Preliminary Program of Events - Full Session Details

Preliminary Program of Events Brochure	Annual Meeting Registration - May 15-16	Annual Meeting Program - Full Session Details
Preconference Workshops - Full Information	Preconference Workshops Registration - May 13-14	Exhibitors/Sponsors Application
FERB Student Scholarship Application	Accepted Posters & Guidelines	Presenter Bios and Financial Disclosures
Hotel Reservations and Info	AAPB Women’s Forum Luncheon - May 16	FERB Fundraiser Reception Ticketed Event - May 16
General Information	Onsite Guide	2026 Exhibitor Listing

FULL SESSION DETAILS - May 15-16, 2026

Course descriptions, Learning Objectives, Levels and more!

Presenter Bios, Disclosures are available here

Friday, May 15

9 am - 10 am

BOS01: HRV and Sound Therapy as Potentiators of EEG Training

Presented By: Mari Swingle, PhD Psych

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Much like photobiomodulation, the pairing of audio stimulation / harmonic blends above and below auditory threshold combined with HRV appears to notably potentiate neurotherapeutic outcome. This applies across training sessions (as a home protocol) as well as within sessions immediately preceding EEG training. This presentation will show variation in the EEG pre-post administration in isolation as well as pre-post EEG training. Attendees will be shown evidentiary clinical data, including the mechanisms of action and relative attribution to HRV and sound frequency / color therapy. Attendees will also learn how to prescribe specific protocols based on specific EEG phenotypes and clinical assessments.

Target Audience: Clinicians

Subject Matter Classification: Neurofeedback (EEG)

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Summarize the power of multiple mechanisms of action via the central and autonomic nervous system as pre-conditioning for movement in the EEG

Recognize global effects vs individual effects

Identify specific mechanisms of action as per the EEG

Recognise EEG phenotypes

Pair protocols by phenotype

References:

Tracy, L. M., Ioannou, L., Baker, K. S., Gibson, S. J., Georgiou-Karistianis, N., & Giummarra, M. J. (2016). Meta-analytic evidence for decreased heart rate variability in chronic pain implicating parasympathetic nervous system dysregulation. Pain, 157(1), 7-29.

Heiss, S., Vaschillo, B., Vaschillo, C., Timko, A., & Hormes, J. (2021). Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an “ideal range”. Neuroscience & Biobehavioral Reviews 121,144-155. https://doi.org/10.1016/j.neubiorev.2020.12.004.

Lehrer, P., Derby, L., Caswell, J.S. et al. (2024). Physiological Effects of Psychological Interventions Among Persons with Financial Stress: A Systematic Review, Meta-analysis, and Introduction to Psychophysiological Economics. Appl Psychophysiol Biofeedback 49, 503–521. https://doi.org/10.1007/s10484-024-09658-x

Jiao, D. (2025.) Advancing personalized digital therapeutics: Integrating music therapy, brainwave entrainment methods, and AI driven biofeedback. Frontiers Digitital Health 7:1552396. doi: 10.3389/fdgth.2025.1552396

Bouny, P., Arsac, L.M., Guérin, A., Nerincx, G., Deschodt-Arsac, V. (2023). Guiding Breathing at the Resonance Frequency with Haptic Sensors Potentiates Cardiac Coherence. Sensors, 23, 4494.

Limitations/Severe Risks: The limitations and risk of this presentation are not in the content itself but the potential for clinical misinterpretation and application without proper complementary knowledge, credentials and skill or supervision / mentorship while acquiring such.

Diversity Considerations: Diversity is inherent as the sample presented is inclusive. As part of cultural competence, diversity, and (multi)culture are addressed directly as per variance found and not found in the sample.

GAP: Systems-based Practice

GAP Correction: Biofeedback and Neurofeedback are becoming increasingly divided as practice and treatment modalities. This presentation will demonstrate the power of going back to our discipline’s origins and the absolute power and potential of the blend rather than isolation of the modalities.

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Friday, May 15

9 am - 10 am

BOS02: Divergent QEEG Profiles Associated with Depression and Modified with Neurostimulation

Presented By: Louis Damis, PhD, ABPP, BCIA, FASCH

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Neurofeedback and neuromodulation interventions are best tailored to the individual's specific QEEG profiles associated with their symptoms. This case study demonstrates two very different encephalographic profiles (excessive alpha versus excessive beta), both associated with the primary symptom of depression. Neuromodulation with transcranial electrical alternating current (tACs), direct current (tDCs), pulsed electromagnetic frequency (pEMF), and photobiomodulation (PBM) stimulation, tailored to modify each profile, resulted in significant QEEG and self-report symptom changes in the desired and parallel directions. These findings underscore the importance of QEEG assessment for tailoring neuromodulation strategies. Reports of repetitive transcranial magnetic stimulation (rTMS) failures can be explained by the routine application of rTMS to the left dorsal prefrontal cortex without consideration of the specific QEEG profile. Use of continuous theta-burst stimulation (cTMS) to the right dorsolateral prefrontal cortex, which has been shown to increase alpha activity, was similar to the neuromodulation used in my patient with a diffuse spindling beta endophenotype. In addition to reviewing the divergent EEG profiles associated with depression, this workshop will examine the mechanisms by which tACs, tDCs, Random Noise, pEMF, and PBM modulate EEG activity.

Target Audience: Neurofeedback, Neurostimulation, and QEEG providers

Subject Matter Classification: QEEG & Neuromodulation

Track: Basic Science

Level: Intermediate

Focus: 70% Clinical/30% Research

Learning Objectives:

Patient Care

Explain the relevance of a QEEG assessment to the choice of neuromodulation strategies.

Delineate the differential impact of rTMS to the left dlPFC versus cTMS to the right dlPFC on EEG activity.

Describe the mechanisms of action of transcranial electrical stimulation and pEMF on the brain and EEG.

Describe the mechanisms of action of photobiomodulation.

References:

Cheng, Ying-Chih, Po-Hsiu Kuo, Min-I. Su, and Wei-Lieh Huang. (2022). “The Efficacy of Non-Invasive, Non-Convulsive Electrical Neuromodulation on Depression, Anxiety and Sleep Disturbance: A Systematic Review and Meta-Analysis.” Psychological Medicine 52(5), 801–12. https://doi.org/10.1017/S0033291721005560.

Elyamany, Osama, Gregor Leicht, Christoph S. Herrmann, and Christoph Mulert. (2021). “Transcranial Alternating Current Stimulation (tACS): From Basic Mechanisms towards First Applications in Psychiatry.” European Archives of Psychiatry and Clinical Neuroscience 271(1), 135–56. https://doi.org/10.1007/s00406-020-01209-9.

Li, Xingxing, Lei Chen, Kunqiang Yu, et al. (2023). “Impact of Twice-a-Day Transcranial Direct Current Stimulation Intervention on Cognitive Function and Motor Cortex Plasticity in Patients with Alzheimer’s Disease.” General Psychiatry 36(6), e101166. https://doi.org/10.1136/gpsych-2023-101166.

Montazeri, Katayoon, Mohammad Farhadi, Reza Fekrazad, Samira Chaibakhsh, and Saeid Mahmoudian. (2022). “Photobiomodulation Therapy in Mood Disorders: A Systematic Review.” Lasers in Medical Science 37(9), 3343–51. https://doi.org/10.1007/s10103-022-03641-w.

Ren, Caili, Sandeep R. Pagali, Zhen Wang, et al. (2025). “Transcranial Electrical Stimulation in Treatment of Depression: A Systematic Review and Meta-Analysis.” JAMA Network Open 8(6), e2516459. https://doi.org/10.1001/jamanetworkopen.2025.16459.

Limitations/Severe Risks: The preesntation references and meta-analyses provide an evidence base for the neuromodulation strategies reviewed.

Diversity Considerations: This is a two-subject case study with U.S. citizens, one male of Japanese descent and one female, examining divergent QEEG profiles associated with depression. Cross cultural expressions will be briefly reviewed.

GAP: Practice-based Learning and Improvement, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: Improved assessment, interpretion of results, and treatment selection.

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Friday, May 15

9 am - 10 am

BOS03: Getting Started With HRVB for Trauma-Exposed Law Enforcement: A Research–Practitioner Dialogue

Presented By: Judith Andersen, PhD; Lissa Ruocco

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Police officers and tactical operators are routinely exposed to high levels of operational stress and repeated traumatic events, placing them at increased risk for post-traumatic stress injuries (PTSI), depression, burnout, and suicide. Despite this risk, many do not engage with traditional mental health services. This active learning breakout session features conversations with a researcher and police Seargent on how to apply HRV biofeedback with cognitive behavioral skills training in collaboration with active-duty personnel experiencing mental health symptoms or elevated risk for PTSI. Considerations on navigating operational constraints and cultural resistance will be discussed. Rather than a didactic presentation, the workshop is conducted in a facilitated, case-based question-and-answer format with no slides. Presenters will guide participants through real-world cases drawn from research trials and applied interventions, including challenges related to recruitment, adherence, confidentiality, symptom presentation during active duty, and integration with organizational structures. Sergeant Lissa Ruocco will provide concrete, practice-based guidance on engaging police participants, addressing resistance, and aligning interventions with operational realities. Discussion will emphasize decision points, ethical considerations, and adaptive strategies grounded in evidence and field experience. Participants will leave with practical frameworks for tailoring HRV biofeedback and cognitive skills interventions to first responder populations, strategies for increasing participation and trust, and applied insight into resolving common clinical and organizational barriers when working with police and tactical operators.

Target Audience: Researchers and applied practitioners, including early career professionals, interested in designing and implementing combined biofeedback and cognitive skills training focused on mental health and wellness in first responder and tactical populations.

Subject Matter Classification: Heart Rate Variability (EKG, RESP)

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 40% Clinical/60% Research

Learning Objectives:

Identify key planning challenges involved in designing mental health–focused HRV biofeedback and cognitive skills programs for first responders and tactical operators, including constraints related to operational demands, organizational approval, and participant readiness.

Describe effective strategies for establishing access, trust, and participation in mental health initiatives within first responder organizations, informed by practitioner-led experience in police training, negotiation, and peer-supported mental health programming.

Evaluate ethical and confidentiality considerations specific to mental health research and intervention with first responders, including risks related to disclosure, stigma, role duality, and perceived career consequences.

Analyze how organizational culture influences engagement with mental health programs in first responder settings, and identify framing and delivery approaches that increase acceptability of HRV biofeedback and cognitive skills training.

Apply case-based decision-making to real-world mental health implementation challenges, including managing participant resistance, symptom emergence during active duty, and alignment of evidence-based approaches with operational and ethical constraints.

References:

Andersen, J. P., Arpaia, J., & Gustafsberg, H. (2021). A Biological Approach to Building Resilience and Wellness Capacity among Public Safety Personnel Exposed to Posttraumatic Stress Injuries. International Journal of Emergency Mental Health and Human Resilience, 23(7), pg.101-107. ISSN 1522-4821

Huey L, Andersen J, Bennell C, Ann Campbell M, Koziarski J, and Vaughan AD. (2021). Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness. FACETS 6: 1409–1445. doi:10.1139/facets-2021-0055’

Alavi N, Stephenson C, Omrani M, Gerritsen C, Martin MS, Knyahnytskyi A, Zhu Y, Kumar A, Jagayat J, Shirazi A, Moghimi E, Patel C, Knyahnytska Y, Simpson AI, Zaheer J, Andersen J, Munshi A, Groll D (2021). Delivering an online cognitive behavioural therapy program to address mental health challenges faced by correctional workers and other public safety personnel: JMIR Research Protocols. PMID: 34088656

Andersen, JP, Arpaia, J, Gustafsberg, H., Poplawski, S., Di Nota, PM. (2024). The International Performance, Resilience and Efficiency Program Protocol for the Application of HRV Biofeedback in Applied Law Enforcement Settings. Applied Psychophysiology and Biofeedback, DOI: 10.1007/s10484-024-09644-3

Andersen, J.P., Di Nota, P.M., Alavi, N., Anderson, G.S., Bennell, C., McGregor, C., Ricciardelli, R., *Scott, S.C., Shipley, P. & Vincent, M. (2023). Autonomic modulation training protocol: A biological approach to building resilience and wellness capacity among police exposed to post-traumatic stress injuries. JMIR Research Protocols. http://dx.doi.org/10.2196/33492

Limitations/Severe Risks: This discussion based breakout session will serve as an introduction to some issues conducting HRVB clinical research with police - it will not recommend any particular treatment or clinical assessment. HRVB with law enforcement has been found to benefit health (see attached references) and that literature may be referred to but it is not the focus of the discussion.

Diversity Considerations: A researcher working in high-constraint settings is highly likely to be critiqued on the basis of gender, race, LGBT+ presentation and other cultural variables as a way to undermine their research program. This presentation addresses this possibility with potential suggested responses.

GAP: Practice-based Learning and Improvement

GAP Correction: Through discussion, presenters will provide concrete, practice-based guidance on engaging police participants, addressing resistance, and aligning interventions with operational realities.

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Friday, May 15

9 am - 10 am

ORAL01: ORAL PRESENTATIONS: Stress Management

CE Credits: 1

ORAL01a: Interrupting Stress in Real Time: Effects of Mind–Body Self-Regulation Training on Student Health and Clarity of Mind

Presented By: Erik Peper, PhD, BCB; Richard Harvey, PhD; Aiko Yoshino, PhD

Session Type: Oral Presentation

Introducing and reinforcing simple mind–body self-regulation skills within a university curriculum may reduce stress-related symptoms and enhance attentional states characterized by greater clarity of mind. In a university course grounded in a whole-person holistic health framework that includes examination of the psychobiology of stress, the role of posture, and the psychophysiology of respiration; in addition, undergraduate students engaged in daily practices involving stress awareness, muscle relaxation, diaphragmatic breathing, and posture awareness. Students were instructed to apply these techniques whenever they became aware of stress sensations or dysfunctional breathing patterns during daily activities. Across semesters, more than 70% of students reported reductions in stress-related symptoms, including back pain, dysmenorrhea, anxiety, headaches, skin problems, and dry eyes after five weeks of practice. Students also commonly reported that consistent practice was associated with increased clarity of mind and improved academic performance. In the present study, seventy-two students enrolled in the holistic stress management course, while fifty-nine students in a comparable course served as a comparison group. Quantitative analyses indicated that students who practiced self-regulation strategies reported significantly greater reductions in physical symptoms (p < .001, d = 0.87) and increases in clarity of mind (p = .01, d = 0.46) relative to controls. Practice frequency was strongly associated with improvements in clarity of mind (r = .52, p < .001). Qualitative analyses revealed that participants in the intervention group described an increased ability to notice and interrupt automatic stress reactions, resulting in greater self-awareness, improved emotional regulation, and a calmer, clearer mental state. In contrast, participants in the comparison group primarily described gradual adaptation through routine and motivation rather than active self-regulation. Collectively, these findings suggest that mind–body practices are most effective when applied at the moment stress reactions arise, thereby transforming individuals’ relationships to stressful circumstances and supporting clarity of mind, resilience, and adaptive functioning. We recommend that such practices be incorporated into required university curricula, as they may substantially enhance student health and academic performance.

Target Audience: Clinicians and educators

Subject Matter Classification: Stress Management, Practice Management

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Identify and describe common physiological, cognitive, and emotional stress reactions and explain their impact on health, attention, and academic performance.

Demonstrate proficiency in core mind–body self-regulation skills, including diaphragmatic breathing, muscle relaxation, and moment-to-moment stress awareness.

Evaluate changes in personal stress-related symptoms, emotional regulation, and clarity of mind associated with the frequency and consistency of self-regulation practice.

Apply self-regulation strategies in real-life academic and interpersonal contexts to interrupt automatic stress responses as they arise.

Analyze and reflect on the role of mind–body self-regulation in promoting resilience, adaptive functioning, and sustained attentional clarity in university settings.

References:

Crișan, A.F., Pescaru, C.C., Maritescu, A. et al. (2025).A 14-week structured breathing program: an investigation into its impact on psychological health parameters in university students. BMC Public Health 25, 1395. https://doi.org/10.1186/s12889-025-22585-8

Somers, K., Wilson, V., & Peper, E. (2025). Transforming a Group Relaxation/Biofeedback Stress Management Program into an On-Line Format. Biofeedback, 53(20, 28-40. https://doi.org/10.5298/1081-5937-53.02.06

Peper, E., Harvey, R., Chen, S., & Heinz, N. (2025). Practicing diaphragmatic breathing reduces menstrual symptoms both during in-person and synchronous online teaching. Applied Psychophysiology and Biofeedback. https://do.org/10.1007/s10484-025-09745-7

Frausing, K. P., Flammild, M. H., & Dahlgaard, J. (2025). Mind–Body Practices for Mental Health in Higher Education: Breathing, Grounding, and Consistency Are Essential for Stress and Anxiety Management. Healthcare, 13(16), 2049. https://doi.org/10.3390/healthcare13162049

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91

Limitations/Severe Risks: No known risks

Diversity Considerations: This presentation discusses self-regulations strategies that everyone can do.

GAP: Patient Care, Practice-based Learning and Improvement

GAP Correction: Discusses basic skills that should be taught first before beginning and interventions.

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ORAL01b: Nature Contact and Its Effects on Stress, Resilience, and Health

Presented By: Donald Moss, PhD

Session Type: Oral Presentation

Exposure to natural environments—through nature walks, green space views, or virtual nature—produces beneficial effects on stress reduction, mood enhancement, cognitive restoration, and resilience. Conceptual models such as the Biophelia Hypothesis, Stress Reduction Theory, and Attention Restoration Theory offer explanations of how natural settings improve wellbeing. Experimental studies report decreases in self-reported and physiological stress after brief periods in nature. Nature immersion trials produce improvements in mood and immune markers. Observational and intervention studies link green space availability and community “greening” to reductions in depression and anxiety risk, and improvements in wellbeing. Meta-analyses suggest that even 10 – 15 minutes per day in nature improves subjective well-being. Frequency and “dose” matter: repeated interval exposures may yield stronger effects than single, prolonged visits to nature. Nature contact serves as a low-cost enhancer of adaptive capacity. There are many reasons to combine nature immersion as a complement to biofeedback and other mind-body therapies. Access to nature immersion is obstructed by many factors in urban areas and for low socio-economic populations. Building accessible nature contact into ongoing lifestyle is more realistic and impactful than occasional visits to expensive nature spas. Programs such as medically-prescribed walks show clinical promise. Framing nature contact as a public health “ecosystem service” invites broader policy integration.

Target Audience: Biofeedback practitioners, healthcare professionals, mental healthcare professionals, researchers, and students.

Subject Matter Classification: Stress Management

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 25% Clinical/75% Research

Learning Objectives:

Identify therapeutic elements in nature exposure for wellbeing and resilience.

Identify absence of nature contact and its impact on stress level, health, and emotional distress

Explain current research evidence on dosage and frequency of nature exposure and therapeutic benefit.

Identify strategies to integrate nature access as a supplement to biofeedback and other mind-body therapies.

Identify socioeconomic and cultural barriers to nature immersion and current strategies to increase nature access.

References:

Gaekwad, J. S., Sal Moslehian, A., Roös, P. B., & Walker, A. (2022). A Meta-Analysis of Emotional Evidence for the Biophilia Hypothesis and Implications for Biophilic Design. Frontiers in psychology, 13, 750245. https://doi.org/10.3389/fpsyg.2022.750245

Hansen, M. M., Jones, R., & Tocchini, K. (2017). Shinrin-Yoku (Forest Bathing) and Nature Therapy: A atate-of-the-art review. International Journal of Environmental Research and Public Health, 14(8), 851. https://doi.org/10.3390/ijerph14080851

White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., Bone, A., Depledge, M. H., & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports, 9(1), 7730–11. https://doi.org/10.1038/s41598-019-44097-3

Kotera, Y., Richardson, M., & Sheffield, D. (2020). Effects of Shinrin-yoku (forest bathing) and nature therapy on mental health: A systematic review and meta-analysis. International Journal of Mental Health and Addiction. Advance online publication. https://doi.org/10.1007/s11469-020-00363-4

Scott, E. E., LoTemplio, S. B., McDonnell, A. S., McNay, G. D., Greenberg, K., McKinney, T., Uchino, B. N., & Strayer, D. L. (2021). The autonomic nervous system in its natural environment: Immersion in nature is associated with changes in heart rate and heart rate variability. Psychophysiology, 58(4), e13698. https://doi.org/10.1111/psyp.13698

Limitations/Severe Risks: The presentation will include discussion of the most current systematic reviews of evidence that nature contact is salutogenic. Adverse effects of nature contact are minimal but will be discussed.

Diversity Considerations: The presentation will highlight socio-economic and subcultural barriers to nature access and current strategies to enhance nature access.

GAP: Systems-based Practice

GAP Correction: Attention to lifestyle and nature contact is a critical dimension to enhance the effects of professionally delivered biofeedback and neurofeedback practice.

