Biofeedback in Managing Behavior Change - Assignment Example

Running Head: Biofeedback in Managing Behavior Change Student’s Name: Instructor’s Name: Course Code: Date of Admission: Table of Contents Table of Contents 2 1.0 Biofeedback 2 2.1 Clients groups and disorders that suit biofeedback 5 2.2.2 Electroencephalography disorders 6 2.2.3 Cardiovascular system disorders 7 2.3.1 Chronic disorders 8 2.3.2 Bacterial, fungal and viral disorders 8 2.3.3 Physical injuries 8 3.0 Application of biofeedback in the clinical context 8 3.1 The role of the clinician 8 3.2 The role of the client 10 4.0 Professional and ethical guidelines 11 References 13 Appendices 15 1.0 Biofeedback Biofeedback as a terminology refers to the application of the therapeutic technique to a client in order to influence specific physiological processes. The technique involves the role of monitoring the response made by the client as well as the generation of signals by the therapist. The therapist employs different techniques in order to reinforce the attainment of such control. To some level biofeedback can be likened to an educational orientation process whereby an individual is supported to learn specific physiological processes. In applying the technique, the client assumes the major role and becomes an active member who must ensure that the process is made a success. A part from solving the problem, the client is also expected to advance his feelings in order to attain high degree of self-control and process masterly. This is because it is believed that it’s only the client who can actually help in producing the desired results through regular practice under the therapist’s guidance and instructions as stated by Shaffer & Moss (2006). Refer to appendix 1. 1.2 Therapeutic aims of biofeedback The main aim of using biofeedback technique is to help improve certain conditions within the client which are related to health complications. This is intended at achieving certain physiological changes within the client. Therapeutic techniques bring about changes in thoughts, emotions as well as behavior. The long-term objective of biofeedback is to ensure that these changes are sustained even without the use of the extra support. Biofeedback is also intended at identifying certain physiological activities which include the heart function, brainwaves, muscle activities, skin temperatures as well as breathing that need to be managed. All these are achieved by the use of precise and clear measurement instruments. The instruments are actually used to provide accurate and steady information to the user as argued by Geyman & Deyon (2000). Refer to appendix 2 and 3. 2.0 Effectiveness of biofeedback Biofeedback together with neurofeedback for a long time has provided evidence-based practices which the health care sector has been yearning for. Biofeedback was developed as a research based device that evolved from medical research laboratories that have continued to undertake extensive studies on psychophysiology and behavior therapy. The two concepts have provided stronger interventions to both biomedical paradigm and research. The Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neurofeedback and Research (ISNR) have consolidated their efforts in order to validate and rate the treatment procedures for the purpose of addressing issues related to biofeedback applications. For example in 2001 the president of the Association Donald Moss and Gunkelman were appointed in order to determine both the biofeedback and neurofeedback efficacy standards Geyman & Deyon (2000). The task force report that was published in 2002 and other white papers that reviewed the efficacy of biofeedback confirmed that biofeedback is an important milestone in managing behavior change. According to these publications, biofeedback can offer change in attention disorders, facial disorders as well as temporomandibular disorders, urinary incontinence, substance abuse, hypertension as well as headache. Later on a broader document was developed and published in order to take into consideration the efficacy standards to cater for all medical and psychological complications. In 2008, the publication took into account the biofeedback efficacy for approximately 40 medical complications covering entirely substance abuse and vulvar vestibulitis disorders Kropotov (2009). The rating of each behavior change mainly depends on the degree of research done and therefore low rating may not necessary reflect the level of ineffectiveness of biofeedback in improving a given disorder. However important biofeedback is in the field of medicine, criticism has been made clear on it is effectiveness in terms of cost. For example the biofeedback professionals have been raising concerns more so on those health care departments whose goal is to make profits. Skepticism always compare efficacy with cost and therefore forcing the medical professionals to educate the general public more so the service payers on the value of these services. Biofeedback can only gain much acceptance only if more research is done in order to come up with more practical methods to complement the physical therapy Shaffer & Moss (2006). 