Biofeedback and Self-Regulation, VoL 1, No. 1, 1976

Editorial

Self-Regulation: A Context for Biofeedback Biofeedback is a technology. It is also an idea--or rather, part of a more encompassing idea--one which intersects with a number of significant human concerns. And I think it is being part of this more encompassing something that gives biofeedback much of its special significance. To anyone who has worked with it, a notable feature of biofeedback is its way of spreading out, of connecting up with other phenomena, other ideas. Like one of those many-limbed equatorial trees, it sinks roots from its own branches. What follows are some illustrations of how inquiry in biofeedback has a way of branching out, of forging new connections. For example, in the early alpha feedback studies a source of considerable excitement was the thought that the experiential state associated with alpha might be akin to that found in Zen or yoga meditation. Kasamatsu and Hirai (1966), in a study of Zen monks, had noted characteristic EEG changes during meditation such as high-amplitude alpha and trains of theta. Perhaps meditative training could be assisted by suitable EMG feedback techniques. Similarly, those who began to explore the clinical uses of EMG feedback soon realized they were not working with an isolated technique, but with an approach having many antecedents. With respect to relaxation training especially, a considerable body of older work was in evidence. Notable among these earlier approaches was the extensive work of Jacobson (1938). Close examination of his classic Progressive relaxation, first published in 1929, brings to light a great deal of material germane to biofeedback. In addition to practical advice on muscular relaxation, a number of other topics are covered: the electrophysiology of mental activities, the effects of profound relaxation on cognitive activities, differential relaxation, the cultivation of quick relaxation, advances in EMG measurement, the transfer problem, and applications to many disorders of a psychosomatic nature. Actually, since they have been the focus of extensive earlier work, the relaxation therapies are useful for illustrating the wide-ranging nature of the biofeedback idea--and that we are not dealing with an isolated phenomenon. That there is a cluster of somehow connected ideas and practices is 1 © 1976 Plenum Publishing Corporation, 227 West 17th Street, New Y o r k , N.Y. 1 0 0 1 1 . No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any f o r m or by any means, electronic, mechanical, photocopying, m i c r o f i l m i n g , recording, or otherwise, without w r i t t e n permission o f the publisher.

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nicely shown in Stokvis and Wiesenhiitter (1963), Der Mensch in der Entspannung. Ostensibly about relaxation, the book is by no means confined to this topic. To be sure, various approaches to relaxation are in fact described--progressive relaxation, autogenic training, and some of the meditative techniques. But also described are a whole array of other topics: guided imagery techniques, autohypnosis, Cou6ism, combined use of relaxation and autohypnosis, various religious practices--such as those of the Cabalists and the Hassidimmwhich include the use of monotonous chants, rhythmic body movements, the singing of melodies without words, and so forth. One may well wonder if these various practices have anything in common; or are they simply a hodge-podge of unconnected phenomena? My position is that they are related in a valid and important way. It can be argued that a common feature of these practices is that they are all one or another form of self-regulation. This, broadly defined, is the endeavor to modify voluntarily one's own physiological activity, behavior, or processes of consciousness. A little reflection will show that this is indeed a wide-ranging and encompassing aspect of human behavior. A few examples, which range from the everyday to the exotic, will make this clear. For instance, as a means of getting up in the morning, a person may put his alarm clock out of easy reach--he must leave bed in order to shut off the alarm. Here, one is deliberately arranging the environment so as to produce one kind of behavior rather than another at a later time. Once out of bed, one may take a shower or go for a brisk walk in order to alert one's self. The writer or the artist will set aside his best hours for demanding intellectual or creative work. One may engage in physical exercises, not so much for any immediate pleasure, but for the ensuing feeling of vigor and well-being. Finally, toward the end of the day, one may gradually wind down one's activities so as to fall asleep more~ easily. These examples, along with those from Stokvis and WiesenhtRter (1963), indicate that concern with self-regulation in one form or another has been a human preoccupation for a very long time. I think it is the very pervasiveness of the self-regulation endeavor which provokes the great popular interest in biofeedback, both as a technology and as an idea. It is a concept which touches on many important human aspirations--the wish to improve one's self in some way, the desire to overcome anxiety and disease, to retain composure in the face of adversity, to explore one's own potential, to cultivate desirable experiential states. As in the case of any development which intersects with important human concerns, it can be expected that there will be occasional excesses of enthusiasm, and even turbulence. And, indeed, biofeedback has been no stranger to controversy. Such controversy may by no means be all to the bad. In balance, it may be a good thing since often it reflects genuine differ-

