ), and that other, pre"iollsly neutral stimuli
(conditi oned stimuli, or CSs ) associated with the pairing of these events develop The capacit y to elicit
th e same or similar responses or conditioned responses (CRs).
CURARIZED ANIMAl.S. Animals intentionally paralyzed by the drug curare to control for body move-
ments during visceral conditioning, such as biofeedback of heart rate.
CYBERNETI CS. The science of internal body control systems in humans, and of electrical and mlxhani-
cal systems designed to replace the human systems.
ELECTROENCEI'ltALOGRi\I'HY (EEG). The measurement of electrical activity of the brain.
El.ECTRO.\-I ECHA NI CAL. A term describing devices that measure mechanical aspects of the body (e.g.,
position of a joint or degree of pressure or weight placed on it), rather than a property of the body
(e.g., its dirlxt electrical activity or temperature ). Examples of these mechanical aspects include de-
grees thaT a knee bends in a person after knee surgery, steadiness of the head of a child with cerebra l
palsy, and the weight pressure placed on a leg and foot by someone after a stroke. Instruments trans -
form these mechanical forces into ekarical signals.
ELECTRO.\1YOGRAPHY (EM G). The usc of splxial instrumenrs to measure the electrical activity of skel etal
muscles. [n recent yeaN, also calkd "su rfa ce elecTromyography" and sometimes abbreviated as sEMG.
EXTINCTION . The behavioral principle predicting that abruptly and totally stopping all positive rein -
forcements after spccified behaviors will lead to the behavior's no longer occurring.
FADING . Gradually changing a stimulus th at conrrols a person's or animal's performance to another
STimulus. As a behavioral procedure, iT does nOT always mean disappearance of a stimulus .
FIGHT OR FLIGHT. Walter Cannon's well-kn own concept of the body's psychophysiologica l arousal
and preparation for fighting or fleeing actual or perceived threatening stimuli.
GALVANIC SKIN RESPONSE (GSR ). A form of elcctro{iermal activity- increased resistance of the skin to
conducting Tiny electrical currents because of reduced sweat and dryness . Older term less of en used
now, but sti ll accepted. Opposite of "skin conductance" (sq.
INSIGHT-ORIENTED PSYCHO DYN AMIC TJ.1EORIES AND TJ.IERA PIES. A wide range of psychological theo -
ries and therapies, starting from the time of Sigmund Freud . A basic assumption is th at patients need
to gain insight into the psychological origins and forces motivating th eir current psychological prob-
lems and behaviors before they can achieve adequate relief of symptoms.
INSTRUMENTAL CO NDITIONING. Same as operam condiTioning (see below). The behavioral Theories
and therapies originated by B. F. Skinner . For example, reinforcers arc said to be instrumentally linked
to the recurrcnce of behaviors.
OBSERVATIONAL LEARNING. Learni ng that takes pIace by means of the organism's observing another
organism doing the task to be learned.
OPERANT CO NDITIONING. T he same as instrumental conditioning (sec above ), originating with B. F.
Skinner. "Operant" means thaT a response is idemified and understood in terms of its conscquences
rather than by a STimulus that evokes it. STimuli and cirCllmstances emit responses rather than evo ke
th em, as in classical conditioning.
16 L H ISTO RY , ENTERI NG, A ND DHI NIT IONS

PROPRIOCEPTION, Perception mediated by sensory nerve terminals within tissues, mostly muscles, Ten -
dons, and the labyrintha! system for balance. They give us information concerning our movements
and position. Examples include (1 ) the sense of knowing when we arc slightly off ba lance; and (2) the
abi liry to perceive (even with eyes closed ) the difference between, and approximate weights of, objects
weighing 5 ounces and 7 ounces held in each hand .
Ps YCHOPHYSIOLOGY. The science of studying the causa l and intcracti,c processes of physiology, be-
havior, and subjective expe rience.
REINFORC ERS . Events or stimuli that increase the probability of recurrence of behaviors they follow.
SCHEDULES OF RE INFORCEMENT. Usually, forms of inrerm ittenr reinforcemenr of an operanr behav-
ior. A common schedule in life, and mosr resistant to e xtinction, is a variable-l1ltio schedule-one in
wh ich the number of times a reinforcemenr follows a specific behavior varies randomly, so the person
or animal never know s when the reinforcer will occur, T his contrasts with variable·interval, fixed·
inrerval, and fixed- ratio schedules.
SENSORIMOTOR RHYTHM. An EEG rhythm (12- 14 hert"l ) recorded from the central scalp and involv-
ing both the sensory and motor parts of the brain, the sensorimotor cortex. Used in the EEG biofeed-
back of some persons with seizure disorde rs.
A behavio ral principle from operant conditioning, referring to procedu res designed to help
S H APING .
learning of complex new behaviors by very small steps. Also known as ~shaping by successive
approximations. "
SINGLE ." lOTOR UNITS. Ind ividua l spinal nerves or neurons involved in movement. I~iofcedback tra in-
ing of single spinal motor neurons was a major advance in the late 1950s and early I 960s. This tra in-
ing requires fine-wire EMG electrodes.
SKELETALLY ,"IF-DIATED MEC H ANICAL ARTIFACTS . Artifacts in instrumentation-recorded signa ls that are
caused by intentional body movements. Examples include moving a body part such as the head or
neck during recordings of resting muscle activiry, or clenching the teeth during EEG recordings.
SLOW-WAVE ACTlVlTY. EEG activity (3-8 hertz ) included in the frequency Tange often called theta ac-
tivity, also reporte{1 as 4-7 herr.l.
VAS O MOTOR . Affecting the caliber (diameter) of a blood vessel.
VISCERAL LEARNING . Le arning that takes place by body organs, especially those in the abdominal cav-
ity, such as the stomach an d bowels_
VISCERAL REF LEXES . Refle xes in which the stimulus is a stare of an internal organ .
ZEITGEIST. T he spirit or general trend of thought of a time in history. Often used to refer to a time
in history when new ways of thinking and technologies arc more li kely to be accepted by rhe cu ltllre
111 question .

