Donald Moss

Saybrook University · College of Integrative Medicine and Health Sciences

Purchasing biofeedback instruments and learning the technical process of operating each biofeedback instrument with a human subject are not enough. These steps are necessary, but they do not clearly guide one as to how the instruments should be used. A treatment protocol is required that provides an explanation of the patient's current suffering or...

Hypnosis and biofeedback techniques are evidence-based psychophysiological therapies that can be applied with a wide variety of medical and mental health disorders. Research shows efficacy for anxiety, depression, post-traumatic stress disorder (PTDS), chronic pain, hypertension, fibromyalgia, and a host of other disorders. Hypnosis and biofeedback...

Introduction: Posttraumatic stress disorder (PTSD) has been linked to abnormalities within three neural networks: default mode (DMN), salience (SN), and central executive (CEN). This study examined the effectiveness of LORETA z-score neurofeedback (LZNF) training for altering current source within these networks and reducing symptoms associated wit...

The incidence of traumatic brain injuries (TBI) has increased in recent years, now comprising 2.5 million emergency room visits, hospitalizations, and deaths each year in the United States. TBI is frequently a chronic condition with persisting symptoms and disability. This chapter presents a case study in which self-hypnosis, hypnosis-assisted psyc...

Caregiver stress is a growing problem with an aging population; many spouses are cast in the caregiver role for extended periods. Pre-existing anxiety disorders commonly recur in the face of caregiver stress. This chapter narrates the case of a 71-year-old retired professional woman, serving as caregiver for a husband with dementia. The stress of t...

This chapter provides an introduction to chronic illness as conceptualized in the Pathways Model. Health care expenditures and the major conditions requiring costly medical care are discussed. The importance of environment, socioeconomic status, and developmental factors are highlighted. Several patient cases are utilized to demonstrate multiple ri...

Chronic pain is a major cause of human suffering and impairment in function, affecting not only individuals, but also families, productivity in the workplace and society. Selected mechanisms involved in the transformation of acute pain into chronic debilitating pain are discussed. Two cases, one of a patient with chronic migraine and another case o...

This chapter summarizes unique applications of the Pathways concepts. Several examples are provided, including applications of the Pathways Model in support groups, in intensive outpatient services, and in patients with lifestyle issues and patients with vague, diffuse symptoms, among others. When a group intervention is the most practical, then th...

The Pathways Model was developed by Angele McGrady and Donald Moss (Pathways to illness, pathways to health, Springer, New York, NY, 2013), as an integrative model for improving health and remediating illness. The Pathways Model utilizes a coaching-based approach to assess the individual’s readiness for health-supportive changes and articulates a t...

Religion, medicine, and healing have been connected in most cultures and eras. The development of scientific medicine in the nineteenth and twentieth centuries produced a practical divorce between medical care and religion. However, over four decades of research has shown that religious adherence, attendance at services, beliefs, spiritual practice...

This chapter proposes that the major challenge for human health in the twenty-first century is chronic diseases and chronic conditions. This is a global problem, burdening health care systems and economies worldwide. WHO statistics show that almost 70% of deaths annually are caused by chronic diseases, especially cardiovascular disease, cancer, chr...

This chapter will describe the emergence of the complementary and alternative medicine (CAM) movement historically, and the current drive toward integrating complementary therapies and mainstream medicine into a comprehensive integrative medicine. The five domains of complementary medicine are defined; emphasis is placed on therapies with a strong...

In past decades, cancer was often viewed as a death sentence. Today, the diagnosis of cancer often heralds not sudden death but a transformed mode of living, and a challenge to manage the many adverse effects of treatment, the uncertainty of one’s future, and a challenge to quality of life. Cancer survivors frequently report depression and anxiety....

Cardiovascular diseases are the most common chronic illnesses and a major cause of morbidity and mortality. Comorbidity among the physical illnesses in this category and mood and anxiety disorders is very high. Management of symptoms of shortness of breath, rapid heart rate, fatigue, or a sense of malaise are signals requiring attention first by th...

Systemic lupus erythematosus (SLE) is a complex and typically chronic illness, producing a wide variety of symptoms and following an unpredictable course. SLE is an auto-immune condition, commonly affecting the skin, joints, kidneys, the brain, and other organs. This chapter describes the application of a multi-level integrative care plan, followin...

Post-traumatic stress disorder is a psychophysiological disorder, characterized by chronic sympathetic nervous system activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negative emot...

The authors regard substance abuse and addictive behavior as a chronic recurrent illness, with psychological, behavioral, and medical components. They call for multi-modal intermittent treatment throughout the life span, addressing the emotional, social, and biological dimensions of the disorder. A case study of a lifelong alcohol and drug-dependen...

