March 25, 2022 (continued)

PLEASE NOTE: The schedule is preliminary, tentative, and subject to change. We will live ‎stream and record keynote presentations and select breakout sessions for virtual ONLY ‎attendee participation. Pre-conference Workshops will be held onsite, for “in-person” only ‎participation.  Virtual Registration for the conference will be offered separately in early 2022 ‎for those who cannot or prefer not to travel. Thank you for your patience as navigate and ‎accommodate.‎

 

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‎‎2:45pm – 4:15pm ‎        90-MINUTE BREAKOUT SESSIONS - SYMPOSIA

 

The Myths and Misconceptions of Breathing

Presented By: ‎

  • Inna Khazan, PhD, BCB
  • Brad Lichtenstein, ND, BCB

SESSION SYNOPSIS: Respiration lies at the foundation of human physiological functioning. Proper ‎respiratory physiology is essential for healthy autonomic nervous system functioning as well as for ‎optimal biofeedback and neurofeedback training. However, respiratory physiology is rarely taught in ‎mental health settings and is oftentimes not understood deeply enough by practitioners. This leads to ‎breathing training that produces overbreathing and may create more difficulty for the client, as well as ‎reduce the effectiveness of biofeedback and neurofeedback. I addition, a solid understanding of ‎respiratory physiology is essential in order to differentiate between breathing practices that are safe ‎for the client and those that are ill-advised. The purpose of this symposium is to describe and address ‎the most common misconceptions about breathing, providing participants with a deeper ‎understanding of respiratory physiology and healthy ways to train breathing.‎

  • Hot Topics
  • Introductory
  • ‎90% Clinical/10% Research‎

LEARNING OBJECTIVES: ‎

  • Describe the basics of physiology of healthy breathing
  • Define the concept of overbreathing and describe the basics of the physiology of overbreathing
  • Explain the role of carbon dioxide in respiratory regulation
  • Describe proper ways to measure carbon dioxide in the blood

TARGET AUDIENCE: Any clinician who teaches and utilizes breathing practices in their work


DIVERSITY CONSIDERATIONS: Some breathing practices are rooted in cultural traditions, which will be ‎addressed and discussed from an evidence-based standpoint


Autism: New Directions in QEEG Subtypes and Neurofeedback for Autistic Spectrum Disorder

Presented By: ‎

  • Michael Linden, Psychologist
  • Estate (Tato) Sokhadze, Ph.D.‎
  • David Cantor, PhD, Psychology

SESSION SYNOPSIS: The prevalence of Autism has increased dramatically to epidemic proportions, ‎however there is no brain functioning test regularly utilized in diagnosis.  Aspergers remains highly ‎undiagnosed in both children and adults; many people with Aspergers are misdiagnosed (ADHD, ‎Anxiety, Oppositional Defiant Disorder, Bipolar) and prescribed medications which make their ‎symptoms worse.  This talk will present QEEG diagnosis and new directions in Neurofeedback ‎treatment of ASD (Autism, Aspergers).    The presenters (David Cantor, Ph.D., Michael Linden, Ph.D., ‎Sato Sokhadze, Ph.D.) have published numerous research articles since 2004 (Biofeedback & Self-‎Regulation; Journal of Neurotherapy; Autism Science Digest; Images of Autism; etc.) and presented at ‎Autism One, TACA, ISNR, ECNS, National Autism Association, and other national and international ‎conferences about QEEG brainmap subtypes of ASD.  The use of QEEG brain mapping to discover ‎which subtype of Autism and Aspergers be explained.      Biofeedback & Neurofeedback have been ‎used successfully to improve anxiety, communication, social skills and attention in ASD since 1994 ‎‎(Biofeedback and Self-Regulation, 2010). Over our many years of experience, there have been ‎numerous types of biofeedback and neurofeedback utilized. Standard (QEEG Guided Neurofeedback, ‎biofeedback) and new types of Neurofeedback home training for younger children (Mente auditory ‎stimulation) & social-emotional regulation (Socialize ACE) will be presented. Research studies with ASD ‎and Neurofeedback, including results of QEEG, fMRI and DTI will be reviewed.‎

  • Hot Topics
  • Intermediate
  • ‎40% Clinical/60% Research‎

LEARNING OBJECTIVES: ‎
Understand QEEG subtypes pattens in individuals with Autistic Spectrum Disorder.‎
Learn about new types of Neurofeedback home training options for ASD.‎
Learn about new developments in Auditory Stimulation Neurfeedback for Young Children with ASD.‎

TARGET AUDIENCE: psychologists/therapists, physicians/neurologists, neurofeedback therapists, ‎educators

DIVERSITY CONSIDERATIONS: QEEG and Neurofeedback do not have cultural issues and apply to all ‎cultures.‎


Integrating Bio- and Neurofeedback in Psychedelic Assisted Therapies

Presented By:

  • Jeff Tarrant, PhD, BCN
  • Heather Hargraves, MA., C.Psych.Assoc. (SP), NMI-3‎

SESSION SYNOPSIS: Interest in psychedelic-assisted therapies (PAT) has increased dramatically based ‎on clinical research showing that Psilocybin (magic mushrooms), MDMA, and Ketamine can be ‎effective for treatment-resistant depression, PTSD, addictions, end-of-life anxiety, and obsessive-‎compulsive disorder. However, it is important to recognize that these benefits are attained within ‎contexts that provide specialized preparation for the psychedelic experience, active support during, ‎and structured integration sessions for follow-up.    Although it is tempting to view psychedelics as a ‎‎“magic bullet” that can permanently solve personal problems and mental health conditions, it is ‎probably more accurate to think of them as medicines that induce a state of increased brain plasticity, ‎also known as a "pivitol mental state". This neuroplasticity facilitates new ways of thinking, feeling, ‎and behaving for those who use it medicinally (Carhart-Harris & Friston, 2019). With this ‎understanding, it becomes increasingly important to 1) prepare the brain/nervous system for the shift ‎experienced during a psychedelic session, and 2) to take advantage of the increased flexibility created ‎by the experience in the days following a psychedelic session. In addition to incorporating targeted ‎psychotherapy, it can also be helpful to include mental state training in the form of neurofeedback ‎and neurofeedback-guided meditation (neuromeditation) into PAT’s.    This workshop will present the ‎neuroscience, research findings, and practice of psychedelic assisted therapies. We will explore this ‎data in the context of the entropic model of consciousness, and conditions related to therapeutic ‎outcomes. We will discuss how neurofeedback therapies are poised to offer a method to support the ‎various states of awareness that underlie positive outcomes as well as practices that help sustain the ‎‎“afterglow” after a psychedelic session. A model for neurofeedback supported PAT’s will be presented ‎along with case study data.‎