NOTES

1. It. Paul Olson's name is retaincd as coauthor of this chapter because most of it rcmain. from the original
first and second editions. The cnrrent version has added content but essentially has not altered existing content.
Dr. Olson graciously withdrew from the third edition he.:ause of other commitments and a differcnt focus of his
professional lifc. However, his name is rctain~'<l OUt of respect and recognition for his earlier conuiblltions, and
bcca ~lse of his old friendship with Mark S. Schwartz, who takes rCSp<)nsibi1ity for the ncw content.
2. Thc 25Th-anniversary meeTing of thc primary professional membership organi7.ation, ,he AssociaTion for
App1ied Psychophysiology and Biofeedback (/\APB), wa s held in 1994. The conuncmorati,'c AAI'R Sill'''' A""i-
I'tr$,/,}' YeMuook publish~'<l for that meeting contains arricles about rhe histor~' and development of the biofeed-
back field and the organiwtion. Reading it is enriching a nd informaTive. It is available from the AAPS, 10200
West 44th Ave., Suite 304, Wheat Ridge, CO 80033; (303) 422·2615; fa x (303) 422·8894. The Web site is http:
IIwww.aapb.org.
3. Note that this sentence appeared in the fi rst edition of this book in early 1987. It does not seem to be a
coincidence that the Biofeedback Society of America (BSA) Went through the process uf changing its namC to
include Mapplied psychophysiologyM during that year while one of us (Mar k S. Schwartz) was president of the
BSA. Howe,'cr, it is a coincidence! Lung aftcr the name changc and during a rcview of this chapter in prcparaTion
for the second ediTion, Schwart~ not~\1 the term hcre. Its presence in this chaptcr was nc,'cr raised or diseussed
1. 1·listoric.ll I'crs pccti,'c 17

during ~ny of the board I1'Itttings or other IHlblk or private meetings concerning the n~me ch'lnge. Thc term was
written into an early draft of this chapter several rears before 1987.
4. "Health psycholog~'" is a more r(X'ent field with similar rOOts and ties to beha"ioral medicine. The focll"
is more on prevention and health enhancement.
5. Although the term "applied pS~'chophysiology" is now usually gi\"(~n first in this pairing, the order is
rcvcrsed hcre TO reflcct Ihc emphasis On biofeedb'lck in this book.
6. The intent of the glossaries in this and several other chaptcrs is to provide enough information to give
Ihe reader a rea>onablc idca of The meaning of sck'Cted lerms.