Mood disorders, particularly major depression is one of the most common mental illnesses, causing distress and impairing function. Genetic studies have confirmed an increased risk for depression in those with a positive family history, but environment, particularly chronic exposure to stressful events is a major contributor to etiology. Bipolar dis...

Psychosocial factors interact with genetics, environment, and lifestyle to increase risk for the metabolic syndrome (essential hypertension, Type 2 diabetes, hyperlipidemia, and obesity). Patients with the metabolic syndrome often suffer from anxious and depressive symptoms, negatively affecting motivation for self-management. A biopsychosocial app...

Patients today frequently present with conditions caused by or aggravated by stress, lifestyle, and behavior. The number of patients with one or more chronic illnesses has increased worldwide, and lifestyle and behavior frequently contribute to these chronic conditions. Biomedical care fails to address many of the behavioral, lifestyle, and environ...

This expansive text offers a comprehensive mind/body/spirit framework for relieving individual patients of the debilitating effects of long-term disease while reducing the public burden of chronic illness. It introduces the patient-centered Pathways Model, featuring a robust scientific base for psychotherapy, complementary and alternative modalitie...

This article presents a case study in which self-hypnosis, hypnosis-assisted psychotherapy, and palliative care strategies were provided within a multi-modal integrative treatment program for a 38-year-old woman with traumatic brain injury (TBI) secondary to motor vehicle accident. Self-hypnosis was helpful in anxiety reduction and pain management....

Posttraumatic stress disorder is a psychophysiological disorder, characterized by the following: chronic sympathetic nervous activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negati...

Heart rate variability (HRV) is a medical index for morbidity and wellness. Lower HRV accompanies many illnesses; high HRV accompanies healthy states, resilience, and optimal functioning. Heart rate variability biofeedback (HRVB) uses real-time electronic feedback of the moment-to-moment changes in HRV to train patients to produce increases in HRV....

Caregiver stress is a growing problem with an aging population, and many spouses are cast in the caregiver role for extended periods. Preexisting anxiety disorders commonly recur in the face of caregiver stress. This article narrates the case of a 71-year-old retired professional woman serving as caregiver for a husband with dementia. The stress of...

The cover of this special issue of Biofeedback illustrates the widespread problem of incontinence discussed in the lead article by Debbie Callif. According to Callif, more than 25 million Americans suffer with bladder bowel incontinence (thanks to Shutterstock for the image).

Systemic lupus erythematosus (SLE) is a complex and typically chronic illness, producing a wide variety of symptoms and an unpredictable course. SLE is an autoimmune condition, commonly affecting the skin, joints, kidneys, brain, and other organs. This article describes the application of a multilevel integrative care plan, following the pathways m...

Shamanic practices frequently create hypnotic-like states, with altered states of consciousness, heightened suggestibility, and a perception of an abundance of meaning in everyday events. Jaguar medicine (JM) is a form of shamanic healing with roots in the indigenous cultures of South and Central America. Recent years have seen increasing interest...

The cover of this issue of Biofeedback shows a depiction of the mythical Sisyphus, condemned for all eternity to push an immense boulder up a hill, only to watch it roll back down the hill. The myth serves as a symbol for all of the medical and nonbiofeedback factors that can hinder biofeedback and neurofeedback treatment. It is our hope that this...

This article examines the economic and human costs of muscle pain and the role of biofeedback in treating chronic muscle pain. The article reviews the physiology of the musculature and the myofascial mantle and the contributions of physiological dysfunction to pain. The article critiques the relaxation model as an inadequate foundation for biofeedb...

The cover of this issue of Biofeedback shows a photograph reflecting the mindfulness theme of this special issue. Thanks to Shutterstock for the use of this photo.

The author introduces the pathways model, a three-level approach for integrating self-directed lifestyle change, the acquisition of self-regulation skills, and the use of community resources into a comprehensive mind-body treatment approach. The pathways model is illustrated with a case study of a 34-year-old executive with public speaking anxiety....

Millions of women experience substantial pain and suffering from vulvodynia, which is pain around the entrance to the vagina (vulva). A common treatment is surgical removal of the tissue (vestibulectomy). This case report describes the detailed process of a holistic biofeedback-based intervention that successfully resolved the vulvodynia in a 23-ye...

Reviews the book Neurophenomenology and Its Applications to Psychology edited by Susan Gordon (see record 2013-23348-000 ). This book attempts to bridge the gap between philosophical neurophenomenology and such psychological domains as cognition, emotion, learning, pedagogy, meditation, and psychoneuroimmunology. The book also establishes the kinsh...