  • Basic Science
  • Intermediate
  • ‎75% Clinical/25% Research‎

LEARNING OBJECTIVES: ‎

  • Describe the science behind psychedelic assisted therapies (PAT's)‎
  • Discuss the entropic model of consciousness and its connection to mental health
  • Apply bio and neurofeedback approaches to the preparation and integration phases of PAT's
  • Explain a model of neurofeedback supported PAT

TARGET AUDIENCE: Clinicians interested in learning more about bio- and neurofeedback approaches ‎to complement and advance psychedelic assisted therapies.‎


DIVERSITY CONSIDERATIONS: We strongly emphasize the importance of recognizing and honoring ‎diversity-in all its forms. The approaches taught in this workshop are discussed in the context of ‎individual differences based on a person's culture, background, and neurological state.‎

Bridging Physiology, Science and Daily Life when Providing Stress Management Services

Presented By: ‎

  • Harry van der Lei, PhD
  • Wesley Sime, PhD, MPH

SESSION SYNOPSIS: Stress is a normal aspect of life, but stress is also often misunderstood and ‎mismanaged. Poorly managed stress can ‎vastly affect our performance and health. Motivation, ‎education, assessment, and training are important components ‎when delivering stress management ‎services. In addition, an evidence-based framework and objective measures can ‎be very helpful when ‎providing clients tools how to change and enhance their stress management in life. The speakers ‎will ‎deliver a complementary presentation of a comprehensive stress management education, ‎assessment, and ‎training program. This program is based on the presenters’ practical experience and ‎includes an applied-research ‎based stress model and a recent developed stress management ‎consulting service. ‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • The learner will be explained how stress can be described from a clinical and a performance ‎perspective
  • The learner will be able to explain specific effects of stress on performance and health based on a ‎‎scientifically validated stress model.‎
  • The leaner will be able to assess proven training results of stress management programs on ‎performance ‎and health.‎

TARGET AUDIENCE: Biofeedback and Applied Psychophysiology for the enhancement of performance ‎and health in life.‎

DIVERSITY CONSIDERATIONS: Stress is a universal aspect of life. The presentation therefore is designed ‎for providers and consumers of ‎stress management services.‎

 

Oral Presentations Session 2 - HRV Focused

The following 15 to 30-minute abstract presentations will be featured: 1. Heart ‎Rate Variability Biofeedback among Veterans: Pilot Intervention for Sleep Disturbance 2. A Wait List ‎Controlled Pilot Study of Mindfulness-Based Heart Rate Variability Biofeedback for Military ‎Posttraumatic Stress Disorder 3. Investigating Chronic Symptoms Effects on Parasympathetic Activity ‎via HRV Coherence During Sleep 4. HRV Biofeedback in Healthcare Workers with Disordered Eating: A ‎study Protocol


Heart Rate Variability Biofeedback among Veterans: Pilot Intervention for Sleep Disturbance


Presented By: ‎

  • Joshua Mercadel, MSPH, PhD (c)‎

SESSION SYNOPSIS: A healthy amount of sleep is vital for normal human functions, such as daily ‎learning, memory, emotional state, and cardiovascular health. Sleep deprivation has been associated ‎with increases in sympathetic activity, which contributes to autonomic nervous system (ANS) ‎dysregulation. HRV biofeedback (HRVB) training induces HRV coherence, a condition that maximizes ‎HRV and facilitates autonomic and cardiorespiratory homeostasis.     This randomized, sham-‎controlled, intervention trial tested the hypothesis that HRVB can improve HRV coherence and ‎qualitative or quantitative sleep. Participants were randomly assigned to either an active HRVB training ‎group or a sham condition (final enrollment N=113, 57 randomized to the intervention group and 56 to ‎the sham group). Each participant completed a baseline assessment, 6 weekly training sessions, a ‎post-training assessment, a booster training session and assessment (1-month post-training), and a ‎follow-up assessment (2 months post-training). Wrist actigraphy was used to obtain continuous ‎rest/activity recordings 24-hours per day over three 1-week periods coinciding with the baseline, post-‎treatment, and follow-up assessments. Subjective sleep symptoms are included at each assessment ‎using the Pittsburg Sleep Quality Index (PSQI). Outcomes included: 15-minute resting HRV recordings ‎‎(HRV Coherence Ratio), subjective sleep measures (total PSQI and sleep quality scores) and ‎quantitative sleep measures (actigraphic sleep onset latency, duration, efficiency, wake after sleep ‎onset). Participants were provided with portable practice devices to evaluate compliance.    The study ‎concluded with, 113 patients completing their baseline assessment; 87 completed their post-training ‎assessment, and 76 completed the entire protocol. At post assessment, HRVB patients had elevated ‎mean (±SD) HRV Coherence Ratios at the post-training assessment relative to baseline (0.18±0.20 at ‎baseline vs. 0.51± 0.24 post-training, n=42, p<0.001), whereas no differences were observed among ‎controls (0.17 ± 0.22 vs. 0.19 ± 0.26, n=45, p=0.46). Among all participants at baseline, sleep ‎disturbance (elevated total PSQI score) was correlated with depression, pain, and fatigue (pair-wise ‎Pearson correlation coefficient [r]=0.19 to 0.48 p<0.05). Adjusted mixed effects modeling was ‎conducted to test the study hypotheses. At follow-up, PSQI, duration, and efficiency had significant ‎group by time interaction terms. No effect was observed for onset latency or wake after sleep onset.     ‎HRVB is a quantifiable, easily implemented therapy. Previous research suggests that HRVB can ‎improve overall sleep quality.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • Understand the role of reduced HRV as an indicator of overall sleep quality
  • Understand the relationship between resonant frequency breathing and HRV coherence
  • Understand the role of HRV coherence has as an indicator of balanced autonomic activity

TARGET AUDIENCE: Physicians, research scientists, clinical HRV biofeedback specialists, and students.