2.1 Clients groups and disorders that suit biofeedback 2.1.1 Incontinence The incontinence disorder is caused by lack of proper relaxation and contraction of muscles by an individual especially when somebody is a sleep. This problem is more common among the children especially those who urinate when they are asleep and those mothers who deliver. The children of this kind normally have the problem in relaxing and contracting the urinary sphincter and therefore are not able to control their urinating behaviors Tylova & Moss (2007). In solving this disorder, Mowrer came with an approach called classical conditioning whereby an alarm is used to sound when the child is about to urinate while a sleep. Frequent use of this technique enables sensory feedback to replace the alarm thereby enabling the children sleep without urinating. In 1947, Kegel developed a perineometer in order to tackle the same disorder but in this case among the women whose pelvic muscles are weakened during pregnancy and more so during childbirth. The perineometer is inserted to the vagina in order to monitor the process of contraction and relaxation of the pelvic floor muscles. The approach was found to be fully effective in dealing with incontinence among the pregnant women. Given its effectiveness, the United States Agency for Health Care Policy and Research recommended fully the usage of biofeedback in treating incontinence among the adult. 2.2.2 Electroencephalography disorders This biofeedback technique is used to help change behaviors especially among those people who have problems in paying attention to sound and therefore cannot respond well to the stimuli. In 1968, Kamiya published an article that demonstrated how alpha rhythm can be used to operantly condition human beings. According to the findings of this research Kamiya showed how clients could learn recognize when alpha wave was absent and therefore making it easy to shift attention to a more dominant alpha. The research further revealed that many subjects experienced some sensible pleasure as demonstrated by alert calmness Andreassi (2007). This report greatly presented biofeedback as a solution to meditative state. In 1970, Brown described how alpha-theta could be used by clinicians. In his method, Brown used EEG rhythms to train subjects to use alpha, beta as well as theta activities while recording their experiences when the frequencies of the bands are increased as illustrated by Nestoriuc & Martin (2007). In 1989, Lubar, in studying biofeedback using SMR, demonstrated that biofeedback an be used to treat disorders related to attention as well epilepsy. SMR, training was found to improve attention span and performance in academic more so among the children. In his report he found that SMR biofeedback can be used to treat those children who suffer from Attention Deficit Disorder with Hyperactivity (ADHD). He went further to demonstrate how ADHD and theta suppression procedures can be used to support those students who are weak in class to improve their performance Kropotov (2009). Refer to appendix 4 and 5. 2.2.3 Cardiovascular system disorders This is biofeedback technique that is used to help those people who problems with their heartbeat. This technique was aimed at increasing the heart beat rates per minute. In 1962, Shearrn operantly educated human subjects how they can increase their heartbeat by 5 strokes in order to reduce the effect of electric shocks. However, Swami Rama in contrast with Shearn used the yoga in testing the flutter in finding out the effects of 306 beats per minute which later revealed that it was possible to stop blood pumping and therefore proved to be an easy way to control the pulse. While studying the disorders related to cardiovascular system disorders Freedman together with his friends found that the process of warming and cooling hands is activated by a number of mechanisms. Warming of hands is associated with beta adrenergic while the cooling of hands is associated with alpha adrenergic that is inspired by the c-fibres. However the study indicated that warming and cooling of hands totally represent different skills. A study by Lehrer in collaboration with Smetankin discovered that the process could be very essential if it could be used in treating asthma by Ray & Quigley (2001). 2.3 Clients groups and disorders that do not suit biofeedback However, important biofeedback is in managing behavior change, it has some limitations. Biofeedback mainly deals with behavior change and therefore cannot be used to offer medical solutions to those disorders that are short-lived. Biofeedback has been found to be important treatment course for several behavioral disorders which include stress, asthma, hearth related diseases and even attention disorders Steriade (2005). Some of the medical complications that cannot be treated by use of the biofeedback include the following; 2.3.1 Chronic disorders Biofeedback is not so effective in treating those disorders that are on and off and cannot be predicted. This is because it will not be easy to come up with those instruments that can manage the behavior Andrasik, (2008). 