Psychophysiological Recording, Assessment, & Intervention

Taught by Richard A. Sherman, Ph.D.

Richard A. Sherman

Richard A. Sherman

M.S., Ph.D. (Program Director)

Course Learning Objectives:

The course objectives are to provide the depth of knowledge in psychophysiology, biofeedback equipment, and training techniques required to perform psychophysiologically oriented assessments and biofeedback-based interventions.

This course is designed to help the student to:

  1. Summarize the psychophysiological processes underlying each condition covered in the course. This objective is supported by modules 3, 4, 6, 7, & 8.
  2. Use psychophysiological recording and biofeedback devices to record and display psychophysiological information. Supported by modules 2 & 5.
  3. Learn and demonstrate an understanding of the elements of common psychophysiological assessment and intervention techniques such as biofeedback, relaxation training, cognitive restructuring, hypnosis, meditation, and audiovisual entrainment. Supported by modules 6, 7, & 8.
  4. Use psychophysiological recording equipment to assess patients with specific conditions. Explain the physiology underlying optimal functioning and stress responses in order to design and conduct appropriate training to optimize functioning in business, education, sports, and (when appropriately licensed) clinical Supported by module 6.
  5. Use psychophysiological recording and biofeedback equipment professionally and ethically to apply specific assessments and interventions tailored to each condition covered in the course. Supported by modules 9 & 10.

Course Texts For Psychophysiological Recording, Assessment & Intervention:


1. Each student needs their own copy of this book if possible: Schwartz, M.S., & Andrasik, F. (Eds.). (2016). Biofeedback: A practitioner’s guide (4th ed.). New York, NY: The Guilford Press.

~$48 (ebook), ~$52 (paperback), or ~$30 (hardcover)

ISBN: 978-1462531943

2.  DO NOT BUY. E copy Supplied with the course materials: Sherman, R. (2012). Pain assessment and intervention from a psychophysiological perspective (2nd ed.). Wheat Ridge, CO: Assoc. for Applied Psychophysiology and Biofeedback.

3. Only for students who have not had a basic kinesiology course:

 Lippert, L. S. (2017). Clinical kinesiology and anatomy (6th ed.). Philadelphia, PA: F.A. Davis. ~$40 (paperback)  ISBN 978-0803658233

4. BUY ONE FOR THE DEPARTMENT. Students do not need their own copies unless they wish to purchase one: Andreassi, J. (2013). Psychophysiology: Human behavior & physiological response (5th ed.). New York, NY: Psychology Press. ~$20 (ebook), ~$50 (paperback)

ISBN: 978-0805849516 or 0805849513 



Required Assignments:

This course requires participation in 10 nearly weekly live class meetings, student review of up to 40 master lectures, watching required videos, and answering short essays related to each lecture.

NOTE: Assignments are due on Sunday of the last week the module is covered.

Assignment 1: Live / real time class meetings: There are 10 nearly weekly real-time / synchronous live classes that are used for demonstrations of recording and student practice with their recording equipment. These are required meetings. Students cannot pass the course without attending all but two of these meetings.

Week1 Live class 1: Course introduction and review of recording instruments students have.

Week 7 Live class 2: Common systems – difficulty of use, exaggerated claims, smart Phone applications, ambulatory recorders, ability to program screens.

 Week 9 live class 3: What each parameter is actually recording.

 Week 11 live class 4: Signal quality, filters, & artifacts – many people just feedback artifacts, average raw signals.

Week 13 live class 5: Different parts of the signal – amplitude vs. frequency change, did the signal really change or is it noise, etc.?

Week 14 live class 6: Active learning and shaping.

Weeks 16, 17, 18 live classes 7, 8, 9: Student Demos.

Week 20 live class 10: Course conclusion and what to buy.


Assignment 2: Complete the 10 required modules in the course. Each module includes Listening to Recorded Talks, Watching Required Videos, and Reviewing Readings. Note that an 11th module on kinesiology may be required if student have not had training in kinesiology.

Listen to up to 40 Recorded Talks, distributed in the eight required course modules and in the three selective modules. The recorded talks are generally less than an hour long and can be viewed at the student’s discretion within the assigned week for that module. Complete assigned readings for each course module. Then, document your learning by submitting answers to the review questions related to each module. Do not re-answer questions you answered in previous psychophysiology courses. When you skip a question, state the course and module within the course where the question appeared. There are 9 sets of review questions, which you will email to the instructor after watching each lecture and doing the course reading. Each answer to individual questions should be no more than about 200 words and take you no more than ten minutes to complete. Before answering a set of review questions, ensure that you have viewed the lecture associated with the questions and have read the correct material in the texts. When you submit a set of review questions, label it with its topic number rather than the lecture number or book chapter number. You must correct any mistakes you make and have two chances to do so. When you re-submit a set of questions for re-review, you must include the instructor’s comments, and mark your changes in a different color or they will not be reviewed because otherwise the instructor would have to re-read your entire submission.

