How Emory University Counseling and Psychological Services’ Dana Wyner uses biofeedback

We are often asked by counselors in counseling programs how they can incorporate biofeedback in to their counseling programs.  Helping students cope with stress and offering an avenue for counseling services is a very valuable commodity to any university and its student body. Dr Wyner and Emory University have an excellent counseling program at Emory and asked her Emorys’ model This is from the desk of Dr Wyner:

This is the core of the letter that I send to counseling center psychologists who ask me how we run our program…

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Emory University Student Counseling Program Helping Students Cope with Stress

Great article about the student counseling program at Emory University. See the full story below.

“As the calm and collected overseer of Eagles at Ease Stress Management Services, Dana Wyner ’04 PhD encourages her clients to take a mental mini holiday, go limp like JELL-O and feel snug as a bug in a rug.

Those practical lessons for relaxation on the go are particularly helpful during exam time, when nerves are frayed and performance anxieties go into overdrive.

The Student Counseling Center Stress Clinic, funded by Emory’s new mental health fee, sees more than 30 students each semester for issues such as test-taking anxiety, phobias, insomnia, difficulty concentrating, headaches and hypertension. Services include helping students develop a personalized toolbox of positive coping strategies, small group training in relaxation skills and biofeedback, and individualized therapy sessions.”

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What is BCIA? Why is BCIA Certification Important?

What Is the Role of the Biofeedback Certification International Alliance (BCIA)?

BCIA serves as the certification body for the clinical practice of biofeedback and neurofeedback, including Pelvic Floor Muscle Dysfunction Biofeedback. BCIA serves as the standard bearer for the fields of biofeedback and neurofeedback.  The BCIA mission statement is quite simple:

            BCIA certifies individuals who meet education and training standards in

            biofeedback and neurofeedback, and progressively recertifies those who

            advance their knowledge through continuing education.

 It is apparent from this mission statement that education and training should be the main focus for BCIA– and they are!  Where does the educational process start?

It all starts with the blueprints of knowledge.  BCIA’s Board of Directors has spent countless hours reviewing the science and the literature on biofeedback, neurofeedback, and self-regulation to ensure that the three blueprints carefully outline the fundamental science, history, and theory of the modalities and thus set templates for what every beginning clinician needs to know.  As the science and clinical efficacy literature have evolved, we have revised the blueprints to keep pace and to truly represent current best practice.

BCIA can only add information to our blueprints when efficacy has been scientifically established. We recommend that you read LaVaque and colleagues’ (2002) informative “Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological evaluations.” Additionally, the BCIA blueprints must be free of commercial bias. Once beginners can understand the accepted fundamental science, the same science as others who are certified, they are better able to review the field and make a good decision about various theories or equipment choices.

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Biofeedback in Sports

Biofeedback training has been widely recognized as an excellent way to promote a relaxed state for many sports applications. Many studies have been done on using biofeedback as a method of relaxation and to increase performance.

Athletes should ask themselves “Can I perform better in a relaxed state?” If it is the bottom of the ninth, with the bases loaded, the athlete needs to be able to clear their mind and focus on the performance. Anxiety and high stress can cause many athletes to “choke” in clutch situations. By learning to alter their mental and physiological state with a few simple relaxation techniques they tend to perform better. Biofeedback devices are great tools in achieving these results.

There have been several Olympic athletes, NHL hockey teams, professional football teams, golfers and more, that have credited biofeedback training as a factor in their success.

In a recent chat with Thought Technology Vice President Lawrence Klein, he could not resist the opportunity to discuss the many uses of his company’s biofeedback and neurofeedback equipment. Mr. Klein said, “We have a strong presence in professional and elite sports.” Thought Technology’s equipment has been used by a number of leading Olympic Sport Coaches and several professional sports teams.

Some teams have even set up mental training centers where trainers monitor the brainwaves and other physical functions such as surface EMG, temperature, GSR, heart rate, and respiration. This helps the players learn to reduce performance anxiety and improve their ability to focus under stress – giving them the “mental edge” they need to win.

There are devices like the Resperate, that promote meditative breathing patterns and very simple to use items such as the GSR2, that measures minute changes in skin conductance or resistance and conveys the stress level by an audio tone. These devices are easy to use and very effective. Organizations and teams have also used more sophisticated systems that measure multiple physiological measurements at once for a picture of the body’s stress level.

