COMPUTERIZED BIOFEEDBACK APPLICATIONS IN MEDICAL PSYCHOLOGY

ABSTRACT

Relatively new advances in computerised biofeedback assessment and treatment are explained in terms of projective and cognitive measures with related psychophysiological implications. Biofeedback treatment programs are constructed on the basis of EM, BSR and FM data; applying traditional techniques to disorders.

Non-dominant brain (Stress Map) results - scored through slide projections, are solidly on the patient’s involuntary responses, enabling data analysis which may be less reliant on subjective interpretation. Obvious advantages are demonstrated through efficient assessment with minimised fatigue and discomfort to the patient and added possibilities of periodic monitoring for comparisons between initial and ongoing/pre-post computerised biofeedback assessment.

COMPUTERIZED BIOFEEDBACK APPLICATIONS IN MEDICAL PSYCHOLOGY

Biofeedback provides accurate and measurable information about physiological states aroused by either conscious or unconscious stimuli. The concept has far reaching implications in the Mental Health Delivery Services through reporting and monitoring data for the patient and referring General Practitioner. This paper elaborates methods of applying computerised biofeedback in diagnosis and treatment with an advantage of pre/post graphic, statistical measurement. Appropriately designed programs provide assessment/continuous monitoring in blood pressure, electromyography, temperature regulation, heart rate or electroencephalography. For the purpose of this paper three modalities are utilised Viz; electromyograph (EMG). heart beat (HB) and basal skin response (BSR). The pulse monitor (PM) is a heart beat index.

Psychophysiological Implications

A concise explanation is provided in Appendix A (E. and A. Green 1985). It is contended that biofeedback is designed to provide patients with a knowledge of their progress in relation to specific control i.e. EMG for striated muscles, pulse monitor for heart beat, temperature trainer for smooth muscles. Through possession of continued feedback patients achieve improved functioning and freedom from external controlling pressures as their self-control increases. Relaxation and freedom from muscle tension is considered to be the initial stage of self-control. Plausibly, patients may de-condition or modify negative responses associated with repressed psychological trauma.

Further. normal every day stressful situations may produce an over-excessive/ exaggerated emotional reaction. The patient’s heart may beat faster, his breathing accelerate and his muscles become tense. His glands produce more adrenaline, which increases glycogenolysis in his muscles and liver. He also secretes more noradrenaline, which increases lipolysis in his fat stores (Levi 1985). General practitioners are sadly accustomed to such stress related disorders reported by their patients.

The smooth muscles have primary concern with the cardiovascular system and serve to regulate the pulse and heart beat. Typically, the smooth muscles of relevance lie within the arteries. Migraine headaches, sexual impotence etc., are often associated with a loss of control of smooth muscle functioning so vaso-capillary dilation/constriction can be viewed as a secondary involuntary conditioning (Budzynski 1973). Pulse monitoring and training then suggests the second stage in development of control.

Biofeedback Diagnostic Assessment Of Emotional Control

The affective qualities of the patient deal with total bodily functioning so the primary concern is represented by the endocrine system. Critical experiences in the patient’s developmental history are seen to evoke conditioned physical responses. Thoughts create feelings. Assessment of various life spaces which produce malfunctioning are characteristically detected through investigating the non-dominant side of the brain. Since this side is "mute" and not conscious to the patient coloured and black and white picture slides are focused on a screen by a slide projector. Various "life spaces" or areas of investigation are measured through physical responses to the selected slides. A "stress map" is developed for these physical unconscious responses (Cassel 83).(See Fig 1. and Appendix B)

Non-Dominant Brain Projective Testing

Life, space slide selections parallel developmental history thus determining pertinent emotional/affective response. Twelve picture slides are projected for each of the following groups with an exposure time of four seconds, facilitating average EMG and BSR recorded for each slide. Telemetric electrodes replace obtrusive leads to biosensors enabling the patient a comfortable viewing with minimal distraction.

When considering that a sophisticated "identification process" is adopted, separate sets of slides are selected for children, adolescents and adults. Slides evoking an index of excitation are clearly denoted by means and standard deviations, discerning immediate evaluation for the following life spaces:

1. Home And Family
2. Conscience And Inner Development
3. Social Affiliation
4. Authority - Law - Responsibility
5. School And Learning Experiences
6. Romance And Psychosexuality
7. Sports And Risk Taking
8. Health And Safety
9. Travel And Relaxation
10. Aesthetic Appreciation
11. Productivity And Money (See Appendix B).