Activities During Each Module:

Module 0 (about one week before the course begins)

Shortly before the course begins, a Doodle type pole will be conducted to establish the optimal day of the week (Pacific time zone) for the live meetings. All classes will be at 9 AM Pacific time.

These will be the choices: Monday, Wed, Thurs, Friday 9 AM Pacific time.

NOTE: Assignments are due on Sunday of the last week the module is covered.

Module 1 (A) (week 1): Administrative Introduction

Module 1 Overview: This is a course in psychophysiological recording, assessment and intervention as usually performed in coaching, educational, and clinical environments. Thus, it is very different in depth and content from a typical basic biofeedback course. Many basic biofeedback courses concentrate nearly entirely on clinical aspects of the field with many more mainly teaching students how to use equipment without teaching how to integrate the knowledge

into clinical, coaching, and educational settings. Students will review the basic concepts of psychophysiology and biofeedback in this introductory module.

Module 1 Lectures and Readings

  • Watch Talk 1
  • Read Text File “electricity as magic”
  • Read Leskowitz – chapter 10
  • Read MacLachlan & Gallagher – chapter 6
  • Watch Video – Lehrer, P (1853). Proof that humans can control sympathetic activity.

                     Retrieved from:https://www.youtube.com/watch?v=nFwzGyiik9I&t=60s

  • Watch Optional Talk: Biofeedback in Action


Module 1 Assignment

Live class 1: Course introduction and review of recording instruments students have.

Answer review questions for “electricity as magic”.

  1. Do currents follow paths in humans or flow freely?
  2. Why are voltage, amperage, and resistance related to each other?
  3. Describe and explain a series circuit. Include how amperage, voltage, and resistance are measured in one.
  4. Describe and explain a parallel circuit.
  5. Why is current flow in the human body considered to be closer to AC than DC?
  6. What is a power spectrum in muscles and why is it important to know about it? Include the concept of frequency as related to power in your answer.
  7. Explain the relationship between the direction of current flow and of a magnetic field both in a wire and in the body.
  8. What is an ion and how does something ionize?
  9. Describe ionic and covalent bonds.
  10. Why are some atoms more stable than others (physically not mentally)?
  11. What is an organic molecule and how do large ones wind up in their typical shapes?
  12. What is the difference between a tract and a circuit?
  13. What is the difference between resistance and impedance?



Module 2 (weeks 2 & 3): Basic Concepts in Biofeedback

Module 2 Overview – This module covers:

  1. Psychophysiology vs. biofeedback (BFB)
  2. How BFB is done
  3. History of psychophysiology & BFB
  4. Establishing the credibility of psychophysiology and biofeedback

Module 2 Lectures and Readings

  • View Talks 2-4
  • Read Andreassi – chapter 1
  • Read Textfiles – psychophysiological recording, Rules for establishing credibility, signs of bogus science, & establishing cause and effect
  • Watch Optional Talk: Biofeedback

Module 2 Assignments

Answer the following short essay questions:

  1. What are the major components of a typical, computer based, biofeedback system?
  2. Define biofeedback.
  3. What is clinical psychophysiology and what is it usually used for?
  4. Which professions utilize psychophysiological and biofeedback techniques and in what environments do they do so?
  5. Within the context of biofeedback, what is optimal functioning and what does biofeedback have to do with the idea.
  6. Give an overview of biofeedback’s history and at least four of the people you feel made a significant impact on its development.
  7. What does research have to do with credibility of biofeedback interventions?
  8. Discuss the difference between correlation and cause.
  9. What are the key points you need to know to avoid fatal flaws in a study?
  10. Why bother with placebo-controlled studies in behavioral medicine since “we can see our patients getting better?
  11. Why not just trust the “weight of clinical evidence” since that means that the “experts and everybody else can tell that a treatment is working?
  12. What is the difference between a structural and a functional disorder?


