JEFFREY MISHLOVE, Ph.D.: Hello and welcome. I'm Jeffrey Mishlove, and today we'll be examining biofeedback, the ability of the human mind to control physiological functions that were once thought to be only within the realm of the unconscious mind. With me is George Fuller von Bozzay, a medical psychologist, director of the Biofeedback Institute of San Francisco, and author of numerous books, including Psychology Today and Tomorrow, Methods and Techniques of Biofeedback, and Behavioral Medicine and Stress Management. Welcome, George.
FULLER VON BOZZAY: Thank you. It's nice to be here, Jeffrey.
MISHLOVE: It's a pleasure to have you here. You know, I remember back when I was an undergraduate student in college some twenty years ago, and we were told at that time that there was just beginning to be some evidence that human beings could actually control their heartbeat, or control their brain waves, and I was just astonished, because I had been brought up to believe, as had most people of my generation, that these functions were simply not under conscious control. It looks like we've come a long way since that time.
FULLER VON BOZZAY: That's right, we have. It's been twenty years now, and biofeedback has moved from the kind of thing with little beep boxes to now very sophisticated computerized equipment, helping people really learn many different kinds of control -- not just brain waves, but heart rate, blood pressure, muscle tension, skin surface electrical changes -- quite a number of things. Virtually anything that could be measured could be potentially controlled.
MISHLOVE: Well, I know the field has had an unusual history. At one time it seemed like it was a major popular fad, and everybody was talking about alpha waves and alpha training. At other times it seemed as if it was going to fizzle out completely.
FULLER VON BOZZAY: That's right. I think in some ways that hurt the field. For many years I think people even thought, "Well, what ever happened to biofeedback?" But during that time there was substantial research going on in the area -- in terms of personal growth, in terms of education, and in terms of medical practice. And so that, coupled with the new equipment, has made some major strides in the use of biofeedback for what's called behavioral medicine and other areas.
MISHLOVE: Now I'm told that virtually every single cell in the body, if it were hooked up to an electrode, would be amenable to conscious human control.
FULLER VON BOZZAY: It's interesting that you mention that, because there's actually a researcher, very well regarded, John Basmajian, who has needle electrodes which he puts through the surface of the skin -- this is not for clinical use, but research -- and has the person control a single motor unit, which is one part of a muscle cell. And then he can put that in combination with other motor units, and the person actually plays a tune, because they can specifically control single-motor-unit cells.
MISHLOVE: What's the principle behind it?
FULLER VON BOZZAY: Well, the main principle is that of learning, and I think we forget that with all our talk about equipment -- that the bottom line to biofeedback is that it's a learning procedure. You learn self-control skills, just as you would learn how to walk or talk, ride a bicycle, or throw darts. You need feedback. Could you imagine, for example, being able to hit the bull's eye in a dart board without feedback, without some form of knowing whether you missed it or hit it?
MISHLOVE: For example, if you were blinded.
FULLER VON BOZZAY: That's right, or also didn't have any hearing, so you couldn't even use that skill.
MISHLOVE: In other words, it's as if the human mind is capable of learning almost anything, but without the sophisticated equipment to give us the kind of precise feedback which is now possible, we learn really rather gross control of our body, rather than the kind of fine control that might otherwise be possible.
FULLER VON BOZZAY: That's exactly it, and that's frankly why I'm so excited about this field, and have been over the last twenty years. Its potential is great; it's that we've never learned in our schooling -- I mean, you've had history, you've had math. When have you ever had a course, for example, in school, which could teach you heart rate control, or which could teach you certain mental control skills like controlling your own brain waves to focus or defocus?
MISHLOVE: We do a lot of programs on Thinking Allowed in relationship to mystical traditions -- yoga, Zen meditation, Buddhist meditation -- and in these traditions there's also an exquisite sense of self control, and I know biofeedback researchers have verified that this is the case. I wonder if you could comment on the differences or distinctions that would occur between other forms of self control training, such as hypnosis, meditation, autogenic training, and biofeedback.
