The Clinical Handbook of Biofeedback

A practical guide to the clinical use of biofeedback, integrating powerful mindfulness techniques.

• A definitive desk reference for the use of peripheral biofeedback techniques in psychotherapeutic settings, backed by a wealth of clinical research
• Introduces mindfulness and acceptance techniques and shows how these methods can be incorporated into biofeedback practice
• Step-by-step instructions provide everything a clinician needs to integrate biofeedback and mindfulness including protocols, exemplar logs for tracking symptoms, and sample scripts for mindfulness exercises
• Includes scientifically robust treatment protocols for a range of common problems including headaches, hypertension and chronic pain

List of Figures vii

List of Tables ix

Acknowledgments xi

Introduction xiii

Part I Foundations 1

1 Mindfulness and Acceptance Approach to Biofeedback 1

2 General Issues in Biofeedback 24

3 Biofeedback Equipment 29

Part II Assessment 33

4 Initial Evaluation 33

5 Psychophysiological Stress Profile 37

6 Psychophysiological Relaxation Profile 47

7 Evidence-Based Treatment Planning 57

Part III Biofeedback Modalities 67

8 Breathing 67

9 Heart Rate Variability 97

10 Surface Electromyography 118

11 Temperature 157

12 Skin Conductance 165

Part IV Biofeedback Application 172

13 Anxiety 172

14 Asthma 196

15 Migraine Headaches 204

16 Tension-Type Headache 215

17 Essential Hypertension 224

18 Irritable Bowel Syndrome 234

19 Raynaud’s Phenomenon 242

20 Temporomandibular Joint Disorders 250

21 Chronic Low Back Pain and Other Chronic Pain Disorders 261

22 Emerging Directions 276

Appendix I Meditation Scripts 285

Appendix II Client Logs 300

Index 326

Inna Khazan is a Clinical Instructor of Psychology at Harvard Medical School, USA, where she teaches biofeedback. A clinical psychologist specializing in health psychology and biofeedback, Dr. Khazan also maintains a private practice in Boston, working with clients presenting with various psychophysiological disorders, using both biofeedback and mindfulness-based approaches to psychotherapy.

This practical handbook guides clinicians step by step through the processes of applying biofeedback in a clinical setting, providing proven and effective methodologies for those new to the technique as well as offering established practitioners a means of enriching their work and improving patient outcomes. Integrating powerful mindfulness approaches into biofeedback practice, the book’s clearly defined sections cover core aspects of the peripheral biofeedback method, now widely recognized as one of the most scientifically robust applications of psychophysiology and behavior therapy.

Beginning with a clear and authoritative introduction to mindfulness and acceptance, the author describes proven and effective ways of integrating these approaches with biofeedback, as well as dealing with general aspects such as instrumentation. She moves on to protocols on assessment, providing step-by-step instructions and guidelines on interpretation. Next is detailed coverage of five peripheral biofeedback modalities including heart rate variability, surface electromyography, and temperature. Finally, a section on psychophysiological disorders brings the material and approach together across a range of conditions for which biofeedback has been shown to work as an efficacious treatment option, including sample scripts for use with patients.

Dr. Khazan has done a masterful job of taking the essence of biofeedback protocols and presenting them in a clear, understandable manner. She captures most of the current practice and techniques in applied psychophysiology/biofeedback.—Professor Richard Gevirtz, Distinguished Professor of Psychology, CSPP @ Alliant International University

This masterful book belongs on the desk of every clinician and educator interested in biofeedback. It is the only book that takes biofeedback beyond learning how to attach the sensors to how to do clinical treatment/training. It offers a structured approach to optimize clinical success and is filled with pragmatic clinical instructions and pearls of wisdom which will significantly improve clients’ outcome. It is the much awaited clinical teaching manual that complements our own book, Biofeedback Mastery- An Experiential Teaching and Self-Training Manual.—Professor Erik Peper, San Francisco State University.

This book has it all! It a remarkably comprehensive, clearly-written, practical guide to all the ins and outs of biofeedback. If you were ever curious exactly what we mean by overbreathing or heart rate variability, what specifically to ask in a biofeedback evaluation, how to treat irritable bowel or migraine headache, or exactly where to place electromyography sensors, this is the sourcebook you’ve been waiting for. Dr. Khazan has done the work for us. A unique contribution is the mindfulness perspective which helps clients to release self-judgment and the struggle to control their symptoms that undermines treatment and leads to many psychophysiological disorders in the first place. I highly recommend this insightful book for students of both biofeedback and mindfulness-based therapies, and for seasoned clinicians who wish to stay at the cutting-edge of their craft.—Professor Christopher Germer, PhD, Clinical Instructor, Harvard Medical School