DIVERSITY CONSIDERATIONS: Heart rate variability biofeedback training is scalable to many target ‎populations. In the context of this study the population is comprised of Veteran patients with chronic ‎pain. Participants are recruited without consideration of race, sex, religion, or nation of origin.‎
 

Heart Rate Variability Biofeedback with Mindfulness for Military Posttraumatic Stress Disorder: A Pilot ‎Study

Presented By:

  • Donna Schuman, PhD, BCB, BCN
  • Karen A. Lawrence, PhD
  • Ian Boggero, PhD
  • J. P. Ginsberg, PhD
  • Debra Moser, PhD

SESSION SYNOPSIS: Although empirically supported psychotherapeutic interventions have ‎demonstrated efficacy in reducing posttraumatic stress disorder (PTSD) symptoms, clinical-level ‎residual symptoms persist in 31% and subthreshold-level symptoms in 59% of individuals who ‎complete a full course of empirically supported treatment, with hyperarousal and physiological ‎symptoms being particularly persistent (Larsen et al., 2019 Previous research supports the efficacy of ‎heart rate variability (HRV) biofeedback, a non-invasive, non-pharmacological, breathing-based ‎cardiorespiratory training technique, as an adjunctive intervention that reduces PTSD and depressive ‎symptoms in veterans (Lehrer et al, 2000). However, the optimal number of clinical sessions and ‎amount and type of home practice are unclear. The purpose of the study was to pilot a 3-session ‎mindfulness- and mobile app-adapted version of a heart rate variability protocol to determine effects ‎on veteran’s military-related PTSD symptoms, depression, HRV time and frequency domain measures, ‎as well as adherence. Thirty-five U.S. Veterans with PTSD arising from military service were recruited ‎from a Veterans Affairs Health Care Center and randomized into an intervention (n=18) or a waitlist ‎control group (n=17). Symptom change was measured using the Posttraumatic Stress Disorder ‎Checklist-5 (PCL-5; Blevins et al., 2015). Depression was measured using the Beck Depression ‎Inventory-II (BDI-II, Beck et al., 1996). For the primary outcome measure of PTSD severity, mixed ‎ANOVA results showed only a significant main effect of time. However, there was a significant group x ‎time interaction for depression in the intervention group. Controlling for age, the intervention group ‎saw significant increases in SDNN (Standard Deviation of Normal-to-Normal interbeat intervals) ‎compared to control. Findings indicate that a brief 3-session mindfulness-based protocol significantly ‎reduced depression symptoms and improved cardiac autonomic functioning in veterans with military-‎related PTSD compared to waitlist control. SDNN was positively correlated with amount of home ‎practice. Autonomic improvements may occur independently of self-reported change in PTSD severity. ‎Findings underscore the importance of including objective psychophysiological measures to assess ‎response to adjunctive PTSD interventions.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎100% Research‎

LEARNING OBJECTIVES: ‎

  • Summarize literature on the effects of military posttraumatic stress disorder on cardiac autonomic ‎functioning.‎
  • Identify at least two ways mindfulness techniques can be easily integrated into a clinical heart rate ‎variability biofeedback training protocol.‎
  • Recognize how clinical biofeedback training can be combined with the use of a mobile app and sensor ‎to reinforce effects and validate adherence.‎

TARGET AUDIENCE: Researchers and clinicians interested in the use of adjunctive psychophysiological ‎interventions to treat traumatic stressor disorders.‎

DIVERSITY CONSIDERATIONS: In our study, we sought to include a diverse sample in terms of culture, ‎sex, age, veteran status, military service, and military trauma type. Our enrollment was consistent with ‎the number of these groups enrolled in VA PTSD treatment in Western Kentucky. Our research team ‎was trained in culturally competent research practices. In our presentation, we will include ‎information on multicultural issues related to our research.‎


Investigating Chronic Symptoms Effects on Parasympathetic Activity via HRV Coherence During Sleep


Presented By: ‎

  • Joshua Mercadel, MSPH, PhD (c)‎

SESSION SYNOPSIS: While we sleep, we experience multiple ~60-90-minute cycles that typically contain ‎‎4 stages, including three non-rapid eye movement (NREM) sleep stages and one rapid eye movement ‎‎(REM sleep) stage.  It is hypothesized that the HRV Coherence Ratio responds to cardiorespiratory ‎coupling, the synchronization of breathing and heart rate, which in turn corresponds to increased HRV ‎Coherence during NREM sleep stages and indicates parasympathetic activity.  During REM sleep, ‎parasympathetic activity decreases and sympathetic activity increases. Throughout the night cycling ‎occurs through each stage in a pattern like motion. The HRV Coherence Ratio is a possible metric of ‎parasympathetic activation exhibited during our sleep.   This pilot study was an optional component to ‎a randomized, sham-controlled, intervention trial on chronic pain veterans at the VA Medical Center in ‎Columbia, South Carolina. Twenty-three participants completed the additional protocol at baseline (12 ‎intervention, 11 sham-control), 14 completed the post assessment (7 intervention, 7 sham-control). ‎Participants were randomly assigned to either an active heart rate variability biofeedback (HRVB) ‎training group or a sham condition at enrollment into the study. Each participant completed a baseline ‎assessment, 6 weekly HRVB training sessions, a post-training assessment, a booster HRVB training ‎session and assessment (1-month post-training), and a follow-up assessment (2 months post-‎training). At each assessment a questionnaire was administered to assess symptoms of pain, ‎depression, stress, and sleep disturbances. Individuals were asked to wear a Firstbeat monitoring ‎device for electrocardiogram (ECG) recordings during sleep periods for a total of three days. The ‎median score of each outcome was calculated and participants’ data were categorized as either ‎‎“good” or “poor” for analysis per symptom.  Baseline metrics were used to analyze the effect of self-‎reported depression, pain, stress, and sleep disturbances on autonomic function during sleep. Results ‎from grouping of participants will be presented at the meeting. Graphs were generated per variable to ‎visually assess any trends of rhythmic differences in HRV Coherence between the “good” and “poor” ‎groups. Significant differences between grouped participants with severe symptoms and reduced ‎symptoms of pain, depression, stress, and sleep disturbances were found in the initial 90-minute ‎window of sleep.   The HRV Coherence Ratio, was reduced in the first 90-minutes of sleep in ‎symptomatic individuals for each of the symptom categories analyzed. This pilot study displays ‎evidence of HRV Coherence being a proxy variable to parasympathetic activity.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎25% Clinical/75% Research‎