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Friday, May 15

10:30 am - 12:00 pm

KEY01: KEYNOTE: From Stress Management to Resilience: Development of a Comprehensive Model and Approach to Psychological Transformation and Optimal Functioning

Presented By: Stephen Sideroff, PhD

Session Type: General Session

CE Credits: 1

Resilience is not simply the ability to “bounce back,” and recover baseline, but as the capacity to sustain optimal functioning across physiological, psychological, relational, and existential domains in the face of stress and adversity. In this keynote address, Dr. Stephen Sideroff presents his Nine Component (Pillars) Model of Resilience, developed through decades of clinical practice, research, and integration of behavioral medicine, psychophysiology, and mind–body interventions. The Nine Component Model conceptualizes resilience as a dynamic, trainable system that supports self regulation, recovery, adaptability, and growth. The model includes core elements such as physiological regulation and recovery, emotional healing and flexibility, cognitive appraisal and meaning making, relational attunement and co regulation, values based purpose, behavioral adaptability, healthy engagement, and integrative self awareness. Together, these components provide a comprehensive framework for understanding resilience as optimal functioning rather than symptom reduction alone. The presentation will review the theoretical foundations of the model, drawing from contemporary resilience science, neurobiology of stress and recovery, and psychophysiological research. Construct of “The Path” will be introduced as a methodology for sustained effort, mobilizing motivation, engaging reward systems and reducing overwhelm. Emphasis on the use of biofeedback, heart rate variability training, breathing, attentional regulation, and other innovative interventions to help strengthen specific resilience components. Case examples will illustrate how the model informs assessment, treatment planning, and outcome measurement in behavioral medicine, trauma informed care, chronic illness, and performance focused settings. Current research on the relationship between the 9-pillar model and rate of aging will be presented. Presentation will include practical strategies for integrating the Nine Component Model into clinical and performance environments. Attendees will gain a clear, clinically actionable framework for enhancing resilience that can be adapted across diverse populations, cultural contexts, and professional disciplines.

Target Audience: This presentation is designed for health psychologists, biofeedback practitioners, behavioral medicine clinicians, physicians, nurses, mental health professionals, researchers, trainees, and allied health providers interested in resilience, stress related conditions, psychophysiological self regulation, and performance optimization.

Subject Matter Classification: Optimal Performance

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 75% Clinical/25% Research

Learning Objectives:

Describe the nine core components of the Nine Component Model of Resilience and their role in optimal functioning.

Describe the “4 horsemen of stress” that make us most vulnerable to dysregulation and stress overload, while creating resistance to developing resilience

Apply interventions to enhance development along the 9 dimensions of resilience

Describe the process for breaking free of childhood survival learning – referred to as Primitive Gestalt Patterns (PGP) – and unfreezing the ability to adapt: from one’s PGP to healthy present centered adaptation.

Use and train the development of pillar #5 “Mental balance and mastery”

References:

Kalisch, R., Müller, M. B., & Tüscher, O. (2015). A conceptual framework for the neurobiological study of resilience. Behavioral and Brain Sciences, 38, e92.

Kalisch, R., Cramer, A. O. J., Binder, H., et al. (2019). Deconstructing and reconstructing resilience: A dynamic network approach. Nature Human Behaviour, 3(7), 706–716.

Southwick, S. M., & Charney, D. S. (2018). The science of resilience: Implications for the prevention and treatment of depression. Science, 359(6382), 730–734.

Feder, A., Fred Torrisi, L., Southwick, S. M., & Charney, D. S. (2019). The biology of human resilience: Opportunities for enhancing resilience across the life span. Molecular Psychiatry, 24(12), 1835–1852.

Porges, S. W. (2021). Polyvagal safety: Attachment, communication, self regulation. New York, NY: W. W. Norton & Company.

Limitations/Severe Risks: N/A

Diversity Considerations: The Nine Component Model of Resilience is explicitly contextual and culturally responsive, recognizing that resilience is shaped by cultural values, social environments, belief systems, and lived experience rather than uniform coping styles. The model and specifically the construct of “Primitive Gestalt Patterns” supports culturally competent practice through individualized assessment, avoidance of one size fits all assumptions, and collaborative interventions aligned with clients’ cultural narratives, community resources, and values.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal Communication Skills

GAP Correction: Presenting a model that includes all factors impacting optimal functioning and self regulation, structural factors that make one vulnerable to dysregulation while creating resistance to growth, how to overcome these structural factors and resistance to free up optimal adaptability with effective teaching tools

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Friday, May 15

12:30 pm - 1:30 pm

LL01: LUNCH&LEARN - INVITED Lecture: Restoring Function and Resilience in Functional Neurological Disorder

Presented By: Jarhed Peña, PhD; Cameron Paxton, MA

Session Type: Special

CE Credits: 1

This presentation will examine Functional Neurological Disorder (FND) through a disability and rehabilitation lens and then translate this understanding into practical treatment strategies for clinicians. FND will be framed as a disorder of disrupted brain network functioning involving salience detection, interoception, attention, emotional processing, and motor control, rather than structural neurological disease. The session will emphasize how altered processing of bodily signals and threat-related cues contributes to symptom expression, reduced sense of agency, and further functional impairment. Particular attention will be given to practical clinical treatment strategies, including physiotherapy strategies that retrain automatic movement through diverted attention and psychotherapy approaches that address maladaptive attention, avoidance, and threat appraisal. The presentation will highlight how biofeedback-informed methods—such as training attention regulation, interoceptive awareness, and autonomic flexibility—can support recovery when integrated within a multidisciplinary care model.

Target Audience: Practitioners

Subject Matter Classification: Mindfulness, Peripheral Biofeedback (HRV/Resp)

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 100% Clinical

Learning Objectives:

Describe Functional Neurological Disorder as a disorder of altered brain network functioning involving salience, interoception, attention, emotion, and motor control rather than structural neurological disease.

Explain how disrupted processing of bodily and threat-related signals contributes to symptom expression, reduced sense of agency, and functional impairment in patients with FND.

Identify mechanism-informed treatment strategies for FND, including physiotherapy, psychotherapy, and biofeedback-relevant interventions that target attention regulation, interoceptive awareness, and autonomic control.

Apply practical communication and intervention principles that support patient engagement, reduce symptom reinforcement, and facilitate functional recovery within a multidisciplinary care framework.

References:

Drane, D. L., Fani, N., Hallett, M., Khalsa, S. S., Perez, D. L., & Roberts, N. A. (2021). A framework for understanding the pathophysiology of functional neurological disorder. CNS Spectrums, 26(6), 555–561. https://doi.org/10.1017/S1092852920001789

Perez, D. L., Edwards, M. J., Nielsen, G., et al. (2021). Decade of progress in motor functional neurological disorder: Continuing the momentum. Journal of Neurology, Neurosurgery & Psychiatry, 92, 668–677. https://doi.org/10.1136/jnnp-2020-325536

Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: New subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537–550. https://doi.org/10.1016/S1474-4422(22)00130-9

Sverre, K. T., Nissen, E. R., Færver-Vestergaard, I., Johannsen, M., & Zachariae, R. (2023). Comparing the efficacy of mindfulness-based therapy and cognitive-behavioral therapy for depression in head-to-head randomized controlled trials: A systematic review and meta-analysis of equivalence. Clinical Psychology Review, 100, 102234. https://doi.org/10.1016/j.cpr.2022.102234

Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-based cognitive therapy in clinical practice: A systematic review of neurocognitive outcomes and applications for mental health and well-being. Journal of Clinical Medicine, 14(5), 1703. https://doi.org/10.3390/jcm14051703

Limitations/Severe Risks: N/A

Diversity Considerations: This proposal addresses issues related to cultural diversity, cultural competence, and multicultural issues by focusing on efficacy of service provision and collaboration amongst other clinicians and practitioners to provide optimal service to patients with functional neurological disorder.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction:

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Friday, May 15

2 pm - 3:30 pm

BOS04: Maximizing the Impact of Alpha-theta Therapy: Tools and Resources

Presented By: Linda Walker, PhD

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

The good news is: alpha-theta neurofeedback has such a tremendously broad base of applications and the potential to be creatively integrated into a diversity of therapy and training. The bad news: please refer to the last sentence. Beginning and intermediate clinicians may avoid this therapy as a resource because they find the therapy so broad-based that it’s difficult to know where to begin and how to avoid the pitfalls — the facilitation of a glorified nap, or worse — the unplanned abreaction. This workshop is intended to give clinicians some tools and guardrails, as well as an assurance there is a place in their practice for alpha-theta NFB. We will begin with structuring the facilitation — planning with the client, constructing a “script” or an intention, and planning an “escape” should clients need to reset. We will also explore within-session facilitation to help trainers and clinicians discern the quality of the state and troubleshoot any snafus. Clinicians will depart with tools to help structure scripted facilitation.

Target Audience: This workshop is for beginning to intermediate neurofeedback practitioners who are exploring alpha theta neurofeedback but want resources to help them feel confident in managing and facilitating a session.

Subject Matter Classification: Neurofeedback

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 70% Clinical/30% Research

Learning Objectives:

Identify four basic “ingredients” of alpha-theta facilitation

Describe how to minimize unwanted reactions

Identify three factors critical to ethical facilitation of alpha-theta neurofeedback

Contrast and compare the strengths and weaknesses of two alpha-theta facilitation scripts.

References:

Lotfinia, S., Shahkaram, H., Yaseri, A., Kianimoghadam, A. S., Sarani Yaztappeh, J., & Masjedi Arani, A. (2025). A clinical trial comparing the efficacy of two EEG-based neurofeedback protocols for generalized anxiety disorder: Sensory motor rhythm and alpha-theta. Iranian Journal of Psychiatry and Behavioral Sciences, 19(2), e158451. doi:10.5812/ijpbs-158451

Kerson, C., & Martins-Mourao, A. (2017). Alpha-theta neurofeedback in the 21st century: A handbook for clinicians and researchers (2nd ed.). Foundation for Neurofeedback and Neuromodulation Research / BMED Press.

Shapero, E. J., & Prager, J. P. (2020). ILF neurofeedback and alpha-theta training in a multidisciplinary chronic pain program. In H. W. Kirk (Ed.), Restoring the brain: Neurofeedback as an integrative approach to health (2nd ed., Chap. 11). Routledge. doi:10.4324/9780429275760-11

Sanader Vukadinovic, B. (2025). Neurofeedback in substance and non substance-related addictions: A mini review of current evidence and future directions. Frontiers in Psychiatry, 16, 1716390. doi:10.3389/fpsyt.2025.1716390

Imperatori, C., et al. (2017). Alpha/theta neurofeedback increases mentalization and default mode network connectivity in a non-clinical sample. Brain Topography, 30(6), 822–831. doi:10.1007/s10548-017-0593-8

Limitations/Severe Risks: Alpha-theta neurotherapy has carried with it a caveat that “abreaction” could occur during session, though there has been a counter argument that sometimes mild negative response facilitates insight and healing. This workshop is to help therapists recognize and prevent unwanted reaction and develop guardrails to work with at-risk clients.

Diversity Considerations: The workshop is presented with a sensitivity to diversity and culture by inviting clinicians to consider how

they may encounter and work with a client’s unique cultural or diversity qualities during facilitation.

GAP: Patient Care,

GAP Correction: Session will help clinicians consider concepts to help their neurofeedback interventions become more

efficient.

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Friday, May 15

2 pm - 3:30 pm

BOS05: Pharmacological Impact in Pediatric Psychophysiology

Presented By: Katie Fleischman, PhD; Seth L. Enos, ND, BCB, EMT-P; Debbie Miller, ND, BCB; Ashley Greene, ND, BCB

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

In this symposium, we'll address concepts of psychopharmacology and its potential effects on physiology and mood. We aim to address clinical & research practice with the use of commonly prescribed pharmaceuticals within the pediatric and young adult population. More specifically, we will provide an overview of certain drug classes and their effects on physiology and psychophysiological practices. Lastly, we will address practical strategies to become aware of these possible effects in association with overall therapeutic self-reported gains.

Target Audience: Clinicians at all stages of career

Subject Matter Classification: Phrama

Track: Hot Topics

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

List several ways medications may impact Heart Rate Variability (HRV).

Review common pediatric-focused drug classes in chronic pain management (headache/migraine, musculoskeletal pain, functional gastritis, cardiology, etc.).

Overview of common pharmaceuticals prescribed for pediatric patients with anxiety/depression.

List several tips to improve clinical & research practice with the use of commonly prescribed pharmaceuticals in the pediatric and young adult population

Describe several current gaps in the medication effects within biofeedback research

References:

Aschbacher, K., Mather, M., Lehrer, P., Gevirtz, R., Epel, E., & Peiper, N. C. (2024). Real-time heart rate variability biofeedback amplitude during a large-scale digital mental health intervention differed by age, gender, and mental and physical health. Psychophysiology, 61, e14533. https://doi-org.ezp-prod1.hul.harvard.edu/10.1111/psyp.14533

AlvaresGail A., QuintanaDaniel S., HickieIan B., and GuastellaAdam J.. 2016. Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis. Journal of Psychiatry and Neuroscience. 41(2): 89-104. https://doi.org/10.1503/jpn.140217

Hospers, L., Dillon, G. A., McLachlan, A. J., Alexander, L. M., Kenney, W. L., & Jay, O. (2024). The effect of prescription and over-the-counter medications on core temperature in adults during heat stress: a systematic review and meta-analysis. eClinicalMedicine, 77, 102780

Novak, P. Electrochemical skin conductance: a systematic review. Clin Auton Res 29, 17–29 (2019). https://doi.org/10.1007/s10286-017-0467-x

Huang, W.-L.; Liao, S.-C.; Kuo, T. B. J.; Chang, L.-R.; Chen, T.-T.; Chen, I.-M.; Yang, C. C. H. (2016). The Effects of Antidepressants and Quetiapine on Heart Rate Variability: Pharmacopsychiatry 2016; 49(05): 191 - 198, DOI: 10.1055/s-0042-102964

Miyabara Renata , Berg Karsten , Kraemer Jan F. , Baltatu Ovidiu C. , Wessel Niels , Campos Luciana A. (2017). Quantifying Effects of Pharmacological Blockers of Cardiac Autonomous Control Using Variability Parameters: Frontiers in Physiology Volume 8 - (2017), DOI: 10.3389/fphys.2017.00010

Iman Idrees, Alessio Bellato, Samuele Cortese, Madeleine J. Groom: The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis, Neuroscience & Biobehavioral Reviews, Volume 144, 2023, 104968, ISSN 0149-7634, https://doi.org/10.1016/j.neubiorev.2022.104968. (https://www.sciencedirect.com/science/article/pii/S0149763422004572)

Ling-Zong Hong, Keh-Feng Huang, Siu-Wan Hung, Li-Te Kuo, Chronic fluoxetine treatment enhances sympathetic activities associated with abnormality of baroreflex function in conscious normal rats, European Journal of Pharmacology, Volume 811, 2017, Pages 164-170, ISSN 0014-2999, https://doi.org/10.1016/j.ejphar.2017.06.021. (https://www.sciencedirect.com/science/article/pii/S0014299917304272)

Limitations/Severe Risks: Scarcity of published literature on this topic.

Diversity Considerations: An overview of multicultural considerations as they relate to psychopharmacology and its potential effects on physiological and mood presentation will be reviewed.

GAP: Patient Care, Research Practice, Medical Knowledge, Pediatric Pharmacology, Systems-based Practice

GAP Correction: Awareness of the availability of pharmaceutical research with respect to biophysiological measurements that would impact biofeedback therapy for pediatric patients.

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Friday, May 15

2 pm - 3:30 pm

BOS06: Motivational Interviewing in Biofeedback Practice: Getting Clients to Want to Change

Presented By: Saul Rosenthal, PhD, BCB-L, BCB-HRV, BCN-L, QEEG-DL; Matt Bennett, MA, MBA

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Many biofeedback and neurofeedback practitioners find themselves frustrated when, despite our best efforts, clients do not follow through with changes that will improve their health. This despite strong evidence that regular daily practice—often 20 minutes or more—is essential for meaningful cognitive, neurological, emotional, and behavioral change. While providers often know what needs to change, we're less equipped to help clients actually engage in the process of change. This workshop addresses that gap by equipping practitioners with Motivational Interviewing (MI) skills tailored specifically for biofeedback, HRV, and neurofeedback training. Motivational Interviewing (MI) is a collaborative, evidence-based communication style designed to strengthen a client's own motivation for change. Rooted in humanistic psychology, MI offers a structured yet flexible way to guide behavior change conversations. Emphasizing compassion and respect for autonomy, MI aligns with many of the core values of applied psychophysiology. In this symposium, we will explore the "spirit" of MI, key tools like OARS (open questions, affirmations, reflections, and summaries), and techniques for evoking client change talk and planning meaningful action. Participants will learn practical tools such as eliciting change talk around home practice, collaboratively developing practice plans, reinforcing autonomy, using reflective responses to deepen engagement, and guiding clients to articulate their own goals and values around regulation and health. This session is ideal for clinicians seeking to enhance client motivation, reduce resistance, and feel more effective in their work. No prior experience with MI is required.

Target Audience: Practitioners who are interested in improving client engagement and motivation to change.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Neurofeedback (EEG), Heart Rate Variability (EKG, RESP), Evidence-based, Client and intervention management

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 90% Clinical/10% Research

Learning Objectives:

Describe the core principles spirit of Motivational Interviewing

Explain strategies for eliciting client change talk

Demonstrate the use of OARS and other MI tools in practice scenarios

Identify situations where a Motivational Interviewing approach is appropriate

Practice MI skills in guided small-group exercises

References:

Bischof, G., Bischof, A., & Rumpf, H. J. (2021). Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Deutsches Arzteblatt international, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014

Mack, Rory & Breckon, Jeff & Butt, Joanne & Maynard, Ian. (2020). Practitioners’ Use of Motivational Interviewing in Sport: A Qualitative Enquiry. The Sport Psychologist. 35. 1-11. https://doi.org/10.1123/tsp.2019-0155

Marchant, J., Jack, R., Howe, K., Peterson-Hancey, D., Freeman, B., Murphy, C., & Steffen, P. (2025). Combining Motivational Interviewing with HRV Biofeedback: A Feasibility Study. https://doi.org/10.21203/rs.3.rs-7852670/v1

Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.), The Guilford Press.

Nurmi, J., Knittle, K., Naughton, F., Sutton, S., Ginchev, T., Khattak, F., Castellano-Tejedor, C., Lusilla-Palacios, P., Ravaja, N., & Haukkala, A. (2023). Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App. JMIR Formative Research, 7, e34232. https://doi.org/10.2196/34232

Limitations/Severe Risks: Motivational Interviewing requires the practitioner take a more egalitarian, rather than "expert" role. This may trigger feelings of vulnerability and embarrassment.

Diversity Considerations: Cultural beliefs, values, and experiences shape how clients understand health, change, and their role in treatment, all of which impact motivation. When practitioners lack cultural awareness, they may misinterpret client behavior as resistance, while clients may perceive the clinician’s approach as intrusive or insensitive. Motivational Interviewing promotes culturally responsive care by emphasizing client autonomy, collaboration, and compassion. Its focus on eliciting the client’s own perspective and goals supports respectful dialogue and reduces the risk of imposing culturally biased assumptions. In this symposium, participants will explore how MI’s stance of curiosity and acceptance can help navigate cultural differences and foster more effective, individualized care.

GAP: Patient Care, Interpersonal and Communication Skills

GAP Correction: Participants will learn to better rely on client-centered motivations for behavior change. This can help bridge the gap between practitioner and client expectations, improving the likelihood of positive change.

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Friday, May 15

2 pm - 3pm

BOS07: Autonomic Dysregulation, Interoception, and Self-Regulation: Biofeedback Applications for Dysautonomia

Presented By: Anna Hayburn, PsyD

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Dysautonomia encompasses a heterogeneous group of conditions characterized by impaired autonomic regulation, which can include symptoms such as orthostatic dizziness/lightheadedness, altered heart rate, activity intolerance, fatigue/insomnia, cognitive dysfunction, pain, digestive problems, temperature dysregulation, and anxiety (Blitshteyn, 2025). Symptoms are often exacerbated by postural changes, stress, illness, and/or activity. Dysautonomia can be a primary condition (e.g., Postural Orthostatic Tachycardia Syndrome, vasovagal syncope, inappropriate sinus tachycardia) or can be secondary to other illnesses (e.g., Long-COVID, autoimmune conditions, hormone dysregulation) or injuries (e.g., traumatic brain injury). As such, there can be high variability regarding symptomatic presentations and level of functional impairment. Literature suggests a connection that autonomic dysfunction can contribute to heightened interoceptive awareness, visceral hypersensitivity, and increased bodily vigilance (e.g., Chen et al., 2021). Though there are some medication treatments, management of dysautonomia is considered to be largely non-pharmacological with an emphasis on rehabilitation and improved self-management. Biofeedback interventions, including heart rate variability (HRV), surface electromyography (sEMG), and thermal techniques offer noninvasive, self-regulation–based approaches to help people with dysautonomia to better understand and influence their body’s responses, which can support improved autonomic regulation, symptom management, greater interoceptive balance, and overall resilience when living with an often-disabling chronic condition. However, biofeedback interventions can be complicated by an exacerbation of autonomic-related symptoms for this patient population. Literature is currently limited in this emerging specialty (Corrado et al., 2024; Gitler et al., 2025). This symposium will provide an overview of the psychophysiology of autonomic dysfunction as well as application of the above biofeedback interventions from a health psychologist at a nationally recognized autonomic center. Common findings in practice, unique treatment considerations for people with dysautonomia, and patient outcomes will be discussed.