In preference to traditional pencil and paper tests which may produce fatigue, these are replaced by computerised personality batteries, utilising visual display units whereby patients simply respond to multiple choice Items (Costello 1982). Appropriate personality tests selected on the basis of the patient’s presenting problems are immediately scored by the computer, providing a profile for comparison with the projective biofeedback assessment. The technique is expedient in detecting critical need areas from high stress scores, based on the patient’s own perceptions. Profiles also depict low stress scores where need areas are presently well gratified or controlled.

From Diagnostic Assessment To Treatment And Stress Management

Stress reactions can lead to symptoms of disease - e.g. Syndromes caused by lasting painful muscular tension, accelerated respiration (leading to respiratory alkalosis) or accelerated intestinal passage diarrhoea/nervous bowel syndrome are perceived as illness and if they persist, disability. If these reactions are chronic/intensive/recurring, increased wear and tear will not only damage the function but also the structure of different organs and systems. Physiological reactions to stress produce various behavioural reactions (Selye 1967). Apart from severe emotional reactions such as acute anxiety and depression many patients cannot function socially consult a doctor and are put on a sick list. The promise is well defined by Levi. Ultimately, it is the patient who may best control/alter lifestyle and his consequent Interactions with it (Costello 1979).

"In almost no other area is one’s intellectual understanding so dependent on an adequate experiential base as in the consciousness disciplines. Both history and modern psychology are replete with countless examples of misunderstanding, dismissals and pathological interpretations of these disciplines but by those without personal experience and training in them"
--(Walsh 1983).

Obviously, once patients have a clear understanding of psychogenic influences related to their disorder/illness (provided by computerised assessment), self-administering treatment programs can be designed to eliminate conditioned physical stress reactions, modify or at least desensitise them.

Biofeedback Treatment Programs

On the basis of results scored through Non-Dominant Brain Projective Testing and Dominant Brain Cognitive Testing which are fully discussed with the patient, a formal list/hierarchy of stress related problems is drafted. The list is developed in rank/priority order, deduced from EMG and GSR excitation states which remarkably exceed the patient’s mean. This data is related to the Cognitive Personality Assessment enabling an overlay of conscious and unconscious test profiles. (Please see Appendix B)

1. When using constructs of systematic desensitisation, the patient is asked to use EMG and GSR biofeedback equipment at home. He contemplates the stress evoking situation/memory and attempts to reduce or oven extinguish the affective response which is readily understood as a physiological reaction. Fundamentally, the precept is to gradually work up from minimal stress related situations to more evocative reactions depicted by the hierarchy. A positive, reinforcing learning process is thus achieved as patients experience measurable Success. Systematically, the hierarchy of stress reaction is modified using a suitable gradient Individually derived for each patient.

   Biofeedback equipment is provided for the patient’s use at home so achievements can be recorded through progressive self-assessment (Costello 1971). A longitudinal achievement profile is drafted for daily recordings enabling the patient to perceive areas of success through self-assessment. Weekly attendance to monitor improvement is provided at minimal cost where the patient simply replicates efforts in biofeedback training. However, sequential computerised results may thus be compared to illustrate progress.

2. Relaxation tapes can be prepared for patients whereby constructs devised by Budzynski can be applied. This is a general approach but specific autohypnosis tapes can also be provided, using auto-suggestions related to the diagnostic Stress Map hierarchy.

3. When accepting the primacy of the patient’s needs as derived through the assessments, a (20 minute) program of relaxing music can be developed. Music is subjective in its positive appreciation. Patients are instructed to select pieces of music that evoke warm feelings/positive memories to off-set traumatic experiences. The patient takes responsibility in deciding and accepting a newly paired positive response or relaxing response which would be otherwise negative.

4. Imaginative relaxation or visual imagery through Autogenics (Koenig-Mill 1986) is effectively monitored by patients who require a more structured system of daily exercises.

Numerous case studies reveal that biofeedback is an effective technique in developing "self-control". The patient is trained to perceive his emotional response to a given stressful stimulus and can thus modify/desensitise, or extinguish his affective response accordingly. It is simply a matter of diagnosing repression’s or operant conditioning which relinquishes the patient’s ability to control either his environment or his responses to it. The locus of control is thus modified.