LEARNING OBJECTIVES: ‎

  • Understand the role of reduced HRV as an indicator of overall sleep quality
  • Understand the relationship between resonant frequency breathing and HRV coherence
  • Learn the effects symptoms such as depression, stress, and pain have on the autonomic nervous ‎system while asleep

TARGET AUDIENCE: Physicians, research scientists, clinical HRV biofeedback specialists, and students.‎

DIVERSITY CONSIDERATIONS: Racial differences in symptom management and symptom effects exist. ‎Heart rate variability is a measurable outcome that can display symptom severity in some cases better ‎than questionnaire data is able. Chronic pain, stress, and depression can all affect the autonomic ‎neverous systems balance and mitigate the effectiveness of the parasympathetic to activate during ‎sleep. HRV-B non-pharmacological therapy that can be used to rebalance the autonomic nervous ‎system and improve symptom management. Participants were recruited without consideration of ‎race, sex, religion, or nation of origin.‎
 

HRV Biofeedback in Healthcare Workers with Disordered Eating: A Study Protocol


Presented By: ‎

  • Janell L Mensinger, PhD
  • Mary Ann Cantrell, PhD, RN, CNE, ANEF, FAAN
  • Guy Weissinger, PhD, RN

SESSION SYNOPSIS: Eating disorders (EDs) are severe mental illnesses doubling in prevalence over the ‎past two decades—now impacting 1 in every 13 people globally; far greater suffer from subthreshold ‎eating problems. Methods to prevent the escalation of subthreshold problems from becoming full-‎blown EDs are sorely needed, especially given the lack of specialist providers to meet the current ‎demands for ED care. Research suggests interoception—the capacity to detect and respond to signals ‎from the body—is disrupted in those with EDs. Though there is limited evidence on the relationship ‎between heart rate variability (HRV) and interoception, it is theoretically plausible that superior ‎interception would predict improved vagal tone. Data on HRV and disordered eating/EDs are mixed ‎and sometimes paradoxical, thus marking an area that is ripe for research advancement. HRV ‎biofeedback could be a potential method for both ED prevention and enhancing stress management in ‎individuals with disordered eating. The present study seeks to begin addressing this gap with a ‎feasibility trial aiming to test a preliminary conceptual model by examining the acceptability and ‎potential efficacy of HRV biofeedback for healthcare workers reporting disordered eating. Beginning in ‎June/July, we will recruit 28 eligible participants via email from a registry of healthcare providers ‎enrolled in an ongoing study of the health effects of working during the COVID-19 pandemic. The ‎study overview and consent to enroll will occur via Zoom. Online questionnaires at baseline, midpoint, ‎and post-intervention will provide measurements of the constructs for testing the conceptual model. ‎Participants will be registered in an app that records daily HRV readings, trends, and biofeedback ‎practice in an online dashboard for study personnel to follow. Weekly check-ins with participants will ‎discuss progress, barriers and facilitators of using HRV biofeedback. Generalized estimating equations ‎will be applied to analyze changes in outcomes and potential mechanisms of effects.‎

  • Basic Science (All Levels)‎
  • Introductory
  • ‎20% Clinical/80% Research‎

LEARNING OBJECTIVES: ‎

  • Describe the study protocol to test the feasibility of implementing an HRV biofeedback intervention in ‎healthcare providers with disordered eating
  • Summarize three hypothesized mechanisms by which HRV biofeedback potentially improves ‎disordered eating and self-care in healthcare providers
  • Discuss barriers, facilitators, and the general experience of using HRV biofeedback for healthcare ‎providers
  • Demonstrate preliminary results (if available) of pre-to-post change in HRV, perceptions of stress, ‎disordered eating, and self-care behaviors

TARGET AUDIENCE: This is a talk that will likely appeal to both researchers and clinicians. While the ‎primary purpose is to describe the protocol of the feasibility study, I will also present the conceptual ‎model, the early results, and discuss the successes and barriers to using HRV biofeedback in this ‎population.‎

DIVERSITY CONSIDERATIONS: While the proposal is not DIRECTLY addressing issues of cultural ‎diversity, it is important to say, like all of my research, given the constructs measured (e.g., body ‎appreciation, intuitive eating, self-compassion) this study is conducted from a weight-inclusive care ‎lens (Tylka et al., 2014). Weight-inclusive care is a social justice-oriented framework that recognizes ‎systems of oppression and the marginalization of certain bodies and identities in our culture, including ‎racial and ethnic minorities. Moreover, it is a framework that appreciates the intersectional nature of ‎systemic and institutionalized oppression and thereby underscores matters of health equity and ‎access to care for all. The model views health as multi-dimensional and grounded in socio-cultural ‎processes (ie, social determinants are central factors to health outcomes). While upholding this ‎broader social justice lens, 'weight-inclusive care' specifically supports the health of people across the ‎weight spectrum by seeking to end the stigmatization of weight-related health problems, weight-‎related discrimination, bias, and iatrogenic practices within healthcare and other health-related ‎industries.    Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & ‎Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: evaluating ‎the evidence for prioritizing well-being over weight loss. Journal of Obesity, 2014, 983495. ‎https://doi.org/10.1155/2014/983495‎
 