Target Audience: This symposium is designed for practitioners who are interested in learning the psychophysiology of dysautonomia and advancing evidence-based biofeedback interventions for dysautonomia/autonomic dysfunction.

Subject Matter Classification: Successful Clinical Outcomes

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 80% Clinicial/20% Research

Learning Objectives:

Summarize the psychophysiological mechanisms of autonomic dysfunction and a review of related dysautonomia conditions (e.g., POTS, vasovagal syncope, long-COVID).

Provide a rationale for the use of HRV, sEMG, and thermal biofeedback for autonomic disorders.

Review case studies that outline a protocol regarding the use of HRV, sEMG, and thermal biofeedback strategies for autonomic disorders and objective/subjective patient benefit.

Review unique treatment considerations for the use of biofeedback with people with dysautonomia.

Discuss clinical challenges, ethical considerations, and future research directions for this patient population.

References:

Blitshteyn S. (2025). Dysautonomia: a common comorbidity of systemic disease. Immunologic research, 73(1), 105. https://doi.org/10.1007/s12026-025-09661-2

Chen, W. G., Schloesser, D., Arensdorf, A. M., Simmons, J. M., Cui, C., Valentino, R., Gnadt, J. W., Nielsen, L., Hillaire-Clarke, C. S., Spruance, V., Horowitz, T. S., Vallejo, Y. F., & Langevin, H. M. (2021). The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends in neurosciences, 44(1), 3–16. https://doi.org/10.1016/j.tins.2020.10.007

Corrado, J., Iftekhar, N., Halpin, S., Li, M., Tarrant, R., Grimaldi, J., Simms, A., O'Connor, R. J., Casson, A., & Sivan, M. (2024). HEART Rate Variability Biofeedback for Long COVID Dysautonomia (HEARTLOC): Results of a Feasibility Study. Advances in rehabilitation science and practice, 13, 27536351241227261.

Gitler, A., Bar Yosef, Y., Kotzer, U., & Levine, A. D. (2025). Harnessing non invasive vagal neuromodulation: HRV biofeedback and SSP for cardiovascular and autonomic regulation (Review). Medicine international, 5(4), 37. https://doi.org/10.3892/mi.2025.236

Wareing, L., Readman, M. R., Longo, M. R., Linkenauger, S. A., & Crawford, T. J. (2024). The Utility of Heartrate and Heartrate Variability Biofeedback for the Improvement of Interoception across Behavioural, Physiological and Neural Outcome Measures: A Systematic Review. Brain Sciences, 14(6), 579. https://doi.org/10.3390/brainsci14060579

Limitations/Severe Risks: A limitation of applying biofeedback for people with dysautonomia is that the nature of autonomic disorders can be debilitating, which can impact feasibility of application and follow-through of interventions, a common challenge observed in this setting. A related risk is that people with dysautonomia frequently experience a paradoxical response to biofeedback interventions, meaning that it is common for them to initially experience an exacerbation of their dysautonomia symptoms (e.g., orthostatic intolerance, tachycardia) during application of the interventions before achieving improvement. This does not mean biofeedback is harmful, but it highlights the importance of an individualized approach and the need for education regarding this response. Symptom exacerbation should be conceptualized as clinically informative, offering insight into autonomic and respiratory dynamics and interoceptive dysfunction, rather than as evidence of treatment failure (see Wareing et al., 2024).

Diversity Considerations: Dysautonomia presents with wide variability of symptoms, functional impairment, and illness trajectory. It is a common co-morbid condition among people with complex chronic illnesses and disabilities. By emphasizing careful assessment of individual symptom patterns, exacerbating triggers, and lived experience, the proposal implicitly supports culturally responsive practice that avoids one-size-fits-all assumptions and recognizes that cultural beliefs, health literacy, access to care, and prior medical experiences may shape how symptoms are perceived, reported, and managed. The use of non-pharmacological biofeedback interventions further supports cultural competence and multicultural sensitivity by offering flexible, noninvasive, and self-regulation-based approaches that can be adapted to diverse populations. Biofeedback can be tailored to respect cultural values related to mind-body practices, autonomy, and self-management, and it may be especially beneficial for individuals who face barriers to medication access or who hold cultural preferences for behavioral or holistic interventions. Additionally, the symposium’s focus on heightened interoceptive awareness, bodily vigilance, and anxiety acknowledges that sociocultural stressors - such as chronic discrimination, medical mistrust, and systemic inequities - may influence autonomic functioning and symptom severity. By educating clinicians on unique treatment considerations and variability in patient responses, the proposal promotes culturally competent care that is sensitive to multicultural contexts, health disparities, and the need for equitable, inclusive treatment strategies for individuals living with dysautonomia.

GAP: Patient Care

GAP Correction: Literature is currently very limited regarding the use of biofeedback as a treatment modality for dysautonomia / autonomic disorders. An estimated 70 million people live with dysautonomia, and this figure has likely increased since the COVID-19 pandemic as up to 30% of people who have a COVID-19 infection develop autonomic dysfunction. Thus, it is likely that biofeedback practitioners will encounter clients with dysautonomia symptoms. This session will provide education to improve understanding of the mechanisms of dysautonomia, as well as unique treatment considerations and a detailed review of how various biofeedback modalities can been utilized to improve self-awareness and functioning in this patient population.

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Friday, May 15

4:00 pm - 5:30 pm

BOS08: Beyond Resonance Frequency: Capnography-Informed Restoration of Reflexive Breathing in Biofeedback Practice

Presented By: Lisa V Kusch, M.Sc., B.Ed., SBT

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Optimal Performance, High-level science from aligned disciplines, Evidence-based, Case Studies

Target Audience: This session is designed for clinicians, researchers, and applied psychophysiology professionals who use or interpret breathing-based biofeedback, HRV, or other peripheral biofeedback modalities and are interested in improving assessment validity, outcome interpretation, and long-term self-regulation. It is particularly relevant for psychologists, psychotherapists, physicians, physical and occupational therapists, performance coaches, and allied health professionals working in clinical, developmental, or performance contexts. Attendees should have foundational familiarity with biofeedback or psychophysiology and be interested in advancing beyond technique-driven approaches toward physiology-informed, evidence-based intervention sequencing.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Optimal Performance, High-level science from aligned disciplines, Evidence-based, Case Studies

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 70% Clinical/30% Research

Learning Objectives:

Explain why respiratory chemical stability constrains the validity of downstream psychophysiological biofeedback measures.

Describe the downstream physiological and emotional effects of hypocapnia, including its impact on cerebral blood flow, autonomic signaling, neural excitability, and affective experience, and explain why these effects may confound interpretation of biofeedback outcomes.

Integrate capnometry as an independent, primary biofeedback modality within multimodal clinical or performance practice.

Apply breath-first sequencing to determine when and how additional biofeedback modalities (e.g., HRV, EMG, peripheral temperature) can be introduced to optimize outcomes.

Evaluate how incorporating capnometric assessment improves data quality, learning durability, and long-term self-regulation within their professional specialty.

References:

Ramakers, I., Van Den Houte, M., Van Oudenhove, L., Van den Bergh, O., & Bogaerts, K. (2023). End-tidal CO₂ in patients with panic disorder, stress-related or functional syndromes, versus healthy controls. Applied Psychophysiology and Biofeedback, 48, 149–157. https://doi.org/10.1007/s10484-022-09573-z

Duffin, J., Mikulis, D. J., & Fisher, J. A. (2021). Control of cerebral blood flow by blood gases. Frontiers in Physiology, 12, 640075. https://doi.org/10.3389/fphys.2021.640075

Novak, P. (2018). Hypocapnic cerebral hypoperfusion: A biomarker of orthostatic intolerance. PLOS ONE, 13(9), e0204419. https://doi.org/10.1371/journal.pone.0204419

Shaffer, F., & Meehan, Z. M. (2020). A practical guide to resonance frequency assessment for heart rate variability biofeedback. Frontiers in Neuroscience, 14, 570400. https://doi.org/10.3389/fnins.2020.570400

Tolin, D. F., McGrath, P. B., Hale, L. R., Weiner, D. N., & Gueorguieva, R. (2017). A multisite benchmarking trial of capnometry guided respiratory intervention for panic disorder in naturalistic treatment settings. Applied Psychophysiology and Biofeedback, 42(1), 51–58. https://doi.org/10.1007/s10484-017-9354-4

Limitations/Severe Risks: The content of this presentation is educational and does not introduce severe or unusual risks. Capnometry-informed assessment and breathing behavior interventions are non-invasive and widely used in clinical and research settings. When applied appropriately, risks are minimal and comparable to those associated with other breathing-based or biofeedback interventions. Potential limitations and considerations include the possibility of transient discomfort, increased symptom awareness, or anxiety when individuals become more aware of breathing patterns or physiological signals. In individuals with complex medical conditions, respiratory compromise, or acute psychiatric instability, breathing interventions should be applied cautiously and in coordination with appropriate medical or mental health providers. The presentation emphasizes the importance of individualized assessment, pacing, and scope-of-practice considerations to mitigate these risks. A key limitation addressed in the session is that capnometry data must be interpreted within clinical context and should not be used as a stand-alone diagnostic tool. The presentation explicitly cautions against overgeneralization, protocolized application, or inferring causality from single measures without corroborating clinical and physiological information. The evidence supporting the content includes peer-reviewed research on respiratory physiology, end-tidal CO₂ measurement, cerebral blood flow regulation, and capnometry-guided interventions published within the past ten years. The session integrates this evidence with applied clinical frameworks and case-based illustrations to demonstrate appropriate, evidence-informed use rather than prescriptive treatment protocols.

Diversity Considerations: This presentation addresses cultural diversity and multicultural considerations by emphasizing physiological assessment and learning processes that are not culturally bound, while remaining sensitive to how breathing behaviors are shaped by lived experience, stress exposure, health access, and developmental context. By focusing on capnometry-informed assessment rather than normative assumptions about “correct” breathing, the approach reduces bias that can arise from culturally specific behavioral expectations or symptom interpretations. The breath-first framework supports culturally competent practice by prioritizing individualized assessment, pacing, and learning plans that respect differences in background, health history, trauma exposure, and embodied experience. Case illustrations demonstrate how the same physiological principles can be applied flexibly across diverse clinical and performance contexts without imposing uniform techniques or interpretations. The session also emphasizes clinician self-awareness and humility in interpreting biofeedback data, encouraging practitioners to distinguish physiological regulation from culturally influenced expressions of distress or coping. This approach supports equitable, respectful care by grounding intervention decisions in measurable physiology while adapting delivery to the needs and values of each individual.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: This session addresses a critical practice gap in biofeedback and applied psychophysiology: breathing-based interventions and downstream psychophysiological measures are frequently interpreted without confirming respiratory chemical stability or reflexive respiratory regulation. As a result, mechanical breathing patterns or psychological strategies may appear effective while underlying respiratory chemistry remains unstable. The session will clarify why respiratory chemical stability is a primary determinant of physiological self-regulation and why mechanical or psychological approaches alone cannot reliably restore regulation when carbon dioxide levels are dysregulated. Because carbon dioxide directly influences cerebral blood flow, acid–base balance, autonomic signaling, and neural excitability, unrecognized hypocapnia or CO₂ instability can constrain or distort outcomes observed in downstream biofeedback measures. Building on this physiological rationale, participants will learn how to integrate capnometry as an independent, primary biofeedback modality to assess respiratory chemical stability and reflexive breathing regulation. The session will demonstrate how to interpret end-tidal CO₂ (EtCO₂) data to distinguish compensatory or volitional breathing from restored self-regulation, and how to sequence additional biofeedback interventions accordingly. By adopting a breath-first assessment and training framework, attendees will be able to improve outcome interpretation, enhance the effectiveness of downstream modalities, and increase the durability and generalizability of clinical and performance outcomes within their specialty.

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Friday, May 15

4:00 pm - 5:30 pm

BOS09: Ethics I: Professional Ethics and Practice Standards in Biofeedback

Presented By: Donald Moss, PhD

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

This session will review legal and ethical responsibilities of biofeedback practitioners. Biofeedback professionals are governed in clinical practice by state regulations under the relevant licensing act, professional codes of ethics for his or her home profession, and the Professional Standards and Ethical Principles of Biofeedback (9th rev., May 2016) of the Biofeedback Certification International Alliance (BCIA) and the Professional Standards and Ethical Principles of the International Society for Neuroregulation and Biofeedback (ISNR, 2018). The workshop will provide an overview of medical ethics, ethical principles endorsed by most behavioral professions, and a discussion of the current AAPB/BCIA standards. Violation of published guidelines, even when unintended, invites the risk of lawsuit, criminal prosecution, financial penalties, loss of licensure, and expensive and stressful legal and administrative reviews. The presenter will discuss relevant guidelines governing: entry level competence; scope of practice; the delivery of experimental or non-documented therapies; the informed consent process; principles of privacy, confidentiality, and privileged communication; guidelines on dual/multiple relationships; and questions of touch, privacy, and respect. The presenter will place emphasis on the imperative to maintain a positive treatment relationship, eliciting rapport and trust. The therapeutic relationship, along with knowledge of current standards of practice and adherence to professional guidelines, minimize the risk of misunderstanding and litigation.

Target Audience: Health professionals and behavioral health professionals engaged in the practice of biofeedback, neurofeedback, and self-regulation-oriented therapies

Subject Matter Classification: Practice Management, Ethical Standards

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 75% Clinical/25% Research

Learning Objectives:

Discuss the Professional Standards and Ethical Principles documents published by BCIA, and their interpretation for decisions in biofeedback and neurofeedback practice.

Describe how to navigate the conflicting jurisdictions of state laws and regulations, professional codes of conduct, BCIA guidelines, and federal regulations.

Review and discuss practice standards governing entry level competence, continuing education requirements, and scope of practice.

Summarize guidelines for multicultural awareness and diversity.

Recognize principles and guidelines governing touching patients and attaching electrodes, while maintaining an empathic respectful professional relationship

References:

Biofeedback Certification International Alliance (2016). Professional Standards and Ethical Principles of Biofeedback (9th edition). http://bcia.org/files/public/ProfessionalStandardsAndEthicalPrinciplesofBiofeedback.pdf

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

The Medoc Portal. (2023). Medical ethics. Website: The Royal Society of Medicine and Dukes Education. https://www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/

APA (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code/ethics-code-2017.pdf

Moss, D. (2022). Ethical principles, professional conduct, and practice standards. In D. Moss & F. Shaffer, A primer of biofeedback (pp. 98-109). AAPB

Limitations/Severe Risks: This seminar covers the basic ethical principles, professional standards, and best practices needed for practicing with integrity in the biofeedback and neurofeedback fields. This seminar also prepares attendees for certification and recertification by BCIA in general biofeedback and for recertification by BCIA in neurofeedback. The acquisition of knowledge about professional standards and ethical behavior does not guarantee ethical practice by the attendee.

Diversity Considerations: This seminar covers the ethical principles and professional guidelines governing work with diverse patients and populations.

GAP: Professionalism

GAP Correction: The breakout session will cover official ethical guidelines but also the personal and philosophical aspirations upon which best practice is founded. The session includes attendee discussion of current challenges in their practices and those of colleagues.

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Friday, May 15

4:00 pm to 5:00 pm

BOS10: Mindblowing Science of Piezo2: Mechanosensory Interoception Meets HRV Biofeedback

Presented By: Matt Bennett, MA, MBA

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Heart rate variability (HRV) biofeedback is a proven method to enhance vagal tone and stress resilience – but emerging science reveals a missing link in how these benefits arise. Meet Piezo2, a specialized mechanosensitive ion channel that serves as the body’s internal pressure sensor. Piezo2 channels convert mechanical forces from within the body – for example, the pressure of each heartbeat – into nerve signals, essentially enabling the brain to feel heartbeats and other internal motions. This workshop introduces Piezo2 as the bridge between HRV training and interoceptive awareness, explaining in accessible terms what Piezo2 is and why it matters for clinicians. Building on recent findings, we will explore how robust vagal tone (reflected in high-frequency HRV) can actually amplify or dampen these Piezo2-mediated signals from the cardiovascular system. This creates a bidirectional feedback loop: as participants practice slow, deep breathing or other HRV biofeedback techniques, they not only increase parasympathetic activity but also “tune” the Piezo2-driven mechanosensory pathways that monitor internal state. Over time, this enhanced coupling leads to clearer internal signals (e.g. stronger heartbeat perceptions) and a heightened awareness of one’s own bodily rhythms. Participants will gain insight into mechanosensory interoception – the internal sense of pressure, stretch, and movement – and understand how it intertwines with vagal regulation of heart, lungs, and other organs. By bridging cutting-edge mechanistic research with practical biofeedback know-how, this solo lecture highlights why Piezo2 is timely and valuable to AAPB’s community: it offers a novel, clinically relevant perspective on how HRV biofeedback may literally be “training” the body’s internal sensors. Attendees will come away with a deeper understanding of how activating Piezo2 mechanotransducers can enhance interoceptive awareness and autonomic balance – ultimately empowering more effective self-regulation strategies grounded in the latest science.

Target Audience: Those interested in the latest science on the mechanisms behind the results we get with HRV biofeedback. Piezo2 shifts the paradigm and provides a new understanding of the power of HRV.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Heart Rate Variability (EKG, RESP), High-level science from aligned disciplines

Track: Hot Topics

Level: Intermediate

Focus: 35% Clinical/65% Research

Learning Objectives:

Explain the role of Piezo2 as a mechanosensory ion channel and how it enables internal bodily senses (e.g. sensing heartbeats and blood pressure).

Describe the interplay between vagal tone, HRV, and Piezo2-mediated mechanosensation, including how signals from Piezo2 sensors (baroreceptors, lung stretch receptors, etc.) feed into autonomic reflexes.

Identify how HRV biofeedback practices (such as slow breathing) engage Piezo2 pathways, strengthening baroreflex sensitivity and interoceptive awareness of internal rhythms.

Discuss the clinical significance of mechanosensory interoception for biofeedback and mind-body medicine – recognizing why this emerging knowledge (e.g. new 2025 findings on Piezo2 and heartbeat perception nature.com ) can inform more effective interventi

References:

Candia-Rivera, D., et al. (2025). Heart rate dynamics shape brain perception of heartbeats through a mechanosensory pathway. Communications Biology.

Zeng, W.-Z., et al. (2018). PIEZOs mediate neuronal sensing of blood pressure and the baroreceptor reflex. Nature, 554, 487–492. https://doi.org/10.1038/nature25780

Woo, S.-H., et al. (2023). PIEZO2 in somatosensory neurons controls gastrointestinal transit. Cell, 186(18), 3932–3949. https://doi.org/10.1016/j.cell.2023.07.020

Zahid, A., et al. (2024). It is time to consider the lost battle of microdamaged Piezo2 in the context of E. coli and early-onset colorectal cancer. International Journal of Molecular Sciences, 26(15), 7160. https://doi.org/10.3390/ijms26157160

Bernardi, L., et al. (2005). Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension, 46(4), 714–718. https://doi.org/10.1161/01.HYP.0000179581.68566.7d

Limitations/Severe Risks: No risks are identified.

Diversity Considerations: N/A

GAP: Medical Knowledge,

GAP Correction: This session addresses a critical practice gap: most clinicians and biofeedback practitioners use HRV training and vagal-enhancement techniques without understanding the mechanosensory mechanisms that make these interventions effective. While the field has long focused on autonomic modulation, new evidence shows that Piezo2 mechanosensitive ion channels play a foundational role in sensing heartbeat pulsations, blood pressure changes, lung stretch, and other internal mechanical rhythms. These channels form the bottom-up sensory pathway that informs the brain about the state of the cardiovascular and respiratory systems—yet this emerging physiology is largely absent from current clinical education.

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Friday, May 15

4 pm - 5 pm

BOS11: Progress in Applied Psychophysiology: Status of Applied Psychophysiology and Biofeedback and Results of an Updated Meta Analysis of Research on HRV Biofeedback

Presented By: Paul Lehrer, PhD

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Target Audience: People interested in the status of research in the field of biofeedback, particularly HRV biofeedback

Subject Matter Classification: Heart Rate Variability (EKG, RESP), Peripheral Biofeedback (HRV/Resp)

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 25% Clinical/75% Research

Learning Objectives:

Summarize the status, growth, and development of the biofeedback field as reflected in Applied Psychophysiology and Biofeedback

List the procedures and value of meta analysis for our field

Explain the strength of effects of HRVB for various applications in an updated meta analysis

References:

Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback, 45(3), 100-129.

Lehrer, P and Woolfolk, R (Eds) (2021) Principles and practice of stress management. NY : Guilford.

Leyro, T. M, Versella, M. V., Yang, M.-J., Brinkman, H. R., Hoyt, D. L. & Lehrer, P. (2021). Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clinical Psychology Review. 8401980

Lehrer, P.; Derby, L., Caswell, J. S., Grable, J., & Hanlon, R. (2024). Physiological effects of psychological interventions among persons with financial stress: A systematic review, meta-analysis, and introduction to psychophysiological economics. Applied Psychophysiology and Biofeedback, 49,(4), 503-521. https://doi.org/10.1007/s10484-024

Lehrer, P. (2025) Importance of including psychophysiological methods in psychotherapy. Applied Psychophysiology and Biofeedback, 50,169-188,10.10007/s10484-024-09667-

Limitations/Severe Risks: No risks are identified.