Module 3 (C) (weeks 4 & 5): Underlying Processes

          (and Module 11 – Kinesiology – if needed)

Module 3 Overview – This module covers:

  1. Mechanisms of stress response leading to disease and malfunction
  2. Electricity, Muscles, and SEMG
  3. Development and nerves

Module 3 Lectures and Readings

C1. Stress and disease

  • View Talks 5 & 6
  • Read Textfiles – psychophysiology of stress responses, stress brain changes, HRV failing heart, & basic concepts of disease, Stress vs. EMG in experiment
  • View Optional Talk: Paul Lehrer’s Talk on stress and resiliency

C2. Electricity, Muscles, and SEMG

  • View Talk 7
  • Read Andreassi – chapter 7
  • Read Optional Textfile – BFB muscle type vs. function
  • Read Optional Thought Technology booklet on SEMG

C3. Development and nerves

  • View Talks 8 & 9
  • Read Andreassi – chapter 2
  • Read Textfile – Gut brain

Module 3 Assignments

  1. No live class
  2. Work on the kinesiology module if required.
  3. Answer the following short essay questions:
  4. What are the usual physiological responses to stress?
  5. Describe the health consequences of sustained stress.
  6. Discuss the magnification of physiological disease symptoms by stress reactions.
  7. What are the stages of stress arousal?
  8. Describe the Homes-Rahe life stress scale and its applicability to groups and individuals.
  9. For people with chronic pain, what is the relationship between actual and perceived awareness of muscle tension?
  10. Discuss relationships between anger, stress, and heart disease (from BFB Heart & stress)
  11. Define the SEMG and describe its properties.
  12. Explain the concept of a differential amplifier. (Be sure to include the idea that it is the “difference” between signals from the 2 active sensors which is amplified and, thus, seen.)
  13. What is common mode rejection?
  14. Explain depolarization of a muscle (not a nerve) and relate the process to why you need to record along the length of a muscle.
  15. What is a motor unit?
  16. Describe a chemical synapse and how signals are transmitted across the gap. Include events in the pre-synaptic button such as vesicles.
  17. What is the difference in ways signals are transmitted along individually wrapped (myelinated) and group wrapped (unmyelinated) axons? Include differences in depolarization and explain the reason transmission speeds differ in your answer.
  18. What are dermatomes?
  19. Describe a typical reflex arc.
  20. Describe how you consciously know where you are touched on your body. Include the concept of the cortical homunculus and its organization in your answer.


Module 4 (D) (Weeks 6 & 7): Pain Mechanisms

Module 4 Overview – This module covers:

  1. Mechanisms of referred pain
  2. Relationships between pain, EEG, and blood flow
  3. Headache mechanisms
  4. Mechanisms of Low back pain and trigger points

Module 4 Lectures and Readings

D1. Pain 1: Referred pain, EEG, and blood flow

  • View Talk 10
  • Read Andreassi – chapters 3 – 7
  • Read Textfiles – SEMG & pain review and BFB p100
  • Read Optional Textfile – pain marker on fMRI

D2. Pain 2: Headache

  • View Talk 11
  • Read Textfiles – headache Rx review, TMD Rx review, temp & SEMG BFB do not help migraines, headache protocol, & Why people don’t take headache meds

D3. Pain 3: Low back pain, trigger points

  • View Talk 12

Module 4 Assignments

Live class 2: Common systems – difficulty of use, exaggerated claims, smart

Phone applications, ambulatory recorders, ability to program screens.

Answer the following short essay questions:


  1. Is there an objective, physiologically based way to record pain intensity? Explain.
  2. What is wind-up and how does it happen?
  3. Explain the pain gate. Include peripheral and central inhibition in your answer.
  4. Discuss relationships between pain and blood flow. Include Raynaud’s, RSD, and burning phantom limb pain in your answer.
  5. What is sympathetically maintained pain?
  6. Discuss the concept of referred pain.
  7. Differentiate between jaw pain from muscle tension and TMJ.
  8. Discuss the genetics of pain sensitivity.


  1. Are treatments other than medications needed to control headaches in the general population? Support your answer with facts.
  2. What are the typical symptoms of tension headaches?
  3. What are the typical symptoms of migraine headaches?
  4. What are the key diagnostic signs of headaches other than migraine and tension?
  5. Give at least 5 examples of medications which commonly cause headaches.
  6. What probably causes tension headaches?


  1. What is piriformis syndrome and how is it usually treated?
  2. Describe the relationships between low back pain and muscle tension. Include problems with the literature in your answer.
  3. What are trigger points?
  4. Why is it important to include a trigger point evaluation as part of low back pain diagnosis?