‎4:30pm – 5:30pm    60-MINUTE BREAKOUT SESSIONS - SYMPOSIA

 


Brief Biofeedback and Cognitive-Behavioral Therapy Protocol in Pediatric Headaches

Presented By: ‎

  • Katie Fleischman, PhD
  • Inna Khazan, PhD, BCB
  • Justin Doo, BS

SESSION SYNOPSIS: Pediatric pain is a major public health concern leading to one of the highest ‎economic costs (e.g., $560-635 billion ‎dollars) for governments, tax payers, and families. Pediatric ‎headaches are one of the most common pain ‎complaints and psychophysiological condition affecting ‎children and adolescents (Singhi, Jacobs & Gladstein, 2014). ‎These chronic pain complaints can lead to ‎repeated emergency room visits, ineffective pain management, ‎inadequate access, education and ‎delivery of services (International Association for the Study of Pain, 2005; 2019). ‎Many studies on ‎pediatric chronic pain can lead to significant disability, higher levels of internalizing and ‎externalizing ‎psychiatric symptomology, and decreased quality of life in emotional, social, and educational ‎domains ‎‎(Balottin et al., 2012; Holden et al. 1999, Powers, Gilman, & Hershey, 2006). The pain symptoms that ‎can ‎sometimes co-occur with the various psychiatric symptoms can create a unique picture that ‎requires a bio-‎behavioral and multi-model approach to treatment. Cognitive behavioral therapy (CBT) ‎and biofeedback offers an ‎efficacious way of alleviating this challenging-to-treat condition and ‎increase overall functionality and health care ‎quality of life. Electromyography (EMG) and finger ‎temperature biofeedback have demonstrated efficaciousness in ‎the treatment of tension type ‎headaches (TTHs) and migraines respectively, while heart rate variability (HRV) and ‎skin conductance ‎‎(SC) biofeedback have shown to be effective interventions for a variety of psychophysiological ‎‎disorders (Ernst, O'Brien & Powers, 2015; Stubberud et al., 2016). Not all biofeedback protocols and ‎modalities ‎have been systematically investigated as a treatment for various headache types (Lehrer et ‎al.; 2013). This ‎symposium will discuss a comprehensive approach to treating 3 types of pediatric ‎headache (tension type, ‎migraines, and mixed), which includes biofeedback, Cognitive behavioral ‎therapy (CBT), Mindfulness Meditation ‎and other psychosocial/behavioral based interventions. ‎Additionally, this symposium will address how to improve ‎the communication or "buy in" from these ‎families that are only seeking a medical approach to their child's pain ‎and how to talk to children and ‎families about the complexities of headaches and pain factors and alternative ‎efficacious treatments ‎than medication alone. Lastly, this presentation will present data on our brief ‎CBT/Biofeedback ‎protocol finalized from ongoing pilot studies examining its effectiveness treating pediatric ‎headache ‎youth as part of multi-interdisciplinary comprehensive treatment.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • Recognize and observe various dialog, materials, and analogies of pain education to youth and their ‎‎families in order to increase the “buy in” for treatment ‎
  • Summarize an early intervention algorithm triage/referral model of care for appropriate treatment ‎‎candidates and use of established measure pre-post and follow-up treatment ‎
  • Summarize and observe development of final protocol analysis & results of a comprehensive brief ‎‎biofeedback/CBT-based Intervention for pediatric headache
  • Utilization of application of standardized protocol with ability to use with various populations and ‎‎individualistic adaptations

TARGET AUDIENCE: All

DIVERSITY CONSIDERATIONS: Use of a bio-psycho-social theory, Brofenbrenner’s Ecological Theory, ‎and multicultural framework. ‎Treating the mind & body within its whole systems with use of the standardized protocol with ‎individualistic and ‎collective adaptations. Use of updated practice and theory from American ‎Psychological Association (APA) and ‎literature from multicultural counseling field leaders, Derald Wing ‎Sue and David Sue Brofenbrenner’s Ecological Theory (https://hubbli.com/impact-of-parent-‎involvement/(Brofenbrenner’s ‎Ecological Theory)‎

 

What’s All the Noise About? Aperiodic Noise in the Brain and Its Colors of Pink, White and ‎Brown

Presented By: ‎

  • Tiff Thompson, PhD, R.EEG.T., BCN, QEEG-D, MFT

SESSION SYNOPSIS: This talk covers the fundamentals between signal (i.e. EEG rhythms and patterns) ‎and aperiodic noise in ‎the brain and the latest findings of aperiodicity, as well as its clinical application. ‎In the infancy and ‎childhood of life, there are rapid changes in the complexity and diversity of neurons ‎and neuronal ‎connections. At the same time there is lessening aperiodic activity and increasing ‎oscillatory frequencies ‎and signals occurring throughout the span of childhood, while overall ‎amplitude decreases. By seniority, ‎the signal to noise ratio is relatively flattened (i.e. periodic noise ‎increases), reflecting in lessened ‎neuroplasticity, resiliency, and malleability to change. ‎Until recently, aperiodic noise was thought to be “filler,” against which the signal was superimposed; ‎‎analogous to a blank canvas and colorful paint. New research is finding that there is information in the ‎‎noise, which likely hold undiscovered secrets to the inner working of the brain. Turns out, this 1/f ‎pattern ‎crops up frequently in many aspects of nature and phenomena like the stock market; some ‎believe it ‎represents a yet unknown law of nature.  This talk looks at the analysis of aperiodic noise, as ‎well as the ‎application of white noise, brown noise, and pink noise in neuromodulation. ‎

  • Hot Topics
  • Advanced
  • ‎37% Clinical/67% Research‎

LEARNING OBJECTIVES: ‎

  • Participants will be able to define pink noise from brown noise and white noise.‎
  • Participants will summarize an enhanced understanding of the principle of aperiodic noise in modern ‎‎neurology
  • Participants will be able to apply pink, white and brown noise in their clinical settings with an ‎enhanced ‎understanding of their respective utilities

TARGET AUDIENCE: Any and all interested in neuroanalysis (beginners to advanced)‎