Sometimes it will be necessary to alter the environment which in itself produces psychosocial stressors to which the patient might not wish to adjust but this is a matter for counselling following assessment and follow-up interviewing.

Non-Dominant Brain (Affective/Projective Assessment) based solely on physiological responses to various emotive picture slide projections might well replace currently devised projective personality tests so heavily loaded with content analysis. Data obtained through physiological responses comes direct from the patient. It is not reliant on subjective interpretation. A psychophysiological set of data is revealed, specifically pertinent to the patient based on his perception, conscious or unconscious.

Cognitive Personality Assessment is largely standardised but the process has been streamlined using the VDU. Obvious advantages are observed through efficient, immediate computerised printout. The process is cost efficient but when adopting a precept of superlative patient care it is also time saving for the patient and referring General Practitioner. Immediate computerised assessment through biofeedback interface is provided at the first consultation. Diagnosis is also provided in the first assessment session and appropriate, specific individualised treatment programs are then derived.

Every change in physiological state is accompanied by a specific mental-emotional state, conscious or unconscious. Conversely, each change in emotional state is coupled with a physiological change. In either case, the patient has the ability to internalise such data at a cognitive level and thus determine his emotional response through biofeedback training. Thoughts evoke feelings. Through biofeedback training, after assessment and the discovery of subconscious and conscious determinants, patients develop a deliberate internal locus of control. It is they who regulate their lives while we advise with pertinent data based solidly on their assessments.

References

Budzynski, Thomas H. Biofeedback Procedures In The Clinic. Seminars in Psychiatry, 1973. 5(4), 537-548
Cassel, R.N. The Computerised-Biofeedback Personal Needs Map (STRMAP), Education, 1983 Spr Vol 103(3) 210-214, ISSN: 00131172
Costello, B.R. The Application Of Computerised Psychological and Educational Assessment In South Australia. School Psychology International. Holt, Rinehart and Winston 0143 0343/82/
Costello, B.R. Misconceptions of Giftedness or Retardation. American Psychological Asn., Annual Convention N.Y. 1979
Costello, B.R. Assessment Techniques, Vaughan Press. Vic. 1971-78
Green, E.E. and A.M. Biofeedback and States of Consciousness, Handbook of States of Consciousness, New York: Van Nostrand Reinhold, 1986-
Koenig-Mill, B., Autogenics - An Easy Guide To Stress Management, Autogenics Institute Canada. m.s. 1986
Levi, L. , Stress: definitions, concepts and significance. Cardiovascular Information, AB Hassle, Sweden 1985
Selye, H., In vivo. The Case For Supramolecular Biology. New York: Liveright, 1967
Walsh, R., The consciousness disciplines. J. Humanistic Psychol. , 23. 1983

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Appendix (A)

NORMALLY - CONSCIOUS VOLUNTARY DOMAIN - CORTIAL AND CRANIOSPINAL

Figure 1: Simplified operational diagram of "self regulation" of Psychophysiological events and processes: Sensory perception of OUTS events, stressful or otherwise (upper left box), leads to a physiological response along Arrows 1 to 4. If the physiological response is "picked up" and fed back (Arrow 5) to a person who attempts to control the "behavior" of the feedback device, then Arrows 6 and 7 come into being, resulting in a "new" limbic response. This response in turn makes a change in "signals" transmitted along Arrows 3 and 4, modifying the original physiological response A cybernetic loop is thus completed and the dynamic equilibrium (homeostasis) of the system can be brought under voluntary control. Biofeedback practice, acting in the opposite way to drugs, increases a person’s sensitivity to INS events and Arrow 8 develops, followed by the development of Arrows 9 and 10. External feedback is eventually unnecessary because direct perception of INS events becomes adequate for maintaining self regulation skills. Physiological self control through classical yoga develops along the route of Arrows 7-3-4-9-10-7, but for control of specific physiological and psychosomatic problems biofeedback training seems more efficient.

By permission E.E. & A.M. Green, Biofeedback and States of Consciousness, Handbook of States of Consciousness, New York: Van Nostrand Reinhold, 1986

Appendix (B)

CASSEL RESEARCH CENTER
717 3rd Avenue, Chula Vista, California 90210

AREAS AND SUB-AREAS OF LIFE-SPACE COVERED BY ‘EMOT’ SLIDES