RHERJ: NCES
Anchor, K. N., &':k, S. E., Sieveking, N., & Ad kin s, J. (1982 ). A hinory of dinica l biofeedback. Americ"" Jour-
.",1 of C/i"i<:.11 Biofeedlm<:k, 5 (1), 3-16.
Andrasik, I'. (1997). EJiroria L Applied PSydlOphysi%g)' .omd Biofeedlnd:, 12,1.
Andrews, J ......]. (]964). Neuromuscular re-eJucation of the hemipk;;ic with aid of electromyograph , Archi"es o{
PI,),sic.1/ Medici"e <1",1 RefMbili{,uio", 45, 530-532.
Anliker, J. (1977). Biofcedback from the perspective of cybernetics and systems \:Cience. In J- Beatty & H. Lcgewie
(Eels. ), Biofeedb.1ck .1J!d I>eh'"'ior. New York, Plenum Press.
Annett, J. (1969). Feedb.1ck lIIul hum.1" bcil.wio,. Baltimore: Penguin Books.
Ashby, W. R, (1963). A" i"{,oductio,, 10 c,.bemetics. New York: Wiley.
S.,ndura, A., & Walters, R. (1963). Soci<l/ /e.l"'i"g .1J,,1 perso".1/ily del"eiopml!lli. New York: Holt.
i:>asmajian, J. V. (]%3). Conscious control of individual motor units. Science, 141, 440--441.
Basmajian, J. V. (1978 ). Muscles "Iil'e: TI,eir {u"ctioJ15 rel·e.1/ed by electromyograpby (4th ed. ). Baltimore: Wil-
liams & Wilkins.
Basmajian, J. V. (1:'..:1.). (1983). Biofeedb.lCk: Principles .1nd praaice for cli"ici.1J1S (2nd ~.J , ) . Baltimore: Williams
& Wilkins.
Basmajian, J. V. (EeL ). (1989 ). Biofeedb.~ck: Principles a",/ practice {or c/iuicimlS (3rd cd. ). Baltimore: Williams
& Wilkins,
Basmajian, J. V., Kukulka, C. G., Narayan, M. G., & Takcbe, K. ( 1975), Biofeedb"ck (re"lIncn( of foot drop
after stroke compared with standard rekabilitation te<:hnique: Efie<:1S on "oluntary control and strength.
Arcbi"cs o{ I'''ysica/ Medicine mId ReI",bilit<ltioll, 56, 231-236.
Beatty,]., Greenberg, A., Deib ler, W.P " &. OHanlon,J . F. (1974). Operant control of occipital theta rhythm
affccts performance in radar monitoring task. Seieuce, 183,871-873.
Benson, H. (1975 ). '/1,e relaxatiou respOllSe. New York: Morrow.
Bernstein, D. A., &. Barko,'ee, T. D. (1973 ). I'rogressi"e rel.-Ix,"io" tTllilli"S: A "',/lml,1 for Il,e beipiuS p rofes -
siOlI.lI. Champaign, 11.: Research Press.
Binder-,'vlacLeod, S. A. (1983). Biofeedback in stroke reh"bilitation.ln J. V. Basm<ljian (Ed. ), Bio{eedl).1ck: I'd,,-
cip/es ,,,,,I pmclice {o, c!i"ic;.1J/s (2nd cd. ). S.,ltimore: Williams & Wilkins.
Blumemhal, A. L. (1977 ). Tl,c process of cosnilio". Englewood Cliffs, NJ; Prentice-Hall.
Brown, B. (1977). SlreSS .1Jld Ihe arl ofbi,,{eedb.u k . New York: H"rper & Row
BTudny, J. (]982 ). Biof~""'dback in chronic neurological cases: Thempeutic ek·c tromyography. In L. White &
B. Tllrsky (Eds. ), CIi"ical bio{eedb.u k: Efficacy a"d mec"mlisms. New York: Guilford Press.
Bruner, J. S. (1966 ). Toward" Iheory of ;'lSlructiml, Cambridge, MA: Bel knap Press of ]-la"'aTd Uni,·ersity.
Butler, F. (1978 ). Biofeedba<:k: A sun'ey of tbe literature. New York: Plcnum Press.
Butler, F., &. Sto}""a, J. (]973). Hio{eedb.~ck aud sel{-coutrol: A bibliography. Whe"t Ridge, CO: Biofeedback
Socie!}' of America.
Cannon, W. B. (1932). TI!e wisdom of Ihe body. New York: Norton.
G,rrington, P. (1977). Freedom i" medilatio". Garden Ci!}', NY: Doubleday/Anchor.
CharleSWOrTh, E. A., & Nathan, R. G. (1985). Stress m",~~gemCJtI; A comprehe"s;"'e guide /0 wel/"ess. New York:
Atheneum.
D,wis, M., Eshclm~n, E., & McKay, M. (1980). The ,ef"x:llioll m,,1 Slress reductio" workbook. Richmond, CA:
New Harbinger.
Fehmi, L. G., &. FriTI., G. (1980, Spring). Open foeu" The "ttentional foundation of health and well being. So"'Mics,
pp.24- 30.
Fehmi, L. G., &. Selzer, F. (1980 ). Attention and hiofeedback tra ining in psychotherapy and transpersonal growth.
In S. Boorstein &. K, Spccth (Eds. ), E."tp/or.1lioJlS i" I",,,sperso,,,t/ psychother.1py. New York: Aronson.
Forem, J. (1974). T rmlSce",leJl'a/ ",edit.1tio". New York: \)ullon.
Fox, S. S., & Rudell, A. P. (1968 ). OperJIl! control led neural e,'enT: I'ormal and systematic approach TO d(.'Ctrical
coding of lxh~vior in brain. Science, 162, 1299- 1302 .
18 L H ISTO RY, ENT ERI NG, AND DHIN IT IONS