DIVERSITY CONSIDERATIONS: The neurological phenomena covered in this talk are universal to all of ‎humanity.‎


What Our QEEG May be Missing in Children’s Brains: Ethical Considerations for Practice

Presented By: ‎

  • Ronald J. Swatzyna, PhD, LCSW
  • Robert P. Turner, MD, MSCR, BCN, QEEG-D

SESSION SYNOPSIS: Children and adolescents are very difficult to treat, both with medication and ‎therapies including neurofeedback. Efforts to treat based solely on the presenting symptoms too often ‎fail. There may be neurological abnormalities that the quantitative electroencephalogram (qEEG) is ‎unable to discern. During this of rapid brain growth, as puberty approaches and hormonal surges ‎occur, we see a variety of ever-changing symptoms. Stimulants that address challenges with focus, ‎attention, and hyperactivity are prescribed first. Antidepressants are prescribed to treat anxiety. With ‎the onset of puberty, behavioral issues are commonly treated with antipsychotics. All stimulants, ‎antidepressants, and antipsychotics lower seizure threshold and increase the likelihood of brain ‎instability. At least a third of children and adolescents who have had a negative response to past ‎medication trials have isolated epileptiform discharges (IEDs). In a recent study of 772 children and ‎adolescents without epilepsy, we identified 286 (37%) to have IEDs. In the last decade, multiple studies ‎have found a high prevalence of IEDs across multiple diagnoses. As neurofeedback clinicians, we often ‎see children on multiple medications and, if they have IEDs, we are trying to counter factors that the ‎medication is making worse. QEEG brain mapping fails to identify IEDs for two reasons. First, the qEEG ‎artifacting process removes or averages out IEDs. Second, only a board certified ‎electroencephalographer has the training to detect subtle abnormalities.  Without this interpretation, ‎protocols to address the IEDs cannot be made from just the qEEG data alone as they will remain ‎unidentified. Psychiatrists need to be made aware of IEDs. Having a report from an MD who is a board ‎certified electroencephalographer goes a long way to a working relationship with treating psychiatrists.‎

  • Hot Topics
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • What brain abnormalities can be made worse by commonly prescribed medications for children
  • What is a very common EEG abnormality in children and adolescents.‎
  • Why it is important to have the EEG read by an MD board certified in electroencephalography
  • Why it is ethically important for clinicians not to comment on what abnormalities they see in the EEG

TARGET AUDIENCE: This presentation is targeted for all of those who treat children and adolescents ‎even if they do not do qEEGs or neurofeedback.‎

DIVERSITY CONSIDERATIONS: EEG and qEEG data are blind to culture, race, or religious bias. This ‎demographics information is not collected.‎


Oral Presentations Session 3: Mindfulness/HRV Focus

The following 15 to 30-minute abstract presentations will be featured: 1. ‎Mindfulness Biofeedback for Improved Selective Attention 2. Breathing is Not Always in Phase with ‎HRV during Resonance Frequency Breathing3. HRV biofeedback in healthcare workers with disordered ‎eating: A study protocol 4. Adding heart rate variability biofeedback to a remote digital intervention for ‎depression
 

Mindfulness Biofeedback for Improved Selective Attention


Presented By: ‎

  • Rose Schnabel, MA, MSW, PhD
  • Vietta Wilson, PhD

SESSION SYNOPSIS: Teenage-scholar athletes are at risk of mental health concerns, including high ‎levels of stress due to the constant demands across academic and athletic domains (Lavallee & ‎Wylleman, 2000; Watt & Moore, 2001) where they have to self-regulate to reach optimal levels of ‎attention (Gross, 1998a). Additionally, they need the ability to deliberately shift into a state of  ‎attention for optimal performance in sports and academics (Wilson et al., 2018).  Research indicates ‎that practicing mindfulness is beneficial in improved executive functioning, and in well-being (Zanesco ‎et al., 2018, Farb et al. 2015; Kabat‐Zinn, 2003).  Biofeedback training is a method of self-regulation of ‎autonomic responses (Moss, 2016). Mindfulness biofeedback (MB) has recently showed benefits for ‎well-being (Khazan & Moss, 2020) and athletic performance (Perry, 2018) but the effect of MB on ‎attention has yet to be investigated. This study details the effects of MB induction on selective ‎attention scores and psychophysiological changes in electrodermal activity (EDA). Method: 71 high-‎school scholar athletes were randomly assigned to play multiple object (MOT) game with MB ‎‎(experimental) and without MB (control). EDA recordings of alerting, and orienting phases provided an ‎active measure of emotional arousal throughout the MOT phases and a selective attention test was ‎conducted pre and post(Cambridge Brain Science [CBS]). Results: Significant effects of MB were ‎evident through higher selective attention scores through a mediating effect of a decrease in EDA ‎variability (Coefficient-of -Variability).  A 1-month-follow-up survey showed MB was applied by ‎participants to regulate preperformance in sport and academic domains. Conclusion: These results ‎suggest that MB improves the stability of  emotional arousal (decrease of EDA variability) and it is this ‎effect that improves selective attention scores.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎40% Clinical/60% Research‎

LEARNING OBJECTIVES: ‎

  • Design/methodology for examining the effects of Mindfulness Biofeedback on selective attention.‎
  • Compare traditional EDA/equipment with new FDA approved equipment at the wrist site
  • Understand EDA Mindfulness Biofeedback through the theoretical lens of  reappraisal process of ‎emotion regulation
  • Be able to explain the differences between effectiveness of MB on attention an how the mediator ‎influences the results

TARGET AUDIENCE: researchers, clinicians

DIVERSITY CONSIDERATIONS: Suggestions for future studies to include the current design that is used ‎for scholar athletes, to different group