FULLER VON BOZZAY: Well, I respect those disciplines, and I think that that's often what they have to be -- disciplines that take years and years of practice, and sometimes a great deal of giving up of one's life in order to practice a discipline, let's say, that involves self-control of the body. In our modern age, and with the speed at which things are moving, sometimes we want to do things faster, and one thing that biofeedback lends is that the learning tends to be more precise. Why? Because you get immediate feedback as to whether you're successful or not successful in learning a skill. So the difference in one way is that the practitioner of these various strategies often does it in a hit-and-miss way. Sometimes it takes years, and then they stumble upon the right way, or the way that seems to work, whereas with the biofeedback the person tends to get the information more quickly. When they do, they can then not only do more, they can do it faster, and often with greater precision.
MISHLOVE: So almost a sense, then, in which the biofeedback trainer and the equipment is functioning like a guru, only a guru capable of giving so much more precise feedback, I suppose.
FULLER VON BOZZAY: That's an interesting way of looking at it. It is, it's a helper. In fact I'm fond of saying to the people that I train, whether they be patients, or people coming for personal growth, that the purpose of all biofeedback is to get rid of the instruments. We essentially use the instruments to internalize learning, so once you've got the internal loop instead of the external biofeedback loop, you now have a skill that you can take with you.
MISHLOVE: In other words, once the machine has taught you how to distinguish, say, between alpha and beta and theta brain waves, or between different levels of blood pressure or GSR or body temperature, then you can use your own internal sensors, your own nervous system, to give you that same feeback, because you've learned inside how to make that distinction.
FULLER VON BOZZAY: Exactly. And that kind of distinction might be interesting to your viewers. If the viewers, for example, were to sit right now and lower their blood pressure ten millimeters of mercury -- that is, then points -- and when they they finished, they would know it, right? Well, maybe they did it, or maybe they didn't know if they did it. Maybe they practiced a particular skill that they'd learned -- Transcendental Meditation, or relaxation training, or self hypnosis.
MISHLOVE: It would be very hard, I suppose, for you or me to articulate to a viewer just what that would feel like.
FULLER VON BOZZAY: That's right.
MISHLOVE: But the biofeedback instrument would be able to do it precisely.
FULLER VON BOZZAY: That's right. If they had in front of them a small device -- it could be this small -- and with every beat of the heart it gives their blood pressure, beat by beat, then they could say, "Oh, look, I just did it and it came down. I'll do it again. Well, I did it again. Now I've done it several times, I'll turn it to you. OK, I just did it once more. And yet the instrument's not doing it to me; I'm doing it myself. And I'm no longer getting feedback because I've learned what it takes to do that, whatever skill or strategy that I'm using, and then now I'm no longer needing the instrument." And that's basically the progression in all biofeedback training.
MISHLOVE: You've mentioned that you used biofeedback with your clients, both for personal growth and for dealing with medical problems. Let's talk about those two realms. Let's start with medical problems. What are the basic medical problems that are most amenable to this type of training?
FULLER VON BOZZAY: Well, probably the three major psychophysiologic disorders that are seen by biofeedback practitioners are hypertension, which is high blood pressure; insomnia, sleep disorders; and the headaches, especially migraine and muscle contraction headaches. Those three conditions represent about a third or thirty percent of all of the conditions that biofeedback treats.
MISHLOVE: In the case of hypertension, one learns how to lower blood pressure.
FULLER VON BOZZAY: That's right.
MISHLOVE: In the case of insomnia, I suppose one learns how to activate a sleep response in the brain.
FULLER VON BOZZAY: That's right. In some ways, the person who has a sleep disorder has forgotten or unlearned the process of falling to sleep normally. By letting their brain waves cycle down into slower and slower frequencies as we normally do and fall asleep, they instead maintain high arousal -- usually muscular or other kinds of arousal -- and high brain wave frequencies, continuing to think about or worry about problems. So you teach them body body relaxation, brain wave control, and have shaping down towards frequencies of delta sleep.
