Biofeedback: Clinical Applications in Behavioral Medicine By David S. Olton and Aaron R. Noonberg (review)

Abstract

Shortcomings of the book include King's tendency to oversimplify biological issues currently under active investigation and debate and his somewhat dated view of the genetic organism as a computer or cybernetic device. (If the genetic organism is like a computer, it is like no computer currently known.) One could just as easily argue that, as a thoughtful introduction to the biology of race, King's simplification misses few if any of the salient issues and provides a welcome starting point for the interested reader. Michael Wade Department ofBiology University of Chicago Biofeedback: Clinical Applications in Behavioral Medicine. By David S. Olton and Aaron R. Noonberg. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1980. $24.95. This book addresses behavioral medicine, an approach which has rapidly branched from its relatively austere and rigid roots into an emphasis on behavioral assessment, analysis, and therapy. As such, behavioral concepts as they have been absorbed into medicine have incorporated in practice, if not in principle, many aspects of brief psychotherapy. There are major differences which lend themselves to the so-called medical model utilized by physicians. The assessment and analysis are directed toward a precise definition of the problem. A careful identification of all the contingencies diat relate to that behavior is made. The identified problem and contingencies are individually objectified and are viewed as if outside the patient, somewhat as traditional medicine attempts to view disease as an externally imposed phenomenon. The patient, widi therapist, develops strategies to mobilize internal and external resources in confronting this "enemy." The patient is challenged to keep records actively and make correlations of the occurrence of the symptom with other events in his life. Similarly, he is viewed as the active, willful, agent determined to succeed in overcoming his problem. To succeed in this endeavor, he engages in relearning or learning new strategies which are facilitated by various hypnotic and self-induced states that allow for relaxation and suggestibility. These may be monitored by biofeedback processes demonstrating for the subject his ability to control physiologic processes in the direction mutually agreed upon with the therapist. Internal and external rewards and punishments, self- or therapist-imposed, result in reinforcement of desired and desensitization of undesirable behavior. Biofeedback: Clinical Applications in Behavioral Medicine reviews die theory and practice of biofeedback therapy—a modern approach to the self-control of various abnormal body functions. This book is lucidly written, excellently organized, and replete with clinical examples and explanations of therapeutic approaches. It is well designed as a textbook for instructing a wide variety of health professionals in the art and techniques of biofeedback. The book is organized into three sections. The first describes the theoretical rationale for biofeedback, namely, that with the assistance of biofeedback machines, people can learn to control various muscles and organs previously thought to be "involuntary." This is followed by a concrete outline of the process and procedures involved in a 678 I Book Reviews therapeutic program. The concluding, overview section presents clinical approaches and supporting literature for a wide variety of illnesses in which biofeedback has been useful. The machinery of biofeedback measures body functions (such as muscle tension ) which are felt to be abnormal in certain disease states. These are displayed to the patient who often is not aware of the abnormal functioning of diese processes. The patient is then taught how to interact with the machine to alter die body process in order to alter the course ofthe disease. For example, patients with tension headaches are often unaware of the contraction of neck and head muscles which occurs with the headaches. With the use of a biofeedback machine that measures and displays die level ofthe muscle tension, the patient is taught to decrease the degree of tension, thereby also decreasing the headache pain. The book attempts to provide a complete theory of how such diseases occur and how to use biofeedback to treat them. The descriptions of current and future research are careful to avoid any unsubstantiated hypothesizing, and the authors suggest many creative and useful techniques for treatment. Unfortunately, however, they present an often simplistic behavioral approach to therapy. They fail to integrate their approach to therapy into die wider body...