An A to Z collection of useful Tips & Notes accumulated from several years of practice and experience on Biofeedback Temperature Monitoring, that could be a valuable reminding and proposing solutions tool to professionals who use similar applications.

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29 Hot tips
for professional
biofeedback
application.
By Prof. Spiro Diamantidis M.D
TEMPERATURE MONITORING

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011
Workshop: “ 29 Hot tips for professional biofeedback application” Revised edition. Version B1.0.0
TEMPERATURE MONITORING (THERMAL)
Hand out by Prof. Spiro Diamantidis M.D
Dear LinkedIn colleagues. Knowledge has many levels.
I offer you this initial level that may be used as a foundation
for more extended knowledge in the future,
wishing you all the best of success.
Please give me feedback regarding the use and utilization of this work.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Biofeedback is a technically supported scientific process demanding specialBiofeedback is a technically supported scientific process demanding special
knowledge and understanding of the equipment as well as of the monitoredknowledge and understanding of the equipment as well as of the monitored
organism’s neurophysiology, in order to enable practitioner to achieve the best oforganism’s neurophysiology, in order to enable practitioner to achieve the best of
valid for evaluation data. Although there are no tricks in science and especially invalid for evaluation data. Although there are no tricks in science and especially in
neurophysiology, still there are some processes helping the biofeedback applier toneurophysiology, still there are some processes helping the biofeedback applier to
organize and utilize his practice without losing any infoorganize and utilize his practice without losing any info
useful for assessment or application. The does and don't s in biofeedback, consistinguseful for assessment or application. The does and don't s in biofeedback, consisting
the set of skills required for successful biofeedback practices, will be presented inthe set of skills required for successful biofeedback practices, will be presented in
this workshop in order to establish, support or enhancethis workshop in order to establish, support or enhance
practitioner’s skills according to their former knowledge and understanding. Thepractitioner’s skills according to their former knowledge and understanding. The
electronic data labyrinth usually under or hyper estimated, need an Ariadne’s clewelectronic data labyrinth usually under or hyper estimated, need an Ariadne’s clew
which will be provided to the attendees of this workshop in order to help themwhich will be provided to the attendees of this workshop in order to help them
practice and develop mastery on how to understand the function mechanism of thepractice and develop mastery on how to understand the function mechanism of the
equipment, how to operate the equipment, how to record the physiological signals,equipment, how to operate the equipment, how to record the physiological signals,
how to distinguish them from artefacts and how to find the correlation between thehow to distinguish them from artefacts and how to find the correlation between the
physiological signals and the person’s internal or external events. Skin conductance,physiological signals and the person’s internal or external events. Skin conductance,
temperature, surface electromyography, photoplethysmograph, respiration and HRVtemperature, surface electromyography, photoplethysmograph, respiration and HRV
will be discovered. The main gain from this hand out is the concentrated knowledgewill be discovered. The main gain from this hand out is the concentrated knowledge
that could be used as an every-days guide to the special pathways of a successfulthat could be used as an every-days guide to the special pathways of a successful
biofeedback practice.biofeedback practice.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Temperature MonitoringTemperature Monitoring
(THERMAL)(THERMAL)