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ences in opinion and the freedom to express them. Eventually, empirical work should separate substance from effervescence. It is important to note a significant parallel development to biofeedback: the behavioral self-control techniques. Growing out of an operantconditioning framework, these techniques focus on the self-regulation of behavior, and thus complement the physiologically oriented biofeedback approach. An attractive feature of the behavioral self-control techniques is that they explicitly derive from laboratory-based principles of learning D reinforcement of target behaviors, recording of baseline levels, shaping, chaining, fading, disruption of undesirable response chains, use of incompatible responses, and so forth. A growing literature shows that a great many clinical applications are being pursued (see Thoresen & Mahoney, 1974; Mahoney & Thoresen, 1974; both reviewed in this issue). There seems every reason to think that biofeedback and behavioral self-control techniques could be fruitfully used in combination, and indeed this is already occurring at the level of day-to-day clinical applications. Take, for example, the question of transferring biofeedback control into everyday life situations. On this matter, the behavioral self-control area has much to offer by way of specific training techniques (see Watson & Tharp, 1972). A combined approach may prove especially useful in the area of psychosomatic and stress-linked diseases. If it is true that a major component of such disorders is a continuing maladaptive response to the environment, perhaps it may be possible to change such maladaptive behavior. Consider the case of cardiovascular disease, which accounts for 50% of all deaths (principally heart disease and strokes). Although heredity indeed plays a part, and not much can be done about that, many of the risk factors are behavioral in nature and therefore open to change--for example, smoking, obesity, lack of exercise, levels of animal fats in the diet, and the individual's habitual reactions to the stresses of everyday life. Evidence has accumulated that certain personalities (actually, those with certain habitual behavior patterns) are especially prone to heart disease--what Friedman and Rosenman (1974) call the Type A individual. The Type A person is an unceasing striver, is constantly preoccupied with work, has an unremitting sense of time urgency, and reacts powerfully to the problems and irritations of everyday life. He can be thought of as someone who unintentionally has created a high-stress environment for himself. Perhaps Type A behavior and its attendant stress reaction are open to learned modification. At least, with biofeedback and behavioral self-control techniques, we have some tools to begin the attempt. In recent years, students of behavioral self-control have ventured into territory long forbidden to the orthodox behaviorist, the realm of private events. This enterprise has been legitimized, from a traditional behaviorist

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standpoint, by the adoption of the homogeneity assumption--that private events (ideas, thoughts, images, feelings) are subject to the same learning principles as is overt behavior. Though not everyone may wish to take this homogeneity assumption as holy writ, the research generated by it has been stimulating and fruitful (Cautela, 1969; Kanfer & Phillips, 1970; Meichenbaum, 1973). Parenthetically, it may be noted that the self-control techniques exhibit one fundamental departure from the biofeedback approach to modifying private (i.e., cognitive) events. In biofeedback, a critical first step is the modification of some physiological response--muscle activity, theta EEG, alpha EEG, skin temperature, etc. Then one proceeds to ask what, if any, are the identifiable experiential concomitants of such physiological modification? In contrast, the self-control techniques assume that private events (usually as reflected in speech) can be directly modified through reinforcement procedures. For example, in Meichenbaum's (1973) approach, the individual is taught to reinforce himself after he has made specific desirable statements about himself. A central assumption in this work is that reinforcing the individual's statements about himself will produce changes in cognitions and attitudes. Again, in keeping with the "connectedness" theme, it may be noted that both biofeedback and the behavioral self-control approaches to self-regulation enjoy a number of clear historical antecedents. To take but one historical example of a behavioral approach to the modification of an internal event, we can cite the case of Francis Galton, a many-sided genius and one of the major influences in the development of modern psychology. As an experiment, Galton set out to induce a paranoid condition in himself --one in which he became greatly suspicious of all men with red hair (Boring, 1950). Thus, as he strolled the streets of Victorian London, whenever he met a red-haired man, he would begin to think suspicious thoughts. Not only would he think suspicious thoughts, he would act on them--for example, he would step into a shop to avoid an approaching red-haired individual. Within three days, Galton managed to develop a respectable paranoia. A main point of interest in this example is that Galton not only attempted to modify his thoughts, he engaged in behavior appropriate to the thoughts--probably a critical addition to the technique. Similarly, the antecedents of biofeedback reach back a considerable distance--although it is worth observing that a common feature of the cases cited below is the absence of explicit recognition that a wide-ranging new principle of learning was, in fact, involved. Jacobson (1954), for example, has sometimes allowed patients in relaxation training to observe their own EMG activity on an oscilloscope. Kubie and Margolin (1944), as a means of inducing a hypnagogic condition, allowed subjects to listen to the (amplified) sounds of their own breathing. These sounds were detected by a micro-

