Biofeedback Certification Research Articles

Michael Thompson, MD

Michael Thompson, MD

A Tribute to Eugenia Bodenhamer-Davis

Eugenia Bodenhamer-Davis has trained generations of professionals in neurofeedback and provided visionary leadership to the board of the Biofeedback Certification International Alliance (BCIA). This article pays tribute to Genie's signature achievements as an educator and chair of the task force that revised BCIA's neurofeedback certification program.

Special Issue: Current Practice in Neurofeedback Assessment and Treatment

Special Issue: Current Practice in Neurofeedback Assessment and Treatment

Biofeedback for Pelvic Muscle Dysfunction

Biofeedback for pelvic floor muscle dysfunction provides a practical and effective intervention for elimination disorders. Dysfunction in the pelvic floor muscles can affect bladder and bowel function and can cause pelvic pain. According to the National Association of Continence, there are 25 million Americans affected by bladder or bowel incontinence. Surface electromyographic (sEMG) sensors monitor the electrical activity of the pelvic floor muscles. Additional muscle co-contractions of the obturator internus, hip adductors, and transverse abdominis can facilitate improvements in symptoms affected by pelvic floor dysfunction. Pelvic floor therapy incorporates urge reduction techniques and functional control strategies. Dietary and lifestyle recommendations are also provided. The Biofeedback Certification International Alliance (BCIA) is the primary certifying body in the fields of biofeedback and neurofeedback. BCIA has a Blueprint of Knowledge specific for certification in pelvic muscle dysfunction biofeedback (PMDB). The Blueprint outlines the fundamental science, history, and theory of sEMG biofeedback as used for elimination disorders and chronic pelvic pain. You can find more information on PMDB at www.bcia.org.

The I in BCIA Stands for International

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

A Progress Report from the BCIA Neurofeedback Certification Task Force

Professional certification programs must continuously assess and improve their blueprints, exams, and reading lists to stay relevant. In 2009, the Biofeedback Certification International Alliance (BCIA) revised its biofeedback and neurofeedback certification programs under the leadership of Randy Neblett and Leslie Sherlin. In 2012, BCIA revamped the Pelvic Muscle Dysfunction Biofeedback program under the guidance of Debbie Callif. For the past 8 months, BCIA's Neurofeedback Task Force, led by Genie Davis, has collaborated with its stakeholders to revise the entire neurofeedback certification program to continue to reflect current science, technology, and practice standards. This article explains the goals and process that guided this herculean effort.

What Nonprofit Board Members Don't Know Can Hurt Them (and Their Organizations)

The author dedicates this article to current and future board members of the Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification International Alliance (BCIA), and the International Society for Neurofeedback and Research (ISNR); their related foundations; state and regional societies; and any other nonprofits who serve our field. This article explores the advantages and disadvantages of self-management versus the use of a for-profit management company, explains the value of board orientation, identifies what new and established board members should understand, and stresses the importance of board service with integrity.

What BCIA Learned from Bob Dylan

Biofeedback and neurofeedback certification expanded internationally, and the Biofeedback Certification International Alliance (BCIA) revised both recertification and certification programs in 2013. This article examines the main engines that have fueled certification growth: the BCIA affiliate program, the international expansion of BCIA-accredited training programs, and international educational and scientific society meetings held by the Society for Applied Neuroscience and the Biofeedback Federation of Europe. The authors conclude with a review of recent changes in recertification, academic certification, and the Neurofeedback Blueprint and a progress report on BCIA's HRV Biofeedback Certificate of Completion, Board Certified Practitioner and Mentor Directory, and Job Board programs.