Module 5 (E) (weeks 8 – 11): Psychophysiological Recording

Module 5 Overview – This module covers:

  1. Equipment overview
  2. Recording muscle tension/SEMG
  3. Recording GSR, CO2, blood oxygen saturation, respiration, HR, and HRV
  4. Recording temperature and blood pressure
  5. Recording the EEG
  6. Safety
  7. Identifying Artifacts

Module 5 Lectures and Readings

E1. Recording 1: Equipment overview

  • View Talk 13
  • Read Andreassi – chapters 9 – 14
  • Read Textfiles – Effects of medications on signals & Equipment decisions
  • Watch Video 1

E2&3. Recording 2 & 3: SEMG

  • View Talks 14 & 15
  • Watch Video 11
  • If not done so already, Read Optional Thought Technology booklet on SEMG

E4. Recording 4: GSR, Respiration, Heart Rate, Heart Rate Variability

  • View Talk 16
  • Read Andreassi – chapters 12 & 13 and 15 & 16
  • Read Textfiles – HRV and anxiety disorders, capnometry, HRV failing heart, HRV A&P, HRV Thought Technology booklet, HRV feedback mechanisms, & HRV vagus nerve


E5. Recording 5: Temperature and Blood Pressure

  • View Talk 17
  • Read Textfiles – drugs, EEG signal, revised EEG 10-20 system, EEG recording, What is neurofeedback? & What is Quantitative EEG?
  • Watch Optional Video 12 (Dr. Cynthia Kerson teaches our EEG biofeedback CE course. She made the following video to demonstrate a pretty typical EEG biofeedback session from hook-up through use of operant conditioning to induce changes to session summary. Here is the link: http://www.youtube.com/watch?v=REcNVlpdOnQ)

E6. Recording 6: EEG & Safety

  • View Talk 18
  • Watch Optional Video 13


E7.  Recording 7: Artifacts

  • View Talk 19


Module 5 Assignments

2 live classes for this module:

  1. What each parameter is actually recording
  2. Signal quality, filters, & artifacts – many people just feedback artifacts, average vs. raw signals

Answer the following short essay questions:


  1. What are the most commonly fed back physiological signals?
  2. What is meant by garbage in – garbage out with respect to psychophysiological recording and what is its impact on biofeedback-based interventions?
  3. Explain bandwidth and how it is altered by filters. Include how filters alter the signal.
  4. What is a muscle’s power spectrum?
  5. How does the setting of an incorrect bandwidth affect the display of muscle tension?
  6. Explain signal attenuation due to distance between the sensors and the muscle. Include the effect of differing thicknesses of fat in your answer.
  7. Discuss how a signal is averaged. Include rectification in your answer.
  8. Explain A to D conversion with respect to transforming physiological signals. Include the effect of A to D speed on accuracy of the transformation.
  9. Discuss the use of gain, offset, and sweep speed to produce an optimally visible signal on a biofeedback display.
  10. Did you find video 1 helpful? Why or why not?



  1. When recording the biceps and triceps, what do you see on the display as the arm is sequentially bent and straightened at the elbow? Include where either signal goes to resting baseline during the various phases of the motion and cross talk in you answer.
  2. When mounting SEMG sensors to the skin, describe the appropriately conservative method if using older equipment or you don’t have the manufacturer’s instructions.
  3. How do you know which muscles to record from?
  4. Discuss recording-to-recording reliability of the SEMG signal. Include factors which effect reliability in your answer.
  5. Discuss how accurately changes in muscle tension are reflected by changes in the SEMG signal and factors affecting the relationship (think of squeezing a ball or dynamometer and seeing the change in the SEMG recorded from the forearm).
  6. What did you learn from watching the video of head and back anatomy?


  1. How is respiration usually recorded by people interested in biofeedback?
  1. Discuss physiological & emotional impact of a life-long pattern of rapid, shallow breathing.
  2. Describe capnometry and how it is used to estimate and then increase the efficiency of breathing (See Meckley Text file).
  3. Can inhalation/exhalation cycles appear normal while capnometry shows ineffective breathing? What is the impact of this on recognizing & correcting breathing problems?
  4. What is the electrodermal response and how is it recorded?
  5. How are conductance and resistance related? Include typical values in your answer.
  6. What is the EDR recording usually used for?
  1. What are the two usual methods of recording HR for biofeedback and how do they work?
  2. What is heart rate variability and how is it related to breathing?


  1. How are limb motion and force usually recorded?
  2. How is pressure against the skin usually recorded and what factor has to be controlled to produce consistent readings?
  3. List three methods for recording skin temperature for biofeedback and assessment.
  4. How does a thermistor measure skin temperature?
  5. What is the appropriate way to attach a thermistor to a fingertip? Include why the stem of the wire needs to be taped down in your answer.

E6. Recording 6: EEG & Safety

  1. Why do metal cup style EEG sensors have holes at their tops?
  2. Name and describe the standard EEG sensor placement system.
  3. What are the effects of at least four medications on the EEG signal? Include alcohol, sedatives, and beta blockers in your answer.
  4. Discuss methods for ensuring electrical safety of your patient. Include ground fault interruption and optical isolation in your answer.
  5. Discuss infection control when performing psychophysiological recordings and biofeedback. Include universal precautions in your answer.


