1. I’m Rich Sherman. I have been president of AAPB and have been involved in biofeedback for over 30 years so am familiar with many of the problems which happen when people try to perform biofeedback without an adequate background. I’m going to give you an idea of why you need to know A&P to do an effective job at biofeedback. Why should you go to all the time and effort to take a course in Anatomy and Physiology / Human Biology?? Richard A. Sherman, Ph.D. Dean, College of Psychophysiology, University of Natural Medicine. rsherman@nwinet.com

2. (This slide appears in all 4 basic skills talks so skip it if you already read it.) You are attending one of four brief talks in the series on “what you need to know to perform biofeedback effectively”. The series contains talks on why: 1.You need to know how biofeedback devices actually record physiology and how to set the devices to produce useful recordings (Biofeedback Instrumentation). 2. You need to know how the body works in order to use biofeedback effectively to change physical and mental functioning. Otherwise, you may try to do training which can’t work well or can’t be done at all (A&P / Human Biology). 3. You need to be able to tell if there is enough solid evidence supporting the use of a technique for you to even try it, let alone charge for it, and to tell whether the results you see or hear about are due to placebo or treatment effects (Basics of clinical research). 4. Everybody needs a basic biofeedback course before doing biofeedback. You need to know when an introductory level general biofeedback or neurofeedback course doesn’t provide the depth you need to effectively incorporate biofeedback into interventions for the kinds of disorders you treat (e.g. chronic pain, incontinence, muscle rehabilitation, etc.).

3. (This slide appears in all 4 basic skills talks so skip it if you already read it.) Before we get started, let’s be sure you and I have the same general concept of what biofeedback is. Biofeedback includes (a) performing accurate psychophysiological recordings using standard techniques to evaluate known problems with levels and patterns of function of one or more known physiological systems and then (b) immediately showing these levels and patterns to a client as they are recorded so he or she can learn to recognize and control them. Numerous placebo controlled studies with long term follow-ups have proven that biofeedback is effective for many disorders. The crucial points here are (1) that biofeedback includes actual learning by the client and (2) that widely recognized problems in function are corrected. Biofeedback devices are NOT magic machines recording unverified physical problems using methods not explainable through normal scientific means. They do not magically cause the body to change its functioning through unproven methods to fix problems which can not be demonstrated through standard tests. No scientifically acceptable studies have shown devices making such claims to be effective. If you are not familiar with psychophysiological recording and biofeedback, please see the introductory lecture in the “Want to know what biofeedback and psychophysiology are?” section on this site.

4. I’m going to be telling you why taking a course in A&P / human biology will help you be a better biofeedback / neurofeedback practitioner. This chat is intended to provide a few examples of why you can’t do a competent - let alone a good – job assessing and treating many types of patients unless you know much of the material you will be exposed to during an A&P / Human Biology course designed for people who will be doing biofeedback (as opposed to one designed for people going into nursing, EMT, etc.). I’ll spend the next few minutes going through many of the topics usually included in an A&P / Human Biology course intended for people who will be doing biofeedback in order to point out only a very few of the reasons you need to know about each topic.

5. Most A&P courses begin by digging into the chemistry of life. You may think - or mutter disgustedly - what do I need this for? You need it because you need to understand how neurotransmitters actually work – and fail to work - so you understand how anything effecting the ability of neurotransmitters to do their jobs (from physical crimping of the tubes which carry them to subtle changes in receptors for them) has overwhelming effects on our bodies and behaviors which can’t be altered with any amount of training. You need to understand how the foods and drugs we put into our bodies effect our chemistry. The wrong ingredients can make a hash out of our normal operating processes – and, thus, our behaviors, which training can’t overcome. You need to know how the body’s chemistry and organization effects transmission of currents – which alter the signals we record from the skin. SEMG & EEG are especially vulnerable to the body’s currents. Next, its on to basic concepts of disease.

6. You need to know the difference between structural diseases (such as a crimped nerve) and functional disorders (disorders of how a physiological system is working) such as habitually incorrect levels of muscle tension. Structural diseases cause many of the functional and emotional problems we try to treat using biofeedback. Stress reactions cause not only functional diseases but structural ones as well. You need to know enough to know the underlying relationships between stress and anatomy and physiology to know which problems we can and can’t help – as well as how. You need to know enough about how medicines intended for structural disorders interact with the body and mind so you know that many produce the very symptoms of functional and emotional disorders we are trying to treat. You need the vocabulary and concepts required to understand medical test results and to communicate with health care providers in their own language.