Gaarder, K_ R_, & Montgomery, P. S. 0977). Clinic"/ bioleedb.uk: A procedur,,' """",,,I lor belMI'ioml me,li-
ci"e. Baltimore: Williams &: Wil kins.
Gaarder, K. R, &: Montgomery, P. S. (1981 ). CIi"ical bioleedb.,ck: A procedural ",,,,,u,,1 lor beh",-ioral medici""
(2nd ed. ). Haltimore: Wi ll iams &- Wilkins.
Gatchel, R. J., &: Price, K. P. (1979). CIi"ical applicalio"s 01 bioleedb,,~k: Appr"is"I.,,,,1 sl.,lus. New York:
Pergamon Press.
Grrenficld, N . S., &: Sternback, R. 1\. (1972). I/",,,/book 01 psychophysiology. New York: Holt, Rineha rt &:
Winston.
I-Iarlow, H. F., &: Harlow, M. K. (1962). Social deprivation in monkeys. Scielllilic Americ"", 207,136-146.
Harris, A. H., &: Brady. J. V. ( 1974). Animal learning: Visceral and autonomic conditioning. Am",,,1 Re,';ew 01
Psychology, 25, 107-133.
Hart, J. T. (1968). Autocontro l of EEG alpha [Abstract]. PsyciJOphysiology, 4, 506.
Has5<)tt, J. (1978 ). A primer of psyci}()p/}ysiology. Sa n Francisco: Frreman .
Hatch, J. 1'. (1993, March). Declining rates of publication within the field of biof~>eJback continue: 1988-1991.
In Proceedi"l{$ of Ihe 241h Am",,,1 Meeli"8 of Ihe ASjoci,lIio" for Applied I'syc/}oplJ}'siology .md Biofeed-
b.,ck, Los A"geil!5. Wheat Ridge, CO: A.sociation for Applied Psychophysiology and Biofeedback.
Hatch, J. P., &- Rik'Y, P. (1985). Growth and (!e-'e!Opl1lCnt of biofredback: A bibliographic analysis. BiofeedbMk
~U(I Sell-Regul"lio", 10(4),289-299.
Hatch, J. P., &: Saito, I. ( 1990). Growth and (Ic>'elopmcnt of biofeedb,H;k: A bibliographic update. BiofeedbMk
mrd Sell-Reg"/.'Iio", 15(]), 37-46.
Jacobson, E. (1938 ). Progressiuc re/"".1Iim,. Chicago: University of Chicago Press.
Jacobson, E. (978). You musl rd.1" _ New York: McGraw-HilL
Jacobson, E. (1982). The hum.'''' mi"d: A physiologic"j darifi,,,lio,,. Springfield, II.: Thom"s.
J"cobson, E., &: McGuigan, F. J. (1982). Pri"ciples .m" pr"cliu of progressi, -e rel"""lio,,: A lea~hi"8 primer
[Cassette[. New York: BMA Audio Cassettes.
Kami),a, J. (1969). Operant control of the EFG alpha rhythm and some of if> reponed efk-cts On consc iousness.
In C. T. Tan (Ed. ), Allercd SI,lIe5 of co'"ciouSlless. New York: Wiley.
Kimmel , H. O. (1979). Instr\lmental conditioning of a\ltonomically medi ated responses in human beings . Ameri-
Cm' I's)'chologisl, 29, 325-335 .
Krippner, S. (1972). /\ltered states of consciousness. In J. White (Ed. ), The bighesl sl"le of cO!"cious"ess. Garden
Ci ty, NY: Doubleday.
Langler, L. L. ( 1965). Homeosf.1sis. New York: Van Nostrand Reinhold.
Lehrer, P. M., &: Woolfolk, R. L (1984). Arc all stress reduction techniques equiv"lent, or do they have differen-
tial effects!: A review of the comparative empirical literature. In R. L. Woolfolk &- 1'. M. Lchrer (F..ds. ),
Pri"ciples ",,,I pr.,aiu of slress m""ageme"l. New York: Guilford Press.
Lehrer, P. ''I., &: Woolfolk, R. L IE.ls.). (1993). Principles mid pTilclice of SfreSj ''''I11''gem"nl (2nd 00. ). New
York: Guilford Press.
Lichsrein, K. L (1988). CIi"ic,ri rel,u"lio" SIr.-tlegies. New York: Wiley.
Lubar,1- F. ( ]982). EEG operant conditioning in SC,'ere epileptics: Controlled ml,hidimensional studies _
In L Whi te & B. Tursky (&Is. ), CIi"ical biofeedbMk: Ef{ic.1C), .1"'/ mcci"misms. New York : Guilford
Press
Lubar, J. F. (1983). Electroencephalographic biof~-edback and neurological a pplications. In J. V. Hasmajiatl (Ed. ),
8ioleedb .• ck: Principles "ml pr"Clice for cJiuicim" (2nd ed. ), Baltimore: Williams & Wilkins.
tubar, J. F. (1991 ). Discourse on the development of EEG diagnostics and biofeedback treannent for attention-
deficitIhYl"'racti"ity disorders . /Jiofcedb.,ck a"d Self-Regul"liou, 16,201 - 225.
Luthc, W. (Ed.). (1969). Aulogenic Ih"TIlpy (Vok 1--4». New York: Grune &- Stratton .
Marinacci, A. A., & I-Iorande, M. (1960). Eb;lromyogram in ncuromusn,lar rc-education. /J"I/eli" of Ihe Los
Angeles Ne"rologic,,1 Society, 25, 57-7 1.
Ma)'r, O. (1970 ). TIJe origi"s of feedb.1ck coulrol. Cambridge, MA: MIT Pres •.
McKay, '\-1., Davis, M., &- Fanning, P. (198 1). T/lOug/m ,md feelings: TlJe IIrl of cog"itj,'e Slress i"lcrvcntioll.
Richmond, CI\: New Harbinger.
Miller, N. E. ( 1978). Biofcedb'lck and "isceral learning. AIlUU.11 Re"iew of /'sychology, 29, 373-404.
Miller, N. E., &- DiCara, L (967). Instrumental learning of heart rate cha nges in curarized rats: Shapi ng and
sp~-cificity to discriminat ive stimnlus. jou",al oIComt,,,,ali,'e aml Physiologic,,1 PS)'cho/ogy, 63,12- 19.
Mitchell, L. ( 1977). Simple reiu.1Iio": The pbysiologic,,1 melhod lor c.1sing Ic"sio". New York: Atheneum.
Mitchell, L. (1987). Simple rela..."lio,,: The Mitchell melhod for e.05i"8 le"sio1l (rev . ed. ). London: Murm}·.
I\-]O$s, C. S. (1965). /'/yp"osis i" pe rspeclir·e. New York: Macmillan.
Mulholland, T. (1977). Biob,dback as scientific method. In G. E. SchwartL &: J. lkattr (I;ds.), BiofeedbMk: TIJeoT)'
..,ul researeh. New York: i\c'l<lcmic Press.
CHAPTER 2

