Donald Moss

Task Force Report on Methodology and Empirically Supported Treatments: Introduction

Recent criticism of biofeedback has increased the importance of rating the efficacy of each biofeedback and neurofeedback therapy. A joint task force of the Association for Applied Psychophysiology and Biofeedback (AAPB) and the Society for Neuronal Regulation (SNR) has developed standards for efficacy research methodology and template for rating the level of efficacy of each application. The Task Force Report has been approved as a policy guideline by both the AAPB and SNR Boards.

The Circle of the Soul: The Role of Spirituality in Health Care

This paper examines the critical attitude of behavioral professionals toward spiritual phenomena, and the current growing openness toward a scientific study of spirituality and its effects on health. Health care professionals work amidst sickness and suffering, and become immersed in the struggles of suffering persons for meaning and spiritual direction. Biofeedback and neurofeedback training can facilitate relaxation, mental stillness, and the emergence of spiritual experiences. A growing body of empirical studies documents largely positive effects of religious involvement on health. The effects of religion and spirituality on health are diverse, ranging from such tangible and easily understood phenomena as a reduction of health-risk behaviors in church-goers, to more elusive phenomena such as the distant effects of prayer on health and physiology. Psychophysiological methods may prove useful in identifying specific physiological mechanisms mediating such effects. Spirituality is also a dimension in much of complementary and alternative medicine (CAM), and the CAM arena may offer a window of opportunity for biofeedback practice.

Special Issue: Advances in the Use of QEEG and Neurofeedback for ADHD

The cover of this special issue shows a three-dimensional graphic of a brain depicting the “reward network” as a target for biofeedback intervention. The article by Robert Thatcher in this issue discusses the use of functional network analyses and a Z-score approach to selectively target a network of brain areas for training. (The editors are grateful to Dr. Thatcher for this graphic.)

The Frustrated and Helpless Healer: Pathways Approaches to Posttraumatic Stress Disorders

Abstract Posttraumatic stress disorder is a psychophysiological disorder, characterized by the following: chronic sympathetic nervous activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negative emotional state including fear and shame. The psychophysiological basis for this disorder calls for psychophysiologically based interventions. This article presents the case narrative of a 29-year-old national guardsman, exposed to combat trauma and later to civilian trauma in public safety work. His treatment followed the Pathways model, comprised of multimodal interventions, beginning with self-directed behavioral changes, then the acquisition of skills (including self-hypnosis), and finally professional treatment including clinical hypnosis and EMDR.

The Use of Biofeedback and Neurofeedback in Pediatric Care

Biofeedback and hypnosis are complementary techniques, sharing an evidence-based approach and accessing powerful neurophysiological mechanisms. Both approaches are suitable for use with children, when implemented in developmentally appropriate ways, and each facilitates the development of self-regulation. Biofeedback can serve as an adjunct to hypnotherapy, and hypnosis can augment biofeedback treatment. Biofeedback and hypnosis can serve as alternative pathways for patient care or can be integrated into a comprehensive mind–body intervention plan. Common uses for biofeedback in pediatric care include the following: mind–body and affective education, biofeedback-assisted relaxation, neurofeedback for attention deficit hyperactivity disorder, biofeedback for medical problems, and neuromuscular education. Mind–body education teaches the child to recognize the effects of the mind—thoughts and feelings on the body. Affective education teaches the child to recognize emotions and cope with emotional responses to life situations. Neuromuscular education retrains muscles to recover movement after injury or illness affecting motor nerve control or central nervous system control of the musculature. In addition, biofeedback is a useful tool for optimal performance applications.

Complementary and Integrative Medicine for the Pathways Model

This chapter will describe the emergence of the complementary and alternative medicine (CAM) movement historically, and the current drive toward integrating complementary therapies and mainstream medicine into a comprehensive integrative medicine. The five domains of complementary medicine are defined; emphasis is placed on therapies with a strong evidence base. The second part of the chapter will summarize applications of complementary medicine to some of the disorders on which this book is focused. The chapter closes with discussion of continuing obstacles in creating access to complementary and integrative clinical practice, and challenges in design and implementation of research studies.