From the Editor

The cover of this issue of Biofeedback shows a neurofeedback session at the University of North Texas (UNT) in Denton. The photo was chosen for two reasons. The session illustrates the case described by Cara Guziak and Julia Smith in an article on anxiety misdiagnosed as dementia. The photo also serves as a tribute to Dr. Eugenia Bodenheimer-Davis, who has skillfully guided so many students into the field of neurofeedback. Dr. Bodenheimer-Davis has now retired, and her UNT lab, where Guziak and Smith conducted their research, is closing. Both Genie and the lab have contributed decades of service to the field of biofeedback.Cynthia Kerson, a Board member of the International Society for Neurofeedback and Research (ISNR) Research Foundation, begins a two-part series in this issue about the foundations that support research and education in biofeedback and neurofeedback. In this first article, she interviews David Trudeau, the president of the ISNR Foundation. In the interview, Trudeau describes trends in current research in neurofeedback, the challenges in obtaining funding for neurofeedback research, and the role of the ISNR Research Foundation.Judy Crawford and Fred Shaffer provide an update on the Biofeedback Certification International Alliance (BCIA). They quote a line from a Bob Dylan song, “He not busy being born is busy dying.” BCIA is busy growing and renewing itself through growth of an international BCIA affiliate in Australia, increases in international certifications, and streamlined certification and recertification requirements worldwide.Cara Guziak and Julia Smith provide a case study of “J. C.,” a 63-year-old woman referred with a diagnosis of dementia after difficulties locating her new office building. The authors describe a thorough assessment including psychometric testing as well as a Test of Variable Attention (TOVA) and a quantitative electroencephalogram (QEEG). The assessment documented measurable anxiety, depression, hopelessness, sleep disturbance, and impulsivity, as well as a QEEG pattern typical of persons with heightened anxiety but with additional markers possibly reflective of dementia and/or medication effects. Their intervention included counseling, training in diaphragmatic breathing, heart rate variability training, and neurofeedback. J. C. improved with treatment, showing improved cognitive function, enhanced sleep, and improved scores on anxiety, depression, and hopelessness. Both the TOVA and the QEEG showed normalization. This case study shows the positive role for biofeedback and neurofeedback for some patients with apparent dementia.Erik Peper, Annette Booiman, I-Mei Lin, and Fredric Shaffer provide an article on the use of surface electromyography biofeedback to teach muscle awareness and reduce chronic muscle contraction. The authors observe that poor awareness of low-level muscle tension and poor ergonomics contribute to muscle bracing and the development of musculoskeletal symptoms, including pain. They describe a research study with a sample of 34 physical therapists, which conducted an initial assessment of muscle awareness and then utilized visual feedback of muscle activity to train muscle awareness and control. The participants, who were physical therapists educated in muscle kinesiology, were surprised at the extent of their muscle awareness on the initial task. The article closed with a brief case study showing the usefulness of muscle awareness training in a woman with severe pelvic girdle pain.Rafal Stzembis, a cardiologist in Poland, and Donald Moss contribute an article showing the role of biofeedback in the clinical practice of cardiology. Increasing attention is being given to psychological factors, including depression, anxiety, and stress, as important factors that influence progression of heart disease. Sztembis conducted a study in a Polish hospital-based cardiology unit, utilizing a Psychophysiological Stress Profile to assess patients after myocardial infarction. The researchers identified patients who could implement diaphragmatic breathing practice at home and others who required more extensive biofeedback training. The authors call for further research to document improved medical and psychological outcomes using this model.Elizabeth Bigham, Lauren McDannel, Isabel Luciano, and Guadalupe Salgado-Lopez contribute an article reporting a study measuring the impact of a guided imagery intervention on perceived stress. The researchers studied 29 participants and administered a symptom checklist and a biofeedback assessment of heart rate and heart rate variability coherence levels before and after an intervention. Their intervention consisted of a guided imagery script of a beach scene. Their postintervention assessment documented significant reductions in emotional symptoms and in heart rate and a correlation between symptom reduction and heart rate reduction.Daniel Rapport provides a review of a new book by Angele McGrady and Donald Moss, Pathways to Illness, Pathways to Health (Springer, 2013). The book provides a stepwise program for integrating self-directed life style and health behavior changes and the acquisition of self-regulation skills, with professional treatment interventions to address a wide variety of medical and emotional disorders. Each chapter is illustrated with a case study applying the Pathways approach to treatment of a specific disorder. Rapport recommends the Pathways book for beginners and experienced clinicians alike.

BCIA in 2014: What's New?

