FROM THE GHOST IN THE BOX
ROBERT SHELLENBERGER, Ph.D.
JUDITH ALYCE GREEN, Ph.D.
HEALTH PSYCHOLOGY PUBLICATIONS
by Robert Shellenberger. Ph.D. and Judith Green. Ph.D.
AH rights reserved.
No part of this book may be reproduced without written permission
from the publisher. except by a reviewer who may quote brief
passages or reproduce illustrations in a review nor may any part of
this book be reproduced, stored in a retrieval system, or transmitted
in any form or by any means electronic, mechanical, photocopying,
recording, or other without written permission from the authors.
This book is manufactured in the United States of America.
It has been typeset and printed by Pioneer Press.
Published by Health Psychology Publications.
710 11th Avenue. Suite 106
Table of Contents
Models of Biofeedback Training
Conceptualizations of Biofeedback 1
Biofeedback Research Models 1
The Official Doctrine 4
Category Mistake 7
Category Mistakes and the Ghost in the Box 7
Consequences of the Official Doctrine and Category Mistakes 10
Methodological and Conceptual Errors 13
Error #1: Insufficient number of training sessions 13
Table 1: Studies with minimal training 14
Error #2: Insufficient length of each training session 16
Error #3: Homework exercises are not given 17
Error #4: Failure to maximize internal locus of control 19
Error #5: Failure to provide adequate cognitive support 22
Error #6: Double-blind designs 25
Error #7: Failure to establish training criteria 30
Error #8: Using a relaxation control group for comparison to biofeedback training 35
Error #9: Failure to incorporate mental/emotional variables in biofeedback training 39
Error #10: Failure to establish reliability measures and confidence bands 43
Figure 1: EMG Confidence Bands 45
Error #11: Failure to control for adaptation 48
The Mastery Model 50
Error #12: Failure to train to mastery 50
Unsuccessful Biofeedback Training 55
Successful Biofeedback Training 57
Essential Hypertension and Biofeedback Training 58
Table 2, Successful Clinical Biofeedback Training for Essential Hypertension 59
Training for Treatment of Headache 59
Table 3, Successful Clinical Biofeedback Training for Migraine, Tension, & Mixed Headache 64
Tension Headache 67
Migraine Headache 68
Raynaud’s Disease and Biofeedback Training 69
Biofeedback Training for other Disorders 69
Applied Clinical Biofeedback Studies and the Mastery Model 70
The Mastery Model 70
Clinical Biofeedback Practice 73
Table 4, Systematic Case Studies 76
Table 5, Follow-Up Studies 81
The Tomato Effect, The Placebo Effect, and Science 85
The Tomato Effect 85
Confounding Variables 87
Specific vs. Non-specific Effects 91
The Placebo Effect 92
Control Groups 93
There is No Sugar Effect 96
From the Ghost in the Box to Successful Biofeedback Training 103
Self Regulation Training 108
About the Authors 113
The history of this document flows from symposium presentation, to lengthy article, to monograph. This final form has evolved over months of trying to make it shorter.
It began in 1984 in preparation for the Biofeedback Society of America Annual Meeting. The theme of the meeting was ‘Biofeedback in Perspective–Fifteen Years of Development.’ In keeping with that theme, Bob created a symposium titled, ‘When Does Biofeedback Training Succeed and When Does it Fail?’
In reviewing the literature. Bob found that many biofeedback studies have failed and for a variety of reasons. In most cases, minimal training was given and subjects failed to learn. A pattern became apparent: studies that provided minimal training assume an innate power in the biofeedback instrument, and from that came the title of Bob’s presentation on the panel. “From the Ghost in the Box to Successful Biofeedback Training.”
To clarify the puzzle of poor biofeedback research. Bob reread “The Concept of Mind” by Gilbert Ryle. The concept of the “category” mistake is developed in detail in that book. A category mistake occurs when concepts appropriate to one category are inappropriately applied to another category. The category mistake helped to clarify the impression that faulty conceptualizations are at the core of problems in biofeedback research. This was strikingly verified in articles by Hatch (1982 and 1983) in which biofeedback is described as having specific, innate effects like a drug. With this clue to a drug model approach to biofeedback training, we searched the literature again and found that a drug model is indeed prevalent and is a common model “when biofeedback fails”.
In reviewing the literature we were also immediately confronted with a model of biofeedback training more extensively used than the drug model, the operant conditioning model derived from animal learning. These models appeared to be different, but in analyzing them carefully, we found that both assume “specific effects” of biofeedback that can and should be studied independently of trainee variables, such as expectations, instructions, and relaxation. We found that certain research methods, and designs derived from these models, often prevent the demonstration of the efficacy of biofeedback training because they prevent learning.
At the same time, the other half of the symposium presentation, ” . . to Successful Biofeedback Training” generated considerable thought about the elements of training that lead to successful learning and symptom reduction. Our own research and clinical practice in biofeedback training were of value because we had already developed successful training protocols.