Breathing is Not Always in Phase with HRV during Resonance Frequency Breathing

Presented By: ‎

  • Paul Lehrer, PhD

SESSION SYNOPSIS: Previous research on young people has found that the  phase relationship ‎between heart period (HP) and breathing is approximately 180 degrees (or for heart rate, 0 degrees) ‎during resonance frequency breathing.   . We analyzed this phase relationship for 5-min periods  ‎among 26 adults from a recent study of heart rate variability biofeedback to treat adults with mild to ‎moderate currently symptomatic asthma, ages between 18 and 75. We calculated rate variability for ‎all frequencies in the low frequency range (0.05-0.15 Hz). For the frequency with the highest HRV ‎amplitude, usually close to 0.1 Hz, we calculated coherence, transfer function, and phase between ‎cardiac interbeat interval and the respiration curve, using the WinCPRS program . Among records with ‎coherence > 0.8, we found a phase relationship of 95 degrees with HPl, or about 51 degrees with heart ‎rate, with heart rate preceding breathing.  We computed Spearman correlation coefficients between ‎phase and various subject characteristics, partialling out age, gende and  height.. We found no ‎relationship between phase and gender, height, or asthma symptoms. However, when controlled for ‎gender and height, we found a significant correlation between phase and age, with younger ‎participants having values closer to 180 degrees, r = 0.47, p < 0.03.   Cardiovascular characteristics of ‎older people may affect the phase relationship. Despite the deviation from the in-phase relationship, ‎particularly among older individuals, breathing nevertheless presumably stimulated the baroreflex, as ‎shown by high-amplitude heart rate oscillations. In this case, heart rate appeared to have been ‎stimulated in the middle of its swing in each direction, but not at the extremes of each swing. ‎Implications are discussed for treatment of lung diseases, as well as for HRV biofeedback training ‎protocols.‎

  • Hot Topics
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • Learn that HR and breathing are not always in phase during resonance frequencyn breathing
  • Learn that phase disparities are greater in older people
  • Learn some possible explanations for the phase disparities

TARGET AUDIENCE: Anyone who does HRV biofeedback or is interested in its effects.‎

 

HRV Biofeedback in Healthcare Workers with Disordered Eating: A Study Protocol

Presented By: ‎

  • Janell L Mensinger, PhD
  • Mary Ann Cantrell, PhD, RN, CNE, ANEF, FAAN
  • Guy Weissinger, PhD, RN

SESSION SYNOPSIS: Eating disorders (EDs) are severe mental illnesses doubling in prevalence over the ‎past two decades—now impacting 1 in every 13 people globally; far greater suffer from subthreshold ‎eating problems. Methods to prevent the escalation of subthreshold problems from becoming full-‎blown EDs are sorely needed, especially given the lack of specialist providers to meet the current ‎demands for ED care. Research suggests interoception—the capacity to detect and respond to signals ‎from the body—is disrupted in those with EDs. Though there is limited evidence on the relationship ‎between heart rate variability (HRV) and interoception, it is theoretically plausible that superior ‎interoception would predict improved vagal tone. Data on HRV and disordered eating/EDs are mixed ‎and sometimes paradoxical, thus marking an area that is ripe for research advancement. HRV ‎biofeedback could be a potential method for both ED prevention and enhancing stress management in ‎individuals with disordered eating. The present study seeks to begin addressing this gap with a ‎feasibility trial aiming to test a preliminary conceptual model by examining the acceptability and ‎potential efficacy of HRV biofeedback for healthcare workers reporting disordered eating. Beginning in ‎June/July, we will recruit 28 eligible participants via email from a registry of healthcare providers ‎enrolled in an ongoing study of the health effects of working during the COVID-19 pandemic. The ‎study overview and consent to enroll will occur via Zoom. Online questionnaires at baseline, midpoint, ‎and post-intervention will provide measurements of the constructs for testing the conceptual model. ‎Participants will be registered in an app that records daily HRV readings, trends, and biofeedback ‎practice in an online dashboard for study personnel to follow. Weekly check-ins with participants will ‎discuss progress, barriers and facilitators of using HRV biofeedback. Generalized estimating equations ‎will be applied to analyze changes in outcomes and potential mechanisms of effects.‎

  • Basic Science (All Levels)‎
  • Introductory
  • ‎20% Clinical/80% Research‎

LEARNING OBJECTIVES:

  • Describe the study protocol to test the feasibility of implementing an HRV biofeedback intervention in ‎healthcare providers with disordered eating
  • Summarize three hypothesized mechanisms by which HRV biofeedback potentially improves ‎disordered eating and self-care in healthcare providers
  • Discuss barriers, facilitators, and the general experience of using HRV biofeedback for healthcare ‎providers
  • Demonstrate preliminary results (if available) of pre-to-post change in HRV, perceptions of stress, ‎disordered eating, and self-care behaviors

TARGET AUDIENCE: This is a talk that will likely appeal to both researchers and clinicians. While the ‎primary purpose is to describe the protocol of the feasibility study, I will also present the conceptual ‎model, the early results, and discuss the successes and barriers to using HRV biofeedback in this ‎population.‎

DIVERSITY CONSIDERATIONS: While the proposal is not DIRECTLY addressing issues of cultural ‎diversity, it is important to say, like all of my research, given the constructs measured (e.g., body ‎appreciation, intuitive eating, self-compassion) this study is conducted from a weight-inclusive care ‎lens (Tylka et al., 2014). Weight-inclusive care is a social justice-oriented framework that recognizes ‎systems of oppression and the marginalization of certain bodies and identities in our culture, including ‎racial and ethnic minorities. Moreover, it is a framework that appreciates the intersectional nature of ‎systemic and institutionalized oppression and thereby underscores matters of health equity and ‎access to care for all. The model views health as multi-dimensional and grounded in socio-cultural ‎processes (ie, social determinants are central factors to health outcomes). While upholding this ‎broader social justice lens, 'weight-inclusive care' specifically supports the health of people across the ‎weight spectrum by seeking to end the stigmatization of weight-related health problems, weight-‎related discrimination, bias, and iatrogenic practices within healthcare and other health-related ‎industries.    Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & ‎Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: evaluating ‎the evidence for prioritizing well-being over weight loss. Journal of Obesity, 2014, 983495. ‎https://doi.org/10.1155/2014/983495‎


Adding Heart Rate Variability Biofeedback to a Remote Digital Intervention for Depression