Special Applications of the Pathways Model

This chapter summarizes unique applications of the Pathways concepts. Several examples are provided, including applications of the Pathways Model in support groups, in intensive outpatient services, and in patients with lifestyle issues and patients with vague, diffuse symptoms, among others. When a group intervention is the most practical, then the Pathways principles are adapted to provide the best care. Some patients with complex psychiatric and medical comorbid chronic illnesses need more than weekly sessions, so an intensive outpatient program using the Pathways Model is detailed. Patients with medically unexplained symptoms often search for ways to cope with their daily suffering, but also the negative reactions of medical professionals to them. This chapter will also attempt to project the Pathways Model into the future, particularly to anticipate what advances people with chronic illness can expect. The use of technology, self-help programs, and better understanding of the biological basis of illness hold great promise for those who struggle every day with pain or depression. Finally, the chapter described the application of the Pathways Model for those who are biologically and psychologically healthy—“not sick”—but who desire to be fully well, mentally, emotionally, and spiritually, with suggestions for implementation.

Mind, Body, and Spirit in Chronic Illness

This chapter provides an introduction to chronic illness as conceptualized in the Pathways Model. Health care expenditures and the major conditions requiring costly medical care are discussed. The importance of environment, socioeconomic status, and developmental factors are highlighted. Several patient cases are utilized to demonstrate multiple risk factors, both biological and psychosocial, that increase the probability of developing a chronic illness. Patients describe in their own words the aspects of their background with which they have struggled. Adversity during the critical developmental period of childhood has ramifications for morbidity well into the adult years. Individuals who have experienced emotional, physical, or sexual abuse are at great risk for chronic illness, particularly pain conditions, depressive disorders, and cardiovascular disease. At similar risk are minimally educated, low-income patients who reside in a high stress neighborhood. The influence of lifestyle, particularly inactivity and high fat, high sugar diets is explored within the context of personal decisions and choices made by individuals. Isolated patients without social support who do not have a stable home suffer the effects of their environment both emotionally and physically. Chronic stress, due also to the illness itself, is associated with damaging effects mediated through the nervous system and the immune complex. First, the mind, body, and spiritual aspects of chronic illness are explored, and then they are correlated with the levels of intervention in the Pathways Model.

Chronic Illness, Global Burden, and the Pathways Approach

This chapter proposes that the major challenge for human health in the twenty-first century is chronic diseases and chronic conditions. This is a global problem, burdening health care systems and economies worldwide. WHO statistics show that almost 70% of deaths annually are caused by chronic diseases, especially cardiovascular disease, cancer, chronic respiratory diseases, and diabetes. Factors contributing to the increase in chronic illnesses worldwide are aging populations, rapid urbanization, and the globalization of unhealthy lifestyles. This global burden of chronic disease is felt most strongly in minority and low-income populations and in developing countries. The first order of interventions includes community-based public health interventions, for example, initiatives to ban tobacco and alcohol advertising, replace trans fats with polyunsaturated fats, and increase breastfeeding. The chapter also introduces functional medicine and the Pathways approach to chronic conditions, two perspectives integrating a holistic evolutionary systems-based approach, with attention to lifestyle variables, affective regulation, early trauma, and environmental influences. The example of obesity is utilized to illustrate the influence of lifestyle, nutrition, stress, trauma, and the human biome on chronic conditions.

A Pathways Model Approach for Traumatic Brain Injury

The incidence of traumatic brain injuries (TBI) has increased in recent years, now comprising 2.5 million emergency room visits, hospitalizations, and deaths each year in the United States. TBI is frequently a chronic condition with persisting symptoms and disability. This chapter presents a case study in which self-hypnosis, hypnosis-assisted psychotherapy, and palliative care strategies were provided within a multi-modal integrative treatment program for a 38-year-old woman with TBI secondary to motor vehicle accident. Self-hypnosis was helpful in anxiety reduction and pain management. Hypnosis-assisted psychotherapy was beneficial in desensitizing many post-traumatic memories, and in managing post-concussion pain, including neuropathic pain and post-traumatic migraine headaches. A variety of palliative care techniques and spiritual interventions were applied to enhance sleep, moderate cognitive deficits, and enhance quality of life.