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Behavioral test for every physiological signalBehavioral test for every physiological signal
should be applied before the beginning of anyshould be applied before the beginning of any
recording.recording.
Tip:Tip: Always ask trainee's permission to touch inAlways ask trainee's permission to touch in
relation with any manipulation during training.relation with any manipulation during training.
Tip:Tip: Attach the thermistor in the trainee’s nonAttach the thermistor in the trainee’s non
dominant index finger.dominant index finger.
Tip:Tip: Calibrating the thermistor and attaching itCalibrating the thermistor and attaching it
correctly on the trainee's non-dominant indexcorrectly on the trainee's non-dominant index
finger is critical for avoiding the “blanketingfinger is critical for avoiding the “blanketing
effect”.effect”.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Do all your measurements of the same trainee locatingDo all your measurements of the same trainee locating
sensor every time on the same part of the body, to avoidsensor every time on the same part of the body, to avoid
thermistor location artifact.thermistor location artifact.
Note:Note: Training in thermal control somebody who indulges inTraining in thermal control somebody who indulges in
reach meals with big quantities of alcohol (vasodilator) followedreach meals with big quantities of alcohol (vasodilator) followed
by a strong coffee (vasoconstrictor) is like hunting butterfliesby a strong coffee (vasoconstrictor) is like hunting butterflies
with a torn net.with a torn net.
Tip:Tip: A good practice in thermal biofeedback training is to useA good practice in thermal biofeedback training is to use
both a photoplethysmograph and a thermistor simultaneouslyboth a photoplethysmograph and a thermistor simultaneously
so as to help trainees to regulate their body temperature byso as to help trainees to regulate their body temperature by
regulating their blood flow.regulating their blood flow.
Tip:Tip: In thermal training it may be necessary to re-adjust theIn thermal training it may be necessary to re-adjust the
temperature range as time progresses so start by setting atemperature range as time progresses so start by setting a
meaningful display range that allows you to track all possiblemeaningful display range that allows you to track all possible
temperature changes.temperature changes.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: The former technique helps you to have all theThe former technique helps you to have all the
information on screen when providing after traininginformation on screen when providing after training
feedback to the trainee.feedback to the trainee.
Tip:Tip: Don't forget markers since they are the compass inDon't forget markers since they are the compass in
the route of training. Markers are very important for safethe route of training. Markers are very important for safe
and utilized training and for extracting awarenessand utilized training and for extracting awareness
arising conclusions.arising conclusions.
Tip:Tip: Respect, warmth and caring by the therapist can beRespect, warmth and caring by the therapist can be
just as important ingredients for success as proper usejust as important ingredients for success as proper use
of specific biofeedback procedures.of specific biofeedback procedures.
Note:Note: Temperature self regulation is subject to theTemperature self regulation is subject to the
influence of the “person effect” more than otherinfluence of the “person effect” more than other
biofeedback modalities.biofeedback modalities.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Use the changing attitude techniques to avoidUse the changing attitude techniques to avoid
impersonal attitude so as to express a positive “personimpersonal attitude so as to express a positive “person
effect” and increase your outcome as a biofeedbackeffect” and increase your outcome as a biofeedback
trainer-therapist.trainer-therapist.
Note:Note: Training conditions and trainers attitude that ariseTraining conditions and trainers attitude that arise
the trainee's feelings of support, care and acceptance,the trainee's feelings of support, care and acceptance,
facilitate peripheral hand warming and the sense offacilitate peripheral hand warming and the sense of
general relaxation.general relaxation.
Tip:Tip: Give after training feedback by analyzing the wholeGive after training feedback by analyzing the whole
graph always in correspondence with the events and notgraph always in correspondence with the events and not
only parts of it.only parts of it.
Tip:Tip: Be aware of the artifacts that are different extraneousBe aware of the artifacts that are different extraneous
variables influencing the biofeedback measurement.variables influencing the biofeedback measurement.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Don't underestimate the use of rubber insulatedDon't underestimate the use of rubber insulated
adhesion tape to attach the sensor to avoid ambientadhesion tape to attach the sensor to avoid ambient
temperature artifact.temperature artifact.
Note:Note: Ambient temperature artifact is a commonAmbient temperature artifact is a common
cause of failure in thermal training in trainees withcause of failure in thermal training in trainees with
low temperature start regarding body corelow temperature start regarding body core
temperature.temperature.
Tip:Tip: Be aware of the blanketing artifact.Be aware of the blanketing artifact.
Tip:Tip: For more accurate measurements especiallyFor more accurate measurements especially
with narrow range display settings and smallwith narrow range display settings and small
increments, isolate thermistor wire with wireincrements, isolate thermistor wire with wire
isolation tube to avoid stem effect artifactisolation tube to avoid stem effect artifact.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: In temperature measurements at athletes or highIn temperature measurements at athletes or high
performers on real time and motion on the field it is a must toperformers on real time and motion on the field it is a must to
cover the thermistor with isolating tape and the wire withcover the thermistor with isolating tape and the wire with
isolating tube.isolating tube.
Tip:Tip: Take always into consideration the law of initial valuesTake always into consideration the law of initial values
i.e. the initial starting point of a physiological measurement.i.e. the initial starting point of a physiological measurement.
Feedback must be clear and sound both in high or law initialFeedback must be clear and sound both in high or law initial
values.values.
Note:Note: Increasing extremities temperature by controlling andIncreasing extremities temperature by controlling and
raising peripheral blood flow facilitates a psychological senseraising peripheral blood flow facilitates a psychological sense
of general relaxation.of general relaxation.
Tip:Tip: Before training for temperature control make a bio-Before training for temperature control make a bio-
behavioral assessment testing trainee's ability of autonomicbehavioral assessment testing trainee's ability of autonomic
body function to be affected by imagery.body function to be affected by imagery.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Remind trainees not to forget to include in theirRemind trainees not to forget to include in their
imagery all five senses i.e. tactile, visual, olfactory,imagery all five senses i.e. tactile, visual, olfactory,
auditory and gustatory.auditory and gustatory.
Tip:Tip: Adjust temperature control strategy to trainee'sAdjust temperature control strategy to trainee's
idiosyncrasy.idiosyncrasy.
Tip:Tip: Keep the trainee's thermoregulatory mechanism inKeep the trainee's thermoregulatory mechanism in
balance adjusting the training room temperature withinbalance adjusting the training room temperature within
the normal range regarding trainee's idiosyncrasy.the normal range regarding trainee's idiosyncrasy.
Note:Note: Since stressors are causing sympathetic arousal,Since stressors are causing sympathetic arousal,
the worst indication for the physiological system is thethe worst indication for the physiological system is the
inability to return to the pre-baseline levels.inability to return to the pre-baseline levels.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: Try to avoid judgmental statements or advice-giving,Try to avoid judgmental statements or advice-giving,
exceptexcept regarding specific procedures in this modality.regarding specific procedures in this modality.
Note:Note: Law of “reverse effort” that influences manyLaw of “reverse effort” that influences many
physiological functions, has a special negative effect onphysiological functions, has a special negative effect on
non judgmental allowing condition that facilitates peripheralnon judgmental allowing condition that facilitates peripheral
warming.warming.
Note:Note: Success in peripheral warming doesn't depend onSuccess in peripheral warming doesn't depend on
absolute number of degrees of temperature raising butabsolute number of degrees of temperature raising but
rather on the number of degrees near the core bodyrather on the number of degrees near the core body
temperature.temperature.
Note:Note: Passive attention that lets things happen with noPassive attention that lets things happen with no
judgment or strive can be a powerful trigger for autonomicjudgment or strive can be a powerful trigger for autonomic
changes.changes.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: In order to be a successful thermal trainer-therapist it isIn order to be a successful thermal trainer-therapist it is
important to develop the right intonation, inflection, speed ofimportant to develop the right intonation, inflection, speed of
delivery, voice volume and correspondence between verbal anddelivery, voice volume and correspondence between verbal and
non verbal cues when applying autogenic phrases.non verbal cues when applying autogenic phrases.
Tip:Tip: Trainer-therapist should change the imagery theme or styleTrainer-therapist should change the imagery theme or style
of speaking according to the fluctuation or direction of trainee'sof speaking according to the fluctuation or direction of trainee's
temperature.temperature.
Tip:Tip: In temperature control autogenic training, if you notice thatIn temperature control autogenic training, if you notice that
a specific phrase leads to an increase of peripheral temperature,a specific phrase leads to an increase of peripheral temperature,
keep repeating the same phrase until the temperature stopskeep repeating the same phrase until the temperature stops
increasing.increasing.
Tip:Tip: If an image in guided imagery is followed by a decrease inIf an image in guided imagery is followed by a decrease in
temperature it is possible to be triggered an anxious responsetemperature it is possible to be triggered an anxious response
due to trainee's former traumatic experience. In such a casedue to trainee's former traumatic experience. In such a case
change to an image that promotes relaxation.change to an image that promotes relaxation.