Entering the Field

and Assuring Competence

MARK S. SCHW ARTZ

DOlL D. MO NTGOMERY

Hiofccdback and applied psychophysiology consritllTc a mu ltidisciplinary and heterogencous

field of many professional disciplines and types of applications. Educational and training
opporrunities in the field range from courses at universities and individual workshops ro com -
prehensive biofeedback training programs. T he Biofeedback Certification Institute of America
(I~C IA ) provides accreditation for the biofeedback programs that arc indcpendcTlt of univer-
sities. For many, the sources of education afC the anllual meetings and workshops of the
Association for Applied Psychophysiology and Hiofccdback (AAPB) and the Society for Neu-
fOlia l Regulation; workshops sponsored by state and regional societies; and private training
programs that offer multi day programs.

GENERAL SUGGESTIONS ron. [ NTHUNG

AND MAINTAINING CO MPETENCE

The development and maintenance of clinical competence require active participation in a

variety of educational and training experiences . Responsible professionals seek continuing
education and training. Supervisors and others involved with the educa ti on and training of
professionals in their setting have the responsibility to suppOrt attendance at educational and
training programs. Professionals providing clinical services also have a responsibility to re-
quest time and financial suppOrt to attend these programs. T he fo llowing genera l suggestions
aTe made, withou t any order or preference, as ways to obtain and maintain competence. We
urge you, our readers, to consider them seriously and to try as many as arc feasible .

1. Enroll in carefully selected workshops, private programs, and academic courses. Ask
sponsors and presenters for the names of those who have attended in the past, and talk to
them .
2 . Read recommended books, journal articles, manuals, AAPB publications, and pa-
tiem education bookleTS. Consider the BelA references as a resource. Furthermore, listen to
audiotapes, such as those from na tional meetings.

