General blueprint

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General blueprint

  1. 1. The Biofeedback Certification International Alliance (formerly the Biofeedback Certification Institute of America) Blueprint of Knowledge Statements for Board Certification in BiofeedbackThe provider certified in Biofeedback will have knowledge of:I. ORIENTATION TO BIOFEEDBACK – 4 hours A. Definitions of biofeedback 2. Traumatic stress and posttraumatic stress disorder B. History of biofeedback 1. Pioneers in biofeedback C. Psychophysiological reactions to stressful 2. Forces leading to the emergence of events biofeedback (e.g., operant conditioning, 1. Negative affect, e.g., anxiety, anger, self-regulation, cybernetics, miniaturization, hopelessness, depression computerization, founding of the 2. Acute stress: Cannon’s fight-or-flight Biofeedback Society of America) response a. Sympathetic-adrenomedullary C. Concepts of feedback and control in biological activation systems b. Relationship to panic disorder and somatization D. Overview of principles of human learning as 3. Chronic stress: Selye’s general adaptation they apply to biofeedback syndrome 1. Learning theory (e.g., habituation, a. Hypothalamic-pituitary Adrenocortical classical and operant conditioning, activation discrimination, generalization, extinction) b. Stages of the general adaptation 2. Application of learning principles to syndrome biofeedback training (e.g., reinforcement, c. Health consequences of chronic discrimination training, length and number stress of sessions, massed vs. spaced practice, 4. Immune system disruption generalization to the life situation) a. Psychoneuroimmunology (PNI) b. Implications of PNI for immune-related E. Research methodology illness 1. Differences between correlational and randomized controlled outcome studies D. Psychosocial mediators of stress 2. Threats to internal validity 1. Cognitive appraisals of stress and coping 3. Specific and nonspecific treatment resources effects 2. Personality dispositions, e.g. optimism- 4. Control group designs pessimism, self-efficacy 5. Case study designs 3. Social support 6. Small-N designs 7. Meta-analysis III. PSYCHOPHYSIOLOGICAL RECORDING – 8 8. Criteria for clinical efficacy hoursII. STRESS, COPING, AND ILLNESS – 4 hours A. Descriptions of most commonly employed biofeedback modalities: SEMG, skin A. Stress and the biopsychosocial model of temperature, electrodermal activity, EKG and illness heart rate variability, respiration, EEG 1. Sensors and sensor placements B. Stressful life events and risk of illness 2. Characteristic signals 1. Assessing stressful life events 3. Signal processing and feedback displays
  2. 2. B. Sources of artifact accident, cerebral palsy, spinal cord injury, 1. How to identify and eliminate peripheral nerve injury, and chronic pain environmental noise, including 60 Hz, radio frequency, and electrostatic C. Chronic neuromuscular pain interference 1. Ascending and descending pain 2. How to evaluate instrument noise levels pathways 3. How to perform a continuity check on 2. Gate control theory electrodes and cables 3. Neuromatrix theory 4. How to identify and correct electrical short 2. Trigger point mechanisms circuits 3. SEMG differences between chronic pain 5. How to identify and correct extraneous subjects and normal subjects biologic activity in recordings 6. The relationship of skin impedance to D. General treatment considerations amplifier input impedance; effects on 1. SEMG assessment strategies physiological recordings 2. SEMG down-training strategies 3. SEMG up-training strategies C. Identification and elimination of electrical shock hazards E. Target muscles, typical electrode placements, and SEMG treatment protocols for specific D. Essential electronic terms and concepts for neuromuscular conditions biofeedback applications, including: 1. Tension-type headache 1. Conduction and insulation 2. Temporomandibular disorders 2. Voltage (E) 3. Posterior neck and upper back pain 3. Current (I) 4. Low back pain 4. Resistance (R) 5. Urinary and fecal incontinence 5. Ohm’s Law (E=IR) 6. Power 6. Paresis and spasticity secondary to 7. Impedance central nervous system disorders and 8. Electrode impedance injuries 9. Input impedance 7. Worksite ergonomic applications 10. Signal-to-noise ratio 11. Amplifiers: single-ended and differential V. AUTONOMIC NERVOUS SYSTEM (ANS) amplifiers APPLICATIONS – 8 hours 12. Common mode rejection 13. Artifact A. Structure and function of the autonomic 14. Amplitude nervous system 15. Integration methods: integral average 1. Sympathetic and parasympathetic voltage, peak voltage, peak-to-peak divisions voltage, and root mean square voltage 2. Anatomy and autonomic innervation of the 16. Bandpass cardiovascular, GI, and respiratory 17. Frequency response curve systems 18. Volume conduction 3. Physiological mechanisms underlying 19. Time constant commonly employed biofeedback 20. Power spectrum modalities, including electrodermal 21. Optical isolation activity, skin temperature, heart rate, 22. Telemetry respiration, heart rate variability 4. Homeostasis, disregulation, and self-IV. SURFACE ELECTROMYOGRAPHIC (SEMG) regulation of ANS activity APPLICATIONS – 8 hours 5. The effects of commonly employed medications on autonomic activity A. Muscle anatomy and physiology; antagonistic and synergistic muscle groups B. Psychophysiological Concepts 1. Tonic and phasic activity B. Central nervous system 2. Orienting, arousal, and habituation Neuroanatomy, neurophysiology, and 3. Situational specificity of physiological pathology relevant to cerebral vascular response
