Dan Chartier, Ph.D.Dan Chartier, Ph.D.Licensed PsychologistLicensed Psychologist

Certified BiofeedbackCertified Biofeedback and and NeurofeedbackNeurofeedback ProviderProviderQ.E.E.G. Q.E.E.G. DiplomateDiplomate

©©Dan Chartier, Ph.D. Life Quality Resources, Raleigh, NCDan Chartier, Ph.D. Life Quality Resources, Raleigh, NCwww.lifequalityresources.orgwww.lifequalityresources.org

AN INTRODUCTION TO THE AN INTRODUCTION TO THE SCIENCE OF BIOFEEDBACK SCIENCE OF BIOFEEDBACK AND THE ART OF SELFAND THE ART OF SELF--REGULATIONREGULATION

APA REQUIRED STATEMENTAPA REQUIRED STATEMENT

"Materials that are included in this course may "Materials that are included in this course may include interventions and modalities that are include interventions and modalities that are beyond the authorized practice of mental health beyond the authorized practice of mental health professionals.professionals. As a licensed professional, you As a licensed professional, you are responsible for reviewing the scope of are responsible for reviewing the scope of practice, including activities that are defined in practice, including activities that are defined in law as beyond the boundaries of practice in law as beyond the boundaries of practice in accordance with and in compliance with your accordance with and in compliance with your professions standards."professions standards."

Who am I? How did I get here?Who am I? How did I get here?

•• Undergrad UNCUndergrad UNC--CH CH –– Lab assistant for Lab assistant for FogleFogle Clark Clark –– NASANASA

•• Rats, pigeons, squirrel monkeysRats, pigeons, squirrel monkeys

•• Masters degree UNC Masters degree UNC –– Raja YogaRaja Yoga

•• Ph.D. NCSU Ph.D. NCSU –– First experience with BFB,First experience with BFB,last elective courses in biolast elective courses in bio--electronics.electronics.

Learning to do this workLearning to do this work

•• 1983 1983 –– Starting private practiceStarting private practice–– PsychotherapistPsychotherapist–– Biofeedback practitionerBiofeedback practitioner

•• PsychophysiologicPsychophysiologic TherapyTherapyMy patients/clients taught me the mostMy patients/clients taught me the mostimportant things I would like to share with you.important things I would like to share with you.

OBJECTIVESOBJECTIVES

Upon successful completion of this Upon successful completion of this workshopworkshop

Participants will:Participants will:•• Understand what BFB is and is not.Understand what BFB is and is not.•• Acquire knowledge re: the history and Acquire knowledge re: the history and

science of BFB.science of BFB.•• Describe the 5 most common forms of Describe the 5 most common forms of

biofeedback training used in clinical biofeedback training used in clinical practice practice

OBJECTIVES (2)OBJECTIVES (2)

•• Understand applications/indications for Understand applications/indications for BFB BFB –– evidence based practice.evidence based practice.

•• Indentify contraindications for biofeedback Indentify contraindications for biofeedback training.training.

•• List the elements of a comprehensive List the elements of a comprehensive initial intake evaluation in preparation for initial intake evaluation in preparation for a course of BFT. a course of BFT.

OBJECTIVES (3)OBJECTIVES (3)

•• Describe the steps Describe the steps –– expectations for expectations for normal progress in BFT. normal progress in BFT.

•• Explore methods for managing/resolving Explore methods for managing/resolving emotional reactions that can occur during emotional reactions that can occur during BFBBFB--SRT.SRT.

•• Provide examples of ethical considerations Provide examples of ethical considerations in the practice of BFBin the practice of BFB--SRT.SRT.

OBJECTIVES (4)OBJECTIVES (4)

•• Discuss interesting clinical variants in BFBDiscuss interesting clinical variants in BFB--SRT SRT

•• Identify elements of case presentation Identify elements of case presentation ––grand roundsgrand rounds

•• Locate Sources and Resources: training Locate Sources and Resources: training and equipment for BFBand equipment for BFB--SRTSRT

•• Describe practice organization models. Describe practice organization models. •• OTHER???OTHER???

BIOFEEDBACKBIOFEEDBACK

•• A training process in which a subjectA training process in which a subject’’s s biological activity is monitored by some biological activity is monitored by some type of device/instrument andtype of device/instrument and……

•• The information from that monitoring is The information from that monitoring is made available to the subject in some made available to the subject in some understandable form such as a changing understandable form such as a changing sound, visual display or physical sensation.sound, visual display or physical sensation.