20
2. En ter ing t h e Field anti Ass ur ing Co mpet ence
"
3. When feasible, visit with credible professionals to discuss and observe their elinica l
approaches. These opportunities arc very limited .
4. Study the BClA Blue print Kn owledge Statements, and prepare for and attain gClA
certification .
5. Regularly read the principal journal in this field, Applied Psychophysiology alld Biofeed-
back, and other journals that publish pertinent articles . Subscribe to abstracting services .
6. Attend the annual meetings of the AAPB. These meetings are the best chance to at-
tend a wide variety of sym posia, panels, and workshops. T hey also present an excellent chance
to talk with professionals in this field. These meetings are high in caliber and attended by
many clinicians and researchers who are imeresting, competent, academically sound, and
especially sociable. The address for the AAPB office is 10020 West 44 th Ave., Suite 304, Wheat
Ridge, CO 80033; (303) 422-26 15; fa x (303) 422-8894. T he Web site is http://www.aapb.org.
7. lkcome involved in a state or regional biofeedback society .
8 . Comact credible professionals who have experience. Ask th eir advice aboUT treat-
ment of selected pa tients.
9. Invite highly credible and experienced professiollals wh o are good th erapists, edu-
cators, and/or researchers to your professional setting. Institutions or other groups of profes-
sionals call cooperate to absorb the COSts .
10. Bcginners should usually limit the number of biofeedback modalities used. Consider
startillg with surface electromyographic (EMC ) and skin temperature feedba ck. T rying to
learn and use several modalities often unduly complicates assessment and therapy sessions.
11 . He familiar with a few instrument:uioll mallufactmers before purchasing instruments
and discuss instrumentation with professionals experienced with different manufacturers and
models. T he AAPH annual meetings and some state and regional meetings usually provide
such exposure to new equ ipment. A number of independent distributors sell instruments from
several manufacturers. Shop around and get good ad\'ice abour what will ideally meet your
setting's particular needs and be mOst cost-effective. Avoid getting more instruments than
needed for your serting; o n the other hand, avoid getting less than is needed.
12. EMC instrumentation that allows multiple simu ltaneous recording sites often en-
hances evaluation and therapy.
13. Locate a competent biomedical engineer and familiarize him or her with existing
instruments. A competent local engineer can reduce time lost in sending instruments away
for needless checking.
14. Consider ini tially limiting the number of disorders for which to offer services. It is
logical to choose among disorders that arc more prevalent and those for which the research
on biofeedback's effectiveness is more su pportive. Consider those disorders that arc of the
most interest to you and that arc li kely TO generate referrals.
15. He prepared and willing to accept patients with difficult problems, to invest more
time with these patients, and to adjust therapeutic goals accordingly. Even some improve-
ment can be very satisfying to such patients and to the referral source. Referral sou rces will
probably appreciate a practitio ner's willingness TO accept such patiems.
16. Review sample a ssessment and therapy protocols from highly credible and experi-
enced professionals. Standardized assessment and therapy protocols have a place ill some
practices. However, it is equally true that successful and cost-efficient services benefit from
tailoring assessment and treatmem to individual patiellTs. Practitiollers can always alter the
protocols of other therapists to fit their own needs, preferences, and situations . Again , isola-
tion breeds limited competence.
17. Review the patient education documents and presentaTions of others.
18. Make every effort to see that supervised therapists attaill certification by the BCIA
or are seriously working toward certification.
22 L H ISTO RY, ENT ER ING, AND DH INIT IONS

19. Those who arc supervising others and those who afC being supervised should main-
tain close and frequent communications abour paTients and services. Supervision varies WiTh
circumstances, such as competence, type, and complexity of patients, and specific responsi-
bilities or job functions. Some therapisTS who practice biofeedback are supervised by profes-
sionals WiTh Iittlc or no biofeedback expertise. Some wel l-meaning professionals do not know
what they do nOt know.
Competent use of biofeedback obviously requires an understanding of the symptoms and
disorders treated . Inrerprcration of psychophysi ologica l and clill ica l data must be proper ;lnd
responsible. Clear, accurate, and responsible interprofessiona l communica tions must be pro-
vided . Proper interpretation of pu blications is yet another part of competent practice. All this
is a lot to expect from ma ny biofeedback therapists, so proper supervision by qualified pro-
fessionals is often necessary to guararuee all of it. Furthermore, none o f us should avoid self-
scrutiny and reappraisal. All of us must be willing to update and change our practices.
20. Superviso ry professionals with expertise in biofeedback should usually provide at
least some sessions with biofeedback and other applied psychophysiological therapies . T here
is 110 substitute for this type of direct experience, at least periodically. Prudent supervising
professionals avoid allowing too much distance from patients. One exception occurs when
the person providing therapy with limited supervision is clearly highly qualified, competeru,
and highly experienced .

EDU CATI ON AND 'IltA I N I NG PHOGHAM S

Selecting courses, workshops, alld rraining programs is often difficult. One source of infor-
mation about training programs is the BCIA Didactic Education Accreditation Program, which
was established in January 1990 . Contact the Il,CIA for accreditation criteria, and the names
and addresses of accred ited educational and training programs. The phone number for the
IK IA is 303-420-2902. The Web site is htt p:www.bcia.org. If you are considering educational
and training programs without BCIA accreditation, the following steps arc essential:

I . Consider the presenter's reputation as a clinical practitioner.

2 . Consider the presenter's experience. T his includes number of years using bio-
feedback and o ther applied psychophysiological the rapies, number of patients treated, and
percentage of time devoted to using biofeedback and other applied psychophysiologica l
therapies.
3 . Select a program sponsored or accredited by a credible organization, such as the
American Psychological Association or your state professional agency.
4. Consider The presenter's qualifications and experience to Teach about the spcci fie topic,
as well as the number of workshops, courses, and other presentations provided by the presenter.
5. Consider comments by previous recipien ts of the specific education and training
program.
6. Check the time available for the topics listed in the program. A minimum of I hour
is o ften necessary to cover even very specific topics. H alf-day and fu ll-day wor kshops are
often necessary for covering topics thoro ugh ly . It is desirable for presenters to know the needs
and preferences o f enrollees a few weeks ahead of time.
7 . Ask about the meaning of the term "hands-on experience." Will the presenter ob-
serve enrollees preparing::l subject, attaching elecrrodes and Thermistors, adjusting the instru-
ments, and providing a few minutes of physiological mon itoring and biofeedback? If you only
need or wam to observe and briefly become familiar with an instrumem, then you do not
need much hands-on experience. However, if you need or want to learn more about using the
2. Ent ering th e Field anti Ass uring Com pet e n ce 23