  1. How do you check signal quality from sEMG sensors, temperature sensors, GSR sensors, heart rate sensors, and respiration sensors?
  2. How do you eliminate heartbeat artifacts from an sEMG signal?


Module 6 (F) (weeks 12-14): Psychophysiological Assessment

Module 6 Overview – This module covers:

  1. Interviews and tracking changes
  2. Psychophysiological profiles
  3. Assessing low back pain, headaches, & anxiety
  4. Assessing phantom pain & Pelvic floor disorders
  5. Assessing sleep/psychophysiological interventions
  6. Norms for typical psychophysiological parameters
  7. Habituation to the recording environment


Module 6 Lectures and Readings

F1. Assessment 1: Interviews and tracking changes

  • View Talk 20

F2. Assessment 2: Psychophysiological profiles

  • View Talk 21
  • Read Text file – psychophysiological profile table
  • Watch Videos 2 and 3

F3. Assessment 3: Low back pain and headaches

  • View Talk 22
  • Read Text files – headache log & headache protocol
  • Watch Videos 4, 5, & 6

F4 & 5. Assessment 4 & 5: Phantom Pain & Pelvic floor

  • View Talks 23 & 24
  • Watch Videos 7, 8, 9, & 10

F6. Assessment 6: Sleep, Norms, and habituation

  • View Talk 25
  • Read Andreassi – chapters 2, 3, & 4
  • Read textiles – summary of common parameter norms & psychophysiological interventions for sleep disorders

Module 6 Assignments

2 Live classes:

  1. Different parts of the signal – amplitude vs. frequency change, did the signal really change or is it noise, etc.?
  1. Active learning and shaping


Answer the following short essay questions:


  1. Describe several typical pain scales and explain why they are crucial parts of a pain assessment. Include why a definition of maximum pain is needed.
  2. Describe a typical pain diagram and explain why it is a crucial part of a pain assessment.
  3. Describe a typical pain log and explain why it is a crucial part of a pain assessment. Include the elements which would usually be included.
  4. What are some of the conditions where extra care needs to be taken when incorporating biofeedback into a treatment (contraindications, etc.)



  1. What are several reasons for performing psychophysiological profiles?
  1. Which physiological parameters are usually recorded during a profile and why?
  2. Describe an example of a guided image which would be used to help a patient understand the depth you want the patient to use when imagining a scene. (This has nothing to do with stressful images – just helping patients be aware of sensations from all the senses.)
  3. What are the typical steps (sequence of events) in a stress profile?
  4. Contrast the likely effectiveness of personally relevant stressor images relative to standardized stressor images.
  5. At any stage in a psychophysiological profile, what criteria is used to ensure that numbers you write down are representative of the emotions you are trying to elicit (this question is asking how you know when to note the numbers, stability of the recording, etc.)? 
  1. What did you learn from the two videos on profiles?



  1. What are the goals of the low back pain assessment?
  1. What do you ask when you screen for low back problems requiring referral to a physician?
  2. Describe the typical SEMG evaluation for low back pain. Include what you should expect to learn from it.
  3. How do you differentiate muscle tension related back pain from the other types?
  4. What did you learn from the video on low back pain evaluation?
  5. What are the goals of the headache assessment?
  6. What are the warning signs of headaches which mean patients have to be sent/taken to a physician immediately?
  7. Discuss posture and headache incidence (include both forward head thrust and posture while at a computer terminal).
  8. If you can’t find anything wrong with the patient, does that mean the person is faking?

F4 & 5.

  1. Discuss the bladder sphincter – detrusor reflex in relation to quieting the detrusor.
  2. Define urge, stress, and overflow incontinence.
  3. How are pressure sensors used for fecal incontinence?
  4. How is the pelvic floor usually recorded from when assessing and treating urinary incontinence for psychophysiological interventions?
  5. Why is lower abdominal SEMG included as part of a biofeedback assessment for UI?
  6. What are the tensing patterns of the pelvic floor and abdomen when a person with (a) no incontinence problems and (b) with stress incontinence is told to tense the pelvic floor?
  7. What did you learn from the videos on the pelvic floor?
  8. How is a psychophysiological assessment of phantom limb pain performed?
  9. What did you learn from the videos on phantom pain?


  1. How do you know if a reading you get on a biofeedback machine is normal or abnormal?
  2. What is physiological habituation and what factors influence it?
  3. What is the effect of habituation on blood pressure within and across sessions?
  4. Discuss the stability of finger temperature in a biofeedback session relative to learning curves.
  5. What is the effect of which model of recording equipment is used on levels (magnitudes) of parameters recorded? (Think of whether you get the same readings on two different models of equipment from different manufacturers when recording EMG, EEG, etc.)
  6. What is usually being looked for when assessing sleep problems?
  7. Describe the psychophysiological recordings made during a sleep assessment.
  8. Identify the 4 major stages of sleep and the major EEG and EMG characteristics of each.
  9. Describe the treatments commonly used for mild to moderate sleep apnea.