2.3.2 Bacterial, fungal and viral disorders Given that biofeedback is purely about behavior change it is important to note that most of the disorders in human body are a subject of bacteria, virus and even fungal which require specific medications for them to get treated. Some of the diseases may include cancer, tuberculosis and malaria Andrasik, (2008). 2.3.3 Physical injuries These are complications caused as a result of an individual suffering from physical injury which leads to permanent bone fracture. For example if somebody gets injured and looses both limbs then it is through common sense to understand that the person will walk no more. 3.0 Application of biofeedback in the clinical context 3.1 The role of the clinician In applying biofeedback, both the clinician and the client have a role play in ensuring that everything step is taken into account. There is need for the two parties to identify the necessary precautions from the onset in order to avoid any risk that may be available in the process of using supportive instruments. The clinician is the medical professional who is expected to offer guidance to the clients on how to apply the biofeedback techniques in order to realize the intended changes within the client. The main role of the clinician is to administer the most appropriate technique to the client that could enable achieve certain changes. Apart from offering professional support, the clinician is also expected to play the role of giving descriptions on certain techniques that need to be implement Florimond (2009). The role of research and study plays an important part in making a biofeedback a success. Therefore it is important for the clinician to recognize the role played by biofeedback in treating different human behavior disorders. The clinician is expected to engage him/herself in doing extensive research that will expose hi to more knowledge that will enable him the best in administering therapeutic techniques. During the consultation process, the clinician and the client are expected to do extensive consultations. These consultations are important in informing the client on what is expected at the end of the process. Much of the information can be sourced from the research that has been done and therefore the more the clinician engages himself in research the better for him since he will always be able provide proper advice to the client Moss (2005). The clinician also assumes the role of training the client on how to use various instruments. This is because most of the instruments are more sophisticated and if they are not properly used they may not be able to give the intended responses. Some instruments are not very sensitive and therefore it the clinician to let the client know that it will take some time before noticing the changes Florimond (2009). 3.2 The role of the client The client in this context is the patient who is expected to receive biofeedback treatment. The first and foremost thing the client is expected to do is to do extensive consultation in order to make an informed choice on the kind of therapy that will fit him. He is expected to background information especially on medical in order to enable the clinician give appropriate advice. The client is also expected to understand the reasons as to why he wants to undertake that kind of treatment and what he wants to achieve. This is important because it will make him take the treatment with the kind of seriousness it deserves Moss (2005). The patient must also be willing to play an active role of ensuring that the treatment process is implemented. Given that biofeedback is more of behavior change, the client is also expected to examine the symptoms in order to find out if there are any changes and therefore it is important for him to undertake psychodynamic therapy. It is important for the client to undergo medical examinations before settling in any medical treatment in order to remove any risk that might be available. Those clients who are suffering from certain diseases and complications such as cancer and diabetes must always understand that therapeutic treatment is not medical substitute and therefore should be used concurrently Moss (2003).. The client is expected to show willingness in taking his time to explore and understand how he can be self controlled. This is important because this is one of the skills the client must learn. It does not matter how best the program is but how much the client is ready to follow it in order to give good responses Lehrer (2007). 