The photo on the cover of this special issue shows multidisciplinary treatment at the Cleveland Clinic Children's Hospital for Rehabilitation. A physical therapist is guiding a patient through a stretching maneuver, while the biofeedback practitioner monitors and supports the patient's self-regulation using HRV biofeedback. (Our thanks to the Cleve...

Acute coronary syndromes (ACS), including unstable angina (UA) and myocardial infarction (MI), are clinical symptoms of heart disease, called ischaemic heart disease (IHD), and are important cause of death worldwide and in Poland. Medical associations including the European Cardiac Society (ECS) and the American Heart Association (AHA) recognize ps...

Biofeedback and hypnosis are complementary techniques, sharing an evidence-based approach and accessing powerful neurophysiological mechanisms. Both approaches are suitable for use with children, when implemented in developmentally appropriate ways, and each facilitates the development of self-regulation. Biofeedback can serve as an adjunct to hypn...

Biofeedback and hypnosis are complementary techniques, sharing an evidence-based approach and accessing powerful neurophysiological mechanisms. Both approaches are suitable for use with children, when implemented in developmentally appropriate ways, and each facilitates the development of self-regulation. Biofeedback can serve as an adjunct to hypn...

The Biofeedback Certification International Alliance (BCIA) has developed a certificate of completion program to establish education and training standards for the exciting modality of heart rate variability (HRV) biofeedback. HRV represents the beat-to-beat changes in the intervals between consecutive heartbeats. A growing list of HRV biofeedback...

This chapter begins with definitions of important concepts in genetics and continues with summaries of genetic influences on personality and behavior. Interactions between heredity and environment are described within the context of the Pathways Model. Genetic factors that create necessary and/or sufficient contributions to the physical and psychia...

This chapter details multilevel intervention plans based on the principles and concepts underlying the Pathways Model. The main focus of the Level One interventions is to reestablish normal biological rhythms that have been disrupted by conditioning, stress, or trauma. Skill building is the main objective of the Level Two interventions, for example...

The demographics and etiologies of illness have changed in the past ­century. The most common causes of mortality and morbidity today are diseases of lifestyle, behavior, and adaptation; stress-related conditions; chronic illnesses and impairments; and complex biopsychosocial conditions. No illness is purely physical or emotional, but rather illnes...

Blood pressure is regulated by neural and endocrine systems to maintain sufficient perfusion of tissues during rest and activity. Sustained elevated blood pressure increases risk for heart disease and stroke. In contrast, periods of low perfusion or hypotension are associated with dizziness and syncope, which are risk factors for sudden death. Many...

Psychosocial factors contribute to the onset of illness and the recovery of health. Careful attention to the person’s life history (or “psychosomatic history”) discloses individual patterns of illness onset and recovery and times of exacerbations and clinical improvement. Stressful life events trigger illness, as do experiences of separation and lo...

Research has documented multiple examples of linkages between psychological states and physical conditions in chronic pain, cardiovascular disease, sleep disorders, metabolic diseases, and respiratory illnesses. The target systems or tissues are partially determined by heredity, lifestyle choices, and environment in various proportions. This chapte...

This chapter describes the process of assessment of clients according to the Pathways Model. Emphasis is placed on active participation of the client in identifying immediate concerns, major problems, and setting goals for treatment. Quotations from typical clients are utilized to highlight the importance of the therapeutic relationship. Examples o...

Sleep is a natural, repetitive function of the brain that restores energy and partially maintains mental and physical health. Disruptions in sleep, particularly slow-wave sleep, are associated with mood disturbance, decreased function, and physical illness. The Pathways Model is useful in understanding sleep disorders, whether they be primary or se...

Substance abuse is a major public health problem, with high prevalence in the US population, and many associated economic costs. The problem of substance abuse is a useful example for better understanding the paradox and the challenge of chronic illness. Substance abuse has significant genetic heritability, along with elements of individual choice...

The Pathways Model is applied to the case of a client who presents with a desire to improve his health and mental well-being. Imbalances in the clients’ energy allocations and stated needs form the framework for implementation of the Pathways Model. Recommended approaches to this type of client, goal-setting strategies, and choice of interventions...

Anxiety disorders manifest themselves as uncomfortable emotions, ­over-arousal of biological systems and changes in self-care behaviors. Interventions must address each of these categories of anxiety responses to help patients return to health. This chapter describes two clinical cases to demonstrate the use of the Pathways Model in anxiety disorde...

Simple Pathways are user-friendly intervention strategies that can be delivered with relatively little training by the professional, and without the use of expensive instrumentation. In many cases the provider can acquire the techniques from written materials or brief instruction, and can teach clients to use the strategies for self-care. Other sel...