Historical Diagram of BFBHistorical Diagram of BFB

Simple Diagram of BFBSimple Diagram of BFB

Instrument Measuring a Instrument Measuring a Bio(logicalBio(logical) Signal and ) Signal and Presenting RepresentationPresenting Representation--Feedback of that Signal Feedback of that Signal

BIOFEEDBACK IS NOT:BIOFEEDBACK IS NOT:

•• Invasive Invasive –– imposed controlimposed control•• Guided Imagery*Guided Imagery*•• Listening to Relaxing Music*Listening to Relaxing Music*•• Hypnosis or SelfHypnosis or Self--Hypnosis*Hypnosis*•• Meditation*Meditation*

**May be used as adjunctive methods during BFB May be used as adjunctive methods during BFB –– SR training.SR training.

BIOFEEDBACK IS:BIOFEEDBACK IS:

Grounded in the Science: The Law ofGrounded in the Science: The Law ofOperant Conditioning: Operant Conditioning:

When a behavior (operant) is followed by a When a behavior (operant) is followed by a stimulus there will be an increase in the stimulus there will be an increase in the frequency of occurrence of that behavior.frequency of occurrence of that behavior.

BFB History: Convergence of Medical BFB History: Convergence of Medical Technology and Space ExplorationTechnology and Space Exploration

•• Development of medical monitoring Development of medical monitoring equipment: HR, BP equipment: HR, BP –– bored hospital bored hospital patients learning they could alter/exert patients learning they could alter/exert control over basic biological functions.control over basic biological functions.

•• NASANASA’’s need to monitor physical function s need to monitor physical function of animals then humans being sent into of animals then humans being sent into space.space.

StermanSterman’’ss Cats: UCLA Cats: UCLA –– NASA NASA

BIOFEEDBACK is used to facilitate: BIOFEEDBACK is used to facilitate: SELF SELF --REGULATIONREGULATION

•• Biofeedback (and Biofeedback (and NeurofeedbackNeurofeedback) provide ) provide technology and information to facilitatetechnology and information to facilitate……

•• SELFSELF--REGULATION: Volitional control or REGULATION: Volitional control or influence of some biological activity.influence of some biological activity.

•• The patient becomes an ACTIVE The patient becomes an ACTIVE PARTICIPANT in directed selfPARTICIPANT in directed self--care.care.

BFB: Complex and SimpleBFB: Complex and Simple

THE CHALLENGE of BFBTHE CHALLENGE of BFB

NEUROFEEDBACKNEUROFEEDBACK

•• A.K.A. EEG biofeedback.A.K.A. EEG biofeedback.

•• Sensors are placed on the scalp (or elsewhere) Sensors are placed on the scalp (or elsewhere) to pick up EEG/Brainwave activity.to pick up EEG/Brainwave activity.

•• Auditory and/or visual feedback assists the Auditory and/or visual feedback assists the individual in learning to alter brainwave individual in learning to alter brainwave components: dominant frequency, amplitude, components: dominant frequency, amplitude, coherence, ratio etc.coherence, ratio etc.

Feedback Leads to Learning Feedback Leads to Learning –– Skill Skill AcquisitionAcquisition

““Learning CurvesLearning Curves”” from Operant Conditioningfrom Operant Conditioning

Why Feedback Works to Change BehaviorWhy Feedback Works to Change BehaviorGary Lynch, Ph.D. Gary Lynch, Ph.D. –– UC IrvineUC Irvine

RE: Rats running maze RE: Rats running maze -- cued by scent for correct path.cued by scent for correct path.

““Our studies sought to use rat brain networks that includeOur studies sought to use rat brain networks that includethese same areas and to find behavioral tasks that samplethese same areas and to find behavioral tasks that samplememory systems which correspond to those described for memory systems which correspond to those described for humans. These constraints led our search to the littlehumans. These constraints led our search to the little--studied olfactory system in the rat brain. Thus far we havestudied olfactory system in the rat brain. Thus far we havefound that the relevant circuitries in rat brains bear afound that the relevant circuitries in rat brains bear asurprising resemblance to networks designed by theoristssurprising resemblance to networks designed by theoristsin the computer sciences to accomplish humanin the computer sciences to accomplish human--like like recognition and associative memory.recognition and associative memory.””

Neurons that fire together Neurons that fire together --

WIRE TOGETHER!WIRE TOGETHER!

