Name: Psychophysiological Stress Assessment Using Biofeedback (Video) | JoVE Journal
Uploaded: 2009-07-31T16:00:00.000+00:00
Duration: 10 min 16 s
Description: Learn psychophysiological stress assessment using biofeedback with EMG, ECG, skin conductance, and breathing sensors. This method helps identify stress reactions and develop effective treatment plans.

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5 minutes

Part 1: Setting up and preparing the skin
<ol>
<li>Set up the following sensors breathing belt, EMG, ECG, skin conductance, temperature, ground;</li>
<li>Prepare the skin by gently rubbing with an alcohol wipe in the following locations: forehead above the eyes for EMG, inside of both wrists for ECG, back of left hand for the ground (location of ground electrode may vary depending on equipment used);</li>
<li>Attach sensors to the skin in the following locations: breathing belt around the waist, EMG on the forehead above each eye, ECG on the inside of each wrist, skin conductance on middle finger of left hand, thermometer on the pointer of left hand, ground on the back of left hand;</li>
<li>Select session for Breathing+HRV;</li>
<li>Make sure that impendence is acceptable for all sensors and that the sensors are responsive to client&rsquo;s movement and producing reasonable readings.</li>
</ol>
Part 2: Recording
<ol>
<li>Explain the procedure to the client.</li>
<li>(min 0-2) Instruct the client to sit quietly with eyes open. Record a two-minute baseline.</li>
<li>(min 2-4) At the end of two minutes, begin a two-minute cognitive stressor &ndash; arithmetic problems gradually increasing in difficulty to be solved without use of pen &amp; paper or calculator (if arithmetic is particularly difficult for the client, ask them to repeatedly subtract seven starting from 100, i.e., &ldquo;serial sevens&rdquo;). Give the following instructions to the client: &ldquo;In the next 2 minutes, I will be asking you to solve some math problems. Please work as quickly as you can and tell me the answer&rdquo;. Do not provide feedback as to whether the client&rsquo;s answer is correct or incorrect and provide minimal encouragement (eg., &ldquo;just do the best you can&rdquo;) so as not to eliminate the mild stress inducing properties of this exercise.</li>
<li>(min 4-6) Let the client know that this part of the assessment is over and ask him/her to sit quietly with eyes open for 2 minutes.</li>
<li>(min 6-8) Begin physical stressor: turn on loud noxious noise (babies crying, car crashes, etc.) and ask the client to listen to the sounds without tuning out.</li>
<li>(min 8-10) Turn off noise, and ask the client to sit quietly with eyes open for 2 minutes.</li>
<li>(min 10-12) Begin emotional stressor: ask the client to talk about a stressful incident that they remember well, include the details of the event, what they were thinking and feeling. Provide minimal empathic response so as not to mitigate the stress response.</li>
<li>(min 12-14) Interrupt the client&rsquo;s story, even if he/she has not finished, and instruct the client to sit quietly with eyes open.</li>
<li>Stop recording, save the data, and let the client know that the assessment is done.</li>
</ol>
Part 3: Debriefing and treatment planning
<ol>
<li>Ask the client about their experience during the assessment. Which parts were particularly stressful and why? Did he/she feel any physiological changes happening?</li>
<li>Review data according to the criteria described in appendix I.</li>
<li>Chose physiological parameters that need to be addressed based on above analysis. If sensor reading at baseline is higher or lower than normal, the treatment goal is to help the client bring that physiological parameter to normal in a non-stressful environment. If sensor reading during the stressor is higher or lower than normal, the treatment goal is to help the client identify stressors and be able to maintain normal level of physiological functioning under stress. If sensor reading during down time indicates lack of recovery, the treatment goal is to help the client bring that physiological parameter to normal level quickly following a stressor. Any or all of these goals may be included in the treatment plan.</li>
</ol>
Appendix I
Stress assessment interpretation guidelines
(all &ldquo;bold&rdquo; answers indicate areas to be addressed)
<table border="0">
<tbody>
<tr>
<td colspan="3">EMG (normal reading &lt;3 microvolts)</td>
</tr>
<tr>
<td>1. Is EMG elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is EMG elevated past the baseline at any of the 3 stressors?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of EMG to baseline level during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td colspan="3">Heart rate (normal range 60-80 beats per minute)</td>
</tr>
<tr>
<td>1. Is heart rate elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is heart rate elevated past the baseline at any of the 3 stressors?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of heart rate to baseline level during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td colspan="3">Breathing rate (normal rate &lt;12 breaths per minute)</td>
</tr>
<tr>
<td>1. Is breathing rate elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is breathing rate elevated past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of breathing rate to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td colspan="3">Skin conductance</td>
</tr>
<tr>
<td>1. Is skin conductance elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is skin conductance elevated past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of skin conductance to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td colspan="3">Finger temperature (normal reading &gt;90F)</td>
</tr>
<tr>
<td>1. Is finger temperature low at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Does finger temperature decrease past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of finger temperature to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td colspan="3">Heart rate variability (norms vary by age)</td>
</tr>
<tr>
<td>1. Is heart rate variability low at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Does heart rate variability decrease past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of heart rate variability during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
</tbody>
</table>
Appendix I
Stress assessment interpretation:
<table border="0">
<tbody>
<tr>
<td colspan="3">EMG (normal reading &lt;3 microvolts)</td>
</tr>
<tr>
<td>1. Is EMG elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is EMG elevated past the baseline at any of the 3 stressors?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of EMG to baseline level during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>Heart rate (normal range 60-80 beats per minute)</td>
</tr>
<tr>
<td>1. Is heart rate elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is heart rate elevated past the baseline at any of the 3 stressors?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of heart rate to baseline level during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>Breathing rate (normal rate &lt;12 breaths per minute)</td>
</tr>
<tr>
<td>1. Is breathing rate elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is breathing rate elevated past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of breathing rate to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>Skin conductance (normal reading &lt;5 micro ohms)</td>
</tr>
<tr>
<td>1. Is skin conductance elevated at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Is skin conductance elevated past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of skin conductance to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>Finger temperature (normal reading &gt;90F)</td>
</tr>
<tr>
<td>1. Is finger temperature low at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Does finger temperature decrease past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of finger temperature to baseline during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>Heart rate variability (norms vary by age)</td>
</tr>
<tr>
<td>1. Is heart rate variability low at baseline?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>2. Does heart rate variability decrease past the baseline for any stressor?</td>
<td>yes _</td>
<td>no _</td>
</tr>
<tr>
<td>3. Is there recovery of heart rate variability during rest periods?</td>
<td>yes _</td>
<td>no _</td>
</tr>
</tbody>
</table>
Treatment planning: If a reading is higher or lower than normal at baseline, goal of treatment is to help client bring that physiological parameter to normal in all circumstances If a reading is higher or lower than normal during the stressor, goal of treatment is to help client identify stressors and be able to maintain normal level of physiological functioning under stress If a reading indicates lack of recovery during down time, goal of treatment is to help client bring that physiological parameter to normal level quickly following a stressor.

