I'm pleased to report that we have now posted all 140 pages
of Shellenberger and Green's book, "From The Ghost in the Box
to Successful Biofeedback Therapy", on the website. The full
address is:
http://www.incontinet.com/ghost.htm
which will take you to the several chapters, as follows:
ghost0.htm (19K)
ghost1.htm (34K)
ghost2.htm (111K + 19K graphic)
ghost3.htm (10K)
ghost4.htm (86K)
ghost5.htm (51K)
ghost6.htm (27K)
ghost7.htm (66K)
As an added incentive, I've written and posted a
critique of a current article that violates most
of the points made by Ghost in 1986. Blanchard
et al., heavily critiqued in the book, continue to
search for "specific effects" of biofeedback, in
spite of what they should have learned from Ghost.
My critique is located at
http://www.incontinet.com/blanchard.htm.
George von Hilsheimer called it "Masterly application.
Thank you. A plus!!!" on the psyphy list. But
don't take George's word for it -- check it out
yourself!
For those who are new to the controversy, Ghost takes
the position that -- unlike drugs -- there is no
"active ingredient" inside the biofeedback machine that
"causes" any change in the patient. The biofeedback
device is better compared with a mirror (which shows
you how effective you are at wiggling your ears), or
to a stopwatch (which shows you how effective you are
at pacing yourself around the track).
GHOST should be required reading for all physical
therapists, since it explains how different biofeedback
instruments are from the very similar-looking devices
like electrical stimulators that they use every day.
The electrical stimulator really does have a "ghost", or
"agent" inside; it does something (often, not much) to
your body even if you are asleep! The biofeedback device,
on the other hand, doesn't "do" anything to you; it
simply shows you what you are doing to yourself, and
(by quantification), precisely how much you are doing it.
[For example, how tightly you are holding your pelvic
muscles, even when you try to relax them.]
GHOST differentiates between "training results" and
"symptom results". The former refers to whether or
not the patient was able to relax the muscles or warm
the fingers, for example; the latter refers to the
change in headache frequency or urinary leakage. The
connection is that *unless* there is a change in the
muscles or circulation, we should not EXPECT a change
in the symptoms.
Most drugs (and e-stim) do not require that we look
first for training effects; they release their active
ingredients into the bloodstream at a uniform rate,
regardless of any action on the part of the patient.
So we can study the effects of "aspirin" on "headaches"
directly, without doing bloodwork to verify that the
aspirin really did get into circulation.
Of course we can readily imagine a drug testing
situation where it is not possible to assume that
there was a "treatment effect"; for example, a drug
that had such noxious side effects that many
subjects just refused to take all the prescribed
pills. In that case, we would want to verify that
XX mg. of the drug actually got into the bloodstream
before deciding if the drug kills cancer cells, for
example.
Biofeedback is even more extreme. The biofeedback
device is an aid to learning -- in this case, learning
to control an internal biological process. Not every
person learns at the same rate. If you offer a fixed
number of training sessions, some will and some will
not learn the skill. [I once took a five-day course
in sailing; all I can say is that anyone who loaned
me their sailboat on the basis of five days training
would be a fool, even though I have a certificate
showing that I've been "trained" to sail.]
How many lessons does it take to become an "expert"
skier? A 100-wpm typist? A graphic artist? A
computer wiz? If you appreciate these analogies,
you can understand that any biofeedback research that
offers a small, fixed number of training sessions is doomed
to failure. But see http://www.incontinet.com/blanchard.htm
and http://www.incontinet.com/burns.htm for examples of
research that still doesn't understand this basic point.
Blanchard got trivial changes in finger temperature,
and concluded it didn't effect headaches; Burns got
tiny changes in pelvic muscle strength, and concluded
biofeedback didn't help incontinence. Both researchers
made fundamental errors, according to THE GHOST.
The Ghost is being published as shareware. If you read
the book, and allow it to influence your thinking, you
are asked to "register" your copy and pay the authors the
sum of $5. That's a bargain, since thousands of copies
were sold in late 1980s and early 1990s for $9.95! And
the electronic version can be searched instantly for key
words, using your web browser's "find in page" function.
Plus you can cut and paste exerts in letters to your
friends and colleagues.
IncontiNet website receives nothing from the distribution
of The Ghost, except for your good will and thanks. It
is our goal to continue to be the world's largest source
of (free) information about the EMG biofeedback treatment
of urinary and fecal incontinence and other pelvic muscle
disorders. Last month visitors downloaded over 45 Megabytes
of information -- EVERY DAY! For the month we topped One
Gigabyte! That's how we know you appreciate our efforts.
John D. Perry, PhD
Webmaster, IncontiNet
http://www.incontinet.com
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