Generality and Specificity in Biofeedback
Sep 23, 2011 |
by: Siegfried Othmer
| Category: Biofeedback
Anyone who has been involved in biofeedback and neurofeedback for any length of time is probably struck by the sense of promise unfulfilled. We know that we can be helpful for a variety of conditions that afflict mankind, and yet the organization of health care delivery seems to frustrate the actualization of this potential from all quarters. In the following, an attempt is made to understand the principal reasons why this might be so. The hope is that an agenda for action might emerge that can replace mere cursing of the darkness.
Whereas there are probably many contributory influences to account for the fact that biofeedback is currently undergoing only modest growth, it is most useful to concentrate on those factors over which we might actually have some control. We are not in a position to change the reimbursement climate directly, for example, but we may well be in a position to persuade third-party payers that we actually
represent a remedy for some of their most significant cash drains.
I begin with the assumption that the barriers to our practical progress lie at the conceptual level. The sixties witnessed the startling early findings in the conditioning of autonomic function in animals by Neil Miller’s group, the conditioning of motor excitability by John Basmajian and Barry Sterman, and the induction of certain mental states through reinforcement on EEGparameters by Joe Kamiya. In that same timeframe, the conditioning of autonomic responding happened to be the topic at a medical conference, where the concept was dismissed as fanciful. The contrary evidence of the yogis of India putting their physiology under voluntary control was apparently brushed aside as merely anecdotal. With the data becoming solid, however, in other quarters in the US, there should have been a crisis moment where the conflict between the standard model and the data was confronted and resolved. That never happened.
Instead, what appears to have occurred over time is a kind of domestication of biofeedback in which its claims were trivialized as mere “relaxation training.” Whatever was going on could be quarantined to the psychological realm and thenceforth safely disregarded. Biofeedback did not speak to the medical enterprise. It was adjunctive and peripheral in all senses of the word. As such, it was tossed into the bin with the multi-headed hydra of the placebo, out of which morass one can never quite emerge with finality.
There were of course applications of biofeedback in which a placebo model could not cloud the waters as readily. Pelvic floor biofeedback and Bernie Brucker’s work with neuromuscular re-education for spinal cord injury are cases in point. Remarkably, these fared no better over some decades in forcing a re-appraisal of selfregulation-based modalities. Brucker’s operation was an insular one even within the mainstream medical setting in which it was situated. The response of the biofeedback community was to accommodate itself to the shrinking turf that was allotted, and to acquiesce to the judgment of the scientific community at large that the basic scientific issues had indicative of psychogenic dissociation. ...continue reading --->
represent a remedy for some of their most significant cash drains.
I begin with the assumption that the barriers to our practical progress lie at the conceptual level. The sixties witnessed the startling early findings in the conditioning of autonomic function in animals by Neil Miller’s group, the conditioning of motor excitability by John Basmajian and Barry Sterman, and the induction of certain mental states through reinforcement on EEGparameters by Joe Kamiya. In that same timeframe, the conditioning of autonomic responding happened to be the topic at a medical conference, where the concept was dismissed as fanciful. The contrary evidence of the yogis of India putting their physiology under voluntary control was apparently brushed aside as merely anecdotal. With the data becoming solid, however, in other quarters in the US, there should have been a crisis moment where the conflict between the standard model and the data was confronted and resolved. That never happened.
Instead, what appears to have occurred over time is a kind of domestication of biofeedback in which its claims were trivialized as mere “relaxation training.” Whatever was going on could be quarantined to the psychological realm and thenceforth safely disregarded. Biofeedback did not speak to the medical enterprise. It was adjunctive and peripheral in all senses of the word. As such, it was tossed into the bin with the multi-headed hydra of the placebo, out of which morass one can never quite emerge with finality.
There were of course applications of biofeedback in which a placebo model could not cloud the waters as readily. Pelvic floor biofeedback and Bernie Brucker’s work with neuromuscular re-education for spinal cord injury are cases in point. Remarkably, these fared no better over some decades in forcing a re-appraisal of selfregulation-based modalities. Brucker’s operation was an insular one even within the mainstream medical setting in which it was situated. The response of the biofeedback community was to accommodate itself to the shrinking turf that was allotted, and to acquiesce to the judgment of the scientific community at large that the basic scientific issues had indicative of psychogenic dissociation. ...continue reading --->