<ol><li>Arena, J., Schwartz, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Psychophysiological+assessment+and+biofeedback+baselines%5BTitle%5D)+AND+%22A+Practitioners+Guide%22%5BJournal%5D)">Psychophysiological assessment and biofeedback baselines.</a> A Practitioners Guide. Schwartz, M. S., Andrasik, M. , 3rd edition, The Guilford Press. 128-158 (2005).</li>
<li>Schwartz, N. M., Schwartz, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Definitons+of+biofeedback+and+applied+psychophysiology%5BTitle%5D)+AND+%22A+Practitioners+Guide%22%5BJournal%5D)">Definitons of biofeedback and applied psychophysiology.</a> A Practitioners Guide. Schwartz, M. S., Andrasik, M. , 3rd edition, The Guilford Press. 27-42 (2005).</li>
</ol>

The authors have nothing to disclose.

Completed psychophysiological in the appendi stress assessment provides a biofeedback practitioner with information necessary for formulating a treatment plan. This assessment provides information about both the individual&rsquo;s response stereotypy, or uniformity of certain physiological responses to all stressors, and stimulus-response specificity, or individual&rsquo;s unique physiological responses to different kinds of stressors. With this information, the client is then able to learn to predict what kind of physio...

<table><tbody><tr><td>Physiolab I-330-C2</td><td>J&amp;amp;J</td><td></td><td></td></tr><tr><td>PLUS 12 ch</td><td></td><td></td><td></td></tr></tbody></table>

psychophysiological stress assessment using biofeedback 

Psychophysiological Stress Assessment Using Biofeedback 

In the last half century, research in biofeedback has shown the extent to which the human mind can influence the functioning of the autonomic nervous system, previously thought to be outside of conscious control. By letting people observe signals from their own bodies, biofeedback enables them to develop greater awareness of their physiological and psychological reactions, such as stress, and to learn to modify these reactions. Biofeedback practitioners can facilitate this process by assessing people s reactions to mildly stressful events and formulating a biofeedback-based treatment plan. During stress assessment the practitioner first records a baseline for physiological readings, and then presents the client with several mild stressors, such as a cognitive, physical and emotional stressor. Variety of stressors is presented in order to determine a person's stimulus-response specificity, or differences in each person's reaction to qualitatively different stimuli. This video will demonstrate the process of psychophysiological stress assessment using biofeedback and present general guidelines for treatment planning.

In this video we will describe one method of assessing person's psychophysiological reaction to stress using biofeedback. We will also present general guidelines for treatment planning.

In the last half century, research in biofeedback has shown the extent to which the human mind can influence the functioning of the autonomic nervous ...