More recently there are products being introduced to help speed up reaction time. Reaction time can be crucial in many sporting events and in the Olympics millisecond can be the difference between gold and bronze.

Below are a couple of videos about biofeedback and athletic performance.



The Benefits of Biofeedback

“The Benefits of Biofeedback” by Deborah Katz @ US News & world report. This article about biofeedback and use of biofeedback machines ran in the June 16, 2008 issue.

The Benefits of Biofeedback

It’s gaining ground as a stress-management tool

By Deborah Kotz – Posted June 5, 2008 on US News & World Report

Because she was planning to get pregnant, Janelle (who preferred not to give her last name) decided last year to go off powerful medication for stress-induced migraines in favor of a more fetus-friendly therapy. With sensors attached to her fingertips, neck, and abdomen, she spent 20 sessions learning to relax her muscles and slow her breathing and heart rate while watching a computer monitor for proof of the desired result. Eventually, she was able to do the work on her own. “The migraine pain doesn’t go away completely,” says the 39-year-old from Bethesda, Md., who has remained off medication since her son’s birth two months ago. “But it’s been greatly reduced, and I’m able to deal with it better.”

Like meditation and yoga, the biofeedback method that Janelle now swears by is enjoying a sort of renaissance; while it’s been around for some 40 years, a growing body of research has brought it to the mainstream, indicating that it can relieve some hard-to-manage conditions exacerbated by stress. Many major hospitals and clinics, including Harvard’s Brigham and Women’s Hospital and Duke University Medical Center, now offer biofeedback to people with hypertension and jaw pain as well as headaches, for example. And new pocket-size gadgets have hit the market that let you do it yourself.

Biofeedback’s major appeal is that one series of sessions purportedly teaches a set of skills you can use for life—without side effects. And it’s pre-emptive. “Biofeedback teaches you to identify early signs that stress is starting to get to you and to bring that stress reaction down before it causes physical symptoms,” explains Frank Andrasik, a professor of psychology at the University of West Florida in Pensacola who serves as editor-in-chief of the journal Applied Psychophysiology and Biofeedback.

To read the full article click here

Temperature Biofeedback – Hand Warming Explanation

Hand warming is one of the many different methods used in Biofeedback training. At this point it may be useful to specify exactly what Biofeedback is and is not. The first incorrect idea about Biofeedback is that Biofeedback instruments actually change or influence bodily processes. This belief is incorrect. Biofeedback equipment merely monitors or measures bodily functions. The instrument “feeds back” information to you, so you become aware of small changes in your body, and the factors that bring about these changes. Through this, an awareness develops, that makes it possible to control your physiological functions.

Stress Thermometer $21.95

Biofeedback training, and hand-warming in particular, have been shown to have a beneficial effect for those who suffer from migraine headaches, high blood pressure, insomnia, pain, stress, digestive disorders, and many, many other ailments.

Biofeedback training does not require the use of drugs or surgery to alter the body, but teaches your body to alter itself. Once a biofeedback skill has been acquired, the patient usually then has no need for further use of training equipment, and may use feedback only to occasionally tune or validate the utilization of their skill.

The basic theory behind hand-warming stems from our understanding of the fight-flight response. The fight-flight response is an automatic change of physiological markers that take place when a person suddenly perceives danger or stress. Blood flow is significantly decreased in the extremities while being increased to the vital organs of the body. This enables a person to react physically to danger. This physiological change was very favorable and served as an automatic protection device, in primitive society. Although the fight-flight response has been beneficial and necessary for survival, it can also be harmful. If we overuse this natural response by constantly interpreting things as being stressful or dangerous, that really are not, we are chronically sending this response to the body.

The main goal of hand-warming is to assist in measuring our level of stress through skin temperature, and thereby allow us to change our stress level to meet the circumstances. The more stressed a person is, the lower the temperature in the hands, feet, and other extremities. The lower the stress level, the higher the temperature should be in the extremities.

The following hand temperature readings, in a normal office temperature environment, are generally accepted to correspond with these levels of arousal:

Training Recommendations

When measuring hand temperature the following items should be considered:

1.) Attach the probe to the middle finger of your dominant hand.

2.) The probe should be attached to the fleshy underside of your finger.

3.) Always record temperature from the same place of your finger.