Diversity Considerations: Applicable to all ethnic groups

GAP: Patient Care, Medical Knowledge

GAP Correction: This session will focus on the current research and clinical efficacy

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Friday, May 15

6:15 pm - 7:30 pm

KEY02: KEYNOTE: Why Trying Harder Doesn’t Work (and What Motivational Interviewing Does Instead)

Presented By: Michelle Drapkin, PhD

Session Type: Keynote

CE Credits: 1

Motivational Interviewing (MI) is an evidence-based, collaborative approach to supporting behavior change that is especially useful when people feel stuck, ambivalent, or discouraged. Rather than relying on persuasion, advice-giving, or pressure, MI helps clinicians work with motivation as it is, creating conditions that support engagement, persistence, and meaningful change over time.

In this keynote, Dr. Michelle Drapkin will offer a clear, accessible introduction to Motivational Interviewing and explore how it can be applied in everyday clinical conversations. Designed for both those new to MI and those looking to reconnect with its foundations, the session will review the core principles of MI, including empathy, autonomy, collaboration, and evocation, and how these principles translate into practical clinical strategies.

The talk will address common challenges clinicians encounter in behavior change work, such as difficulty sustaining home practice, frustration when progress is slow, perfectionism and over-effort, ambivalence driven by external pressure, and trouble applying skills during real-world stress. Drawing lightly on insights from self-regulation and psychophysiology, Dr. Drapkin will illustrate how MI helps reduce threat, support regulation, and strengthen motivation without requiring people to push harder or get it right.

Through clinical examples and real-world scenarios, participants will see how MI supports persistence and follow-through by aligning change with values and readiness rather than compliance. The session will emphasize practical takeaways clinicians can immediately apply, regardless of setting or theoretical orientation.

By the end of the session, participants will have a grounded understanding of what Motivational Interviewing is, why it works, and how it can be used to support motivation, self-regulation, and resilience in everyday clinical practice.

Target Audience: All

Subject Matter Classification: Stress Management, Mindfulness, Evidence-based, Motivational Interviewing

Track: Hot Topic

Level: Introductory

Focus: 80% Clinicial/20% Research

Learning Objectives:

Define Motivational Interviewing

Describe how to use Motivational Interviewing to support behavior change

Identify specific Motivational Interviewing strategies that can be used in clinical conversations to support motivation and engagement

References:

Drapkin, M. L. (2023). The Motivational Interviewing Path to Personal Change: The Essential Workbook for Creating the Life You Want. New Harbinger Publications.

Andrasik, F., & Grazzi, L. (2014). Biofeedback and behavioral treatments: Filling some gaps. Neurological Sciences, 35(Suppl 1), 121-127.

Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2016). Motivational interviewing improves medication adherence: a systematic review and meta-analysis. Journal of general internal medicine, 31(8), 929-940.

Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., ... & Pollock, A. (2018). Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PloS one, 13(10), e0204890.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.

Limitations/Severe Risks: No severe risks anticipated. Motivational Interviewing is an evidence-based approach with a wide body of research to support its efficacy across a range of settings.

Diversity Considerations: Motivational Interviewing is client-centered by design and supports culturally responsive care by emphasizing empathy, collaboration, and respect for individual values and lived experience. In this session, MI is framed as a communication approach that helps providers remain curious, flexible, and responsive to cultural and individual differences rather than relying on assumptions or prescriptive strategies. The session aims to empower providers to become more attuned to individual differences by listening more carefully and responding more thoughtfully.

GAP: Patient Care, Practice-based Learning and Improvement and Interpersonal and Communication Skills

GAP Correction: This session addresses gaps in interpersonal communication and patient care by helping clinicians translate evidence-based Motivational Interviewing into routine clinical practice. The presentation focuses on improving engagement, supporting motivation, and reducing discord in behavior change conversations, particularly when patients are ambivalent or discouraged. Rather than relying on persuasion or pressure, providers are supported in connecting with patients in ways that empower autonomy and strengthen collaboration.

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Saturday, May 16

9 am - 10:30 am

BOS12: Integrating QEEG and Precision Medicine in Complex Mental Health Care

Presented By: Melanie Dorion, MSN, AGNP-BC; Jessica Eure, M.Ed, Ed.S., LPC, BCN, BCB, QEEG-DL

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

This 90-minute presentation introduces a collaborative clinical model integrating QEEG-guided neurofeedback and precision medicine in the treatment of complex and treatment-resistant mental health presentations. The session provides a high-level overview of how interdisciplinary coordination enhances diagnostic clarity, patient safety, and clinical outcomes. Attendees will review how specific EEG phenotypes, including diffuse slowing patterns, focal slowing, beta spindles, and paroxysmal activity may signal the need for further medical evaluation prior to initiating neurofeedback. Emphasis will be placed on understanding when neurofeedback should proceed, when it should pause, and when additional medical investigation is indicated. Presenters will share data from QEEG cases where systemic contributors may be present. The session also introduces a structured medical decision framework addressing common root contributors to brain dysfunction, including toxic exposures, chronic infections, autoimmune activity, metabolic dysregulation, hypoxic injury, and mitochondrial dysfunction. Rather than offering detailed detoxification or laboratory protocols, the presentation outlines a conceptual roadmap for interdisciplinary collaboration and sequencing of care. Participants will learn how referral decisions are made, how scope-of-practice boundaries are maintained, and how communication between providers supports safe, coordinated treatment planning. Case illustration will demonstrate how collaborative care can improve outcomes in complex presentations.

Target Audience: This session is designed for neurofeedback providers, psychologists, counselors, nurse practitioners, physicians, and other healthcare professionals working with complex psychiatric, neurological, or treatment resistant cases. It is particularly relevant for clinicians seeking to improve interdisciplinary collaboration, refine referral pathways, and enhance precision in clinical decision-making when systemic contributors to brain dysfunction are suspected.

Subject Matter Classification: Neurofeedback (EEG), High level science from aligned disciplines, Successful Clinical Outcomes

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 75% Clinical/25% Research

Learning Objectives:

Identify EEG patterns and neuromarkers that warrant medical referral prior to initiating neurofeedback

Identify neuromarkers that warrant medical referral prior to initiating neurofeedback

Describe common contributors to neurosystemic assault, including toxic exposures, infections, autoimmune processes, metabolic dysfunction, hypoxic injury, and medication effects

Recognize clinical presentations and historical indicators that suggest systemic contributors to brain dysfunction rather than primary psychiatric etiology

Apply a structured screening and referral framework to determine when medical evaluation is indicated before proceeding with or concurrent with neurofeedback intervention.

References:

Köhler-Forsberg, O., Petersen, L., Gasse, C., Mortensen, P. B., Dalsgaard, S., & Yolken, R. H. (2019). A nationwide study in Denmark of the association between treated infections and the subsequent risk of treated mental disorders in children and adolescents. JAMA Psychiatry, 76(3), 271–279.

Krepel, N., van Dijk, H., Sack, A. T., Swatzyna, R. J., & Arns, M. (2021). To spindle or not to spindle: A replication study into spindling excessive beta as a transdiagnostic EEG feature associated with impulse control. Biological Psychology, 165, 108188.

Swatzyna, R. J., Tarnow, J. D., Turner, R. P., Roark, A. J., MacInerney, E. K., & Kozlowski, G. P. (2017). Integration of EEG into psychiatric practice: A step toward precision medicine for autism spectrum disorder. Journal of Clinical Neurophysiology, 34(3), 230–235.

Shelton, J. F., Geraghty, E. M., Tancredi, D. J., Delwiche, L. D., Schmidt, R. J., Ritz, B., Hansen, R. L., & Hertz-Picciotto, I. (2014). Neurodevelopmental disorders and prenatal residential proximity to agricultural pesticides: the CHARGE study. Environmental health perspectives, 122(10), 1103–1109. https://doi.org/10.1289/ehp.1307044

Limitations/Severe Risks: QEEG interpretation carries risk of overgeneralization or misattribution of findings without adequate medical review. Neurofeedback may be ineffective or inappropriate if systemic contributors are unaddressed. Laboratory testing and detoxification strategies must remain within appropriate scope of practice. Evidence supporting neurofeedback varies by condition, with stronger support in ADHD and emerging support in PTSD and mood disorders. This presentation emphasizes patient safety, interdisciplinary collaboration, and adherence to professional boundaries.

Diversity Considerations: This presentation addresses cultural competence by emphasizing patient-centered, collaborative care that considers socioeconomic access to laboratory testing, environmental exposures, and healthcare resources. Presenters will discuss how toxic load, chronic stress, trauma exposure, and systemic health disparities may disproportionately affect marginalized populations and influence neurophysiological patterns. The session reinforces culturally responsive communication, informed consent, and careful sequencing of interventions to avoid overmedicalization or financial burden. Ethical interdisciplinary collaboration supports equitable, comprehensive care across diverse patient populations.

GAP: Patient Care, Medical Knowledge

GAP Correction: Many neurofeedback providers and medical clinicians operate in silos, leading to fragmented care. EEG findings may not prompt appropriate medical referral, and systemic contributors to brain dysfunction may be overlooked. Conversely, medical providers may not consider QEEG assessment in treatment-resistant cases. This session teaches a structured decision-making framework that improves interdisciplinary coordination, enhances diagnostic precision, reduces inappropriate or premature neurofeedback intervention, and supports improved patient outcomes.

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Saturday, May 16

9 am - 10:30 am

BOS13: Optimizing Cognitive Performance Under Extreme Stress Using Respiratory Biofeedback

Presented By: Dylan McKay, MSc Student

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Optimal performance in extreme operational environments depends on the ability to maintain cognitive control, situational awareness, and decision accuracy under intense psycho-physiological stress. In military, emergency response, aviation, and other high-consequence domains, performance failures frequently arise not from insufficient skill or training, but from stress-induced physiological dysregulation that constrains executive function at critical moments. This symposium presents an applied, evidence-informed framework for optimising human performance through the integration of high-fidelity training, wearable psychophysiological monitoring, and respiratory biofeedback. Grounded in dual-process decision theory, recognition-primed decision-making, and Stress Exposure Training (SET), the framework targets physiological mechanisms that undermine decision quality under load. Particular emphasis is placed on stress-related breathing dysregulation. Elevated cognitive demand and threat perception commonly provoke excessive ventilation, leading to reduced arterial carbon dioxide levels (hypocapnia), cerebral vasoconstriction, and impaired oxygen delivery to the brain. This cascade degrades working memory, attentional control, and cognitive flexibility, capabilities essential for effective performance in time-critical, high-risk tasks. The session reviews emerging evidence demonstrating how real-time monitoring of respiratory and cardiovascular metrics, including respiratory rate, end-tidal carbon dioxide (ETCO₂), and heart rate variability (HRV), can identify early physiological precursors to cognitive performance decline. When embedded within realistic, progressively stressful training environments, respiratory biofeedback enables performers to recognise maladaptive stress responses and apply personalised breathing interventions, and behavioural modification to stabilise arousal, preserve executive function, and maintain decision quality under pressure. Applied examples from high-risk training contexts illustrate how wearable psychophysiological tools can be used ethically and without commercial bias to support performance optimisation. Elements of this framework are currently being examined through an ethically approved MSc research program using live-fire Close-Quarters Battle (CQB) threat decision tasks to formally test the relationship between ventilatory strain, cognitive control, and performance under load. The framework is transferable across tactical, clinical, and civilian high-performance settings and aligns with AAPB’s mission to advance applied psychophysiology in support of optimal human performance.

Target Audience: This session is intended for applied psychophysiologists, psychologists, performance coaches, clinicians, researchers, and trainers working in high-stress, high-consequence environments, including military, law enforcement, emergency response, aviation, healthcare, and other elite performance domains. The content is appropriate for professionals with foundational knowledge of psychophysiology and human performance seeking advanced, applied frameworks.

Subject Matter Classification: Optimal Performance

Track: Hot Topics

Level: Advanced

Focus: 50% Clinical/50% Research

Learning Objectives:

Describe how stress-induced breathing dysregulation alters cerebral blood flow and contributes to degraded cognitive control during high-demand performance tasks.

Analyze how ventilatory strain influences decision processes and performance outcomes in high-stress environments.

Identify psychophysiological indicators (e.g., respiratory patterns, end-tidal CO₂, heart rate variability) associated with impending cognitive performance decline.

Apply evidence-informed respiratory biofeedback strategies to support arousal regulation and decision stability under stress.

Design an ethically grounded, context-sensitive approach to performance optimization that integrates psychophysiological monitoring without misuse of physiological data.

References:

Martin, K., McLeod, E., Périard, J., Rattray, B., Keegan, R., & Pyne, D. B. (2019). The impact of environmental stress on cognitive performance: A systematic review. Human Factors, 61(8), 1205–1246. https://doi.org/10.1177/0018720819839817

Martin, K., Périard, J., Rattray, B., & Pyne, D. B. (2020). Physiological factors which influence cognitive performance in military personnel. Human Factors, 62(1), 93–123. https://doi.org/10.1177/0018720819841757

Reale, C., Salwei, M. E., Militello, L. G., Weinger, M. B., Burden, A., Sushereba, C., Torsher, L. C., Andreae, M. H., Gaba, D. M., McIvor, W. R., Banerjee, A., Slagle, J., & Anders, S. (2023). Decision-making during high-risk events: A systematic literature review. Journal of Cognitive Engineering and Decision Making, 17(2), 188–212. https://doi.org/10.1177/15553434221147415

Rabat, A., Van Cutsem, J., Marcora, S. M., Lambert, A., Markwald, R., Kubala, A. G., & Friedl, K. E. (2025). Fatigue and management of warfighter mental endurance. BMJ Military Health. https://doi.org/10.1136/military-2025-002963

Billing, D. C., Fordy, G. R., Friedl, K. E., & Hasselstrøm, H. (2021). The implications of emerging technology on military human performance research priorities. Journal of Science and Medicine in Sport, 24(9), 947–953. https://doi.org/10.1016/j.jsams.2020.10.007

Limitations/Severe Risks: The content of this presentation is evidence-informed and grounded in peer-reviewed research; however, several limitations and considerations are acknowledged. First, the integrated human performance optimisation framework discussed has not yet been validated through completed randomised controlled trials as a unified intervention. Ongoing and ethically approved research is currently examining specific mechanisms, including the relationship between ventilatory strain, cognitive control, and performance under stress. Second, individual variability in physiological responses to stress and breathing interventions represents a limitation. Respiratory patterns, autonomic responses, and cognitive effects differ substantially between individuals, requiring individualised interpretation rather than normative thresholds. As such, the approaches discussed are not intended for diagnostic, screening, or clinical decision-making purposes. The most common risks associated with the content are minimal and primarily educational in nature. These include misapplication of breathing strategies outside appropriate contexts, overinterpretation of physiological data without adequate training, or inappropriate transfer of high-stress performance techniques into clinical or civilian environments without modification. To mitigate these risks, the presentation emphasises context-sensitive application, ethical boundaries, and the distinction between training support, research evaluation, and operational assessment. No severe risks are associated with the educational content when applied as intended. The session does not advocate clinical treatments, medical interventions, or therapeutic protocols, and participants are advised to operate within their professional scope of practice when applying performance optimisation principles.

Diversity Considerations: This presentation emphasises adaptable, non-invasive performance strategies that are applicable across diverse occupational, cultural, and operational contexts. The framework accounts for individual variability in stress responses, physiological capacity, and environmental demands, and avoids reliance on culturally specific assumptions or proprietary methods. Applications are framed to support ethical, inclusive, and context-sensitive performance optimisation across military, clinical, and civilian populations, with a focus on those who work in extremis environments e.g., military, law enforcement fire fighters, emergency medicine etc. Applications are framed around non-invasive, self-regulatory psychophysiological principles rather than prescriptive performance standards. The framework emphasises individual variability, participant autonomy, and context-specific adaptation, ensuring ethical application across military, clinical, and civilian settings. Interventions are individualised, voluntary, and focused on within-individual change rather than normative comparison. We make a clear distinction between using physiological data to support learning, using it for research under consent, and using it for operational decision-making. In this work, data are used only for training support and ethically approved research, not for selection, certification, or performance appraisal. This approach supports inclusive, ethically grounded, and context-sensitive performance optimisation aligned with professional standards of care and applied psychophysiology.

GAP: Patient Care, Practice-based Learning and Improvement

GAP Correction: This session will teach participants how to identify, interpret, and respond to psychophysiological behaviours that influence cognitive performance and decision quality under stress, factors that are frequently under-recognised or addressed only subjectively in applied performance settings. Participants will learn how individualised stress responses, particularly stress-related breathing behaviours and ventilatory strain, can constrain attention, executive function, and cognitive flexibility during high-demand tasks. The session translates current research from psychophysiology and decision science into practical, educational approaches for performance optimisation. Participants will learn how to assess individual performance trend ranges using objective physiological indicators, how to distinguish adaptive versus maladaptive stress responses, and how to apply evidence-informed respiratory self-regulation strategies to support cognitive stability under pressure. By shifting from generalised stress management concepts to individualised, data-informed performance assessment and learning, the session equips practitioners with tools to support competency development, reflective practice, and performance optimisation. These approaches enable learners and practitioners to better understand their own psychophysiological responses, adapt behaviour under load, and sustain effective performance across diverse high-stress environments without framing the work as diagnosis or treatment.

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Saturday, May 16

9 am - 10 am

BOS14: At Risk and Under Stress: Evaluating a Heart Rate Variability–Based Preventive Intervention in Young Adults

Presented By: Amelia Saul, PhD, CTRS, BCB; Linda Bolin, PhD, RN, BCB, FAHA; Polaris Gonzalez Barrios, PhD, MSc

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. There are nonmodifiable causes that contribute to this disease, along with modifiable factors. Stress is a known contributor in the development of CVD. In the young adult population, chronic exposure to stress increases this risk by approximately 40 – 60%. In exploring modifiable risk factors, studies have focused on physical activity and diet modification, but there is limited research related to integrative therapies to target stress and anxiety. With the rise in CVD, there is a need for an effective and non-invasive preventative intervention to address high-risk individuals, particularly young adults. A randomized controlled trial was conducted examining the effectiveness of a 4-week heart rate variability (HRV) prevention intervention in improving physiological stress response and optimizing emotional regulation. Outcomes were evaluated using HRV metrics, the Beck Anxiety Inventory (BAI), and the Socially Evaluated Cold Pressor Test to measure both psychological and physiological responses to stress.The study included 63 participants (experimental n = 32; control n = 31) with a mean age of 21.7 years (SD = 3.2) and the majority female (n = 49). Preliminary results indicate the experimental group demonstrated a larger reduction in BAI scores from pre-intervention (M = 34.00, SD = 9.41) to post-intervention (M = 31.19, SD = 9.22) compared to the control group (M = 31.61, SD = 8.53; M = 31.52, SD = 8.28). Additionally, the experimental group showed greater reductions in diastolic blood pressure from pre-intervention (M = 73.41, SD = 10.65) to post-intervention (M = 70.94, SD = 7.92) relative to the control group. This study concluded that the 4-week preventative intervention may offer a promising approach for reducing psychological and physiological indicators of stress among young adults at risk for CVD.

Target Audience: Individuals interested in learning more about the use of HRV and resonance frequency breathing to mitigate the effects of anxiety/stress in those with a family history of cardiovascular disease.

Subject Matter Classification: Stress Management, Heart Rate Variability (EKG, RESP), Evidence-based, Successful Clinical Outcomes

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Learning Objectives:

Describe the role of chronic stress and anxiety in increasing CVD risk in young adults.

Explain how HRV functions as a non-invasive preventative intervention for stress regulation.

Summarize the design and rational of a 4-week HRV protocol.

Discuss the possible implication of HRV based prevention intervention for reducing long term cardiovascular risk.

Demonstrate the implications of our research findings to translate into practice.

References:

Bolin, L. P., Saul, A. D., Bethune Scroggs, L. L., & Horne, C. (2022). A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease. Clinical hypertension, 28(1), 2.

Bolin, L. P., Horne, C. E., & Wei, H. (2021). A qualitative descriptive study: Young adults’ experiences with biofeedback. Journal of Holistic Nursing, 39(2), 144-153.

Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work?. Frontiers in psychology, 5, 756.

Lehrer, P., Vaschillo, B., Zucker, T., Graves, J., Katsamanis, M., Aviles, M., & Wamboldt, F. (2013). Protocol for heart rate variability biofeedback training. Biofeedback, 41(3), 98-109.

Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International journal of cardiology, 141(2), 122-131.

Limitations/Severe Risks: Several limitations should be noted. First, the study involved a relatively small sample size and a short intervention duration (4 weeks), which may limit generalizability and the ability to detect statistically significant effects. Second, the sample consisted primarily of young adult females, which may restrict applicability to more diverse populations. Third, physiological outcomes were limited to select measures, and HRV metrics may be influenced by factors such as respiration, physical activity, and adherence to protocols. With respect to risks, the intervention was noninvasive and low risk. Potential risks were minimal and primarily included temporary emotional discomfort related to stress-induction procedures (e.g., the Socially Evaluated Cold Pressor Test). No adverse events were reported. All research was reviewed and approved by the Institutional Review Board. The presentation includes discussion of validated clinical assessments and evidence-based interventions. Anxiety was measured using the Beck Anxiety Inventory (BAI), a widely used and psychometrically validated self-report measure. Physiological stress responses were assessed using heart rate variability (HRV) metrics, which are well-established indicators of autonomic nervous system functioning, and the Socially Evaluated Cold Pressor Test, a standardized laboratory stress paradigm with demonstrated reliability in eliciting physiological stress responses. HRV biofeedback interventions are supported by a growing body of empirical research demonstrating efficacy in improving emotional regulation and reducing stress-related physiological arousal across clinical and nonclinical populations.