MISHLOVE: I like that word shaping. It gives you a real sense of working with many different functions at once, perhaps.
FULLER VON BOZZAY: That's right, and much of the biofeedback work is not done in the way that people imagine. For example, you're not just hooked up to a machine and watch a meter wiggle. Often there are several different devices, and you see or hear a very simple feedback tone or light, which then is a composite of several different physiologic measures.
MISHLOVE: For example, we've talked about insomnia and hypertension, but there are also the headaches, you mentioned, as a major one. That I suppose has to do with muscle tension in the scalp muscles, and perhaps other issues such as body temperature.
FULLER VON BOZZAY: That's right. In fact those are the two major headaches -- the vascular headaches, which mainly arise from the dilation of the blood vessels, the stretching that produces the pain of the migraine; and the muscle contraction headaches, which we loosely call tension headaches, which are the headaches, usually, of the masseter muscles of the jaw, or the trapezius muscles of the neck.
MISHLOVE: In the neck and shoulders.
FULLER VON BOZZAY: So these muscles get tight and tense and people don't even realize that they're tense. Even if they rub their neck and twist their head like this, they may not be able to loosen those muscles, and biofeedback in that sense becomes a kind of internal massage. They actually direct -- much as I direct my hand to rise, they direct a relaxation of the muscle. And now that they've learned how to do that -- it's not unlike, by the way, learning how to wiggle your ears; it's learning a new skill. They learn to relax that muscle; the headaches now don't come on, because they don't use the previous kinds of reactions to stress that they had before.
MISHLOVE: I would imagine, of course, that biofeedback must be effective for many, many other conditions -- perhaps controlling nausea, or controlling something like stuttering.
FULLER VON BOZZAY: That's right. In fact there's a project that has been going on for the last ten years with the Space Shuttle, controlling space sickness. One of the biggest problems in space that NASA has had is that this space sickness is produced by dysequilibrium, and the nausea by the floating floating feeling within the inner ear. So there's a biofeedback project training people to be able to control space sickness.
MISHLOVE: Is biofeedback ever used with something like cancer?
FULLER VON BOZZAY: Well, it has been -- not to treat the cancer so much, although there have been attempts even there, but to strengthen the immune system; to have people learn self-control skills in being able to control the fear that then perhaps accelerates the cancer growth, and generally in learning de-arousal skills that allow the body to be more healthy and be able to combat this intrusive cellular growth.
MISHLOVE: Now let's talk about the use of biofeedback in personal growth. Why would somebody want to use biofeedback for personal growth?
FULLER VON BOZZAY: Well, if you think about creativity, as an example, here's something where the artist or the writer or even the musician would like to be able to get in touch with more creative thoughts and feelings. They often talk about having dry periods, periods where they're pushing to try to think of something and come up with something creative. There are brain wave frequencies -- notably theta-wave frequencies, that are just before sleep -- that are associated with passive concentration, in which when a person's able to stay in theta for longer periods -- you and I may, for example, pass through it every night before going to sleep for two or three seconds. But if you maintain it for a long period, you then have passive awarenesses -- thoughts that come to mind very much like revelations, Aha! experiences. And those tend to be the kinds of thoughts that creative people would like to foster and enhance. So we do some work with creativity. We also work with people who would like to improve their reading skills and focusing attention.
MISHLOVE: Really!
FULLER VON BOZZAY: I'm working on a project right now in education, where I'd like to train younger children to learn self-control skills. Why cut up a frog, when you can learn to control your own muscles? In some ways we don't give children an opportunity to do things more precisely. Children, for example, when they're taught to read, may concentrate for awhile, then they get distracted. What if we were to set up devices where they could learn when they're concentrating and when they're not? And that might be a major distinction in being able to focus and attend, read.
MISHLOVE: How about the area of athletic training? Is biofeedback used there?