Hi, I am Ina Hasan from the Boston Center for Health, psychology and Biofeedback. Today we're going to show you a procedure for recording and interpreting a Psychophysiological stress profile. I'll use this procedure to help figure out people's reactions to stress, identify unhelpful reactions, and then help people modify these reactions.So let's get started. This procedure uses the physio lab I three 30 C two plus with 12 channels. To begin the procedure, attach the EMG lead, de port A, the ECG lead de port B, the combined skin conductance temperature, ground sensor, deports C and the breathing belt to Port D.Prepare the subject's skin by gently rubbing with an alcohol wipe.Start with the forehead above the eyes for the EMG sensor. Then wipe the inside of both of the subject's wrists for the ECG sensor. Last wipe the back of the subject's left hand for the ground electrode.Next, start attaching the sensors. Ask the subject to wrap the breathing belt around their waist, making sure that the pressure gauge is in the front and the belt is not twisted. Place the EMG sensors on the subject's forehead above each eye.Place the ECG sensors on the inside of each wrist. The skin conductance sensor is placed on the middle finger of the left hand. The thermometer is placed on the index finger and the ground electrode on the back of the hand.Next, select the session type in this case using the physio lab I three 30 C two plus select breathing plus HRV. When the impedance screen comes up, make sure that the impedance is acceptable for all the sensors. Green and yellow bars indicate good acceptable quality signal while red bars indicate poor quality signal.If any readings are of poor quality, reattach the sensors after repeating skin preparation or check the leads for damage. Next, select the test signal screen and make sure that the sensors are responding adequately. For the EMG test, ask the subject to move their eyebrows up and down.The EMG signal on the screen should increase and decrease accordingly. For the ECG test, ask the subject to engage in some movement. The ECG signal should increase.To test the breathing belt, ask the subject to take a couple of deep breaths. The breathing line on the screen should rise when the subject inhales and drop when the subject exhales with a set of complete. Proceed to the recording session before.Before starting the recording, explain the procedure to the subject. Ask you to sit with the eyes open, just in quiet. You bear the procedure minutes.Instruct the subject to sit quietly with eyes open. Record a two minute baseline. Next, begin the two minute cognitive stressor involving arithmetic problems of increasing difficulty to be solved without the use of pen and paper or calculator.Tell the client and the next two minutes, I will be asking you to solve some math problems. Please work as quickly as you can and tell me the answer.Okay. In the next two minutes, I'm going to give you some math problems just to solve in, in your mind, without any paper or calculator.Do the best you can and give me the answers quickly as you can.Okay? Okay.What is 18 plus 49? 59 93 Minus 15 Minus 1570.Okay.Okay, so this part of this has mid over and I'm gonna ask you to sit quietly with your eyes open for two minutes. So now I'm going to ask you to listen to some sounds and do your best to not tune them out. Actually listen to to the sounds as much as again.Okay.So in the next two minutes, I'm going to again ask you to just sit quietly with your eyes open. In next minutes, I'm going to ask you to talk about something stressful that happened to you recently, something that you remember well, so you can tell me what you were thinking, feeling, and what the situation was. That was stressful.My wife and two kids were in car accident. They okay. They fine.Three years not, so, it was kind of stressful to get a call from my wife that figuring out how to get by with all the shows, it was pretty stressful, but I'm still dealing with it today. Felt like it was totally wrong time to come up with, to have another problem to deal with, but Again, Keeps me alive.Okay. All right.I'm gonna stop you here and ask you for the next two minutes to sit quietly with your eyes open.Okay. Stop recording. Save the data and let the subject know that the assessment is done.Okay.So the assessment is all done. Thank you. With the assessment at hand, a treatment plan can be developed to debrief.Ask the subject about their experience during the assessment. Which parts were particularly stressful and why did the subject feel any physiological changes happening? Tell me how the stress assessment went, whether any of any of the parts were particularly stressful, how you experienced it.Well, the math was definitely much more stressful, intense. The sound. Review the data according to the criteria described in Appendix one.Accompanying this video protocol, choose physiological parameters that need to be addressed based on analysis of the physiological data recorded during the session and develop a treatment plan. After completing the session, review the collected data. Use the stress assessment interpretation guidelines to decide on a treatment.For example, a normal EMG reading is below three microvolts if the reading is elevated. At baseline, the treatment goal is to help the subject bring the physiological parameter to normal in a non-stressful environment. If the reading is elevated during a stressor, the treatment goal is to help the subject identify stressors and be able to maintain normal levels of physiological functioning under stress.And if the reading indicates lack of recovery during the downtime, the treatment goal is to help the subject bring that physiological parameter to normal levels quickly following a stressor, any or all of these goals may be included in the treatment plan. We have just shown you how to conduct a psychophysiological stress assessment using biofeedback. When doing this procedure, it's important to remember to not give the subject much feedback during the stressors and to adhere to the timing.It is also important not to instruct the subject to relax during the recovery breaks, let the subject do what they usually do following a stressful situation. So that's it. Thanks for watching and good luck with your assessments.

psychophysiological-stress-assessment-using-biofeedback

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Learn psychophysiological stress assessment using biofeedback with EMG, ECG, skin conductance, and breathing sensors. This method helps identify stress reactions and develop effective treatment plans.

Psychophysiological Stress Assessment Using Biofeedback

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