The Biofeedback Certification International Alliance (BCIA) has revised its recertification requirements and fees to reduce certificant costs. BCIA has expanded options for earning inexpensive and accessible continuing education, including Massive Open Online Courses (MOOCs). BCIA continues to promote ethics education to protect clients, professionals, and the credibility of our field. More educators teach BCIA's HRV Biofeedback Certificate of Completion didactic course to students and professionals. BCIA's Job Board has helped employers recruit our skilled certificants. Finally, there is a need for infection prevention standards in private practice.

Education: BCIA's Core

The mission of the Biofeedback Certification International Alliance (BCIA) is to certify applicants who demonstrate entry-level knowledge and to progressively recertify them progressively as they expand their knowledge base and skill set through continuing education. BCIA requires accredited coursework to ensure the credibility of its credentials within the insurance and medical communities. Accreditation is provided by regional accrediting bodies, professional organizations, licensing boards, and BCIA itself. BCIA has developed flexible and inexpensive options for earning continuing education to better serve its North American and international audience.

Special Issue: The Promise of Cardio-Plasticity: Psychophysiological Approaches to Cardiovascular Rehabilitation

Special Issue: The Promise of Cardio-Plasticity: Psychophysiological Approaches to Cardiovascular Rehabilitation

BCIA Launches a Heart Rate Variability Biofeedback Certificate of Completion

The Biofeedback Certification International Alliance (BCIA) has developed a certificate of completion program to establish education and training standards for the exciting modality of heart rate variability (HRV) biofeedback. HRV represents the beat-to-beat changes in the intervals between consecutive heartbeats. A growing list of HRV biofeedback applications has earned ratings from possibly efficacious to probably efficacious. BCIA's expert-designed Blueprint of Knowledge and exam promise to increase the academic rigor of didactic HRV biofeedback courses and enhance the knowledge of providers who incorporate this modality into their practice.

Editor's Introduction: Winter Issue 2012

The cover of this Winter 2012 issue of Biofeedback shows a woman in a biofeedback session, displaying a pulse oximeter on her left hand. An article in this issue, by Christopher Gilbert, PhD, introduces the use of the pulse oximeter in clinical biofeedback practice. Our thanks to the photographer, Eric Willmarth, PhD, and the model, Tonya Jackson, for this photograph.Fred Shaffer, Judy Crawford, and Donald Moss provide an article reviewing the expanded role of the Biofeedback Certification International Alliance (BCIA) in global biofeedback and neurofeedback certification. The BCIA mission is as follows: “BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback, and progressively recertifies those who advance their knowledge through continuing education.” The BCIA provides a number of supports for professional education, including a “blueprint of knowledge” describing essential knowledge in each certification area, guidelines for a mentoring process assuring that certified practitioners will possess a basic repertoire of skills, and an expanding number of webinars on topics in biofeedback and neurofeedback.Christopher Gilbert provides an article on the use of the pulse oximeter in breath training. A pulse oximeter measures the level of oxygen in the bloodstream, using a noninvasive and inexpensive sensor applied to the finger or earlobe. The oximeter uses photoplethysmography, which is an infrared sensor to measure oxygen saturation in the bloodstream, as well as current heart rate. Gilbert overviews the physiology of breathing and oxygen saturation, and describes how the oximeter can be used as an educational tool and as a safety measure.Richard Harvey, Erin Thorne, and Jourdan McPhetridge provide a report on a recent study of “dysponesis awareness training.” Dysponesis is a term first developed by George Whatmore and Daniel Kohli (1968) to describe unnecessary muscular effort that does not contribute functionally to a task. Whatmore and Kohli originally applied this concept to clinical patients suffering pathological pain. The Harvey et al. article utilizes healthy undergraduates and examines how biofeedback can be utilized to enhance awareness and control of misplaced muscle effort, and reduce inefficient muscle use.Leah Lagos, Thomas Bottiglieri, Bronya Vaschillo, and Evgeny Vaschillo provide an introduction to a new application area for heart rate variability (HRV) biofeedback—the treatment of postconcussion syndrome. They review the physiological dysfunction that typically follows a concussion, especially altered autonomic function and impairments in cerebral autoregulation. They examine the known therapeutic effects of HRV training and provide a physiological rationale for clinical trials applying HRV to postconcussion syndrome patients. Lagos and her colleagues will follow up in a future issue of Biofeedback with a case study of a patient with postconcussion syndrome with a positive therapeutic response to HRV training.Erik Peper, Dianne Schumay, and Donald Moss provide a discussion of the importance of a patient's illness beliefs or illness attributions in shaping that patient's willingness to pursue self-regulation oriented treatment programs. Patients who are strongly external in their locus of control and who believe that their illness is curable only by such external interventions as surgery or medication are less likely to undertake treatments based on skill acquisition, lifestyle change, and self-regulation. The authors discuss strategies for the use of both biofeedback and somatic education to increase internal locus of control and to introduce corresponding changes in illness beliefs. A case history illustrates a biofeedback intervention to positively change illness beliefs, and a somatic awareness exercise is used to illustrate a somatic education approach.