4.) Use scotch tape with perforations, or cloth medical tape, so that the finger perspires as little as possible.

5.) Do not adhere the tape too tight, or circulation will be inhibited.

6.) Temperature readings should be taken when the ambient temperature is between 69 – 73° F. (Room Temperature)

7.) Avoid areas where fans, air conditioners, heaters, drafts and breezes are present.

8.) Avoid other contact with warm or cold objects such as drinks or outdoor exposure.

Methods of Producing Relaxation

You now have a basic understanding of hand temperature and what it indicates about your present level of stress. How do we regulate our hand temperature and reduce stress?

There are many different ways to increase your hand temperature. We suggest that you try them all, and find the method that works best for you. The basic idea behind each of these methods is to focus yo9ur consciousness on the experience of being profoundly relaxed.

DEEP BREATHING— This is one of the most common ways used to relax. It has an ancient therapeutic history. It is accomplished by taking deep diaphragmatic breathes and then exhaling for a longer count than the inhalation.

MUSCLE TENSING— This is accomplished through sessions of tensing muscles and then completely relaxing them. It is believed that the relief you experience after tensing your muscle is an analogue of the conscious relaxation process you are trying to learn.

IMAGERY— The relaxation response is activated in this method by having the person think about a very peaceful, warm and calm place, such as lying on your beautiful imaginary beach. It is helpful if the person actually imagines the warmth along with imagining themselves there.

MUSIC— We are just beginning to understand the impact of music. Some people find it quite easy to increase their hand temperature by just sitting in a comfortable chair and listening to appropriate soft music.

AUTOGENIC PHRASES— In this method, positive, present tense statements are said to one’s self. Examples would be: I feel quite relaxed. My hands are beginning to feel warm. My muscles are all loose and comfortable. I can feel the blood running into my hands. My hands feel heavy and warm. This is a very popular method and seems to work for most people.

OPEN FOCUS— On open focus training you try to imagine an interior portion of space in your body. Examples might be: Can you imagine the space between your eyes? Can you imagine that your hands and fingers are filled with space? Each statement is made and then you pause briefly concentrating for about 10 seconds on the specific area.

Once you have discovered a method that works for you, take time once a day to practice your relaxation routine. For maximum benefit, you should be able to reach and maintain a temperature of 95.5 degrees F for five minutes each training session. This simple procedure pays great dividend for your effort.

Temperature Training Procedures

1. Starting hand temperature will vary with room temperature; hand temperature will be colder in a cold room than in a warm room.

2. In a room of normal temperature, when you are neither deeply relaxed nor stressed, starting hand temperature will be in the mild or high 80’s. Finger temperature of 80°F is cool, 75° F is cold, and 70° F or below is very cold; 90° F is warm, and the training goal is 95-96° F for 10 minutes. If your hands are quite cold, temperature may increase very slowly, and only after several minutes of training; If your hands are in the low-mid 80’s temperature may increase rapidly; if your hands are in the low-mid 90’s temperature may increase slowly, with only a few degrees of increase, but at that level, a few degrees is a significant change.

3. When you are beginning temperature training find a comfortable, quiet environment in which to train; later training you will be able to practice and use this skill in any environment.

4. You should use a blanket in a cold room.

5. Make sure that the tape is not too tight.

6. Learning to raise and lower hand temperature is the goal for self-regulation.

7. When training on the dominant hand is mastered, place the thermistor on the non-dominant hand to make sure that the training is generalized.

8. The autogenic training phrases are a guide. You may experiment with other phrases, imagery, body feelings, etc. if your hands and feet are cold, it may be best to focus on feelings of heaviness, not warmth.

9. Relaxation sessions should begin with a few minutes of deep breathing.

10. As with all types of self-regulation, PASSIVE VOLITION is essential.

11. Initial temperature training should be practiced when you are feeling relatively comfortable i.e. not during a headache. When the hand warming/relaxation skill is learned, you will use it for prevention of the symptom, at symptom onset, and during the symptom.


12. Raising temperature in the feet may be more difficult than in the hands; feet tend to be many degrees colder than the hands, especially in the winter. Temperatures of 90 – 93 ° F are excellent in the feet.

13. Place the thermistor on the first or second toe. The foot should be covered with a blanket.

14. Following whole body relaxation, focus primarily on relaxation and heaviness in the lower part of the body.