QEEG QEEG

An illustration of data driven An illustration of data driven assessment and treatment assessment and treatment planning planning –– for doing BFB/NFBfor doing BFB/NFB

QEEG ASSESSMENTQEEG ASSESSMENT

•• MultiMulti--channel EEG data collection.channel EEG data collection.

•• Digital storage of EEG data.Digital storage of EEG data.

•• Quantitative analysis of stored data.Quantitative analysis of stored data.

•• Normative and Normative and discriminantdiscriminant database database comparison.comparison.

STARTING WITH EEG RECORDSSTARTING WITH EEG RECORDS

Quantitative Analysis of the EEG data Quantitative Analysis of the EEG data --QEEGQEEG

Example of Topographic AnalysisExample of Topographic AnalysisData on the leftData on the left------------------------Statistical Comparison (zStatistical Comparison (z--score) onscore) on rightright

Two general forms of Two general forms of assessmentassessment

TopometricTopometric AnalysisAnalysis

TREATMENT MAMAGEMENTTREATMENT MAMAGEMENT

Getting Well Getting Well or at least or at least

BetterBetter

From first contact to endFrom first contact to end--ofof--training training ––managing the expectations of a managing the expectations of a patient/clientpatient/client..•• Openness and clarity re goals Openness and clarity re goals ––

expectationsexpectations•• Referral Referral –– records records ––diagnostic workupdiagnostic workup•• Scope of practice Scope of practice •• Treatment team communication Treatment team communication •• Steps / training phase expectations Steps / training phase expectations •• ““GraduationGraduation”” criteria criteria •• Home practice Home practice –– follow up follow up

The essence of assessmentThe essence of assessment

•• What is the presenting symptom, concern, What is the presenting symptom, concern, goal?goal?

•• How long?How long?•• Demographic details Demographic details •• Prior DX assessments, evaluationsPrior DX assessments, evaluations•• MedicationsMedications•• Previous TX, What helps, What hurts?Previous TX, What helps, What hurts?

Assessment (2)Assessment (2)

•• Life style assessment Life style assessment –– DietDiet–– SleepSleep–– ExerciseExercise–– Stress management (+ and Stress management (+ and --))–– Leisure time useLeisure time use–– Support systemSupport system

Matching symptom/goal to Matching symptom/goal to equipment/protocol optionsequipment/protocol options

•• peripheral temperatureperipheral temperature•• sEMGsEMG•• electroelectro--dermal response/GSRdermal response/GSR•• Heart Rate Variability Heart Rate Variability •• EEGEEG--neurofeedbackneurofeedback•• Cranial blood flow Cranial blood flow

InIn--office protocols for office protocols for psychophysiologicpsychophysiologic selfself--regulation regulation

•• IntentionIntention•• AwarenessAwareness•• ““AwherenessAwhereness””•• Influence of responseInfluence of response•• PracticePractice•• MasteryMastery

Adjunctive methods Adjunctive methods –– supportsupport

•• EFTEFT•• EMD/REMD/R•• NETNET•• DBTDBT•• PSYCHPSYCH--KK•• Metaphoric Metaphoric ((David Grove – Resolving Traumatic Memories)

•• MeditationMeditation

Concluding treatment/training Concluding treatment/training

•• Home training Home training •• Graduation criteriaGraduation criteria•• Managing flareManaging flare--upsups•• FollowFollow--up TXup TX•• Referral??Referral??

Standards of record keeping Standards of record keeping

•• Keep general demographic records and Keep general demographic records and treatment specific session notes such that treatment specific session notes such that any other BFB practitioner could take over any other BFB practitioner could take over treatment and would know exactly what to treatment and would know exactly what to do in a next session re: which protocol, do in a next session re: which protocol, what modality, where to place sensors, what modality, where to place sensors, what thresholds, etc.what thresholds, etc.

•• Notes re client comments, strategies etc.Notes re client comments, strategies etc.

CASE PRESENTATIONCASE PRESENTATION

ANOXIC BRAIN INJURYANOXIC BRAIN INJURY

Chip R. Anoxic Brain InjuryChip R. Anoxic Brain Injury

•• PremorbidPremorbid history of ADHDhistory of ADHD•• Early childhood history of ODD.Early childhood history of ODD.•• DesipramineDesipramine Toxicity resulting in..Toxicity resulting in..•• Cardiac Arrest at age 7.5Cardiac Arrest at age 7.5•• Hypoxic for Hypoxic for appproxappprox. 25 min.. 25 min.•• Resulting in severe CNS damage/disabilityResulting in severe CNS damage/disability

Chip R. EO Pre Chip R. EO Pre –– Post Topographic analysis:Post Topographic analysis:From a very abnormal brain (red) to normal (blue)From a very abnormal brain (red) to normal (blue)

ChipChip’’s Treatment Outcomess Treatment Outcomes

•• Graduated from high schoolGraduated from high school•• Got his driverGot his driver’’s licenses license•• Able to workAble to work•• Successful relationshipsSuccessful relationships•• Some impairments Some impairments –– but generally a but generally a

normal life. normal life.