The need to carefully and critically analyze the conceptualizations, models, research designs, data and conclusions underlying both unsuccessful and successful biofeedback training became certain as we discussed these issues for the 1984 conference. After the conference we could not put the topic down. Our candid disapproval of much of biofeedback training research. and the confusion in the field of biofeedback training. spurred us on. Over the months we studied biofeedback training literature and spent hours discussing the issues. Gradually, written material emerged.
At a fortuitous time, when we were bogged down under the weight of ideas and discouraged of ever having a critique of this type published, an article appeared in The American Psychologist (August. 1985) that rekindled our determination to clarify the Issues, “for once and for all” and to hastily complete this document. The author wrote: ” With respect to training. I can only conclude that clinical training no longer prepares psychologists to think critically, or, if it does, that this intellectual skill is not being used by practitioners in the area of biofeedback” (Roberts. 1985. p.938). And “There is absolutely no convincing evidence that biofeedback is an essential or specific technique for the treatment of any condition” (p.940).
This monograph is an answer to claims of this sort, and explains why researchers like Roberts have both confused, and been confused by the field of biofeedback training. We believe that this monograph makes a unique contribution to the field by defining the major problem as conceptual and secondarily as empirical. Other authors have stated that the main problem in biofeedback is the lack of good research (Yates, 1980; Gatchel and Price, 1979; White and Tursky. 1982). We argue that the problems are primarily related to conceptual errors concerning the nature of biofeedback training and the nature of scientific research.
In the detailed analysis of conceptualizations about biofeedback training. and the ramifications of these conceptualizations in research, we provide a framework for understanding many conflicting results and conclusions regarding the efficacy of biofeedback training. This framework includes twelve methodological errors that occur repeatedly in biofeedback research, and distinguishes between trial-and-error learning in biofeedback, referred to as unsystematic biofeedback training. and successful biofeedback training that includes the use of systematic training techniques. Finally, we develop a model of biofeedback training that eliminates these errors and ensures masterful self regulation through thorough training–the mastery model.
In the development of the mastery model. we examine successful biofeedback training studies, and describe the reasons for researchers’ continued disregard of successful work, a phenomenon called “the tomato effect.” The familiar concepts of “confounding variable,” “nonspecific effects,” “placebo effect,” and “unscientific” are critiqued. We challenge the belief that the only form of rigorous scientific research in biofeedback is to isolate an independent variable, external to the trainee, and control for confounding variables. We argue that it is precisely this belief that resulted in the pursuit of a nonexistent entity—the specific effect of biofeedback—the ghost in the box.
We hope that this monograph will provide a guide to researchers. clinicians. and reviewers of the field of biofeedback training. And we dedicate this work to all who are involved in the evolution of self regulation therapy.
We gratefully acknowledge the review of sections of this document by Elmer E. Green, Ph.D., The Menninger Foundation, Topeka Kansas. To our friend and colleague, Pat McCary, Ph.D., we give special thanks for encouragement and editorial assistance. We thank Aims Community College, Greeley, Colorado for its excellent research facilities and John Turner for his personal support. We appreciate the editorial assistance of Gene Frederick. Dave Werner, Frank Gordon, Ph.D., and T. Robnett. And we thank each other for our patience and persistence.
Attention: The Ghost in the Box is “Shareware”!
Please Register Your Copy Today
This internet publication of the historic monograph “From the Ghost in the Box to Successful Biofeedback Training” is itself an historic event — the first known publication of a masterpiece previously-published document as “shareware”.
For years computer software has been published under this “honor system”. You can download a program for free, try it out, and see if you like it. And, if you continue to use the program, you are honor-bound to send the modest registration fee to the author.
If you download and read this Internet Edition of GHOST, either the whole book or any one or more of its chapters, and if you allow its message to influence your thinking about Biofeedback, you are asked to submit the modest sum of FIVE DOLLARS directly to the book’s authors, Bob and Judy. That’s even a bargain, since the original 1986 publication, which is herewith reproduced in its entirety, cost $9.95! Unfortunately, it has been out-of-print for several years, but would surely cost more if reprinted today.
License. Payment of the $5.00 registration fee entitles the reader to print one (1) copy of the entire text, or any part of the entire text, for personal use. Up to ten additional copies may be printed, provided that this notice is always included (once) and each recipient understands that the shareware fee applies to each and every printed copy of the book or any chapter of the book. Reproduction beyond the scope of this license is a violation of US and International Copyright Laws.
To Register your copy of “Ghost”, print this page and send it with your check or US$ 5.00 cash to:
Bob Shellenberger & Judy Green
c/o Psychology Department
Aims Community College
PO Box 69
Greeley, CO 80632 USA
Dear Bob and Judy:
Thanks for making “The Ghost in the Box” available again.
Email Address: __________________________________
Remember, send only one registration per person, regardless of how many chapters you have.
A revised edition of Ghost is in the planning stages; if you do include your name and address, you will be notified if and when it becomes available.
A brief description of your professional involvement in biofeedback would be of great interest to the authors.
Comments, suggestions and criticism are most welcome. Please feel free to make your suggestions or comments here.
This Internet Edition of “The Ghost in the Box” has been made available as a public service by “Incontinence on the Internet“, the world’s leading source of information about the treatment of pelvic muscle dysfunctions by EMG biofeedback. Visit us at http://InContiNet.com.