דצמ' 29 2012
השלוב של ביופידבק ו CBT – פרק מספר Biofeedback a practioner guide. הפרק נכתב על דני חמיאל וארנון רולניק
לטובת צבור מטפלי הביופידבק מחד ואנשי הטיפול הקוגניטיבי התנהגותי מאידך – אנו מפרסמים כאן פרק מספר שנכתב על ידי דני חמיאל וארנון רולניק. הספר עומד לצאת בעתיד הקרוב כהמשך לספר הקלאסי Biofeedback a practioner guide שנערך על ידי Schwartz and Andrasik
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Biofeedback and Cognitive Behavioral Interventions:
Daniel Hamiel and Arnon Rolnick
This chapter discusses the integration of two major treatment approaches: cognitive behavioral therapy (CBT) and biofeedback. CBT is a cognitive evidence-based form of therapy used to treat a variety of psychological disorders. Biofeedback is a psycho-physiological treatment that is gradually receiving scientific support for its efficacy. By integrating these two intervention approaches, we take advantage of and empower both of them.
The concept of a common law marriage can be used figuratively to describe the relationship between biofeedback and CBT. A common law marriage is an informal or de facto relationship that is legally recognized as a marriage even though no legally recognized marriage ceremony has been performed. Similarly, these two interventions, CBT and biofeedback, “live together" de facto: both are short-term goal-directed interventions striving for evidence-based status. Early in their relationship, when CBT was simply behavior therapy, it was very clear that both approaches were related to learning theory and were heavily based on relaxation techniques and desensitization. CBT handbooks today do not include chapters about biofeedback (cf. Dobson, 2001; Bond & Dryden, 2005). The biofeedback literature, on the other hand, clearly recognizes the role of cognitive factors in biofeedback interventions. Nevertheless, to the best of our knowledge there is no clear therapeutic protocol that suggests how to integrate the two methods.
The first part of this chapter discusses how biofeedback practitioners can be assisted by cognitive behavioral concepts and techniques, while the second part demonstrates how cognitive behavioral psychotherapists can use biofeedback techniques. The chapter concludes by considering which patients should be directed to which intervention based upon their general attitude and presenting problem.
Biofeedback intervention was originally based on a learning theory model. Neal Miller's classical studies (Miller et al., 1978) did not include cognitive elements, not only because the subjects were animals, but mainly due to the understanding that biofeedback is a trial and error process only involving conditioning elements (Pavlovian and instrumental).
Yet, as biofeedback moved to human subjects, it became clear that thoughts, emotions and interpersonal processes can affect the success of biofeedback intervention. Although the newer definitions of biofeedback have changed to include cognitions and expectations (see Schwartz & Schwartz, 2003), there is still no clear model that suggests how biofeedback practitioners should deliberately integrate such factors into the biofeedback intervention.
From a theoretical point of view, many authors argue that at least part of the efficacy of biofeedback is due to cognitive factors (Wickramasekera, 2002; Meichenbaum, 1976; Holroyd et al., 1984; and Penzien & Holroyd, 2008 for a newer perspective).
One of the reasons for integrating CBT principles into biofeedback is to help biofeedback practitioners use this form of intervention to treat psychological disorders, and particularly anxiety disorders. While some well established protocols for various somatic disorders do exist (see sections 6, 7, and 10 in this book), only a few protocols have been established to treat psychological disorders (Yucha & Montgomery, 2008; Moss, 2002; Leherer, 2007). Moreover, there is no comprehensive model to guide biofeedback practitioners לאחר indealing with anxiety disorders. The addition of CBT elements can be very useful for this purpose.
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