Biofeedback is a mindBiofeedback is a mind--body therapy using electronic instruments to body therapy using electronic instruments to help individuals gain awareness and control over help individuals gain awareness and control over psychophysiologicalpsychophysiological processes (Gilbert & Moss, 2003; Moss, 2001; processes (Gilbert & Moss, 2003; Moss, 2001; Schwartz & Schwartz & AndrasikAndrasik, 2003). , 2003).

Biofeedback instruments measure Biofeedback instruments measure muscle activity, skin muscle activity, skin temperature, temperature, electrodermalelectrodermal activity, respiration, activity, respiration, heart rate, heart rate variability, blood pressure, heart rate, heart rate variability, blood pressure, brain electrical activity, and brain blood flow. brain electrical activity, and brain blood flow.

Research shows that biofeedback, alone and in combination with Research shows that biofeedback, alone and in combination with other behavioral therapies, is effective for treating a variety other behavioral therapies, is effective for treating a variety of of medical and psychological disorders, ranging including headache,medical and psychological disorders, ranging including headache,hypertension, hypertension, temporotemporo--mandibularmandibular pain, and pain, and attentionalattentional disorders disorders (ADD/ADHD).(ADD/ADHD).

NeurofeedbackNeurofeedback is a specialty field within biofeedback, which is a specialty field within biofeedback, which devotes itself to training control over electrodevotes itself to training control over electro--chemical processes in chemical processes in the human brain (the human brain (LaVaqueLaVaque, 2003; Evans & , 2003; Evans & AbarbanelAbarbanel, 1999). , 1999). Assessment uses a baseline EEG, and sometimes a multiAssessment uses a baseline EEG, and sometimes a multi-- site site quantitative EEG (QEEG), to identify abnormal patterns (quantitative EEG (QEEG), to identify abnormal patterns (LaVaqueLaVaque, , 2003). Many neurological and medical disorders are accompanied 2003). Many neurological and medical disorders are accompanied by abnormal patterns of cortical activity.by abnormal patterns of cortical activity.NeurofeedbackNeurofeedback uses a feedback electroencephalogram (EEG) to uses a feedback electroencephalogram (EEG) to show the trainee current electrical patterns in his or her corteshow the trainee current electrical patterns in his or her cortex. x. Clinical training with feedback EEG then enables the individual Clinical training with feedback EEG then enables the individual to to modify those patterns, normalizing or optimizing brain activity.modify those patterns, normalizing or optimizing brain activity.NeurofeedbackNeurofeedback practice is growing rapidly, with the widest practice is growing rapidly, with the widest acceptance for applications to acceptance for applications to attention deficit hyperactivity attention deficit hyperactivity disorder (ADHD), learning disabilities, seizures, depression, disorder (ADHD), learning disabilities, seizures, depression, acquired brain injuries, substance abuse, and anxietyacquired brain injuries, substance abuse, and anxiety(Clinical EEG, 2000).(Clinical EEG, 2000).

Biofeedback and Biofeedback and NeurofeedbackNeurofeedbackEfficacyEfficacy

•• Level 5: Efficacious and specific:Level 5: Efficacious and specific:

•• Level 4: Efficacious:Level 4: Efficacious:

•• Level 3: Probably Efficacious:Level 3: Probably Efficacious:

•• Level 2: Possibly Efficacious:Level 2: Possibly Efficacious:

•• Level 1: Not empirically supported:Level 1: Not empirically supported:

Level 5 Efficacious and SpecificLevel 5 Efficacious and Specific

The investigational treatment has been The investigational treatment has been shown to be statistically superior to credible shown to be statistically superior to credible sham therapy, pill, or alternative bona fide sham therapy, pill, or alternative bona fide treatment in at least two independent treatment in at least two independent research settings.research settings.