instruments in assessment and therapy, then more time with the instruments is preferable and
necessary.
8. He sure that the p resenter clearly specifies specific goals.
9. Verify which insrrumemation will be available for demonstration or usc.
10. Ask about time for audience questions and discussion .
II. Consider the cost-benefit ratio o f attending. Very experienced and talemed profes-
sionals deserve and have the right to expect reasonable compensation for their educationa l
services. Promotional matenals, space, administrative factOrs, transportation for the presenter,
and daily expenses arc all expensive items . It is also necessary to consider preparation time,
even if the presemer has presemed the same or similar comem before . M ost workshop pre-
senters arc usually underpaid and rarely overly compensated .
12. Check whether the instructOr has BCIA certi fica tion. This is nOt necessary; however,
it is one piece of useful in formation about the presenter's broader knowledge and skills, and
involvemem in the field .
13. Some manufactu res offer tra ining on their equipment. Check with the manufacture
of your equipment, and then ascertain the qualifications of the presemers in you r area of imerest
for applications.
University-based educationa l opportunities arc avai lable at various regionally accred-
ited universities ami colleges, at both the undergraduate and graduate levels. Examples of
such institutions and thei r opportunities are as follows:
• Truman State Un iversity in Ki rksville, Missouri, offers an undergraduate course titled
Applicd Psychophysiology that can be a part of the bachelor's degree in psychology.
• The University of Texas in Austin, Texas, offers master's-Ievel and doctoral -level traill-
ing (a few bachelor's-levcl students arc also allowed TO enroll each year) in general biofeed-
back and electroencephalographic (E EG ) biofeedback. It also offers supervised clinical su-
pervision in both areas.
• The California School o f Professional Psychology in San Diego, Califomia, also offers
a master's degree in clinical psychophysiology and biofeedback.
• Nova Southeastern Uni\'e rsity in Fort Lauderdale, Florida, offers a graduate-level se-
mester co urse in clinical biofeedback and a year-long clinical practicum .
Since the AAPB has recently approved a model curriculum master's degree program in
applied psychophysiology and biofeedback, it is anticipated that training at this level wi ll be
offered at other academic insrirutions in the future .

Cf:RTIHCATION 01; Bl OH:EDBACK PHOI:ESSIONAtS

Hationale
The prima ry reason for certification is to provide the public with some assurance thaT a pro-
vider has met the fundamental training and experience to provide biofeedback services. The
HCIA was established to set minimal standards for service providcrs, because providers have
varied trai!ll ng histories ill differem professions, alld no Olle profession has idemi fied specific
training and experience for providers.
Arrainillg BClA certi fication has several advamagcs for providers of biofeedback services
(these include researchers, practitioners, and presenters of biofeedback educational and train-
ing programs) . Certi ficatioll is valuable for both supervised alld supervisory professionals. There
arc compeTent practitioners without certification; certification is not a guarantee of competence,
 L H ISTO RY, ENT ER ING, AND DH INIT IONS

and it was never intended to guarantee a full range of competencies. However, certification
provides a useful index of fundamenta l knowledge and basic instrumentation proficiency.
Reasons vary for avoiding certi fication. Sometimes professionals with excellent creden-
tials and extensive experience do have a philosophical or economic basis for the avoidance.
For example, some such professionals oppose an y certi fication for themselves and others, and
some say they cannot financially afford it. [n other cases, the avoidance serves to evade ex-
amination an xiety. Some practitioners harbor doubts about their competence to practice in
this field . However, for many responsible professionals, these arc not sufficiellt justifications
to avoid the process . T here arc several compelling reasons why most practitioners using bio-
feedback should seriously consider attaill ing and maintaillillg BOA certificatioll :

1. Certification rcfk"<:ts illvolvement III this field alld increases professiollal credibility.
2. It attests that the certified individual meets specified criteria to usc biofeedback.
3. It illcreases "market value" and mobil ity for many.
4. It gives employers a credible index of competence.
5. Some reimbursemellt systems view the HCIA credential as all importamcriterio ll for
reimbursement.
6 . A credible certification program is a cornerstone alld imporram sign of the matura-
tion of the field. [t improves the image of biofeedback to health care professionals, referra l
sources, a nd others oUTside the field. We shou ld not undervalue the imporrance of this.
7. Preparing for and maintaining certification involve considcrable studying and learn-
illg---a bellefit for applicants, cerrificanrs, and patients .

