​In a biofeedback session we measure and record a whole plethora of physiological measures every time you train. As a result you can easily see changes in your physiology. That’s what the whole process of biofeedback hinges on.  You have to be able to accurately see (or hear) yourself. The result of this is that you can look at every one of your sessions as an evaluation. Despite this, it’s still a good idea for you and the therapist to formalise a few of them.
 
So let’s formalise three of them:

1. The initial evaluation (at the beginning of the process)
2. A progress evaluation (about half way through)
3. A discharge evaluation (at the end)

As the number of sessions needed will probably range from 12 to 18 the progress evaluation will probably come be around session 6 or 9.
 
In our case, for the initial evaluation, we use a “Locus of Control” questionnaire, a conversation, a breathing questionnaire, a Psychophysiological Stress Profile (18 min recording using the instruments) and an intake form. It all takes about 2 hours.

• The ‘Locus of Control’ questionnaire allows us and you to see if you feel that incidences in your life are outside your control.
  
• The conversation is informal but allows you tell us what's the most important thing we need to focus on.
  
• The breathing questionnaire allows us to see if you have any of the symptoms that are associated with breating difficulties.
  
• I have spoken about the PSP and what we look at in a previous blog. (It takes about 20-30 mins between getting the instuments attached and measuring).
  
• The ‘intake form’ is just an information gathering tool that we use to get basic information like your name, phone number and address etc. We also ask about previous diagnoses, therapies you have tried before, triggers, surgeries, medications and a few other things.
  

 
The first and last evaluations are similar. The first recorded session gives us a baseline to compare against and the last evaluation should show a change. There may also be a difference in the ‘Locus of Control’ assessment. 

The progress evaluation is a lot more informal.  Rather than just completely rely on data from the instruments it's a session designed for you to assess everything and ask loads of questions. It also falls around the time where we move from an educational format to a more proactive one. You'll start directing the approach we  and be more involved because you will understand what's going on

When we start biofeedback training we usually begin with breathing. It’s often used as an anchor for many other techniques taught by biofeedback therapists/clinical psychophysiologists.
 
There are 2 big matters that we need to look at first.

1. Why is almost everyone in this field (and many others) interested in breathing?
2. I have been to Yoga/meditation/TaiChi/singing lessons/Feldenchrais or something else and learned all about all this diaphragmatic breathing already so why go over it again?

 


To answer the first question: Why breathing? For one really good answer we have to look at a simple diagram of the nervous system.
 
This diagram and others like it are in high school/secondary and basic anatomy and physiology texts all over the world. They help you understand how you’re wired. (The actual length of the wiring or nervous system depends on how you count but I’ve seen figures that range from 45 to 90,000 miles, one way or another it’s huge, try laying 45 miles of electrical wire sometime, never mind 90,000)


​

• Every system in your body is either Voluntary or Involuntary (Somatic/Autonomic to use older and less descriptive though more common terms)
  • For example, your heart is Involuntary (autonomic). Your thigh muscles are governed by your Voluntary (somatic) nervous system. Your Liver, Spleen, Intestines, Kidneys, Pancreas etc. are activated by involuntary nerves but your biceps are voluntary.

OK, simple question:

• What part of my nervous system do I use when I’m breathing?  If you want to deliberately take a breath while you are reading this, you can, so that makes it  part of the Voluntary (somatic) nervous system. But you breath  behind the scenes all the time (we like to see around 12 or lower a minute, when you're not paying attention) which makes it part of the Involuntary (autonomic) nervous system…Confused?
• It’s both voluntary and involuntary.  And that’s why we like it. A system with one foot in the Voluntary (somatic) camp and another in the Involuntary (autonomic) camp. If we want to influence the involuntary nervous system and all the organs it influences, we do it deliberately by using breathing in a voluntary way. It’s a great go-between.

 
To answer the second question: I’ve learned how to breath already, do I have to do it again?

• Many people start therapy and they seem to be breathing fantastically well but there are a small number who look great but when we look a little deeper they’re not getting much benefit. They’re breathing using their diaphragm, their shoulders and chest aren’t moving much, they’re moving their tummies (Rectus Abdominus) they're just not seeing a strong physiological change.

 
To see the immediate physiological effects you can look at Carbon Dioxide and how much is in your breath or you can look at your Heart Rate and how much it varies. I’ll cover these modalities in a later post.