Presented By: ‎

  • Valerie Forman Hoffman, PhD, MPH

SESSION SYNOPSIS: A rise in the prevalence of depression underscores the need for accessible and ‎effective interventions. The objectives of this study were to determine if the addition of a treatment ‎component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our ‎original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-‎B (“enhanced”) intervention were more likely to experience clinically significant improvements in ‎depressive symptoms than patients in our original (“standard”) intervention. We used a quasi-‎experimental, non-equivalent (matched) groups design to compare changes in symptoms of ‎depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = ‎‎48). Patients in the enhanced group completed a total average of 3.86 hours of HRV-B practice across ‎‎25.8 sessions, and were more likely to report a clinically significant improvement in depressive ‎symptom score post-intervention than participants in the standard group, even after adjusting for ‎differences in demographics and engagement between groups (adjusted OR = 3.44, 95% CI [1.28 – ‎‎9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, ‎remote intervention for depression is feasible and may enhance treatment outcomes.‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎50% Clinical/50% Research‎

LEARNING OBJECTIVES: ‎

  • Identify challenges to providing HRV-B remotely
  • Learn how HRV-B improved the efficacy of a multidisciplinary depression digital health intervention
  • Brainstorm next steps to applying HRV-B remotely throughout interventions that can treat different ‎types of health interventions.‎

TARGET AUDIENCE: Researchers, clinicians, health administrators

DIVERSITY CONSIDERATIONS: Our sample was drawn from both Finland and the U.S. settings.‎

 

6:00pm - 7:15pm   

Distinguished Scientist Lecture: The Integration of Lifestyle Change, Self-Care, and Professional ‎Treatment Interventions for Chronic Conditions: The Pathways Model                                                                                                                                                                 Presented by: Donald Moss, PhD, BCB, BCN, BCB-HRV


SESSION SYNOPSIS: The major challenge for human health in the 21st century is chronic diseases and ‎chronic conditions. This is a global problem, burdening health care systems and economies worldwide. ‎Factors contributing to the increase in chronic illness worldwide are aging populations, rapid ‎urbanization, and the globalization of unhealthy lifestyles.‎ Palliative medicine provides both medical and behavioral interventions offering relief from pain and ‎suffering caused by chronic conditions that are not amenable to cure. Lifestyle medicine emphasizes ‎reversing negative lifestyle elements that cause or exacerbate illness and introducing positive lifestyle ‎elements that enhance wellness.‎
The Pathways Model, developed by McGrady and Moss (2013, 2018), integrates features of both ‎palliative and lifestyle medicine.  The Pathways Model provides a step-wise framework for combining ‎patient-directed lifestyle change and self-care, skills acquisition, and the use of community resources, ‎with professionally administered treatment, to reduce suffering, manage illness, and optimize ‎mindbodyspirit wellness. The presenter will close with case narratives to illustrate the Pathways Model ‎and show the clinical benefit of coordinating lifestyle change and regular use of self-care strategies ‎with professional treatment interventions, for chronic medical illness and chronic mental health ‎disorders.‎

Donald Moss, PhD, BCB, is Dean, College of Integrative Medicine and Health ‎Sciences, at Saybrook University, Oakland, CA. There he has built training ‎programs in biofeedback, clinical hypnosis, integrative mental health, wellness ‎coaching, and integrative/functional nutrition. Dr. Moss is currently President of ‎the Society for Clinical and Experimental Hypnosis. He is also the ethics chair and ‎international certification chair for the Biofeedback Certification International ‎Alliance. He has served as president of Division 30 (hypnosis) of the American ‎Psychological Association, and president of the Association for Applied ‎Psychophysiology and Biofeedback (AAPB). He is also a member of the ‎International, Interdisciplinary, and Interreligious Research Group on ‎‎'Consciousness Studies,' at the Pontifical Academy, "Athenaeum Regina ‎Apostolorum," Rome, Italy. He has a book to be released in July 2018 with co-‎author Angele McGrady on Integrative Pathways: Navigating Chronic Illness with ‎a Mind-Body-Spirit Approach (Springer). He also has a book in preparation with ‎co-editor Inna Khazan on Mindfulness, Compassion, and Biofeedback Practice ‎‎(AAPB) and a book in preparation with co-editor Fredric Shaffer on Physiological ‎Recording Technology and Applications in Biofeedback and Neurofeedback ‎‎(AAPB). Moss is co-editor of Foundations of Heart Rate Variability Biofeedback ‎‎(AAPB, 2016), co-author of Pathways to Illness, Pathways to Health (Springer, ‎‎2013), and chief editor of Handbook of Mind-Body Medicine for Primary Care ‎‎(Sage, 2003) and Humanistic and Transpersonal Psychology (Greenwood, 1998).‎

  • Clinical Interventions and Optimal Performance
  • Intermediate
  • ‎70% Clinical/30% Research‎

LEARNING OBJECTIVES: ‎

  • Summarize global increase and global burden of chronic diseases and chronic conditions.‎
  • Recognize the role of aging, unhealthy lifestyle changes, and urbanization in the increasing the ‎incidence of chronic illness and chronic conditions.‎
  • Apply the Pathways Model to develop comprehensive patient-directed treatment plans, integrating ‎lifestyle change, the acquisition of skills, with biofeedback and other professional interventions.‎
  • Enhance the involvement of patients in active participation in their own healthcare and health ‎maintenance.‎

TARGET AUDIENCE: This address will be useful for practitioners in biofeedback, neurofeedback, and ‎lifestyle medicine, with guidance for the integrative care for medical and mental health disorders.‎

DIVERSITY CONSIDERATIONS: This invited address will include discussions of the need to adapt ‎treatment for diverse populations and the importance of cultural competence for effective treatment.‎

 

7:15 pm - 10:30 pm‎
President/Poster Reception

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Wednesday, March 23, 2022‎

Thursday, March 24, 2022‎

Friday, March 25, 2022‎

Friday March 25, 2022 CONTINUED

Saturday, March 26, 2022‎

Saturday, March 26, 2022 CONTINUED

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