Module 7 (G) (weeks 15 – 17): Biofeedback Based Interventions


Module 7 Overview – This module covers:

  1. Biofeedback based interventions – overview, model protocol
  2. Biofeedback based interventions for muscle and blood flow related problems
  3. Biofeedback based interventions for anxiety and ADHD
  4. Biofeedback based interventions for Raynaud’s disease
  5. Biofeedback based interventions for pelvic floor disorders
  6. Biofeedback based interventions for optimal functioning in sports, education, & work


Module 7 Lectures and Readings

G1.  BFB Interventions 1: Techniques overview, model protocol

  • View Talk 26
  • Read Textfile – BFB efficacy overview. If not done so already, read Textfiles headache Rx review & TMD Rx review (Module 4)
  • Read Textfile – Psychophysiology for optimal functioning in sports by Herzog et al
  • If still not done so, read Optional Thought Technology booklet on SEMG. Note, some of the headache files are associated with earlier lectures.


G2. BFB Intervention 2: Muscle and blood flow related problems

  • View Talk 27
  • Read Textfile – TMD Rx review.
  • Read Optional Thought Technology booklet on Rehabilitation.


G3 & G4. BFB Intervention 3 & 4: Anxiety, ADHD, hypertension, irritable bowel syndrome, Raynaud’s, addiction, etc.

  • View Talks 28 & 29
  • Read Textfiles – EEG vs. placebo for ADHD, EEG for ADHD review, & hypertension treatment review. If not done so already, read Textfile – capnometry (Module 5)


G5 & 6. BFB Intervention 5 & 6: Pelvic floor interventions 1 and 2

  • View Talks 30 & 31
  • Read Textfiles – treatment of UI review, UI protocol, UI handout for males, UI handout for females, & anorectal disorders


G7. BFB Intervention 7: Optimal Functioning in Sports, Education and Work

  • View Talk 32
  • Read Text File Psychophysiology of optimal functioning in Sports by Herzog


Module 7 Assignments

2 Live classes:

  1. Student demonstrations of recordings with subjects
  2. Student demonstrations of recordings with subjects

Answer the following short essay questions:


  1. Which physiological parameters are fed back most and less frequently?
  2. List several disorders for which there is excellent evidence of efficacy for biofeedback treatment. NOTE: The evidence supporting the use of biofeedback for essential hypertension has collapsed. It doesn’t help at all on its own and doesn’t add anything to other behavioral interventions.
  3. List several disorders for which there is moderate evidence of efficacy for biofeedback treatment.
  4. List several disorders for which there is poor/no evidence of efficacy for biofeedback treatment.
  5. What are the basic goals of muscle tension awareness and control training?
  6. What are the basic methods/process of muscle tension awareness and control training?
  7. What are the usual steps for calibrating interpretation of sensations from a muscle to actual levels of muscle tension?
  8. How is shaping used in biofeedback training? Include specific techniques.
  9. How is biofeedback incorporated into treatment of tension headache?


  1. How is biofeedback incorporated into treatment of musculoskeletal low back pain?
  2. How is biofeedback incorporated into treatment of subluxation of the patella?
  3. How is biofeedback incorporated into treatment of torticollis?
  4. How is biofeedback incorporated into treatment of spasm control?

G3 & G4.

  1. How is biofeedback incorporated into treatment of anxiety?
  1. What can happen to cardiac symptoms during biofeedback treatment for anxiety?
  2. How do you perform heart rate variability feedback?
  3. How is biofeedback incorporated into treatment of asthma?
  4. How is biofeedback incorporated into treatment of phobia?
  5. How is biofeedback incorporated into treatment of irritable bowel syndrome?
  6. How is biofeedback incorporated into treatment of Raynaud’s syndrome?
  7. What is the efficacy of non-biofeedback and biofeedback treatments for hypertension?
  8. How is biofeedback incorporated into treatment of epilepsy?
  9. How is biofeedback incorporated into treatment of ADHD?
  10. How is biofeedback incorporated into treatment of alcohol and drug abuse?
  11. Summarize the evidence that biofeedback is effective for alcohol abuse.

G5 & 6. 

  1. List the most common pelvic floor disorders amenable to behaviorally augmented therapy.
  2. What is the efficacy of behavioral interventions for UI?
  3. What is the efficacy of behavioral interventions for anorectal disorders?
  4. What is the typical behavioral intervention for UI problems?
  5. Describe the usual inclusion and exclusion criteria for behavioral interventions of UI.
  6. How is the effectiveness of treatments for UI measured and tracked?
  7. When treating UI, why start with timed voiding?
  8. How do evaluative and post-training recordings compare for people with stress UI?
  9. How is electrical stimulation added to treatments of UI and why?