Th e History of th e Certifi catio n Progra m

There is only one esta bl ished national certification program, the BCIA, which was esta bl ished
in 198 1. A brief histOry of the beginning of the BCIA and the establishmcnt of its credential
process is presellted for those interested in aspects of this professional credential process.
The National Commission for Health Certifying Agencies (NCHCA) was started in [977,
with strong recommendations from and in itial financial SUppOTt from the federa l government.
Its mission was to provide "certification of certifying agencies." The NCHCA required such
agencies to fulfi ll extensi ve, demanding, and challenging criteria. To the credit of the early
BCIA board, it achieved full membership in 1983 . T he BOA later dropped its membership in
the NCHCA because of the weakened state of the NCHCA. As a small certi fying agency,
BO A had concerns about investing thousands of dollars in a weak and uncertain NCH CA.
The weakening of the NCHCA occurred for at least two major reasons. First, the crite-
ria for membersh ip were stringent and extensive. It allowed up to 5 years for fulfillment of
all the criteria, but many organizations striving for certification could not or would not do
what was necessary. Second, the NCH CA had a dynamic and highly competent executive
director who was very successful in obtain ing financial support for projects and keeping the
organization together; however, a tragic car accident changed all that. Nevertheless, the
NCH CA deserves our thallks for establish ing both a vision and admirable criteria . It was very
helpful to the early credibility and success of the BOA.
There are lessons to be leamed from The NCHCA experience. First, a certifying agency
should avoid credential criteria so extensive and strict that many potential applicants canllot
ful fill them in the time frame required . Second, such an agency should ap ply the basic learn-
illg principles of successive approximation or shaping, and usc small steps over a long enough
time to allow participants to learn, change, and maintain their gains. Third, no organization
should rely on a single leader; accidellts happen. Finally, leaders should make every possible
2. Ent e rin g th e Field anti Ass urin g Co mpet e n ce 2S

cffort to acqui rc and wisely invcst cnough moncy to sustain an organilation ovcr at least
2 ycars of hard timcs. Howevcr, thcy must be realistic abo ut thc fces for membcrs and cerrifi-
cants. Is anyone listen ing?

Aspc ct's or Ccrtifica tion

Thc BCl A now offcrs bOTh general biofeedback certification and certification in the specialty
area of EEG biofecdback.
In the general area, the requirements includc an earned dcgree in a hca lth·care-related
ficld, a course ill anatomy and physiology, didactic train ing in a core curriculum, supervised
self·regulation training, supervised clinica l biofeedback experiencc (which incl udes experi-
cncc with EMG alld thcrmalmodalitics), and biofcedback casc conferenccs. T hc applicam
must also successfully completc an examination on thc materials covercd in the Blueprint
Knowledgc Statements.
The BCl A's Hlueprint Knowledge Statements provide a derailed outline of knowledge
nccdcd to cntcr the biofee<i back field and prepare for the examimHions. T he BCl A completed
a revision of the original 1981 Blueprint Knowledge Statements in 1990 , and again in 1999 .
Cerrification for EEG biofeedback b~ame all official parr of the BClA's offerings ill 1997.
There arc corresponding tra ining and experience requirements, and a detailed set of Hlue-
pri nt Knowledge Statements for this eerri fi cation . eOlltact the BCIA for the requirements and
the detailed mueprint Kno wledge Statements.
Hriefly, the Hluepri nr Knowledge Statement areas for general ccrri fication includc the
follow ing:

I. Introduction (including definitions, history, learning principles)

II. Prcparation for Cli nical Interventions (e.g., imake tasks, psychophysiological pro-
filing, ongoing asscssment)
III . Neuromuscular Intcrventions-Gellcral
IV. Neuromuscular Interventions-Specific
V. Ccntral Nervous System Intcrvemions-General
VI. Auto nomic Nervous System Intervcntions-Gencral
Vll . AUTonomic Ncrvous System Interventions-Specific
VIlJ. Bio fecdbac k a nd Distress
IX. Instrumentation
X. Adjunctivc T herapcutic IntcrvcmiOl1S
Xl. Professio nal Conduct

Hriefly, the Hlueprinr Knowledge Statement areas for the EEG certification are as
fo llows:

1. Introduction to EEG Biofeedback

II. Resea rch
111. Basic Ncurophysiology and Ncuroanatomy
IV. EEG and Electrophysiology
V. Instrumenta tion
VI. Psychopharmacology Considerations
Vll. T reatmcnt Planllillg
VllI . Other Therapeutic Techniques
IX. Professional Conduct
26 L H ISTORY, ENTER ING, AND DHI NIT IONS

The certification process acts to deter the least competent practitioners and is an incen-
tive for increasing competence. It is an objective and accepTable criTerion for would-be prac-
titioners to assess their entry-level competence.

SUMMARY

T his chapter provides ideas and suggestions for persons (mering the biofeedback field . For
those already in the field, these ideas and suggestions may help them ma intain and enhance
their competence. Biofeedback is a broad, hererogcllcous, and complex field . Practitioners
need infusions of new knowledge, ideas, and skills. Deciding when and where These infusions
arc to take place, 311d dcrermlIling who is to provide them, arc nOT always easy. In this chap-
ter, we have offered some guidance.
T he AA PB and the Bel A cominue to be the national resourccs and ccmcrs for cominucd
maturation of the fie ld. Those who arc not presently members of the AAPB should join or
rcjoin . Those who arc Hot ccrti fied by thc BCIA should considcr this crcdcntial for themselves.
Those currently certified should continue to stay certified . Those who were certified in the
past bur are HOt currently cerrified should rcrutll.