Diversity Considerations: This research projected was conducted at a minority serving institution with the sample population focusing on racial and ethical minority young adults. These results aim to generate evidence to reduce disparities and access to effective stress management strategies using biofeedback.

GAP: Practice-based Learning and Improvement

GAP Correction: This session will teach participants how HRV–based interventions can be implemented as a noninvasive, preventative strategy to address stress and anxiety among young adults at elevated risk for cardiovascular disease. Attendees will gain an understanding of the physiological mechanisms linking chronic stress, autonomic dysregulation, and cardiovascular risk, as well as practical insight into how HRV biofeedback can be integrated into clinical, educational, and wellness settings.

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Saturday, May 16

9 am - 10:30 am

ORAL02: Oral Presentations: HRV Sessions

CE Credits: 1.5

ORAL02a: Methodological Robustness of Ultra-Short-Window Heart Rate Variability During Resonance-Paced Breathing, Implications for Breathing Protocols

Presented By: Mehdi Kushkestani

Session Type: 15-minute Abstract Presentation

Heart rate variability (HRV) is a cornerstone outcome in applied psychophysiology and biofeedback research, particularly in interventions using resonance-paced breathing (RPB) to enhance autonomic regulation. Although standard HRV analysis relies on 5-minute recordings, this convention limits methodological flexibility and constrains the ability to examine within-session autonomic dynamics. Recent evidence supports the validity of shorter HRV windows, particularly for time-domain and high-frequency measures; however, the implications of window length for capturing autonomic adaptation over time remain underexplored. In this study, we compared three HRV analysis approaches derived from the same 5-minute recordings collected during natural breathing (NB) and resonance-paced breathing: (1) a 60-second sliding window advanced on a 1-second grid and averaged across the session, (2) a 120-second sliding window using the same grid and averaging procedure, and (3) the conventional single 300-second HRV estimate. This design allowed us to evaluate both agreement with the gold-standard method and the capacity of shorter windows to preserve physiologically meaningful effects. Across time- and frequency-domain indices, ultra-short windows demonstrated excellent agreement with the 300-second reference, with particularly strong consistency observed during resonance-paced breathing. Systematic bias was minimal, and group-level HRV differences between NB and RPB were robust across all window lengths. Importantly, window length did not meaningfully alter the magnitude or direction of the RPB effect, supporting the physiological validity of shorter HRV segments. Beyond agreement, the sliding-window approach offers a critical advantage for applied biofeedback research: dynamic tracking of autonomic nervous system adaptation. A 60-second window advanced on a 1-second grid yields approximately 240 overlapping HRV estimates within a 5-minute session, compared with approximately 180 estimates using a 120-second window. This increased temporal resolution enables characterization of individual autonomic trajectories, identification of maximal autonomic adaptation, and estimation of time-to-peak HRV responses, features that are obscured by static 5-minute averages. Together, these findings support the use of ultra-short, sliding-window HRV analysis as a methodologically sound and practically valuable tool for resonance-paced breathing and biofeedback applications, enabling both robust group-level inference and individualized assessment of autonomic dynamics.

Target Audience: This session is intended for applied psychophysiology and biofeedback professionals, including clinicians, researchers, educators, and trainees interested in heart rate variability, breathing-based interventions, and autonomic regulation. The content will be particularly relevant to biofeedback practitioners, health psychologists, exercise and clinical physiologists, and researchers working with resonance-paced breathing or HRV-guided interventions. Attendees who design or deliver biofeedback protocols, conduct HRV research in laboratory or applied settings, or seek methods for tracking dynamic autonomic responses at the individual level will benefit from the methodological insights presented. Graduate students and early-career investigators interested in scalable and flexible HRV analysis approaches are also encouraged to attend.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Heart Rate Variability (EKG, RESP), Stress Management, Practice Management, Technology and Innovations, Evidence-based

Track: Basic Science

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Differentiate between standard 300-second HRV analysis and ultra-short sliding-window approaches (60 s and 120 s) in terms of agreement, bias, and physiological validity during natural and resonance-paced breathing

Evaluate the impact of HRV window length on the detection and interpretation of autonomic nervous system changes induced by resonance-paced breathing

Interpret dynamic HRV trajectories derived from 60-second sliding windows to identify maximal autonomic adaptation and time-to-peak HRV responses at the individual level

Apply ultra-short, sliding-window HRV methods to enhance flexibility and individualization in biofeedback assessment and intervention design across applied settings

References:

Bates, M. E., Price, J. L., Leganes-Fonteneau, M., Muzumdar, N., Piersol, K., Frazier, I., & Buckman, J. F. (2022). The process of heart rate variability, resonance at 0.1 Hz, and the three baroreflex loops: A tribute to Evgeny Vaschillo. Applied Psychophysiology and Biofeedback, 47(4), 327–340. https://doi.org/10.1007/s10484-022-09544-4

Burma, J. S., Graver, S., Miutz, L. N., Macaulay, A., Copeland, P. V., & Smirl, J. D. (2021). The validity and reliability of ultra-short-term heart rate variability parameters and the influence of physiological covariates. Journal of Applied Physiology, 130(6), 1848–1867. https://doi.org/10.1152/japplphysiol.00955.2020

Shaffer, F., Meehan, Z. M., & Zerr, C. L. (2020). A critical review of ultra-short-term heart rate variability norms research. Frontiers in Neuroscience, 14, 594880. https://doi.org/10.3389/fnins.2020.594880

Quigley, K. S., Gianaros, P. J., Norman, G. J., Jennings, J. R., Berntson, G. G., & de Geus, E. J. C. (2024). Publication guidelines for human heart rate and heart rate variability studies in psychophysiology—Part 1: Physiological underpinnings and foundations of measurement. Psychophysiology, 61(9), e14604. https://doi.org/10.1111/psyp.14604

Tanoue, Y., Nakashima, S., Komatsu, T., Kosugi, M., Kawakami, S., Kawakami, S., Michishita, R., Higaki, Y., & Uehara, Y. (2023). The validity of ultra-short-term heart rate variability during cycling exercise. Sensors, 23(6), 3325. https://doi.org/10.3390/s23063325

Limitations/Severe Risks: Several limitations should be considered when interpreting the findings of this presentation. First, although ultra-short HRV windows demonstrated strong agreement with the standard 300-second method at the group level, HRV is inherently variable across individuals. As a result, shorter windows may be more sensitive to transient artifacts, ectopic beats, or momentary changes in posture or attention, particularly in uncontrolled environments. Second, the analyses were derived from five-minute recordings collected under structured laboratory conditions; therefore, generalization to ambulatory or real-world settings should be made cautiously. Third, while the sliding-window approach enables dynamic assessment of autonomic adaptation, the present work focused on methodological robustness rather than establishing clinical thresholds or diagnostic cutoffs. Consequently, these methods should not be interpreted as substitutes for clinical evaluation or diagnostic decision-making. The presentation involves minimal risk. Data were collected using noninvasive physiological recordings (electrocardiography and paced breathing). Resonance-paced breathing is generally considered safe; however, some individuals may experience transient discomfort such as lightheadedness, dizziness, or anxiety when engaging in paced breathing exercises. These risks are well documented, mild, and self-limiting. No adverse events were observed during data collection. All procedures were conducted under institutional review board approval, with informed consent, and participants were free to discontinue participation at any time. The content of this presentation is grounded in established psychophysiological and cardiovascular science. HRV is a widely validated index of autonomic nervous system regulation, and resonance-paced breathing has demonstrated efficacy in modulating vagal activity and baroreflex function across clinical and nonclinical populations. The methodological approaches discussed build on recent peer-reviewed evidence supporting the validity of ultra-short HRV windows for time-domain and frequency-domain measures. The research was conducted in the Cardiac Neuroscience Laboratory as part of an NIH-funded project (Alderman & Bates, 2022–2025; NIAAA R21), ensuring rigorous oversight, standardized procedures, and adherence to current best practices in human psychophysiology research.

Diversity Considerations: This proposal addresses cultural diversity and cultural competence by emphasizing methodological approaches that increase accessibility, flexibility, and individualization in biofeedback research and practice. Traditional HRV protocols requiring long, uninterrupted recordings may pose barriers for individuals from diverse cultural backgrounds, clinical populations, or settings where time, comfort, or environmental constraints limit participation. By validating ultra-short, sliding-window HRV analyses, this work supports shorter, more adaptable biofeedback sessions that can be implemented across a wide range of cultural and clinical contexts. Additionally, the focus on within-session autonomic dynamics and individual response trajectories aligns with culturally competent practice by acknowledging that physiological responses to interventions such as resonance-paced breathing can vary substantially across individuals. This approach encourages practitioners to move beyond one-size-fits-all interpretations and to tailor biofeedback interventions based on individual patterns of autonomic adaptation, which may be influenced by cultural, psychosocial, and contextual factors. Overall, the proposed methods promote inclusive, patient-centered biofeedback practices that can be adapted for use in diverse populations and settings.

ORAL02b: Slow-Paced Contraction Increases HRV But Not Peripheral Blood Flow

Presented By: Fred Shaffer, PhD, BCB, BCB-HRV; Isaac Compton, BS candidate; Emma Suchsland, BS candidate

Session Type: 15-minute Abstract Presentation

Slow-paced contraction (SPC) of the wrists, core, and ankles is hypothesized to enhance heart rate variability (HRV) independent of respiratory sinus arrhythmia. We systematically replicated Meehan and Shaffer’s (2023) randomized controlled trial, adding hand temperature and temporal artery blood volume pulse (BVP) amplitude to determine whether SPC amplifies the baroreflex modulation of vascular tone. We randomly assigned 27 healthy undergraduates (15 men and 12 women, mean age 19.8 years) to a counterbalanced sequence of three 3-min SPC conditions: 3, 6, and 12 contractions per min (cpm). We separated these trials by 3-minute buffer periods to minimize carryover. We instructed participants to gently contract their muscles at the designated pacing frequencies while allowing spontaneous breathing. A Thought Technology ProComp Infiniti™ system monitored ECG, BVP amplitude, and respiration. We provided participants with auditory prompts to contract their muscles for 3 s to reinforce a BioGraph Infiniti™ visual pacing display and confirmed their compliance. We confirmed equivalent breathing rates during 3, 6, and 12 cpm using an abdominal respirometer. We used a Box-Cox or Yeo-Johnson transformation when the data did not meet the parametric test assumptions of normality and symmetry. We used the Shapiro-Wilk test and skewness statistic to determine whether to analyze these data using planned comparisons or a Wilcoxon Signed-Rank Test with corrections for Type 1 error. SPC did not produce greater hand temperature or temporal artery BVP amplitude at 3 cpm than at 6 or 12 cpm. The 6 cpm condition significantly maximized low-frequency (LF) power, the LF/HF ratio, and total variability (triangular index), mirroring the resonance effects typically observed in 6-bpm-paced breathing. The 3 cpm condition maximized very low frequency (VLF) power and systolic blood pressure. Both slow-paced conditions (3 and 6 cpm) produced higher parasympathetic markers (RMSSD, pNN50, SD1) than the 12 cpm condition (p < 0.05). These findings confirm SPC as an alternative or complementary HRV training method to slow-paced breathing, while also highlighting its limitations.

Target Audience: Professionals who use HRV biofeedback

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR)

Track: Basic Science

Level: Introductory

Focus: 75% Clinical/25% Research

Learning Objectives:

Explain how slow-paced contraction is performed.

Describe the physiological rationale for slow-paced contraction as a method to enhance heart rate variability independent of respiratory sinus arrhythmia.

Identify the common effects of 3 and 6 contractions per minute on HRV measures.

Compare the differential effects of 3, 6, and 12 contractions per minute on HRV measures.

Explain when slow-paced contraction may be used as an alternative to slow-paced breathing or to complement it.

References:

Kim, H. J. (2021). Metabolic acidosis in chronic kidney disease: Pathogenesis, clinical consequences, and treatment. Electrolyte & Blood Pressure: E & BP, 19(2), 29–37. https://doi.org/10.5049/EBP.2021.19.2.29

Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., Sgobba, P., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology and Biofeedback, 45, 109-129. https://doi.org/10.1007/s10484-020-09466-z

Meehan, Z. M., & Shaffer, F. (2023). Adding core muscle contraction to wrist-ankle rhythmical skeletal muscle tension increases respiratory sinus arrhythmia and low-frequency power. Applied Psychophysiology and Biofeedback.

Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2017.00258

Shaffer, F., Moss, D., & Meehan, Z. M. (2022). Rhythmic skeletal muscle tension increases heart rate variability at 1 and 6 contractions per minute. Appl Psychophysiol Biofeedback. https://doi.org/10.1007/s10484-022-09541-7

Limitations/Severe Risks: The findings are limited to healthy Truman State University undergraduates. There are no severe or common risks. Meehan and Shaffer (2023) discusses the psychophysiology of slow-paced contraction.

Diversity Considerations: This proposal examines individual differences in applied psychophysiology.

GAP: Patient Care

GAP Correction: This session will show which HRV metrics slow-paced contraction (SPC) at 3 and 6 cpm can increase, when SPC should be used instead of slow-paced breathing, and when they should be used together.

ORAL02c: Mobile HRV Biofeedback for Resilience: Stress Reduction Through Autonomic and Embodiment Pathways

Presented By: Janell L. Mensinger, PhD, FAED; Maria Fernanda Carriel, MPH

Session Type: 15-minute Abstract Presentation

Healthcare workers experienced unprecedented stress during the COVID-19 pandemic, heightening their vulnerability to mental health disorders, and underscoring the need for tools that support stress regulation. Mobile heart rate variability (HRV) biofeedback is one such intervention, yet the mechanisms through which it reduces stress remain understudied. This study draws from a feasibility trial evaluating a mobile-based HRV biofeedback intervention among healthcare workers, examining changes in perceived stress along with three hypothesized mechanisms: mindful self-care, body appreciation, and changes in vagally mediated HRV. Participants (N=24) received an initial online training session in resonant-frequency HRV breathing and completed six weeks of HRV biofeedback using a smartphone application. Most participants consistently engaged in the intervention (M=26 days; SD=14), with 92% completing at least 10 minutes of daily practice for 14 days. Measures included the Perceived Stress Scale, Body Appreciation Scale-2, the Physical Care subscale of the Brief Mindful Self-Care Scale, and rMSSD. Pre–post within-person mediation models were estimated using the MEMORE macro (v2.1) in SPSS (v29) with 10,000 bootstrapped bias-corrected 95% confidence intervals. Results showed a significant reduction in perceived stress with a large effect size (MΔ=6.33; SD=4.95; t(23)=6.27; p<.001; d=1.24). Increases in body appreciation (d=0.63) and mindful self-care behaviors (d=1.31) significantly mediated these reductions, accounting for ~25% and 43% of the total effect, respectively. HRV increased modestly (d=0.33), contributing to a suppression effect in which HRV gains strengthened, rather than explained, pre-post changes in stress. The mechanistic effects of body appreciation and mindful self-care are consistent with positive embodiment theory, which emphasizes the body as a site of attunement and agency supporting emotional and psychological regulation. These preliminary findings suggest that HRV biofeedback may help healthcare workers reconnect with self-care practices and cultivate positive relationships with their bodies, contributing to meaningful stress reductions. Replication in larger controlled studies is warranted.

Target Audience: Applied Psychologists, Psychology Trainees, Biofeedback Practitioners

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Heart Rate Variability (EKG, RESP), Stress Management, Mindfulness, Technology and Innovations, Evidence-based

Track: Hot Topics

Level: Introductory

Focus: 30% Clinical/70% Research

Learning Objectives:

Identify the impact of pandemic-related stress on healthcare workers.

Identify the barriers to adaptive stress regulation to underscore the importance of accessible interventions for vulnerable populations.

Identify potential mechanisms (i.e., mindful self-care behaviors, body appreciation, and HRV changes) that may contribute to reductions in perceived stress following HRV biofeedback

Summarize the positive contributions of enhanced mindful self-care behaviors and body appreciation for reducing stress and improving HRV

Evaluate practical implications of using HRV biofeedback to enhance well-being and a positive relationship with one’s body

References:

Mensinger, J. L., Weissinger, G. M., Cantrell, M. A., Baskin, R., & George, C. (2024). A pilot feasibility evaluation of a heart rate variability biofeedback app to improve self-care in COVID-19 healthcare workers. Applied Psychophysiology and Biofeedback, 49(2), 241–259. https://doi.org/10.1007/s10484-024-09621-w

Pinna, T., & Edwards, D. J. (2020). A systematic review of associations between interoception, vagal tone, and emotional regulation: Potential applications for mental health, wellbeing, psychological flexibility, and chronic conditions. Frontiers in Psychology, 11, 1792–1792. https://doi.org/10.3389/fpsyg.2020.01792

Li, K., Cardoso, C., Moctezuma-Ramirez, A., Elgalad, A., & Perin, E. (2023). Heart rate variability measurement through a smart wearable device: Another breakthrough for personal health monitoring? International Journal of Environmental Research and Public Health, 20(24), 7146. https://doi.org/10.3390/ijerph20247146

De Witte, N. A. J., Buyck, I., & Van Daele, T. (2019). Combining biofeedback with stress management interventions: A systematic review of physiological and psychological effects. Applied Psychophysiology and Biofeedback, 44(2), 71–82. https://doi.org/10.1007/s10484-018-09427-7

Limitations/Severe Risks: The study limitations include a small sample size and a pre-post design, which make our findings preliminary and our hypotheses exploratory. To our knowledge, no risks have been identified for the implementation of mobile-based HRV biofeedback for stress reduction outside of possible fatigue and discomfort with slow breathing.

Diversity Considerations: This study centers on healthcare workers, who are a group of individuals from various racial, ethnic, and cultural backgrounds. This intervention targets the disproportionate risks, cultural stressors, and unique lived experiences of this group of professionals. The use of a mobile HRV biofeedback intervention reduces the traditional barriers to accessing care that impact this population. This intervention can be incorporated into their busy schedules and be flexibly integrated into diverse wellness frameworks, due to its draw from mind-body medicine and somatic awareness practices.

GAP: Practice-based Learning and Improvement

GAP Correction: To our knowledge, vulnerable populations tend to underutilize mindful self-care practices and adaptive regulation strategies when they are experiencing distress due to accessibility barriers such as time constraints, cost, and lack of awareness. This study provides an alternative path to adaptive stress regulation that is accessible to individuals at risk due to its low cost and digital format. Regular engagement and practice are needed for optimal results in stress reduction via HRV biofeedback.

ORAL02d: Modifiable Factors That Can Reduce Heart Rate Variability

Presented By: Fred Shaffer, PhD, BCB, BCB-HRV; Ben Grandstaff, Psychology Junior

Session Type: 15-minute Abstract Presentation

Heart rate variability (HRV), the beat‑to‑beat variation in normal heart intervals, reflects autonomic nervous system (ANS) flexibility and predicts morbidity and mortality. Several modifiable factors can reduce HRV and evidence-based lifestyle interventions can restore it. The strongest evidence points first to habitual physical activity and cardiorespiratory fitness, followed by body weight and obesity, hypertension and blood pressure control, psychological stress and stress‑reduction practices, and finally a range of more specific lifestyle and therapeutic levers. The most compelling and consistent evidence for modifiable influence on HRV comes from exercise training. Across clinical and healthy populations, long‑term physical activity programs shift the autonomic balance toward greater vagal modulation and lower resting heart rate. Body weight and adiposity are closely intertwined with autonomic function. Obesity is consistently linked to reduced HRV, while weight loss tends to restore sympathovagal balance. Psychological stress exerts a potent suppressive effect on HRV. Mental stress tasks reliably lower parasympathetic indices and elevate sympathetic markers, and chronic stress has been linked to persistently reduced HRV in both healthy individuals and those with cardiovascular disease. A recent systematic review and meta‑analysis evaluated stress‑reducing interventions in patients with cardiovascular disease, focusing on HRV outcomes. Many of the included trials used HRV‑biofeedback or yoga, with some employing relaxation or mixed mind–body programs. Although the total number of studies per outcome was modest, pooled analyses showed significant and sizable improvements. Because most included studies were randomized or controlled, albeit with small samples, the overall evidence for stress‑reduction improving HRV in CVD is moderate to strong. Practitioners should prioritize structured, progressive exercise, comprehensive lifestyle‑based weight management, and accessible stress‑management training, using HRV as both an outcome and a biofeedback tool.

Target Audience: Professionals who utilize HRV biofeedback in their clinical or optimal performance practices.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp)

Track: Hot Topics

Level: Introductory

Focus: 50% Clinical/50% Research

Learning Objectives:

Describe how heart rate variability (HRV) reflects autonomic nervous system (ANS) function and cardiovascular risk.