FULLER VON BOZZAY: Very much. In fact there are major programs in the Olympic Committee sites, where people, especially divers and swimmers, athletes of all types, learn to control fine muscle movement through EMG biofeedback -- electromyograph -- getting feedback on agonist and antagonist muscle, opposing muscles. You know, one of the things that causes a tremor is that a person who tries to pick up something may produce a spasm or tremor when they try to lift that object. Instead of having a smooth motion, they contract both muscles simultaneously, so they get this motion. An athlete who would be free to make a bigger jump, a higher jump, needs to relax one muscle completely in order that the other muscle contracts fully without resistance. How can you do that without really understanding the full implication of relaxation and tension of a muscle? And there's a use of EMG, for example.
MISHLOVE: I see. You know, this seems to raise a number of philosophical issues to me. If we have such exquisite control, who's doing the controlling? Is there a self that sort of massages or manipulates the body? Does this ever become an inquiry of yours?
FULLER VON BOZZAY: Absolutely. I think that when we think about self control, you have to look at the whole person. You have to look at not just technical skill, nor do you look at just the machinery, but you also look at the person's motivation, their feelings and emotions, their blocks, their resistances, what frees them to be able to get in touch with their higher self. And so we're really looking at much more than just the nuts and bolts of muscle group contraction.
MISHLOVE: Do you find that as people develop the kind of exquisite control which is possible in biofeedback, that their personalities change, that they become maybe more powerful human beings in other regards, or develop more philosophical or spiritual ideals in their lives?
FULLER VON BOZZAY: Sometimes that's true. You have different types of people, of course. Most of our work is very tailored to the person. An engineer, for example, might get very involved with the equipment, and want to know how this and that works, and in that process his motivation is increased and he starts getting involved in the process of getting in touch with his own body more, and becoming more friends with his own body. At the same time, someone who has self-control problems -- alcoholism, overeating, drug abuse -- while biofeedback doesn't particularly treat drug abuse or any of those other conditions, it helps the person gain their own sense of skill and ability to control themselves. It's not infrequent that the alcoholic actually drinks because they're tense, they're unable to relax, so they may learn relaxation skills and be taught these skills more with biofeedback, so that it will be deeper relaxation, so that they can relax and not have to drink to perform the same things.
MISHLOVE: In other words, this form of self control can serve as a substitute way of meeting the needs that a person might otherwise turn to alcohol or drugs for.
FULLER VON BOZZAY: Well, or I might even think of it the other way around. The person is using alcohol to self medicate, to try to relax in, let's say, a social situation, where they may not realize that they have those very skills within them. Or the new drug now, instead of Valium, is Xanax. People are taking Xanax and becoming quite psychologically dependent on Xanax to even get through their day. They don't sometimes realize that they have those very same skills to be even changing their biochemistry through self control skills in which the physiology and biochemistry changes and replicates those same biochemical changes that they get from the pills.
MISHLOVE: You know, I've heard a number of biofeedback researchers and clinicians mention that sort of as a side effect of doing biofeedback, and one that's rarely mentioned in the published literature, they've often reported that their clients and patients would develop or report psychic skills as sort of a concomitant to that process. Have you noticed this at all?
FULLER VON BOZZAY: I have never studied that, and it's not particularly my area, although I have staff members and colleagues that have looked into this. One engineer that was working with us for years has looked at the increased possibility of ESP and other phenomena by using biofeedback skills and training to try to enhance those ESP phenomena. I think it's very difficult, as you probably know, to try to prove that, yet I think it's a worthy thing to study, because what are the blocks or walls that get in the way of those potential skills?
MISHLOVE: It seems to me that much of the thrust of your own work is oriented right in that area -- the idea that we must create our own blocks. We put up our own walls, and through feedback and through an attitude that I can control myself, these are barriers that we can dissolve.
FULLER VON BOZZAY: That's right, and I think that's where being able to develop one's fullest potential really comes. We say things like "thinking as a child," or "emoting as a child." It's because, I think, in later years one puts layers around them that prevent those more natural responses. In some cases biofeedback training really just allows the person to get back to the equilibrium or homeostasis that they were able to achieve before they had these resistances.