  3. 3. 4. Individual response stereotypy 2. Psychophysiology and biofeedback 5. Physiological differentiation of emotional principles used in explaining treatment states rationale, setting expectations, and motivating compliance C. General applications of autonomic 3. Recognition of secondary gains the biofeedback client may obtain from symptoms 1. Psychophysiological stress profiling 4. Development of a treatment plan based 2. Biofeedback-assisted relaxation on knowledge of relevant research and 3. Psychotherapy process monitoring established criteria for treatment selection D. Pathophysiology, biofeedback modalities, and treatment protocols for specific ANS B. Relaxation methods: Procedures, indications biofeedback applications and 1. Migraine headache contraindications 2. Raynaud’s disease 1. Progressive muscle relaxation 3. Hypertension 2. Autogenic training 4. Cardiac arrhythmias 3. Guided imagery 5. Hyperventilation syndrome 4. Hypnosis 5. MeditationVI. ELECTROENCEPHALOGRAPHIC (EEG) C. Psychotherapeutic techniques APPLICATIONS – 4 hours 1. Empathy and rapport 2. Strategic use of verbal and non-verbal A. Specific central nervous system structures behavior and neurotransmitter pathways subserving 3. Optimizing nonspecific (placebo) effects important psychological states and activities, including sleep-wakefulness, affect and D. Cognitive interventions emotion, pain, motor function, and executive 1. The effect of cognitions (e.g., appraisals, function. schemas, self-talk) on stress levels, presenting complaints, and treatment B. Neuronal sources of scalp EEG activity outcomes 2. Methods of cognitive intervention, e.g., C. EEG patterns and their behavioral correlates, reframing, cognitive restructuring, stress including delta, theta, alpha, low beta, high inoculation, modification of automatic beta, and SMR frequency ranges thoughts D. Clinical uses and efficacy of EEG E. Nutritional considerations pertinent to stress- biofeedback in the treatment of attention related disorders deficit disorder, mild closed head injuries, substance abuse, epilepsy, migraine, F. The effects of exercise on mood, physiological insomnia, anxiety and affective disorders, functioning, and presenting symptoms including the specific EEG parameters and recording sites used for feedback training VIII. PROFESSIONAL CONDUCT – 4 hours E. Potential effects of prescribed and A. Responsibility and competence nonprescribed drugs on clinical presentation, 1. Responsibilities and liability in provision of EEG measures, and EEG biofeedback services learning tasks 2. Demonstrated competence in all aspects of service providedVII. ADJUNCTIVE INTERVENTIONS – 8 hours 3. Limiting scope of practice to areas of professional training and qualifications A. Intake procedures 4. Experimental vs. commonly accepted 1. Interview techniques for charting of biofeedback treatment presenting problems, medical and 5. Contraindications to treatment personal history, psychopathology, and coping resources
  4. 4. 6. Familiarity with the ethical principles of D. Professional relationships BCIA and one’s primary profession 1. Dual relationships 7. Advertising, marketing of services, and 2. Conflicts of interest and exploitation of public statements clients 8. Continuing education and training 3. Consultation, referral, and relationships with other professionals 4. Medical and medication monitoring B. Client rights 5. Procedures for dealing with unethical 1. Privacy, confidentiality, and privileged behavior of colleagues communication E. Record keeping 2. Informed consent to assessment and 1. Technical and legal records treatment 2. Legally required records and retention 3. Accepting clients, abandonment, and appropriate referral 3. Documentation of medical history 4. Universal precautions in biofeedback 4. Security of records to ensure 5. Equal access to health care confidentiality C. Supervision and Consultation 1. Appropriate consultation and supervision in biofeedback 2. Purposes of supervision and consultation 3. The process of supervision 4. Guidelines for seeking supervision©2006 by the Biofeedback Certification International Alliance, (formerly the Biofeedback Certification Institute ofAmerica (BCIA). No portion of this document may be reproduced in any form without the permission in writing ofBCIA.

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