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phone attached to the throat. The neurophysiologist Adrian (1934), in some of the early experiments with the EEG alpha rhythm, placed himself in a closed loop with his own alpha activity. After first arranging to convert his alpha EEG into an auditory signal, he learned to recognize the sounds which were produced whenever alpha rhythms were present. Quite early in this century, the psychologist Bair (1901) endeavored to teach an unusual form of muscular control, the ability to wiggle one's ears. He inadvertantly found that subjects only acquired this skill if they received a type of information feedback. A system of mechanical amplification was used in which movement of the ear was detected by a lever attached to the ear. The lever's movement was mechanically amplified and drove a kymograph stylus which was visible to the subject. Within the past decade or so, several investigators have declared that an important new principle was involved in this type of learning. This recognition seems to have occurred independently to a number of researchers-one thinks of names such as Kamiya, Basmajian, Mulholland, Smith, Green, Brown, Marinacci, Miller and Whatmore (to mention some of those who participated). Furthermore, once explicit recognition does occur--that an important principle is involved--the path is opened to further systematic inquiry, and the matter of the self-modifiability of physiological activity, behavior, and processes of consciousness can be framed as an empirical question. What can be done, and what cannot be done, and for whom? This quest has a way of progressively stealing in upon one's preoccupations. We are reminded of what Freud once said about psychoanalysis--if you but let it take your little finger, soon it will have your whole arm. Finally, it is worth pointing out that the long-run significance of biofeedback and self-regulation techniques does not hinge on the fate of a single parameter--whether this be alpha, EMG, blood pressure, or something else. Probably as important as anything is the recognition that an important and wide-ranging principle is in fact involved. Once explicit recognition of the information feedback principle has occurred, and when it is combined with continuing human ingenuity and persistence, we can reasonably anticipate a variety of exciting explorations. The fruit of these endeavors we expect will be reflected, at least in part, in the pages of Biofeed-

back and Self-Regulation. Johann Stoyva Editor REFERENCES Adrian, E. D., & Matthews, B. H. C. The Berger Rhythm: Potential changes from the occipital lobe in man. Brain, 1934, 57, 354-385. Bair, J. H. Development of voluntary control. Psychological Review, 1901, 8, 474-510.

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Boring, E. G. A history of experimental psychology. New York: Appleton-Century-Crofts, Inc., 1950. Cautela, J. R. Behavior therapy and self-control: Techniques and implications. In C. M. Franks (Ed.), Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969. Friedman, M., & Rosenman, R. Type A behavior and your heart. New York: Knopf, 1974. Jacobson, E. Progressive relaxation (2nd ed.). Chicago: University of Chicago Press, 1938. Jacobson, E. (Article on electromyographic measurement.) Newsweek, February 1, 1954, p. 39. Kanfer, F. H., & Phillips, J. S. Learning foundations of behavior therapy. New York: John Wiley, 1970. Kasamatsu, A., & Hirai, T. An electroencephalographic study on the Zen meditation (Zazen). Folia Psychiatrica Neurologica Japonica, 1966, 20, 315-336. Kubie, L. S., & Margolin, S. An apparatus for the use of breath sounds as a hypnagogic stimulus. American Journal of Psychiatry, 1944, 100, 610. Mahoney, M. J., & Thoresen, C. E. Self-control: Power to the person. Monterey, California: Brooks/Cole Publishing Company, 1974. Meichenbaum, D. H. Cognitive factors in behavior modification: Modifying what clients say to themselves. In C. M. Franks & G. T. Wilson (Eds.), Annual review of behavior therapy. New York: Brunner/Mazel, 1973. Stokvis, E., & Wiesenhfitter, E. Der Mensche in der Entspannung (2 Auflage). Stuttgart: Hippokrates Verlag, 1963. Thoresen, C. E., & Mahoney, M. J. Behavioral self-controL New York: Holt, Rinehart and Winston, Inc., 1974. Watson, D. L., & Tharp, R. G. self-directed behavior: Self-modification for personal adjustment. Monterey, California: Brooks/Cole Publishing Company, 1972.