MISHLOVE: In other words, I guess you're pointing out, say, to a young child, an infant who's able to learn so much so rapidly, and then as adults we seem to learn less and less.
FULLER VON BOZZAY: And sometimes it's that very questioning procedure. I am astounded at what a five-year-old can learn with biofeedback. I had a young child as a patient who has asthma and was in the hospital in ICU one week out of every month for several years. What she did in learning biofeedback skills was phenomenal. She could raise and lower her hand temperature by twenty degrees; she could dilate the bronchioles by listening to the sounds of her lungs as we fed back the sounds.
MISHLOVE: My goodness.
FULLER VON BOZZAY: She could do respiratory feedback and watch her breathing on a screen, and thus change it from halting and erratic to smooth and flowing. And the bronchial sounds changed from a wheezing sound to a quiet sound within a matter of weeks of training. We're not talking months; we're talking just a few weeks of once-a-week training.
MISHLOVE: Is there a sense in which as adults we just have more blocks up to this kind of learning ability?
FULLER VON BOZZAY: I find that it's very difficult, frankly, to treat a fifty-year-old asthma patient. It's as if the symptoms become part of them. It's also as if the instrument becomes some sort of intrusion rather than, for the child, a game: "Oh, this is fun!" And they do it. It's also as if the person really doesn't believe that they're able to make these changes, and I think belief is an important part of this process -- that motivation, and that belief that you can put aside your criticism, and realize that you have more potential in self control than you ever thought was possible. Self regulation skills are there.
MISHLOVE: Well, I guess that's the main message, really, of your work, is we do have vast potentials that we're unaware of.
FULLER VON BOZZAY: That's right. And the future really looks very bright for this area. Biofeedback has undergone many changes, which we just don't even have the time to talk about, but the major modality in behavior medicine of the future, probably equal, some people believe, to surgery and to drugs, is the use of increased abilities of personal self control. And biofeedback is one of the major modalities to give that person this self control.
MISHLOVE: Well, I would think once the tool begins to become more and more understood, self control, it would become pervasive, like surgery, like drugs. We would begin to want to apply it to virtually every condition, and certainly much more in the area of human potential even than you've talked about.
FULLER VON BOZZAY: In the past I've even sort of laughed and said, "Well, I don't know; something like broken bones -- what possible application could biofeedback have?" And then someone would point out to me, "Why are you being so critical? Think about the fact that the bone marrow and the healing process is helped through a change in the physiology which changes the hormone structure." And that certainly is visible through biofeedback in many cases.
MISHLOVE: Can you tell me this -- are there any conditions which you know for a fact biofeedback would not be helpful for?
FULLER VON BOZZAY: Well, no, as a matter of fact I don't. I can think of precautions and contraindications -- diabetics who have been trained and who have changed their need for insulin more rapidly than they expected, and then end up going into insulin shock or coma, because they actually required less medication, less insulin, so they were being overmedicated by their normal medication regimen. That was one of the precautions.
MISHLOVE: In other words, because the biofeedback works so well.
FULLER VON BOZZAY: In that way, yes. And of course there's the precautions about what happens with an older person who's getting blood pressure regulation, and other precautions. I can also think of the misuse -- that is, training a skill in the wrong direction. But the worst thing I can think of is non-use, and that is people who think, "Oh, it's the biofeedback being synonymous with the machine." They go out and buy a machine, and think they've then learned the skill. And in fact the machine is only that part that lets the person know what they're doing.
MISHLOVE: I suppose it's like a pencil. The pencil doesn't really do arithmetic; we do.
FULLER VON BOZZAY: That's right.
MISHLOVE: Well, George Fuller von Bozzay, it's been a pleasure having you with me. We've really covered a lot of ground and looked at how biofeedback can be an effective tool in medical use, and also for self development -- ultimately pointing back at ourselves, and showing us the exquisite amount of self control that we have. Thank you so much for being with me.
FULLER VON BOZZAY: Thank you. It's a pleasure to have been here.
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