Identify key methodological variables that confound HRV measurement and interpretation in research and practice.

Explain how physical training modalities (endurance, resistance, high‑intensity, coordinative, multimodal) influence HRV outcomes.

Analyze how alcohol, caffeine, and nicotine contribute to reduced HRV.

Evaluate evidence‑informed recommendations to help patients modify behavior and exposures to improve HRV.

References:

Addleman, J. S., Lackey, N. S., DeBlauw, J. A., & Hajduczok, A. G. (2024). Heart rate variability applications in strength and conditioning: A narrative review. Journal of Functional Morphology and Kinesiology, 9(2), 45. https://doi.org/10.3390/jfmk9020045

Deng, Y., Zeng, X., Tang, C., Hou, X., Zhang, Y., & Shi, L. (2024). The effect of exercise training on heart rate variability in patients with hypertension: A systematic review and meta-analysis. Journal of Sports Sciences, 42(15), 1750–1761. https://doi.org/10.1080/02640414.2024.2367890

El-Malahi, O., Mohajeri, D., Mincu, R. I., Bäuerle, A., Rothenaicher, K., Rammos, C., Rassaf, T., & Lortz, J. (2024). Beneficial impacts of physical activity on heart rate variability: A systematic review and meta-analysis. PLOS ONE, 19(4), e0300702. https://doi.org/10.1371/journal.pone.0300702

Kirk, U., & Axelsen, J. L. (2020). Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLOS ONE, 15(12), e0243488. https://doi.org/10.1371/journal.pone.0243488

Sammito, S., Thielmann, B., Böckelmann, I., Peyré‑Tartaruga, L. A., & Stein, P. K. (2024). Update: Factors influencing heart rate variability – A narrative review. Frontiers in Physiology, 15, 1404359. https://doi.org/10.3389/fphys.2024.1404359

Limitations/Severe Risks: This presentation is based on published meta-analyses and scoping reviews, which are vulnerable to a file-drawer effect. There are no severe risks or common risks.

Diversity Considerations: This oral paper emphasizes respect for diversity and autonomy in making lifestyle choices.

GAP: Patient Care

GAP Correction: Evidence-based interventions can target factors like a sedentary lifestyle that decrease heart rate variability.

ORAL02e: One Size Does Not Fit All: The Case Against Blanket Ln Transformations

Presented By: Fred Shaffer, PhD, BCB, BCB-HRV; Emma Suchsland, BS candidate

Session Type: 15-minute Abstract Presentation

Quantitative analysis of physiological markers, such as heart rate variability (HRV), typically employs parametric statistical tests that rely on specific distributional assumptions. Foremost among these is normality, the requirement that data follow a symmetric, bell-shaped Gaussian distribution, and a lack of skewness, or asymmetry, where data tail off to one side. When biological data violate these assumptions, researchers frequently default to a natural log (Ln) transformation. This method applies a logarithmic function to compress the scale of large values, theoretically reducing positive skew. However, applying a "one-size-fits-all" Ln transformation is often insufficient or erroneous. This study evaluated optimal normalization strategies for 32 physiological variables across 28 observations. We compared the standard Ln method against the Box-Cox and Yeo-Johnson algorithms. The Box-Cox algorithm iteratively identifies an optimal power exponent (lambda) to maximize normality but is limited to strictly positive data. The Yeo-Johnson algorithm extends this approach to handle distributions containing zero or negative values. For most of the 28 metrics we studied, the algorithmic approaches (Box-Cox and Yeo-Johnson) statistically outperformed the standard Ln transformation. In many cases, the Ln transformation "over-corrected" the data, introducing severe negative skew. This is particularly dangerous because inappropriate transformations alter the data structure, fundamentally distorting the relative distances and variances between data points. This distortion is undesirable because it can artificially manufacture correlations that do not exist or obscure biological relationships that do, leading to flawed statistical inferences. Consequently, we recommend that future researchers avoid defaulting to Ln transformations and instead employ variable-specific Box-Cox or Yeo-Johnson optimizations to ensure statistical validity without misrepresenting the underlying biological reality.

Target Audience: Applied psychophysiology researchers

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp)

Track: Basic Science

Level: Introductory

Focus: 0% Clinical/100% Research

Learning Objectives:

Explain why parametric statistical tests require data to meet assumptions of normality and symmetry when analyzing HRV and other physiological variables

Identify the limitations of applying a default natural log transformation to biological data, including the risk of over-correction and introduction of negative skew.

Compare the Box-Cox and Yeo-Johnson algorithms, specifying when each is appropriate based on whether the dataset contains zero or negative values.

Describe how inappropriate data transformations distort relative distances and variances between data points, potentially manufacturing spurious correlations or obscuring genuine biological relationships.

Select variable-specific normalization strategies using Box-Cox or Yeo-Johnson optimizations rather than defaulting to a one-size-fits-all logarithmic approach.

References:

Laborde, S., Mosley, E., & Thayer, J. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research: Recommendations for experiment planning, data analysis, and data reporting. Frontiers in Psychology, 8, Article 213. https://doi.org/10.3389/fpsyg.2017.00213

Peterson, R. A. (2021). Finding optimal normalizing transformations via bestNormalize. The R Journal, 13(1), 310–329. https://doi.org/10.32614/RJ-2021-041

Pham, T., Lau, Z. J., Chen, S. H. A., & Makowski, D. (2021). Heart rate variability in psychology: A review of HRV indices and an analysis tutorial. Sensors, 21(12), Article 3998. https://doi.org/10.3390/s21123998

Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5, Article 258. https://doi.org/10.3389/fpubh.2017.00258

West, R. M. (2022). Best practice in statistics: The use of log transformation. Annals of Clinical Biochemistry, 59(3), 162–165. https://doi.org/10.1177/00045632211050531

Limitations/Severe Risks: The findings are limited to the 32 variables contained in the data set.

Diversity Considerations: This statistical methods presentation addresses individual differences in applied psychophysiology.

GAP: Professionalism

GAP Correction: This presentation will explain why researchers researchers should avoid defaulting to Ln transformations and instead employ variable-specific Box-Cox or Yeo-Johnson optimizations to ensure statistical validity without misrepresenting the underlying biological reality.

ORAL02f: STRESS LESS: An Integrated and Interpersonal Digital Framework for Work-Related Stress

Presented By: Alice Fiduccia, Clinical Psychologist, PhD Candidate

Session Type: 15-minute Abstract Presentation

Work-related stress (WRS) is a complex phenomenon shaped by psychological, psychophysiological, and interpersonal dynamics. Despite its major clinical, organizational, and legal impact, WRS is still approached through fragmented and reductionist models. STRESS LESS is a European Union–funded, multidisciplinary project that aims to bridge this gap by advancing an integrated, sustainable, and relational framework for WRS in real-world occupational contexts. The project involves 60 employees from a metalworking company (Trancerie Emiliane). The assessment protocol includes validated self-report instruments targeting core domains of WRS: psychological symptoms (SCL-90-R), personality traits (16PF), burnout (MBI), Type A behavior (PSQ), work-related stress indicators, coworker relationships, and life events (CBA – Sheet 4). Psychophysiological assessment is conducted through the Psychophysiological Stress Profile, including heart rate variability (HRV), electrodermal activity (EDA), and peripheral temperature, measured during resting conditions and relational stress tasks. Participants are allocated to two groups: a control group receiving an individual biofeedback intervention, and an experimental group undergoing an interpersonal biofeedback protocol based on synchronized psychophysiological monitoring between coworkers, designed to foster emotional co-regulation, relational awareness, and adaptive team dynamics. Expected results include a reduction in psychological symptoms, emotional regulation, and perceived WRS, including relational dynamics. Personality traits are expected to play a key role in modulating individual responsiveness to the intervention, with greater benefits anticipated in the experimental group due to interpersonal co-regulation processes. A central output of STRESS LESS is the development of a dedicated web app, co-designed by clinical psychologists, psychophysiologists, engineers, and the company’s Health, Safety, and Environment (HSE) management. The app integrates assessment, monitoring, and intervention into a single digital, inclusive, and low-environmental-impact tool. Ultimately, STRESS LESS reframes WRS as a relational phenomenon, shifting the focus from individual stress control to shared physiological and emotional regulation at work. As Daniel Siegel states, “Integration is health. And integration happens in relationships.”

Target Audience: This session is intended for professionals and researchers working in applied psychophysiology, biofeedback, occupational health, and workplace well-being. The target audience includes clinical psychologists, psychophysiologists, biofeedback practitioners, occupational physicians, HSE managers, organizational consultants, and researchers interested in work-related stress (WRS). The session is particularly relevant for those interested in multidimensional assessment models, the role of personality and interpersonal dynamics in stress regulation, and the application of individual and interpersonal biofeedback in real-world organizational settings. Professionals involved in the design of digital health tools and preventive interventions for workplace well-being will also benefit from this presentation.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Optimal Performance, Heart Rate Variability (EKG, RESP), Stress Management, Technology and Innovations, High-level science from aligned disciplines, Evidence-based, Work-related Stress

Track: Hot Topics

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Describe a multidimensional and relational framework for work-related stress (WRS) that integrates psychological, psychophysiological, and interpersonal components within real-world occupational settings.

Identify key psychophysiological markers of WRS, including heart rate variability (HRV), electrodermal activity (EDA), and peripheral temperature, and explain their role during resting and relational stress conditions.

Analyze how personality traits and psychosocial factors influence individual responsiveness to stress and biofeedback-based interventions in the workplace.

Explain how interpersonal biofeedback processes enhance emotional co-regulation, relational awareness, and adaptive team dynamics, generating benefits that extend to individual functioning.

pply principles of multidimensional assessment and psychophysiological monitoring to the design of preventive, digital, and sustainable interventions for WRS in real-world organizational contexts.

References:

Lehrer, P. M. (2022). My life in HRV biofeedback research. Applied Psychophysiology and Biofeedback, 47(4), 289–298. https://doi.org/10.1007/s10484-022-09535-5

Pruneti, C., Fiduccia, A., & Guidotti, S. (2024). Top-level managers’ psychophysical recovery investigated through different psychophysiological parameters: Benefits from training based on muscle relaxation and self-monitoring of HRV-biofeedback. NeuroRegulation, 11(1), 43–52. https://doi.org/10.15540/nr.11.1.43

Vagedes, J., Szőke, H., Islam, M. O. A., Sobh, M., Kuderer, S., Khazan, I., & Vagedes, K. (2025). Mobile Heart Rate Variability Biofeedback for Work-Related Stress in Employees and the Influence of Instruction Format (Digital or Live) on Training Outcome: A Non-Randomized Controlled Trial. Applied psychophysiology and biofeedback, 50(1), 79–93. https://doi.org/10.1007/s10484-024-09671-0

Abdin, E., Subramaniam, M., Chan, A., Chen, J. A., Chong, C. L., Wang, C., Lee, M., & Gan, S. L. (2019). iWorkHealth: An instrument to identify workplace psychosocial risk factors for a multi-ethnic Asian working population. PloS one, 14(8), e0220566. https://doi.org/10.1371/journal.pone.0220566

Kassel, S. C., & LeMay, J. (2015). Interpersonal biofeedback: Biofeedback in a relationship context. Biofeedback, 43(4), 153–157. https://doi.org/10.5298/1081-5937-43.4.07

Limitations/Severe Risks: The content of this presentation is based on applied psychophysiological assessment and biofeedback approaches used in occupational and preventive contexts. The proposed model relies on non-invasive measures and low-risk interventions. Potential limitations include the preliminary nature of some findings, the context-specific characteristics of organizational settings, and individual variability in psychophysiological responses to stress and biofeedback-based interventions. No severe risks are associated with the assessment or intervention procedures described. Evidence is drawn from validated psychometric instruments, established psychophysiological methodologies, and current literature in applied psychophysiology and occupational health.

Diversity Considerations: STRESS LESS explicitly addresses cultural diversity and multicultural issues by adopting an inclusive, relational, and context-sensitive approach to work-related stress. The project is grounded in the recognition that stress experiences, coping strategies, and relational dynamics are shaped by individual differences, organizational cultures, and broader socio-cultural contexts. The multidisciplinary collaboration among health professionals, engineers, computer scientists, and Health, Safety, and Environment (HSE) managers supports the development of a digital tool designed to be adaptable, inclusive, and sensitive to diverse worker needs and organizational settings. The web app is conceived as a sustainable, low–environmental-impact solution aligned with European Union priorities on industrial innovation, inclusion, and environmental responsibility. The project also contributes to compliance with international occupational health standards and ethical frameworks. In particular, STRESS LESS supports the implementation of principles outlined in European workplace health and safety regulations and has contributed to the attainment of the SA8000 Social Accountability certification by the partner metalworking company (Trancerie Emiliane), reinforcing ethical, inclusive, and culturally respectful workplace practices. By integrating psychophysiological, psychological, and interpersonal perspectives, STRESS LESS promotes a view of well-being as a shared and relational process, fostering cultural competence, equity, and respect for diversity within organizational systems.

GAP: Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Systems-based Practice

GAP Correction: This session will provide participants with conceptual and applied tools to bridge the gap between psychophysiological research on stress and its real-world implementation in organizational settings, where scientific evidence is often not translated into structured, multidisciplinary, sustainable, and relationally oriented models of assessment and intervention. In particular, the session addresses a persistent methodological shortcoming that limits the ability of traditional approaches to capture the psychobiological complexity of stress responses in the workplace. Specifically, the session will enable participants to: Integrate a multidimensional assessment of work-related stress that includes psychological, psychophysiological, and interpersonal variables relevant to organizational functioning and work systems. Understand how relational and team processes influence stress regulation and work performance, moving beyond an exclusively individual-focused view of work-related distress. Apply principles of individual and interpersonal biofeedback as tools for primary and secondary prevention within organizational contexts, with particular attention to co-regulation processes. Translate psychophysiological and relational data into actionable strategies for HSE managers, health professionals, and organizations, supporting evidence-based decision-making. Use digital and web-based tools to integrate assessment, monitoring, and intervention within a single sustainable, inclusive, and transferable ecosystem for real-world organizational settings. Overall, the session promotes a view of work-related stress as a systemic and relational phenomenon with direct psychophysiological implications, offering a concrete and applicable model for improving organizational well-being through shared regulatory processes and multidisciplinary collaboration across professional domains.

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Saturday, May 16

11 am - 12:30 pm

BOS15: Seeing Emotional Suppression: Biofeedback for Cognitive and Emotional Processes

Presented By: Nate Ewigman, PhD BCB; Inna Khazan, PhD, BCB

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Emotional suppression is widely recognized as a transdiagnostic process implicated in heightened stress responses as well as the development and maintenance of psychopathology. Yet the empirical literature reveals a nuanced impact on stress physiology: suppression exacerbates certain aspects of autonomic physiology while leaving others unaffected or even improved, and its impact varies by individual factors as well as whether the process reflects expressive suppression (inhibiting outward display) or emotion suppression/avoidance (inhibiting internal experience). Traditional interventional models have emphasized top-down cognitive–behavioral mechanisms without the benefit of utilizing autonomic patterns to identify and offer live biofeedback for non-suppressive approaches to emotion regulation. This presentation is a continuation of a series illustrating the role of biofeedback in top-down, traditionally psychotherapy-only transdiagnostic mechanisms behind psychopathology.

Target Audience: Biofeedback clinicians interested in applying psychophysiology to styles of emotional responding.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Heart Rate Variability (EKG, RESP), Stress Management, Mindfulness, High-level science from aligned disciplines

Track: Hot Topics

Level: Intermediate

Focus: 80% Clinical/20% Research

Learning Objectives:

Differentiate expressive suppression from experiential emotion suppression/avoidance as distinct emotion regulation processes.

Describe the differential effects of expressive and experiential suppression on autonomic stress physiology, including sympathetic activation and recovery dynamics.

Identify individual difference factors that moderate the physiological impact of emotional suppression.

Conceptualize emotional suppression alongside other traditionally top-down mechanisms as appropriate targets for biofeedback.

Describe how biofeedback can be integrated into psychotherapeutic interventions to detect suppression in real time and support non-suppressive emotion regulation strategies

References:

Lincoln, T. M., Schulze, L., & Renneberg, B. (2022). The role of emotion regulation in the characterization, development and treatment of psychopathology. Nature Reviews Psychology, 1, 272–286.

Zaehringer, J., et al. (2020). Psychophysiological effects of downregulating negative emotions: Insights from a meta-analysis of healthy adults. Frontiers in Psychology, 11, Article 470.

Tyra, A. T., Fergus, T. A., & Ginty, A. T. (2023). Emotion suppression and acute physiological responses to stress in healthy populations: A quantitative review of experimental and correlational investigations. Health Psychology Review.

Monachesi, B., Grecucci, A., & Ghomroudi, P. A. (2023). Understanding the neural architecture of emotion regulation by comparing two different strategies: A meta-analytic approach (Preprint). arXiv.

Limitations/Severe Risks: Clinicians using biofeedback to improve emotional responding styles should have adequate training within a licensed mental health field.

Diversity Considerations: HRV literature describes paradoxical physiological impacts of being in racial minority groups; advancing understanding of emotional responding styles within biofeedback and applied physiology may contribute clinical conceptualizations of the processes behind this phenomenon.

GAP: Patient Care

GAP Correction: Traditionally, top-down mechanisms of human suffering such as emotional suppression have solely been within the purview of psychotherapy; however, biofeedback offers critical interventional pathways towards the identification of and live feedback to shape healthy emotional responding styles.

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Saturday, May 16

11 am - 12:30 pm

BOS16: One With Breathing: Personal Empowerment from Within

Presented By: Harry van der Lei, PhD, BCB

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Breathing applications for optimal performance in sport and daily life: Harry van der Lei, PhD, BCB This presenter will deliver applied-research based models and methodologies associated with different breathing techniques for the enhancement of performance, health, and well-being in athletes and general population. Different breathing assessment and training protocols will be presented based on past and current mental performance services with a wide variety of clients, from Olympic gold-winning athletes to home health patients. The presented applied-research based models and methodologies are utilized to optimize stress management and stress resilience principles. Practical examples of different breathing techniques will be shown to the audience based on past research and personal consulting services with clients.

Target Audience: Any professional that is interested in applied research models to explain the power of breathing on enhancing performance, health, and well-being in life

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Diversity in Psychophysiology, Optimal Performance, Heart Rate Variability (EKG, RESP), Stress Management, Mindfulness, Technology and Innovations, Evidence-based, Case Studies, Deb

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Describe how stress can be explained in terms of action and recovery principles in life

Explain how breathing techniques can be implemented associated with the principles of the Hourglass Performance Model

Describe how stress impacts our lives and how breathing is connected with the different stress factors in life

Demonstrate how the presented models and methodologies are used in practice for the purpose of stress management/resilience assessment and training

References:

van der Lei, H., Tenenbaum, G., Land, W. (2016). Individual arousal-related performance zones: effect on temporal and behavioral patterns in golf routines. Psychology of Sport and Exercise

Volume 26, Pages 52-60

H.C. Lu, R. Gevirtz, C. C. Yang, A. O. Hauson (2023). Heart Rate Variability Biofeedback for Mild Traumatic Brain Injury: A Randomized-Controlled Study. Appl Psychophysiol Biofeedback. 2023 Jun 19;48(4):405–421

Gevirtz, R.N., Lehrer, P., and Schwartz, M.S (2026) “Cardio/Respiratory Measurement and Assessment in Applied Psychophysiology, Chapt. 5” in Biofeedback: A Practitioners Guide (Eds Schwartz and Andrasik), Guilford Press, 4th edition, NY

Gevirtz, R.N., Lehrer, P., and Schwartz, M.S (2026) “Cardio-Respiratory biofeedback”, Chapt. 13, in Biofeedback: A Practitioners Guide (Eds Schwartz and Andrasik), Guilford Press, 4th edition, NY

Land, W. M., Edmonds, W. A., & Pope, J. (2023). Optimal psychophysiological states during police tactical driving: A multiple case study analysis. Journal of Police and Criminal Psychology.

Limitations/Severe Risks: There a no risks. The models and methodologies in this presentation are applied-research validated and empirically based

Diversity Considerations: The use of breathing is helpful to manage stress in all different layers of society, from elite athletes to sick patients. The models and methodologies provided in this presentation has been applicable to any type of person, regardless his/her cultural origin.

GAP: Systems-based Practice

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Saturday, May 16

11 am - 12 pm

BOS17: The Circular Firing Squad: Neurofeedback’s History of Rivalry and Infighting

Presented By: Tiff Thompson, PhD, R.EEG.T, BCN, QEEG-D, LMFT

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1

The Circular Firing Squad is a historical and clinical reflection on how the neurofeedback field has repeatedly been shaped—not only by scientific progress, but by rivalry, fragmentation, and internal conflict. Drawing on interviews conducted between 2017 and 2025 with key figures including Barry Sterman, Siegfried Othmer, Jay Gunkelman, Robert Thatcher, and others. The presentation traces the interpersonal, organizational, and ideological tensions that have influenced the trajectory of neurofeedback. Beginning with early examples of division and credibility struggles in neuroscience, the talk highlights how neurofeedback’s origins were met with both curiosity and derision. It explores the long-standing tension between clinical innovation and academic legitimacy—particularly during the 1970s and 1980s, when methodological critiques, extravagant claims, and lack of replication damaged the field’s reputation and reduced research funding. The presentation then follows major “wars” inside the field: disputes between pioneers, patent conflicts, licensure battles, and the rise of competing certification bodies and training factions. It examines how rebranding, commercial competition, and loyalty to particular protocols (SMR, QEEG-guided, ILF, Z-score, and LORETA) contributed to “tribalism” and sometimes cult-like followings. Later sections address modern controversies around evidence standards, placebo critiques, conflicts of interest, and ongoing fractures between academic skepticism and clinical practice. Throughout, the talk argues that the greatest threats to the field are not technological limitations, but the social and professional dynamics that undermine cohesion, credibility, and scientific rigor. The presentation closes by shifting from critique to reflection, exploring the psychological roots of infighting—envy, shame, resentment, and schadenfreude—while offering an alternative model grounded in curiosity, professional respect, and “freudenfreude”: deriving joy from one another’s success. In doing so, it challenges the neurotherapy community to move toward higher standards, healthier collaboration, and a more unified future.