  1. How is biofeedback used for optimal functioning in academia, athletics, and the workplace?
  2. Why is breath control and respiration training important in sports?
  3. Describe (not just list) 3 methods to help people concentrate better in sports, in school, and at work? Do not use techniques described in the Herzog chapter.
  4. Describe 3 methods for optimizing sports performance found in Herzog’s chapter on psychophysiology of optimization of sports performance.


Module 8 (H) (week 18):

                            Psychophysiological Techniques not based on BFB

Module 8 Overview – This module covers:

  1. Relaxation training
  2. Hypnosis
  3. Meditation
  4. Audiovisual entrainment
  5. Cognitive restructuring
  6. Psychophysiological treatments for sleep disorders
  7. Placebos


Module 8 Lectures and Readings

H1 & 2. Psychophysiological techniques not based on biofeedback 1 & 2: Relaxation training, meditation, cognitive restructuring, etc.

  • View Talks 33 & 34
  • Read Textfiles – aches & pain exercise program, relaxation exercises, exercise effects on mood, mindfulness mediation, focused breathing exercise, & use of CAM
  • Read Textfile – psychophysiological interventions for sleep disorders
  • Read Optional Textfile – CBT for insomnia
  • Read Text-file: Sherman, R. (2019) Thermography as an aid to sensitivity training. Behavioral Medicine R&T Foundation, Sequim, WA.


H3. Psychophysiological techniques not based on biofeedback 3: Hypnosis & Placebo

  • View Talk 35
  • Read Text file – Placebo effects talk by Rick Harvey
  • Text file “nocebo effect”
  • Watch The TED talk on Placebos:

 Lisa Rankin, MD, at TEDx on the power of the mind to heal the body

  • Download and read: Bystad, M., Bystad, C., & Wynn, R. (2015). How can placebo effects best be applied in clinical practice? A narrative review. Psychology research and behavior management, 8, 41–45. doi:10.2147/PRBM.S75670.
  • Read text file: Hypnosis, anesthesia, pain management, and preparation for medical procedures Donald Moss and Eric Willmarth Ann Palliat Med 2019;8(4):498-503 http://dx.doi.org/10.21037/apm.2019.07.01


Module 8 Assignments

Live class: Student demonstrations of recordings with subjects

Answer the following short essay questions:

H1 & 2.

  1. How can you learn more about research on associated techniques discussed in this section?

NOTE: NIH no longer prepares consensus documents.        

  1. Where in a patient’s life can interventions be made to change responses to stress?
  2. What are the major ways you can use life-style to prepare for unavoidable chronic stress?
  3. Describe the concept of cognitive restructuring.
  4. What are several physiological disorders which can be helped with cognitive restructuring and how strong is the supporting evidence?
  5. What are the major elements of progressive muscle relaxation training?
  6. What is autogenic training?
  7. What can a clinician do to maximize the placebo response to enhance a patient’s treatment effectiveness? (This question refers to a clinical setting, not a research project.)
  8. How does knowledge of trigger points relate to evaluation of pain?
  9. What are effects of exercise on mood, endorphins, and respiratory problems?


  1. What is the evidence that the placebo effect is produced though actual psychophysiological mechanisms?
  2. Which types of disorders are more and less likely to be affected by the placebo response?
  3. What is the evidence that hypnosis is different from the placebo effect?
  4. What is the evidence for and against hypnosis being efficacious for pain control?
  5. Is hypnosis efficacious for smoking cessation? Uphold your decision.


Module 9 (week 19): Ethics in Applied Psychophysiology

Students who are BCIA certified can skip this module.

Module 9 Overview – This module covers:

  1. Ethics in relation to applied psychophysiology
  2. Ethics biofeedback as related to the student’s parent profession
  3. The need to be competent in every assessment and intervention utilized
  4. The need to be aware of the physiological processes underlying each problem approached.
  5. Ethics of charging for unvalidated interventions.
  6. Ethics of conflict of interest.
  7. Ethics in use of technicians having direct contract with clients.
  8. Problems with informed consent for psychophysiological interventions.
  9. Ethics of patient privacy and protection of others
  10. Ethics of billing insurance carriers and use of codes.