Urinary Incontinence in FemalesUrinary Incontinence in Females

Level 4: EfficaciousLevel 4: Efficacious::

In a comparison with a noIn a comparison with a no--treatment control treatment control group, alternative treatment group, or sham group, alternative treatment group, or sham (placebo) control utilizing randomized (placebo) control utilizing randomized assignment, the investigational treatment is assignment, the investigational treatment is shown to be statistically significantly superior to shown to be statistically significantly superior to the control condition or the investigational the control condition or the investigational treatment is equivalent to a treatment of treatment is equivalent to a treatment of established efficacy in a study with sufficient established efficacy in a study with sufficient power to detect moderate differences. The power to detect moderate differences. The superiority or equivalence of the investigational superiority or equivalence of the investigational treatment has been shown in at least two treatment has been shown in at least two independent research settingsindependent research settings

Level 4: Efficacious:Level 4: Efficacious:Conditions Treated:Conditions Treated:•• AnxietyAnxiety•• Attention Deficit (ADD) & Hyperactivity Attention Deficit (ADD) & Hyperactivity

(ADHD) Disorder(ADHD) Disorder•• Headache Headache –– AdultAdult•• HypertensionHypertension•• TemporomandibularTemporomandibular Disorders (TMD)Disorders (TMD)•• Urinary Incontinence in MalesUrinary Incontinence in Males

Level 3: Probably Level 3: Probably Efficacious:Efficacious:Multiple observational studies, clinical studies, wait Multiple observational studies, clinical studies, wait list controlled studies, and within subject and intralist controlled studies, and within subject and intra--subject replication studies that demonstrate subject replication studies that demonstrate efficacyefficacy. .

Alcoholism/Substance Abuse, Arthritis, Alcoholism/Substance Abuse, Arthritis, Chronic Pain, EpilepsyChronic Pain, EpilepsyFecal Elimination Disorders, InsomniaFecal Elimination Disorders, InsomniaPediatric Migraine HA, Pediatric Migraine HA, Traumatic Brain Injury, Traumatic Brain Injury,

Level 2: Possibly Level 2: Possibly Efficacious:Efficacious:

At least one study of sufficient statistical At least one study of sufficient statistical power with well identified outcome power with well identified outcome measures, but lacking randomized measures, but lacking randomized assignment to a control condition internal to assignment to a control condition internal to the study.the study.••AsthmaAsthma••Cancer and HIV, Effect on Immune FunctionCancer and HIV, Effect on Immune Function••Cerebral PalsyCerebral Palsy

Level 2: Possibly Level 2: Possibly Efficacious:Efficacious:ContinuedContinued•• Chronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease•• Cystic FibrosisCystic Fibrosis•• Depressive disordersDepressive disorders•• Diabetes MellitusDiabetes Mellitus•• FibromyalgiaFibromyalgia•• Foot UlcersFoot Ulcers•• Hand Hand DystoniaDystonia

Level 2: Possibly Level 2: Possibly Efficacious:Efficacious:ContinuedContinued•• Irritable Bowel Irritable Bowel

SyndromeSyndrome•• Mechanical Ventilation Mechanical Ventilation

(weaning)(weaning)•• Motion SicknessMotion Sickness•• Myocardial InfarctionMyocardial Infarction•• PostPost--Traumatic Stress Traumatic Stress

DisorderDisorder

•• RaynaudRaynaud’’ss DiseaseDisease•• Repetitive Strain Repetitive Strain

InjuryInjury•• StrokeStroke•• TinnitusTinnitus•• Urinary Incontinence Urinary Incontinence

in Childrenin Children

Level 1: Not empirically Level 1: Not empirically supported:supported:

Supported only by anecdotal reports and/or Supported only by anecdotal reports and/or case studies in noncase studies in non--peer reviewed venues.peer reviewed venues.

••AutismAutism••Eating DisordersEating Disorders••Multiple SclerosisMultiple Sclerosis••Spinal Cord InjurySpinal Cord Injury

HOW CAN BFB HOW CAN BFB –– NFB BE HELPFUL IN NFB BE HELPFUL IN TREATING SO MANY CONDITIONS????TREATING SO MANY CONDITIONS????

•• The amazing healing capacity of the The amazing healing capacity of the human body and mind and,human body and mind and,

•• The significant power in the Law of The significant power in the Law of Operant Conditioning.Operant Conditioning.

•• These two factors make it possible for These two factors make it possible for patients to directly participate in patients to directly participate in recovering health and developing recovering health and developing WELLBEING.WELLBEING.