7. After an introduction to disease, tissue repair is next up. You need to know how stress effects wound healing as well as how the flight – fight response really works (not the usual nonsense) and overrides any training we can give – unless we do it right! After tissue repair, its time to look at the central and peripheral nervous systems. You need to know what the parts of the CNS are, what they do, and how they communicate. It is crucial to realize that many parts keep changing throughout life and that these changes profoundly effect our mental processes, pain sensitivity, and emotions. If you don’t understand the structure, you will think that the CNS works with just nerves and their connections. If you don’t know that several neurotransmitters are produced in one area of the brain and transported to other parts through tubes, you can’t know that no amount of training can change the functioning of a part which simply doesn’t get its supply of neurotransmitters. Same problem for blood circulation. Are you one of the people who doesn’t know that most unexpected suicides are probably due to crimped neurotransmitter tubes? That’s what you learn in A&P.

8. Now it’s the senses turn: You need to understand our sensory systems or you certainly can’t figure out what people are reacting to or how to give effective biofeedback. Do you still think there are only five senses? Do you know that pheromones are probably among the most important social mediators? How do you actually know which way is North? After senses, we usually look at the endocrine system. Hormones have at least as much control of our short and long term behaviors as the nervous system. How much of interaction style is due to hormones? How about memory? Hormonal problems can cause many of the behavioral problems we try to treat with biofeedback.

9. Next, we learn about the skin. Why? If you don’t understand it, you can’t know about problems with recording stress responses through the skin or how the skin effects EMG and EEG recordings. You probably won’t recognize the very common, very infectious skin diseases your patients will pass along to you and your other patients. After the skin, its on to the muscular system. This is the unit during which basic somatic pain systems are usually discussed. Lack of understanding (a) how muscles work together to produce and control motions, (b) posture – pain relationships, and (c) the complex temporal relationships between muscle tension and pain have led to some of the most ineffective interventions in biofeedback’s history. Relationships between stress, trigger points, and muscle tension must be understood by everybody doing biofeedback.

10. Next up is usually the cardiovascular system. You need to know how this system works if you are going to actually understand heart rate variability and its impact on diseases - not to mention stress - heart rate variability relationships. Treating hypertension isn’t as simple as teaching people to relax. Teaching people to warm their hands for Raynaud’s, migraines, etc. has little to do with quieting the sympathetic NS. You need to understand this system to have any hope of really treating so many of the cardiovascular related disorders we used to think were simply stress based. Now it’s on to the immune system. You need to understand the interrelationships between stress and immune system function. Do you think there is solid evidence that teaching relaxation increases immune system function?

11. The respiratory system is next. Few people understand how we breathe or the circulating chemicals controlling it. How can you teach somebody to breathe correctly if you don’t know what’s right? The cascade of problems developed by people who habitually breathe just a bit wrong is incredible. Several studies now show that about half the people walking around with chronic anxiety diagnoses actually have breathing problems and that the anxiety goes away without further treatment when breathing is corrected. I’m not talking about hyperventilation! The digestive system really needs to be understood so people will be able to provide more realistic interventions for gut related problems. Do you think that childhood migraines are usually independent of gut function? How can you treat fecal incontinence if you don’t understand the gut?

12. The urinary / pelvic floor system is incredibly complex. Biofeedback practitioners wind up involved with all sorts of problems ranging from pelvic pain to urinary incontinence. You need to understand both the anatomy and physiology of the system to recognize what you can help and what you can’t. There is simply no reason for practitioners to try to train voluntary muscles incapable of sustaining a contraction to do so. You need to know the types of muscles in there and what their capabilities are. Last up is the reproductive system and genetics. Misunderstanding how the reproductive system works has literally caused behavioral therapists to waste much of their careers trying to treat physical problems with psychotherapy. Failure to understand the overwhelming genetic components to many personality traits and to pain sensitivity has led to a host of ineffective treatments.

13. Well, I certainly hope I’ve provided some convincing support for the idea that people need a course in A&P / human biology to do a good job at biofeedback. Just a note on typical A&P courses: Most are designed for people who are going to be biologists, EMTs, medics, etc. They don’t concentrate on physiological factors affecting behavior and vice- versa. Rather, they concentrate on how many bones are in the feet. So, be careful to take a course relevant to your interests. If you have questions – especially about the best ways to learn this material if you are going to be doing biofeedback rather than medicine, please feel free to contact me. Thanks for listening and, especially, for keeping an open mind! Rich Sherman rsherman@nwinet.com