Target Audience: All

Subject Matter Classification: Historical Foundations, Debates

Track: Hot topics

Level: Introductory

Focus: 50% Clinical/50% Research

Learning Objectives:

Describe at least 3 major historical divisions in the neurofeedback field

Name 3 ways professional fragmentation has affected neurofeedback’s scientific credibility, public reputation, or research progress.

Compare at least 2 recurring tensions between academic standards (e.g., methodology/replication) and clinical practice realities

Identify 3 psychological dynamics (e.g., envy, shame, resentment, schadenfreude) that contribute to field-wide conflict and describe one strategy to shift toward healthier professional culture.

References:

Thibault, R. T., & Raz, A. (2017). The psychology of neurofeedback: Clinical intervention even if applied placebo. American Psychologist, 72(7), 679–688.

Coben, R., Hammond, D. C., & Arns, M. (2019). 19-Channel z-score and LORETA neurofeedback: Does the evidence support the hype? Applied Psychophysiology and Biofeedback.

Swingle, M. (Year varies by issue). Neurofeedback: Where are we and where are we going? Three critical issues for consideration: Perspective from 25 years of practice. Biofeedback Magazine.

Hammond, D. C. (2005). Neurofeedback treatment of depression and anxiety. Journal of Adult Development, 12(2–3), 131–137.

Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical EEG and Neuroscience.

Limitations/Severe Risks: None. This is about historical content of the evolution of Neurofeedback and emerging science.

GAP: Interpersonal and Communication Skills, Professionalism

GAP Correction: Understanding how the science, professionalism and collaboration in scientific research/applied clinical practice and the evolution of an intervention, key players and lessons learned.

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Saturday, May 16

11 am - 12 pm

BOS18: When Psychophysiology Meets Psychotherapy: Applications and Technical Fine Points

Presented By: Paul Lehrer, PhD

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

This presentation will review evidence for effectiveness of biofeedback-based and related psychophysiological approaches, when combined with psychotherapy, and will review fine points for use of these therapies. These will include hypnotic approaches to maximizing effectiveness of autogenic training, methods for achieving close to zero residual tension in progressive muscle relaxation, and ways of using HRV biofeedback for maximum effectiveness. It will review instructions given to patients for rationale and use of these methods, the need for regular practice and strategic use, and for collateral use of cognitive and technical behavioral interventions. This session will begin with a review of literature on comparative and collateral use of psychophysiological methods as components in psychotherapy. Rationale and evidence will be given for partial independence of cognitive, behavioral and psychophysiological components of mental illness, as well as rationale for including a psychophysiological component, with evidence for empirical justification. Fine points for use of three psychophysiological methods will be presented: autogenic training, progressive muscle relaxation, and heart rate variability biofeedback. For autogenic training, we will cover presenting instructions without telling people to experience things they cannot experience, and working with autogenic discharges, including heightened anxiety and tearfulness. For progressive muscle relaxation, we will demonstrate how to recognize and eliminate the lowest possible levels of muscle tension. For HRV biofeedback we will explain the rationale for the method while being accurate, but not overwhelming with technical details, and discuss some elements of training that often are overlooked. Some clinical examples of combined use of these techniques in the context of broad spectrum psychotherapy will be given.

Target Audience: Psychotherapists interested in improving their effectiveness by including these methods and psychophysiological therapists interested in improving their technique

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Heart Rate Variability (EKG, RESP), Stress Management, Evidence-based, Case Studies

Track: Clinical Interventions and Optimal Performance

Level: Intermediate

Focus: 80% Clinical/20% Research

Learning Objectives:

Describe where/when biofeedback-based and related psychophysiological approaches in psychotherapy may be useful, based on research evidence

Describe the rationale for progressive muscle relaxation, autogenic training, and HRV biofeedback in ways that are understandable and convincing

Apply these methods described for maximal effectiveness

Allocate time and emphasis for these methods when combined with more broad-spectrum psychotherapy

References:

Lehrer, P.M. Biofeedback: an important but often-ignored ingredient in psychotherapy Policy Insights from the Behavioral and Brain Sciences., 457-63: 2016. DOI: 10.1177/23727322 16683709

Lehrer, P.M. (2018) Heart rate variability biofeedback and other psychophysiological procedures as important elements in psychotherapy. International Journal of Psychophysiology. 131, 89-95

Lehrer, P. (2025) Importance of including psychophysiological methods in psychotherapy. Applied Psychophysiology and Biofeedback, 50,169-188,10.10007/s10484-024-09667-w

Lehrer, P.M. (2024).Why a psychophysiological component in psychotherapy is important. In Steffen, P. & Moss, D. (eds.) Integrating Psychotherapy and Psychophysiology. New York, NY, US: Oxford University Press, US; pp. 221- 242. pp. xiv 430. https://doi.org/ 10.1093/0s0/9780198888727.003.0010

Jacobson, E. (1938) Progressive relaxation., University of Chicago Press

Schultz, J, & Luthe, W. (1964) Autogenic therapy vol 1-6. New York: Grune and Stratton

Limitations/Severe Risks: None. Some people may experience transitory discomfort in using any psychophysiological methods, including transitory hyperventilation symptoms, or disinhibition of emotional experience or pain.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Systems-based Practice

GAP Correction: Methods for determining where psychophysiological methods may or may not be useful, communicating rationale, managing occasional unpleasant side effects, optimization of psychological methods.

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Saturday, May 16

2:30 pm - 4 pm

BOS19: Ethics II: Professional Ethics and Practice Standards in Neurofeedback and Telehealth

Presented By: Donald Moss, PhD

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

This session will review legal and ethical responsibilities of neurofeedback practitioners. Neurofeedback professionals are governed in clinical practice by state regulations under the relevant licensing act, professional codes of ethics for his or her home profession, and the Professional Standards and Ethical Principles of Biofeedback (9th rev., May 2016) of the Biofeedback Certification International Alliance (BCIA) and the Professional Standards and Ethical Principles of the International Society for Neuroregulation and Biofeedback (ISNR, 2020). The workshop will provide current definitions of neurofeedback, neuromodulation, and neurotherapy. Many treatments and devices currently advertised as neurofeedback lack the crucial element of feedback learning, and do not qualify as neurofeedback. Audio-visual entrainment, electrical stimulation, and photobiomodulation are compatible adjunct therapies that may augment and enable more effective neurofeedback but are not feedback learning modalities. Violation of legal and professional guidelines, even when unintended, invites the risk of lawsuit, criminal prosecution, financial penalties, loss of licensure, and expensive and stressful legal and administrative reviews. The presenter will discuss relevant guidelines, as they apply to neurofeedback: entry level competence; scope of practice; the delivery of experimental or non-documented therapies; the informed consent process; principles of privacy, confidentiality, and privileged communication. The presenter will place emphasis on the imperative to maintain a positive treatment relationship, eliciting rapport and trust, as applicable to neurofeedback. Finally, the session will review current standards for telehealth and infection risk mitigation, including guidelines for telehealth delivery of neurofeedback.

Target Audience: Health professionals and behavioral health professionals engaged in the practice of biofeedback, neurofeedback, and self-regulation-oriented therapies.

Subject Matter Classification: Practice Management, Ethic Standards

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 75% Clinical/25% Research

Learning Objectives:

Describe the Professional Standards and Ethical Principles documents published by ISNR (2020), and their interpretation for decisions in biofeedback and neurofeedback practice.

Describe how to navigate the conflicting jurisdictions of state laws and regulations, professional codes of conduct, ISNR guidelines, BCIA guidelines, and federal regulations

Review and discuss neurofeedback practice standards governing entry level competence, continuing education requirements, and scope of practice.

Review and discuss evolving guidelines on telehealth and infection risk mitigation.

Review and discuss the diversity/multicultural requirements in AAPB’s and BCIA’s Professional Standards and Ethical Principles.

References:

The International Society for Neurofeedback and Research (2020). Professional standards and ethical principles. https://isnr.org/wp-content/uploads/2020/09/ISNR-Professional-Standards-Code_of_Ethics_8-9-2020.pdf

Moss, D. (2022). Ethical principles, professional conduct, and practice standards. In D. Moss & F. Shaffer, A primer of biofeedback (pp. 98-109). AAPB.

Moss, D., Hagedorn, D., Combatalade, D., & Neblett, R. (2019). Care for biofeedback and neurofeedback instrumentation. Biofeedback, 47(1), 12-21. doi.10.5298/1081-5937-47.1.04

Khazan, I., Shaffer, F., Moss, D., Lyle, R., & Rosenthal, S. (Eds). (2023). Evidence-based practice in biofeedback and neurofeedback. Association for Applied Psychophysiology and Biofeedback

Limitations/Severe Risks: This seminar covers the basic ethical principles, professional standards, and best practices needed for practicing with integrity in the neurofeedback field. This seminar also prepares attendees for recertification by BCIA in neurofeedback. The acquisition of knowledge about professional standards and ethical behavior does not guarantee ethical practice by the attendee.

Diversity Considerations: Attendees will review and discuss the diversity/multicultural requirements in AAPB’s and BCIA’s Professional Standards and Ethical Principles.

GAP: Interpersonal and Communication Skills, Professionalism

GAP Correction: Identification of the impact of language in the healing process, identification of implicit messages that communicate both expectations and hope. Application of these principles to work with diverse patient groups.

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Saturday, May 16

2:30 pm - 4 pm

BOS20: From Athlete to Performing Artist or Executive: Psychophysiological Self-Regulation as a Transferable Foundation for Performance

Presented By: Tim Herzog, EdD, LCP, CMPC, BCB; Tracy Heller, PhD, CMPC, BCB, CBBA; Christine Sanchez, PhD, CMPC, BCB, CBBA

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Athletes are often assumed to “carry over” mental toughness into other high-pressure roles, yet the mechanisms by which this occurs are rarely articulated. This presentation examines cross-over performers—individuals who were once competitive athletes and who have transferred skills to other performance domains, such as music or business. Given the limited pre-existing literature on cross-over performance, we extrapolate from research in sport psychology, performance science, and psychophysiology/biofeedback, examining relevant case examples. We argue that what transfers most reliably is not competitive mindset or discipline per se, but rather learned regulation of internal states under pressure. Former athletes frequently demonstrate an advanced capacity to recognize stress signatures, modulate autonomic arousal, sustain attentional control, and recover efficiently following high-stakes performance. These capacities are directly relevant to performance anxiety, fine motor control, decision-making under uncertainty, communication effectiveness, and steady leadership presence—contexts in which the task differs from sport, but where stressors such as evaluation, time pressure, and career-impacting consequences remain central (Lehrer et al., 2020; Gross, 2015). Using illustrative case studies, this presentation demonstrates how musicians and business executives with athletic backgrounds apply similar behavioral, breathing, and attentional routines to manage performance anxiety, maintain cognitive flexibility, and regulate emotion during critical moments. These cases are organized within a unified self-regulation framework: (1) perception of internal state, (2) selection of regulatory strategy, (3) execution under pressure, and (4) evaluation and recalibration (Litchfield, 2017; Toering et al., 2012; Zahn et al., 2016). We also address the limits of transfer, the need for contextual recalibration, and identity transitions that influence resilience during career shifts (Stambulova et al., 2021; Zvosec et al., 2023). By reframing resilience as portable psychophysiological competence, this presentation bridges sport, music, and organizational performance, offering practical implications for training design, transition support, and the intentional cultivation of transfer-ready performers across disciplines.

Target Audience: This presentation is intended for professionals and trainees in psychophysiology, clinical psychology, and sport psychology who work with performers under pressure and are interested in resilience, self-regulation, and stress adaptation. It will be especially relevant for practitioners and applied researchers seeking evidence-based models for understanding how psychophysiological regulation skills transfer across performance domains.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Optimal Performance, Heart Rate Variability (EKG, RESP), Stress Management, Mindfulness, Case Studies

Track: Clinical Interventions and Optimal Performance

Level: Internediate

Focus: 95% Clinical/5% Research

Learning Objectives:

Describe core psychophysiological mechanisms of self-regulation (e.g., autonomic arousal, attentional control, recovery) that support resilience across performance domains.

Differentiate transferable self-regulation skills from domain-specific performance demands when athletes transition to roles such as musicians or business executives.

Apply a unified self-regulation framework to analyze case examples of cross-over performers and identify intervention targets under pressure.

Evaluate the limits of skill transfer, including contextual recalibration and identity transitions, that influence resilience during career shifts.

Integrate culturally responsive and ethically informed psychophysiological strategies into applied practice with diverse performers across sport and non-sport settings.

References:

Lehrer, P. M., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., Sgobba, P., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129.

Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26.

Litchfield, Peter M. Breathing: Alignment of Mechanics with Chemistry (IBF Newsletter - June 2017)

Toering, T., Elferink-Gemser, M. T., Jordet, G., Pepping, G.-J., & Visscher, C. (2012). Self-regulation of learning and performance level of elite youth soccer players. International Journal of Sport Psychology, 43(4), 312–325.

Zahn, D., Adams, J., Krohn, J., Wenzel, M., Mann, C. G., Gomille, L. K., & Kubiak, T. (2016). Heart rate variability and self-control — A meta-analysis. Biological Psychology, 115, 9–26.

Limitations/Severe Risks: Limitations are the lack of existing literature. No known risks.

Diversity Considerations: This proposal addresses cultural diversity and multicultural competence by examining resilience and self-regulation as psychophysiological processes that are universally available yet culturally expressed, shaped, and interpreted, particularly among athletes who often come from diverse cultural, racial, and socioeconomic backgrounds. By focusing on transferable self-regulation mechanisms (e.g., arousal awareness, attentional control, recovery), the presentation avoids culture-bound definitions of “mental toughness” and instead emphasizes culturally responsive pathways to performance and resilience that can be adapted across performance domains and cultural contexts.

GAP: Patient Care, Practice-based Learning and Improvement

GAP Correction: Despite growing interest in resilience and self-regulation, applied practice often remains domain-siloed, relying on broad constructs like “mental toughness” without clearly identifying which psychophysiological regulation mechanisms transfer across performance contexts. This session reframes resilience as a portable psychophysiological competence, teaching participants to identify core self-regulation mechanisms—such as autonomic arousal awareness, attentional control, and recovery capacity—that support performance across domains. Using case examples of athletes transitioning to music and business, the session demonstrates how these mechanisms can be assessed and recalibrated as performance demands change.

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Saturday, May 16

2:30 pm - 4 pm

BOS21: Emotional Expectations as Medicine: How Beliefs About Pain Change the Brain

Presented By: Thomas F. Collura, Ph.D., MSMHC, QEEG-D, BCN, NCC, LPCC; Harry Brubaker, MS Psy, M.Ed, BCN, QEEGD; Erik Peper, Ph.D., BCB; Richard J McALister, DC, DAAPM, BCN, QEEG-DL

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

Pain intensity—whether from a broken bone or a broken heart—is not fixed by the injury itself, but by what the brain expects will happen next (Peper et al., 2025). This panel will illustrate how rapidly changing emotional expectations about pain produces large, measurable reductions in both physical and emotional suffering. Clinical examples will be compared: 1. Patients with chronic physical pain who shift from “this will never get better” to “pain is a sensation I can allow and release” using Peper’s effortless breathing can significantly reduce pain. By feeling totally safe and exhaling during the onset of expected pain provides sustained gains when combined with biofeedback as illustrated with case reports transforming backpain, sufi piercing, and eye discomfort. 2. The case of performing artist “Desa,” whose acute heartbreak (emotional pain 9.5/10, chest pressure, insomnia) resolved completely after six sessions once the expectation changed from “I will never get over this person” to “these feelings can pass.” Pre- and post-treatment EEG showed normalization of pain-related biomarkers. Recent evidence links the mu rhythm (8–13 Hz sensorimotor oscillation) to pain modulation: mu enhancement predicts hypoalgesia and reduced pain empathy, whereas selective attention and pain catastrophizing moderate cognitive distraction analgesia (Rischer et al., 2020). The panel will also explore ways to measure pain reliably using brain imaging techniques Panelists will discuss how these expectation shifts are visible in real-time EEG and autonomic measures, and how combining Peper’s breathing practices with neurofeedback can reliably produce them. Attendees will leave with simple, evidence-based techniques to teach clients to use expectation, slow breathing and neurofeedback—rather than medication or rumination—as their primary pain-management tools.

Target Audience: Neurofeedback/Biofeedback practitioners, Medical professionals, Psychologists

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Neurofeedback (EEG), Heart Rate Variability (EKG, RESP)

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 75% Clinical/25% Research

Learning Objectives:

Describe how emotional expectations modulate both physical and emotional pain perception.

Compare EEG and HRV changes in chronic physical pain versus acute heartbreak.

Describe the shared EEG/HRV biomarker changes (anterior cingulate beta, mu rhythm, theta/alpha ratios, HRV) that occur when pain-related expectations shift from threat to safety.

Summarize the role of sensorimotor mu rhythm enhancement in hypoalgesia and reduced emotional pain empathy.

Describe the brain networks involved with pain.

References:

Peper, Erik & Booiman, Annette & Harvey, Richard. (2025). SPECIAL ISSUE: Pain—There Is Hope. Biofeedback. 53. 1-9. 10.5298/1081-5937-53.01.16.

Strohman, A., & Legon, W. (2025). Neuromodulation of the Cingulate Cortex for Pain. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry, 31(6), 611–629. https://doi.org/10.1177/10738584251337652

Zebhauser, P. T., Hohn, V. D., & Ploner, M. (2023). Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain, 164(6), 1200–1221. https://doi.org/10.1097/j.pain.0000000000002825

Rischer, K. M., González-Roldán, A. M., Montoya, P., Gigl, S., Anton, F., & van der Meulen, M. (2020). Distraction from pain: The role of selective attention and pain catastrophizing. European journal of pain (London, England), 24(10), 1880–1891. https://doi.org/10.1002/ejp.1634

Peper, E., Chen, S., Heinz, H., & Harvey, R. (2023). Hope for menstrual cramps (dysmenorrhea) with breathing. Biofeedback, 51(2), 44–51. https://doi.org/10.5298/1081-5937-51.2.04

Limitations/Severe Risks: The presentation focuses on noninvasive, self-regulation interventions: neurofeedback/biofeedback-assisted diaphragmatic and resonant breathing techniques, based on Dr. Erik Peper's evidence-informed protocols for chronic pain and stress-related disorders. These techniques are noninvasive and carry minimal to no risks. Multiple sources, including Cleveland Clinic reviews and systematic studies of HRV biofeedback, report no serious side effects, adverse events, or absolute contraindications. Rare transient effects (e.g., mild dizziness or lightheadedness from initial over-breathing) may occur but resolve quickly with proper guidance. Techniques require active patient participation and may be less suitable for individuals with severe cognitive impairment or inability to follow instructions. No severe risks (e.g., injury, dependency) are associated, unlike pharmacological options. Diaphragmatic/resonant breathing and neurofeedback/biofeedback show evidence for reducing chronic pain intensity, improving function, and lowering stress/anxiety.

Diversity Considerations: Our discussion includes examples of how differing cultures deal with pain management.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: This presentation addresses practice gaps in integrating biofeedback-assisted diaphragmatic breathing and neurofeedback for chronic pain management. Identified Gaps: 1. Patient Care: Over 50 million U.S. adults experience chronic pain, but non-pharmacological options like breathing retraining and/or neurofeedback are underutilized, leading to persistent dysfunctional breathing that amplifies pain via muscle tension and sympathetic arousal, poorer function, and higher opioid risks. 2. Medical Knowledge: Providers often lack familiarity with psychophysiological links between breathing patterns and pain, plus practical neurofeedback/biofeedback protocols, limiting evidence-based application despite moderate supporting evidence. 3. Practice-based Learning and Improvement: Barriers to teaching, monitoring, and evaluating self-regulation techniques hinder personalized care improvements and The session will demonstrate how simple diaphragmatic/resonant breathing—enhanced with neurofeedback/biofeedback (e.g., HRV apps, abdominal monitoring)—restores parasympathetic balance, can reduce pain intensity, and interrupts pain-stress cycles. Recent studies and cases highlight rapid benefits for chronic pain, stress-related disorders, and functional restoration.