Module 9 Lectures and Readings

  • View Talks 36-38
  • Read Textfiles – patient handouts, consents, BCIA ethics document, & evidence-based medicine
  • Read Optional Textfile – Belmont report

Module 9 Assignments

Answer the following short essay questions:

  1. What are several of the issues in obtaining true informed consent?
  2. Discuss the need for competence in every assessment and applied interventional strategy.
  3. Discuss the need to be knowledgeable about the disease you are working with.
  4. Discuss the problem of adequate supervision of technical level people having primary contact with the patient during biofeedback sessions.
  5. Discuss the problem of regularly providing and charging for non-validated treatments.
  6. Discuss the problems inherent in dual relationships and conflict of interest.
  7. When a patient’s insurance runs out before an ongoing treatment which is making progress is over, can you just drop the patient?
  8. What are the main points of evidence-based medicine?
  9. What is the duty to protect?
  10. How do the ethics of providing biofeedback services relate to the code of conduct promulgated by your parent profession?
  11. Discuss the need for confidentiality and how to obtain and release patient records.
  12. What data relevant to biofeedback evaluations and interventions need to be kept?
  13. Discuss the concept that ethical standards evolve over time and vary by culture.
  14. Discuss the problems around people using insurance codes designed for people from other professions or for techniques that the provider is not actually licensed to provide.

Module 10 (J) (week 20): Final Ideas and Conclusions

Module 10 Overview – This module covers:

  1. Cases illustrating evaluation of complex clients
  2. Common tricks for improving patient self-awareness of physiological responses
  3. Methods for deciding which intervention to try first
  4. Course conclusion

Module 10 Lectures and Readings

  • View Talks 39 & 40
  • View slide set / textfile Shaffer et al Biofeedback Review

Module 10 Assignments

  1. Live class: Course conclusion and what to buy
  2. Answer the following questions:


  1. Describe several “cheap tricks” patients can use in their normal environment to enhance their awareness of changes in their physiology.
  2. Given your own clinical expertise, describe the other professionals you need to be able to work with to ensure that a patient referred to you is properly assessed.
  3. Given your clinical expertise, how are you going to approach physicians with different expertise and convince them to perform an evaluation they feel is unnecessary or irrelevant?


  1. How do you decide which intervention to try first for a particular patient?
  2. Is there a consistent relationship between therapeutic conservativeness (safety) and effectiveness?
  3. When starting to integrate biofeedback into your practice, how do you minimize your odds of failing? (Think of type of patients, etc.)
  4. Describe how to avoid the selection of a poor mentor.



Module 11: Human Kinesiology and Motor Control Systems

Students who have taken a basic Kinesiology Course can skip this module.

Students who do not have this training must complete this module by the end of week 5.

  1. Lippert text:

Ch. 1 – Basic Information

Ch. 2 – Skeletal System

Ch. 3 Articular System

Ch 4. Muscular System

Ch. 6 – Basic Biomechanics

Ch, 20 – Normal Gait

Ch 21 – Arthrokinematics

  1. Required video: Wolf’s “human muscle dissection
  2. Watch the following “You Tube” videos:

Module 3: Basic Leverage and body motion

Answer these review questions:

  1. What are the differences between upper and lower motor neurons?
    How can muscles be both painful and relaxed at the same time?
  2. Describe the function of tendons and the difference between a tendon and a ligament.
  3. Explain how isotonic and isometric contractions differ.
  4. Describe what muscle tone is.
  5. Describe how a prime mover is different from a synergist muscle.
  6. Do you have to tense up with acute stress responses? (This is a synthesis question. Material for this answer was presented in Talk 3 – Cells and Tissues.)
  7. What is the homeostatic model of tension and pain? (This is a synthesis question. Material for this answer was presented on slide 50 in Talk 3 – Cells and Tissues.)
  8. Describe trigger points and their proposed (likely) underlying physiology.
  9. What is the effect of aging on skeletal muscles?
  10. What signs and symptoms are likely to accompany a moderate muscle strain?
  11. Posibo has had gallbladder surgery. He is now experiencing weakness of the muscles on his right side, the side with the incision through his abdominal musculature. Consequently, the abdominal muscles on his left side contract more strongly, throwing his torso into a lateral flexion. Mr. Posibo needs physical therapy. What abnormal spinal curvature will result if he doesn’t do it, and why?
  12. Briefly give the functions of tendons, bursae, and synovial membranes.
  13. Can a muscle contract for very long if its blood supply is shut off? Why/why not?
  14. T/F: The placement of SEMG sensors needs to be changed for each patient/client, depending on their direction of muscle orientation.
  15. T/F: The specific activity of deep muscles (under other muscles) can be recorded.
  16. What are the four parts to a lever and how are they arranged in a simple lever?
  17. What are the human body part equivalents for the parts of a lever?
  18. Give one example of each class of lever in the human body.
  19. Explain mechanical advantage and give an example for each class of lever.
  20. Explain the concept of torque.
  21. What is mechanical advantage?


END of Syllabus


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