Ethical considerations in the Ethical considerations in the practice of BFBpractice of BFB--SRT SRT

•• Informed consent Informed consent ––formal and informal.formal and informal.•• Scope of practice Scope of practice –– clinical training and clinical training and

expertise.expertise.•• Appropriate referral (medication?)Appropriate referral (medication?)•• Dual Relationships Dual Relationships –– NOT!NOT!•• ConfidentialityConfidentiality•• Duty to InformDuty to Inform

Practice Practice -- Organization Models Organization Models

•• Collaboration v. soloCollaboration v. solo•• Medical officeMedical office•• Psychiatric practicePsychiatric practice•• Education support (test anxiety, focus, Education support (test anxiety, focus,

attentionattention……..•• Physical Therapy practicePhysical Therapy practice•• Sports facilitySports facility

PEAK PERFORMANCE TRAININGPEAK PERFORMANCE TRAINING

•• 15 subjects 15 subjects -- 3 skill levels3 skill levels•• NFB Training NFB Training –– 20 sessions20 sessions•• ““Perfect PerformancePerfect Performance”” scriptsscripts•• Average of 7.6 stroke reduction Average of 7.6 stroke reduction -- post trainingpost training•• Improved psychological Improved psychological –– emotional function.emotional function.

A Glimpse of the FutureA Glimpse of the Future

Biofeedback Biofeedback –– NeurofeedbackNeurofeedbackviavia

Smartphone appsSmartphone apps

Pip Pip –– GSR appGSR app

Pip GSRPip GSR

Frontiers in PsycholFrontiers in Psychology. 2016; 7: 832. Published online 2016 Jun 17.ogy. 2016; 7: 832. Published online 2016 Jun 17.

Smartphone Applications Utilizing Smartphone Applications Utilizing Biofeedback Can Aid Stress Biofeedback Can Aid Stress ReductionReduction

•• Alison DillonAlison Dillon,, Mark KellyMark Kelly,, Ian H. Ian H. RobertsonRobertson, and, and Deirdre A. RobertsonDeirdre A. Robertson

NeuroskyNeurosky--------------------------------MUSEMUSE

HeartMathHeartMath Inner Balance Inner Balance LumoLumo Lift Posture TrainerLift Posture Trainer

VERSUS EMOTIVVERSUS EMOTIV

““Resistance is futile: you will be assimilatedResistance is futile: you will be assimilated””

NeuroPlusNeuroPlus –– Durham, NCDurham, NC

BioZenBioZen continued:continued:

Information About Biofeedback, QEEG and Information About Biofeedback, QEEG and NeurofeedbackNeurofeedback

•• Websites:Websites:–– AAPB.orgAAPB.org --Association for Applied Association for Applied

Psychophysiology & BiofeedbackPsychophysiology & Biofeedback

–– ISNR.orgISNR.org -- International Society for International Society for NeurofeedbackNeurofeedback and Researchand Research

–– BFE.orgBFE.org –– Biofeedback Federation of EuropeBiofeedback Federation of Europe

READINGREADING

•• Erik Erik PeperPeper, , HanaHana TylovaTylova et.alet.al. . Biofeedback Mastery: An Experiential Biofeedback Mastery: An Experiential Teaching and Self Training Manual. Teaching and Self Training Manual. A.A.P.B.,2008A.A.P.B.,2008

•• Richard Richard SoutarSoutar, Robert Longo. , Robert Longo. Doing Doing NeurofeedbackNeurofeedback: an Introduction. : an Introduction. ISNR Research Foundation. 2011ISNR Research Foundation. 2011

Good Introductory ReadsGood Introductory Reads

Continuing Education and Continuing Education and SupervisionSupervision

•• Adjunctive therapies Adjunctive therapies –– modalitiesmodalities•• SelfSelf--training training •• Supervision Supervision -- mentoringmentoring•• ListList--serve, forums, webinarsserve, forums, webinars•• Annual ConferencesAnnual Conferences•• WorkshopsWorkshops

Professional CertificationProfessional Certification

•• Biofeedback Certification International Biofeedback Certification International Alliance Alliance –– Biofeedback and Biofeedback and NeurofeedbackNeurofeedbackbcia.orbcia.orgg

•• QEEG Certification BoardQEEG Certification Boardqeegcertificationboard.orgqeegcertificationboard.org

Hardware and Software Hardware and Software ConsiderationsConsiderations

•• Thought TechnologyThought Technology•• StensStens•• BrainMasterBrainMaster•• HeartMathHeartMath•• BioMedicalBioMedical InstrumentsInstruments

•• DemonstrationsDemonstrations……....

DISCUSSIONDISCUSSION

------questions???questions???