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Friday, May 15

2:30 pm - 3:30 pm

BOS22: The Nerve of those Disorders: Vagal Withdrawal and a Unifying Theme in Health and Illness

Presented By: Richard Gevirtz, PhD. BCB

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Beginning with Porges' 1995 paper, Vagal Withdrawal has gained scientific stature as a prominent feature in many disorders. Increasingly the vagus is being found to be involved in a wide range of physiological systems as diverse as gene expression, the biome, the gut, and central nervous systems processes. In this symposium, I describe the scientific status of Vagal Withdrawal, its role in numerous disorders, and how it can be seen as a mediator in treatments as diverse as heart rate variability biofeedback to cognitive behavioral therapy to mindfulness-based treatments.

Target Audience: Anyone interested in mechanisms of mind/body disorders and their treatments

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp)

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 70% Clinicla/30% Research

Learning Objectives:

Summarize how the autonomic nervous system evolved

Describe the concept of vagal withdrawal

Measure vagal withdrawal

Summarize how the vagus mediates many physiological sysytems

Describe how prolonged vagal withdrawal leads to symptoms

References:

Porges, Stephen W. "Cardiac vagal tone: a physiological index of stress." Neuroscience & Biobehavioral Reviews 19.2 (1995): 225-233.

Porges, S. W. (1992). Vagal tone: a physiologic marker of stress vulnerability. Pediatrics, 90(3), 498-504.

Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work?. Frontiers in psychology, 5, 756.

Gevirtz, R. (2020). Incorporating heart rate variability biofeedback into acceptance and commitment therapy. Biofeedback, 48(1), 16-19.

Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic journal of medicine, 76(Suppl 2), S86.

Limitations/Severe Risks: No risks are identified.

Diversity Considerations: The model described helps explain the health disparities we see in minority populations.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: Mechanisms that can guide treatment

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Saturday, May 16

4:15 pm -5:15 pm

BOS23: One Molecule, Many Stories: How Dopamine Became Psychiatry’s Most Successful Semantic Artifact

Presented By: Rex Cannon, PhD, BCN

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Dopamine has been widely characterized as a central psychiatric substrate underlying attention-deficit/hyperactivity disorder (ADHD), substance use disorders, mood disorders, and a broad range of behavioral phenotypes. Despite decades of investigation, however, no unified biological mechanism has emerged that coherently links these psychiatric constructs to dopamine function. In contrast, dopamine’s role in motor control and movement disorders, most notably Parkinson’s disease, has remained biologically consistent and mechanistically tractable. In the present study, we conducted a large-scale semantic and geometric audit of the dopamine genetics, parkinson’s, Ritalin and Adderall literature to examine whether psychiatric and neurological dopamine-related domains converge within a shared conceptual space. Using sentence-level embeddings derived from over 250,000 PubMed-indexed articles spanning ADHD pharmacotherapy (including methylphenidate and amphetamine formulations), dopamine genetics, and Parkinson’s disease, we applied Uniform Manifold Approximation and Projection (UMAP) for nonlinear dimensionality reduction and centroid-based geometric analyses to quantify semantic structure, separation, and drift across domains. Distinct and statistically non-random clustering was observed for ADHD-related stimulant literature, dopamine genetics, and Parkinson’s disease research, with large centroid separations and minimal overlap in semantic manifolds. Permutation testing confirmed that observed inter-domain distances significantly exceeded chance expectations (p < .001). Notably, ADHD stimulant literature demonstrated systematic semantic drift toward neurological action and performance framing, while remaining geometrically distinct from both dopamine genetics and Parkinson’s disease. These findings indicate that dopamine’s psychiatric applications do not reflect a unified biological substrate but rather represent domain-specific semantic narratives built around heterogeneous outcomes. Collectively, these results support a reframing of dopamine as a molecule primarily governing movement, action selection, and motor learning, rather than a transdiagnostic psychiatric mechanism. The persistence of dopamine-centered psychiatric models appears to reflect semantic reinforcement rather than biological convergence. This work highlights the importance of large-scale semantic geometry as a tool for evaluating mechanistic claims in neuroscience and psychiatry and calls for renewed precision in how neurochemical evidence is interpreted across clinical domains.

Target Audience: Everyone with interest in the human brain, disorders and evidence based mechanisms.

Subject Matter Classification: Neurofeedback (EEG), Technology and Innovations, Evidence-based, Debates, Successful Clinical Outcomes

Track: Hot Topics

Level: Intermediate

Focus: 30% Clinical/70% Research

Learning Objectives:

Summarize the dopamine hypothesis.

Communicate current issues with replications in genetics

Communicate semantic drift and research core components

Describe research patterns across decades

Conduct research audits and their importance

References:

Dall’Aglio, L., Roberts, C. E., & McGuire, P. (2024). Neuroimaging and genetics in psychiatry: Shared challenges in reproducibility, interpretation, and clinical translation. Asian Journal of Psychiatry, 87, 103644. https://doi.org/10.1016/j.ajp.2024.103644

Andreassen, O. A., Thompson, W. K., Schork, A. J., Ripke, S., Mattingsdal, M., Kelsoe, J. R., Kendler, K. S., & Dale, A. M. (2015). Improved detection of common variants associated with schizophrenia and bipolar disorder using pleiotropy-informed conditional false discovery rate. PLoS Genetics, 11(4), e1005544. https://doi.org/10.1371/journal.pgen.1005544

Sullivan, P. F., Agrawal, A., Bulik, C. M., et al. (2018). Psychiatric genomics: An update and an agenda. American Journal of Psychiatry, 175(1), 15–27. https://doi.org/10.1176/appi.ajp.2017.17030283

Wray, N. R., Ripke, S., Mattheisen, M., et al. (2018). Genome-wide association analyses identify 44 risk variants and refine the genetic architecture of major depression. Nature Genetics, 50(5), 668–681. https://doi.org/10.1038/s41588-018-0090-3

Kendler, K. S. (2019). From many to one to many—the search for causes of psychiatric illness. JAMA Psychiatry, 76(10), 1085–1091. https://doi.org/10.1001/jamapsychiatry.2019.1200

Limitations/Severe Risks: No risks have been identified

Diversity Considerations: Human focused - technical topics will be clear and and explained for all levels. There is no discussion of sensitive or publicly unsettling ideas or language. It will be fun for all cultures and peoples.

GAP: Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: We must evaluate our research base in order to move forward and improve evidence, outcomes and professional success.

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Saturday, May 16

4:15 pm -5:15 pm

BOS24: Adding Heart Rate Variability Biofeedback to Empirically-based Therapies for Anxiety Disorders

Presented By: Richard Gevirtz, PhD, BCB

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

While Empirically-based Therapies have been shown to be efficacious in the treatment of anxiety disorders, effect sizes remain in the low to moderate range for most disorders (especially PTSD and Panic). In this presentation I describe how adding heart rate variability biofeedback (HRVB) to established therapies can boost efficacy and reduce dropout rates. I will focus on exposure-based therapies and Acceptance and Commitment Therapy (ACT) for PTSD and Panic Disorder.

Target Audience: Clinicians who treat anxiety

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Peripheral Biofeedback (EMG/Temp/GSR), Heart Rate Variability (EKG, RESP), Mindfulness, Evidence-based

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 70% Clinical/30% Research

Learning Objectives:

Describe the current strengths and weaknesses of empirically-based therapies

Summarize the underlying physiological mechanisms in Panic Disorder

Describe the underlying physiological mechanisms in PTSD

Describe how HRVB can be combined with ACT or CBT

Summarize the scientific literature supporting this model

References:

Aschbacher, K., Mather, M., Lehrer, P., Gevirtz, R., Epel, E., & Peiper, N. C. (2024). Real‐time heart rate variability biofeedback amplitude during a large‐scale digital mental health intervention differed by age, gender, and mental and physical health. Psychophysiology, 61(6), e14533.

Gevirtz, R. (2020). Incorporating Heart Rate Variability Biofeedback into Acceptance and Commitment Therapy. Biofeedback, 48(1), 16-19.

Pyne, J. M., Constans, J. I., Wiederhold, M. D., Gibson, D. P., Kimbrell, T., Kramer, T. L., ... & Gevirtz, R. N. (2016). Heart rate variability: Pre-deployment predictor of post-deployment PTSD symptoms. Biological psychology, 121, 91-98.

Gevirtz, R.N. (2017) The central autonomic network in trauma etiology and treatment. In APA handbook of trauma psychology, Eds Gold, S., APA, Washington, D.C.213-2

Gevirtz, R.N (2017) Autonomic mediation of stress-related and anxiety disorders using heart rate variability biofeedback. Biofeedback, 45, 19-20

Limitations/Severe Risks: No risks have been identified

Diversity Considerations: The model explains how minority status exacerbates the physiological contributions to anxiety

GAP: Patient Care, Medical Knowledge

GAP Correction: Improve treatment protocols

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Friday, May 15

4:15 PM - 5:15 PM

BOS25: Training Autonomic Resilience in Athletes Using HRV Biofeedback

Presented By: Jay Wiles, BCB, BCB-HRV

Session Type: 60-minute Symposium/Break Out Session

CE Credits: 1

Elite athletic performance is constrained not only by physical capacity and skill, but by the adaptability of the autonomic nervous system (ANS) under stress. Heart rate variability (HRV) reflects the dynamic balance between sympathetic and parasympathetic influences and serves as a practical marker of physiological resilience, recovery, and stress tolerance. This presentation examines the application of heart rate variability biofeedback (HRV-B) as a nervous system training intervention to enhance performance, recovery, and sleep in athletic populations. HRV biofeedback involves paced breathing at an individual’s resonance frequency to maximize cardiorespiratory coupling, baroreflex sensitivity, and vagal regulation. When implemented systematically, HRV-B produces conditioned improvements in autonomic flexibility that generalize to training, competition, and recovery contexts. This session will review the core physiological mechanisms underlying HRV-B, including vagal efferent activity and baroreflex function, and explain how these processes influence arousal regulation, emotional control, reaction to competitive stressors, and overnight recovery. Drawing from applied work with professional and elite athletes, this talk will present a practical framework for integrating HRV biofeedback into sport performance programs. Emphasis will be placed on assessment-driven protocol design, longitudinal interpretation of HRV metrics, and the distinction between relaxation-based breathing and true autonomic training. Case examples will highlight how HRV-B supports performance consistency, stress tolerance, injury recovery, and sleep quality as a secondary but critical performance variable. Attendees will gain actionable strategies for implementing HRV biofeedback within high-performance environments, avoiding common misapplications, and using physiological data to guide individualized nervous system training across seasons.

Target Audience: This session is intended for sport psychologists, mental performance consultants, biofeedback practitioners, athletic trainers, strength and conditioning coaches, physicians, and performance professionals working with competitive and elite athletes. The content is appropriate for practitioners seeking physiologically grounded tools to enhance stress regulation, recovery, and performance consistency.

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Optimal Performance, Heart Rate Variability (EKG, RESP), Technology and Innovations

Track: Clinical Interventions and Optimal Performance

Level: Introductory

Focus: 90% Clinical/10% Research

Learning Objectives:

Describe the autonomic nervous system mechanisms underlying heart rate variability (HRV), including vagal regulation and baroreflex function, as they relate to athletic performance and recovery.

Differentiate between relaxation-based breathing practices and true heart rate variability biofeedback as a conditioned nervous system training intervention.

Analyze HRV metrics longitudinally to assess autonomic adaptability, training stress, and recovery status in athletes.

Design an assessment-driven HRV biofeedback protocol tailored to an individual athlete’s performance demands and physiological profile.

Apply HRV biofeedback strategies to improve stress regulation, performance consistency, and sleep quality within high-performance sport environments.

References:

Plews, D. J., Laursen, P. B., Stanley, J., Kilding, A. E., & Buchheit, M. (2013). Training adaptation and heart rate variability in elite endurance athletes: Opening the door to effective monitoring. Sports Medicine, 43(9), 773–781.

Lehrer, P. M., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z

Laborde, S., Lautenbach, F., Allen, M. S., Herbert, C., & Achtzehn, S. (2018). The role of cardiac vagal control in sport psychology: Current status and future directions. International Journal of Sport and Exercise Psychology, 16(2), 106–123. https://doi.org/10.1080/1612197X.2016.1230262

Jiménez Morgan, S., & Molina Mora, J. A. (2017). Effect of heart rate variability biofeedback on sport performance, a systematic review. Applied Psychophysiology and Biofeedback, 42(3), 235–245. https://doi.org/10.1007/s10484-017-9364-2

Laborde, S., Mosley, E., & Mertgen, A. (2018). A unifying conceptual framework of factors associated with cardiac vagal control in athletes. International Journal of Psychophysiology, 133, 31–44. https://doi.org/10.1016/j.ijpsycho.2018.09.003

Limitations/Severe Risks: None.

Diversity Considerations: This proposal addresses cultural competence by emphasizing individualized, physiology-based interventions that are adaptable across sports, cultures, and performance environments. HRV biofeedback is presented as a nonverbal, data-driven approach that can be flexibly tailored to athletes from diverse backgrounds, varying resources, and differing cultural norms related to stress, recovery, and help-seeking. The session will address how contextual stressors, access to recovery resources, and cultural attitudes toward performance influence autonomic regulation, and will outline strategies for implementing HRV biofeedback in inclusive, culturally responsive high-performance settings.

GAP: Patient Care, Medical Knowledge, Practice-based Learning and Improvement

GAP Correction: This session will translate current psychophysiological and sport performance research into a practical, evidence-based framework for implementing HRV biofeedback as a nervous system training intervention. Attendees will learn how to accurately interpret HRV metrics in the context of autonomic adaptability, training stress, and recovery rather than relying on isolated or proprietary scores. The session will provide concrete guidance on assessment-driven protocol design, resonance frequency identification, longitudinal monitoring, and common implementation errors. By clarifying the distinction between relaxation-based breathing and true HRV biofeedback, the presentation equips practitioners to apply interventions with greater precision, consistency, and effectiveness. These skills directly improve practitioner competency, enhance individualized care, and support better performance, recovery, and sleep outcomes in athletic and high-performance populations.

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Saturday, May 16

4:15 pm -5:45 pm

BOS26: Autonomic Dysfunction and Sensitized Chronic Pain

Presented By: Peter Behel, MA, BCB; JP Ginsberg, PhD; Meghan Varner, BS, DPT

Session Type: 90-minute Symposium/Break Out Session

CE Credits: 1.5

This panel will discuss sensitized chronic pain (SCR) in terms of neuronal plasticity, and provides an understanding of how SCP emerges as a result of changes associated with autonomic dysregulation. The updated discussion will consider three aspects of SCP: functional changes within the peripheral and central nervous system that lead to heightened pain sensitivity; interactions between the chronic stress response and chronic pain; and case studies from the perspective of a physical therapist demonstrating successful application of autonomic modulation, highlighting its therapeutic potential in chronic pain management. Heart rate variability biofeedback (HRVB) is an evidence-based method of managing autonomic functioning through targeted regulation of breathing. Research indicates that autonomic dysregulation assumes a critical role in incubating the disordered pain signaling that constitutes chronic pain; and this maladaptive signaling includes the ampliﬁed pain characteristic of hyperalgesia and central sensitization. In addition, inflammation cascading from peripheral nociceptors may in some cases influence joint hypermobility. Nociception refers to the transfer of pain signals from the periphery to the spinal cord by the dedicated pain signaling neurons known as nociceptors. The release of norepinephrine increases nociceptor activation levels and provides a link between sympathetic excitation and nociceptor sensitization. The involvement of adrenoreceptors in nociceptive coupling provides a basis for autonomic plasticity. This maladaptive neuroplasticity is based on sympathetically-induced nociceptor hyperexcitability, and the resulting synaptic dysfunction is responsible for nociceptive priming, a persistent hyperfunctional state that is the hallmark of central sensitization. This aberrant neuronal excitability is recognized as its own (nociplastic) pain phenotype, wherein actual tissue penetration is not necessarily required to initiate the nociceptive/inﬂammatory cascade classically associated with pain. Accounting for the hyperexcitability phenotype effectively expands the parameters classically associated with a stress-induced response, and increases recognition that moderating persistent sympathetic activation represents a pivotal mechanism in the development of SCP.

Target Audience: Pain practitioners; anyone with interest in HRVB for pain management

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Heart Rate Variability (EKG, RESP), Stress Management, Evidence-based, Case Studies, Successful Clinical Outcomes

Track: Basic Science

Level: Intermediate

Focus: 50% Clinical/50% Research

Learning Objectives:

Summarize the basic nociceptor-autonomic interactions that facilitate the pain reflex

Describe the maladaptive neuroplastic changes that are associated with sensitized pain

Describe how the chronic stress response cycle supports pain sensitization

Describe the measures used to monitor and track changes in HRV after HRVB

References:

Behel, P. (2024). Neuron Bombardment and Cycling Neurotransmission: The Downstream Impact of Persistent Sympathetic Activation. American Journal of Biomedical Science & Research. 24(1) AJBSR.MS.ID.003165, DOI: 10.34297/AJBSR.2024.24.003165

Behel, P. (2022). Central Sensitization: The Unrecognized Expression of Autonomic Dysregulation. International Journal of Arts, Humanities & Social Science. 03. 44-47. 10.56734/ijahss.v3n9a6.

Behel P. (2015). Modulating pain signal transmission: How targeted nervous system regulation can manage pain without side effects. The Pain Practitioner; 25(4): 44-47

Burch, JB, Weggen, J, Ginsberg, B, Maxwell, M, Nath, S, Varner, M, Boylan, L, Chelimsky, T, Chelimsky, G, Kinser, P, McLeod, BD, Ginsberg, JP, Gharbo, R. (2025, 05/16) Heart Rate Variability Skills Training for Autonomic Rehabilitation (HRV STAR):Examining Clinical Implementation Feasibility.

Poster presentation, 55 th Annual AAPB Scientific Conference, San Diego, CA.Gharbo, R., Bagherpour, R., Lazarus, N., Mehrdady, R., Ginsberg, J. P. (2019). Untangling chronic pain and hyperarousal with heart rate variability: A case report. Practical Pain Management 19(7), 33-36.

Limitations/Severe Risks: No risks have been identified

Diversity Considerations: Chronic pain is a trans-cultural health concern, requiring pain management practitioners to be aware of issues of cultural diversity and competence in order to provide effective treatments.

GAP: Patient Care

GAP Correction: Improve treatment protocols

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Saturday, May 16

6 pm - 7:15 pm

KEY03: Distinguished Scientist Lecture: Building Stress Resilience through the Integration of Psychotherapy and Biofeedback

Presented By: Patrick R. Steffen, PhD, BCB

Session Type: General Session

CE Credits: 1

Mind and body are interconnected and indivisible. Psychotherapy and psychophysiology should ideally therefore be interconnected, with interventions being an integration of both. To explore psychotherapy / psychophysiology integration, this presentation focuses on the integration of psychotherapeutic principles with HRV biofeedback to increase stress resilience. Therapeutic principles are drawn from evidenced-based interventions such as Behavioral Activation, Acceptance and Commitment Therapy, and Cognitive Interpersonal Therapy in conjunction HRV biofeedback. A three-part therapeutic integration is proposed. First, resilient self-regulation is built by learning to regulate the stress response using HRV biofeedback. Second, resilient focus is built by narrowing our focus to what matters most and eliminating unnecessary stress by identifying personal life values and personality strengths. And third, resilience capacity is built by building resilient bodies (sleep, activity, diet), resilient minds (positive life narrative), and resilient relationships (interpersonal skills and connection). The goal of this therapeutic integration is to resiliently transform our stress into positive energy, positive mood, and positive mental focus. Research is presented to explore these possibilities and future directions are discussed.

Target Audience: Those interested in integrating psychotherapy and biofeedback

Subject Matter Classification: Peripheral Biofeedback (HRV/Resp), Stress Management, Evidence-based

Track: Hot Topics

Level: Introductory

Focus: 50% Clinicial/50% Research

Learning Objectives:

Summarize concepts on mind/body interdependence and how that contributes to integration of psychotherapy and psychophysiology

Recognize therapeutic principles from different psychotherapeutic orientations and how they might be integrated with biofeedback in an overall treatment approach

Examine potential approaches to integrating biofeedback into other therapeutic modalities

References:

Steffen, P. R., Foxx, J., Cattani, K., Alldredge, C., Austin, T., & Burlingame, G. M. (2021). Impact of a 12-Week Group-Based Compassion Focused Therapy Intervention on Heart Rate Variability. Applied Psychophysiology and Biofeedback, 46(1), 61–68. https://doi.org/10.1007/s10484-020-09487-8

Caldwell Y.T., Steffen, P.R. (2018) Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder. International Journal of Psychophysiology, 131, 96–101.

Blanck, P., Stoffel, M., Bents, H., Ditzen, B., & Mander, J. (2019). Heart rate variability in individual psychotherapy: Association with alliance and outcome. Journal of Nervous and Mental Disorders, 207, 451-458.

Steffen, P. R., & Anderson, T. (2025). Primary appraisal is affective not cognitive: Exploring a revised transactional model of stress and coping. Applied Psychophysiology and Biofeedback, 50(2), 197–211. https://doi.org/10.1007/s10484-025-09699-w

Steffen, P., & Moss, D. (2024). Integrating Psychotherapy and Psychophysiology: Theory, Assessment, and Practice. Oxford University Press.

Limitations/Severe Risks: None.

GAP: Practice-based Learning and Improvement

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