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Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
Tip:Tip: For being a successful thermal trainer-therapist never giveFor being a successful thermal trainer-therapist never give
orders or demands for relaxation avoiding thus to trigger theorders or demands for relaxation avoiding thus to trigger the
phenomenon of reverse response. You always create imagesphenomenon of reverse response. You always create images
that promote feelings of relaxation, relieving heaviness,that promote feelings of relaxation, relieving heaviness,
comfortable warmth, peace and serenity.comfortable warmth, peace and serenity.
Tip:Tip: Give the sufficient time for every one of the following stepsGive the sufficient time for every one of the following steps
of biofeedback training process. 1) awareness 2) use ofof biofeedback training process. 1) awareness 2) use of
moderate and controlled exertion 3) realization 4) skilfulness 5)moderate and controlled exertion 3) realization 4) skilfulness 5)
application and combination with plain activities 6) mastering 7)application and combination with plain activities 6) mastering 7)
counting benefits 8) ensuring results 9) application to morecounting benefits 8) ensuring results 9) application to more
complex and difficult activities (sports, high performance)complex and difficult activities (sports, high performance)
Tip:Tip: It is very important for the trainee to fill up carefully the dataIt is very important for the trainee to fill up carefully the data
forms in any phase of training since these are preciousforms in any phase of training since these are precious
feedback offering tools.feedback offering tools.

15. 15
Presented at 15th annual B.F.E meeting Munich, Germany 22-26 February 2011 by Prof. Spiro Diamantidis M.D
I wish you all the best of success.I wish you all the best of success.
If you need any help don’t hesitate to contact me.If you need any help don’t hesitate to contact me.