Chronic pain is a complex psychobiological condition that creates personal suffering and disability. Chronic pain disorders are often associated with mood, anxiety, and somatoform disorders. Two types of chronic pain are discussed in this chapter: headache and back pain. The Pathways Model is applied to two patient cases, each with their own life s...

Fibromyalgia is a medical syndrome first described 200 years ago, but only recently officially recognized by medical science. The patient with fibromyalgia experiences widespread pain, often burning, in all four quadrants of the body. Fibromyalgia is often accompanied by additional symptoms, including fatigue, low energy, sleep disturbance, morning...

In the Pathways Model, Level Three treatment planning calls for the use of health professionals for specific interventions. Finding a reliable, skilled professional to deliver a specialized intervention is a challenge. Physicians and pastors can often provide a referral. Physicians and behavioral health professionals can also coach patients to beco...

Type 2 diabetes mellitus and obesity are two interrelated disorders that share etiological factors, including heredity, maladaptive behaviors, and distress. The prevalence of both disorders has increased over the past decade, particularly in ethnic minority groups. Understanding the role of choice-driven behaviors in the course of diabetes forms th...

Depression is a serious disorder, affecting 12 % of adult males and 25 % of adult females in the United States, and approximately 121 million people worldwide. Depression frequently progresses to a chronic condition, often producing disability. The social, economic, and medical costs are substantial. Depression has a strong heritability, based on a...

This chapter begins with a brief description of the processes of digestion and absorption in the gastrointestinal tract and then follows with a discussion of the effects of psychological and behavioral factors on gastrointestinal function. Medical, psychotherapeutic, and psychophysiological interventions applicable to functional gastrointestinal di...

IntroductionParadigms in Biofeedback Assisted Optimal Performance WorkThe Field of Optimal Performance PsychophysiologyA Brief HistoryBiofeedback Tools for Optimal Performance: ModalitiesStandards for ApplicationProfessional ResourcesConclusion References

The Health Belief Model proposes that medical treatment and patient self-care plans need to be congruent with the client’s illness beliefs. When the client’s illness attribution are compatible, the client is more likely to comply with both medical treatment and self-care. The authors emphasize the internal versus external locus of control dimension...

This book, designed for professionals, introduces a psychobiological model for understanding the paths that lead people to illness and provides recommendations for alterations of maladaptive pathways so that health is regained. Research findings are incorporated to identify causal variables for illness that can be targets for change. Evidence based...

The Biofeedback Certification International Alliance (BCIA) is the primary international certification body in the fields of biofeedback and neurofeedback, including pelvic floor muscle dysfunction biofeedback. BCIA has established blueprints of knowledge and requirements for independent practice to guide the process of education and training in th...

The Health Belief Model proposes that medical treatment and patient self-care plans need to be congruent with the client's illness beliefs. When the client's illness attributions are compatible, the client is more likely to comply with both medical treatment and self-care. The authors emphasize the internal versus external locus of control dimensio...

One of the requirements for certification by the Biofeedback Certification International Alliance (BCIA) is a specific number of mentoring hours with a BCIA-approved mentor. This article defines mentoring, distinguishes it from clinical supervision, and provides guidance on the search for an optimal mentor. The authors recommend the use of a mentor...

The Biofeedback Certification International Alliance (BCIA)-Australia has recently become the first fully autonomous affiliate of BCIA, certifying neurofeedback professionals in Australia, with requirements equivalent to those of BCIA. BCIA has also established a worldwide network of professionals, who intermittently meet to promote biofeedback and...

The article describes the two hearts – the bioelectric pump of anatomy and the human heart of poetry and philosophy. This latter heart is the center of the soul and the abode of love and caring and emotion. The article introduces phenomenology as an approach aiming to illuminate the individual’s immediate experience of the body, of life, and of hea...

Sigmund Freud described the interpretation of dreams as the “royal road to the unconscious” for psychotherapy (1900). Today psychophysiology can provide that royal road for psychotherapists. This program introduces fifteen principles guiding the use of psychophysiology in psychotherapy, including specific techniques and case examples, showing the u...

Mind-body approaches begin by recognizing that fibromyalgia is a real medical disorder, accompanied by measurable changes in a variety of biological systems. Fibromyalgia has dramatic effects on the body and the mind of the patient. Until quite recently many patients could not persuade their physicians to believe in the reality of their symptoms. T...

A growing body of research reports health benefits of training Heart Rate Variability (HRV), and clinical use of HRV training protocols has increased dramatically in recent years. Many of the home training devices and many of the sophisticated biofeedback instrumentation systems rely on the Blood Volume Pulse (BVP) sensor, or photoplethysmograph, b...