4.0 Professional and ethical guidelines Guidelines and professional ethics outline the code of practice that the clinicians should follow while administering treatment to the patient. It is important to note that the code of ethics, standards and practices are put in place in order to make sure that dignity and professionalism is maintained within the medical field. Guidelines are aimed at reducing costs and geographic variations related to treatment while achieving good results and reputation that is generally accepted by the public and at the same time legitimate with regard to treatment approaches Moss (2003). Clinical practice guidelines were developed in 2003 by the Association for Applied Psychophysiology and Biofeedback (AAPB) for general biofeedback and neurofeedback (AAPB, 2003), the International Society for Neurofeedback and Research (ISNR) for neurotherapy, and the Biofeedback Certification Institute of America (BCIA). They are also revised periodically in order to meet the changing demands for both the clients and the clinicians. Practice guidelines and standards namely those found in AAPB provide the guideline how ethical principles executors should implement the ethical principles. The guidelines have been put in place to ensure that certain modalities are followed in the clinical practice e.g. the skin temperature training. The guidelines have also have been used to ensure that ethical practices agree with the existing laws Striefel (2006). One of the functions of the ethical practice guidelines is to ensure that the clients are always informed of the available treatments, the alternative treatments as well as the advantages and disadvantages of each. It always provides that clients must be made aware of the rationale for each suggested treatment which includes medical fees, insurance options, bills as well as collection policies. Confidentiality is given much consideration and how home trainings could be used to support treatment. Secondly, the guidelines require that medical practitioners maintain dignity and competence in all their areas of practice by mentoring, supervising and providing consultations services. To the general public, the practitioners, are expected demonstrate competence through education, training as well as experience if asked to do so. The practitioners are also expected to be very cautious in order to behave as role models to the society by avoiding those activities that may compromise their relationship and even cause conflict among themselves and to some extent the clients Dombrowski (1998). The guidelines also require that the practitioners observe and respect the rights of the clients by ensuring that all the information about them is kept confidential and private as provided by the law. The practitioners are also expected to apply modern technology in order to ensure no customer is mishandled and confidentiality rights violated Striefel (2006). References Andrasik, F., (2008). "Biofeedback treatment for headache disorders: a comprehensive efficacy review". Appl Psychophysiol Biofeedback 33 (3): 125–40. Andreassi, L. (2007). Psychophysiology: Human behavior and physiological response. Hillsdale, NJ: Lawrence Erlbaum and Associates, Inc. Dombrowski, M. (1998). Behavioral vs drug treatment for urge urinary incontinence in older women. Journal of the American Medical Association, 280, 1995–2000. Florimond, V. (2009). Basics of surface electromyography applied to physical rehabilitation and biomechanics. Montreal: Thought Technology Ltd. Geyman, J. & Deyon, R, (2000). Evidence-based clinical practice: Concepts and approach. Boston: Butterworth-Heinemann. Kropotov, J. (2009). Quantitative EEG, event-related potentials and neurotherapy. San Diego, CA: Academic Press. Lehrer, P. (2007). Biofeedback training to increase heart rate variability. New York: The Guilford Press. Moss, D. (2003). The anxiety disorders. Handbook of mind-body medicine in primary care. Thousand Oaks, CA: Sage. Moss, D. (2005). Psychophysiological psychotherapy: The use of biofeedback, biological monitoring, and stress management principles in psychotherapy, Psychophysiology Today: The Magazine for Mind-Body Medicine, 2(1), 14-18. Nestoriuc Y, & Martin A (2007). "Efficacy of biofeedback for migraine: a meta-analysis". Pain, 128 (1-2), 111–27. Ray, W., & Quigley, S., (2001). Psychophysiological recording. New York: Oxford University Press. Shaffer, F., & Moss, D. (2006). Biofeedback. Complementary and alternative medicine. (pp. 291-312). Steriade, M. (2005). Cellular substrates of brain rhythms. Electroencephalography: Basic principles, clinical applications, and related fields. Philadelphia: Lippincott Williams & Wilkins. Striefel, S. (2006). Are QEEGs necessary? Biofeedback, 34, 82–86. Tylova, H & Moss, D. (2007). Is there more to blood volume pulse than heart rate variability, respiratory sinus arrhythmia, and cardio-respiratory synchrony? Biofeedback, 35(2), 54- 61. Appendices Appendix 1: Picture the technique process used to teach patients in using different instruments Appendix 2: Picture of thoughtstream used to manage stress and emotions Appendix 3: Picture of a BioscanTM for managing alpha brain waves Appendix 4: Picture of the BrainMaster Type 2E module & software Appendix 5: Picture of MindSet EEG Read More