What Is BCIA Really?

The Biofeedback Certification International Alliance (BCIA) is the primary international certification body in the fields of biofeedback and neurofeedback, including pelvic floor muscle dysfunction biofeedback. BCIA has established blueprints of knowledge and requirements for independent practice to guide the process of education and training in the three fields of biofeedback, neurofeedback, and pelvic floor muscle dysfunction biofeedback. BCIA promotes certification globally to ensure consistent standards and quality in the practice of biofeedback and neurofeedback.

Mentoring: What Is It All About Anyway?

One of the requirements for certification by the Biofeedback Certification International Alliance (BCIA) is a specific number of mentoring hours with a BCIA-approved mentor. This article defines mentoring, distinguishes it from clinical supervision, and provides guidance on the search for an optimal mentor. The authors recommend the use of a mentoring contract, discuss goodness of fit between mentor and mentee, and identify BCIA requirements for mentoring.

BCIA Certification Exams—A New Look at This Standard

For the Biofeedback Certification International Alliance (BCIA), assessment is the culmination of a learning process that begins with didactic training that is guided by Blueprints of Knowledge and Core Reading Lists. The references in the BCIA Core Reading Lists help applicants master the learning objectives of the Blueprint and are the source of the exam questions. BCIA certification exams test entry-level knowledge that is relevant to the current practice of biofeedback. Applicants can now take exams in both paper/pencil and online formats. BCIA encourages applicants to use the Blueprints as roadmaps to guide their study, to read the Core references, and to take advantage of their mentors' experience. The quality of the applicants, the excellence of didactic programs, and the careful construction of the exams have resulted in pass rates that exceed 70%. BCIA believes that the applicant's journey, not passing the certification exam, is the best metric for measuring success. BCIA has achieved its mission in the time before the professionals arrive at their testing site.

The Internationalization of BCIA

The Biofeedback Certification International Alliance (BCIA)-Australia has recently become the first fully autonomous affiliate of BCIA, certifying neurofeedback professionals in Australia, with requirements equivalent to those of BCIA. BCIA has also established a worldwide network of professionals, who intermittently meet to promote biofeedback and neurofeedback certification in each national community. BCIA accredits programs providing basic training and continuing education.

BCIA Meets the Challenges of Growth in Biofeedback and Neurofeedback

The Biofeedback Certification International Alliance (BCIA) certifies individuals who meet education and training standards in biofeedback and progressively recertifies those who advance their knowledge through continuing education. Increased national and international interest in our field has been accompanied by closer scrutiny of clinical efficacy and professional conduct. BCIA has expanded its international outreach in order to raise the standards of biofeedback and neurofeedback education and practice throughout the world. This article answers frequent questions about the growth of international certification, continuing education, ethics, and marketing your practice.

BCIA Certification by Prior Experience Provides an Alternative Path for Qualified Biofeedback and Neurofeedback Professionals

The Biofeedback Certification International Alliance offers a Certification by Prior Experience (CPE) alternative to Board Certification in Biofeedback, Neurofeedback, and Pelvic Muscle Dysfunction Biofeedback. There are also academic and technician certification tracks for Biofeedback and Neurofeedback. The CPE program invites applications from professionals who can demonstrate extensive education and experience, and who have made significant contributions to the field. The CPE process preserves the high standards required by the traditional BCIA program, while offering a more expeditious path to certification. This article details the process and requirements for CPE, and discusses the value of BCIA Board Certification.