Biofeedback: A Practitioner’s Guide

(4th Edition)

[Published – March, 2016]

Authors/Editors: Mark S. Schwartz, Ph.D. &

Frank Andrasik, Ph.D. (Eds.)

Publisher content: This comprehensive volume is widely regarded as the definitive practitioner resource and text in biofeedback and applied psychophysiology. Leading experts cover basic concepts, assessment, instrumentation, clinical procedures, and professional issues. Chapters describe how traditional and cutting-edge methods are applied in the treatment of a wide range of disorders, including headaches, temporomandibular disorders, essential hypertension, pelvic floor disorders, attention-deficit/hyperactivity disorder, tinnitus, and others. Applications for optimizing physical performance among artists and athletes are also reviewed. A wealth of information and empirical research is presented in an accessible style, including helpful glossaries.

New to This Edition

  • Incorporates significant technological developments and new research areas.
  • Expanded focus on specialized applications, such as electroencephalographic (EEG) biofeedback/neurofeedback and heart rate variability biofeedback.
  • Chapters on surface electromyography, quantitative EEG, and consumer products.
  • Chapters on cognitive-behavioral therapy and relaxation training.
  • Chapters on additional clinical problems: anxiety disorders, asthma, work-related pain, traumatic brain injury, autism spectrum disorders, and substance use disorders.


Metaphors in Medical

Psychology, Medical Care, Applied Psychophysiology, and Health Care Education:

A Guide for Practitioners, Patients, and the General Public

Author/Editor: Mark S. Schwartz, Ph.D.

This book (and website) focuses on metaphors (and similes and analogies) in communications to patients, their families, students, professionals, the public, educators, and health care professionals. Metaphors are valuable means to enhance communication and education. Metaphors present information, concepts, and plans in more acceptable, understandable, engaging, and memorable ways than other methods. Metaphors help simplify information, concepts, and procedures that are complex. Health professionals commonly use metaphors and analogies in their communications with patients. The book includes definitions, rationale, history, approaches to metaphors, uses of metaphors, cautions, selecting metaphors for patient education and cognitive preparation of patients, references, and websites. The book’s rationale includes the assumption that patients and related audiences are often unfamiliar, skeptical, and/or resistant to communications from healthcare professionals. Furthermore, patients often forget much of the content communicated to them. The book contains various metaphors for explaining psychological and psychophysiological conditions, standard, complementary, and alternative therapies, stress management, making behavioral/habit and lifestyle changes, adjustment to chronic conditions, and the functioning of body systems, including the autonomic nervous system.


BLOG #5 (Dup. Trial location, October 26, 2023)

Reading a Person’s Personal Journal: Why? Why Not? Risks? Perspectives that You Might Not Have Considered.

Mark S. Schwartz, Ph.D. 

Why am I writing this? My rationale for writing this stemmed from two of my patients with very different life situations that presented them and us in our therapy relationship during multiple sessions with circumstances that presented and still present substantial challenges that were and still are unique in my professional experience. Our sessions about the topic and challenges engendered and facilitated thoughts of mine, empathy with the patients for their dilemma and challenge, and my thinking about the potential issues, problems, and even risks. 

One of my patients was struggling with whether or not to read the journal of a family member who was no longer alive, having died from suicide. The content of our sessions, my patient’s dilemma and ambivalence, and my thoughts during and after sessions helped propel me to pursue this blog with the notes I took during our sessions. 

           With the other patient, their journaling was partly motivated by my encouragement and discussions about the potential benefits of creating a personal journal. In this case, another unrelated but very close person in my patient’s life found the journal when alone in my patient’s house, read it, and became very upset and angry about the content. That person’s behavior then was very disruptive and destructive of my patient’s personal property. That person angrily conveyed their reading of the journal to my patient, and their relationship ended. As it turned out, the end of the relationship was probably in my patient’s best interest, but how it occurred was very upsetting to them and disruptive to the preferred therapeutic plans before the events. Fortunately, there was no disastrous outcome, thus no physical harm to anyone. However, the outcome could have been disastrous given a few possible changes in a few specifics in the two parties involved. Our sessions, my notes, and my thoughts during and after these sessions also stimulated my motivation to explore this topic and share my thinking with others. 

           These two cases are intentionally ambiguous in part to disguise any features of the two patients. However, suppose the two patients read this blog. In that case, they might recognize enough that they might have been one of my patients whose experiences I described. However, even this would only be partially clear to either of them. I have no problem or concern with them believing or knowing that their life experiences and our sessions motivate this blog. We discussed much of the content, or at least the gist of this content, in this blog during our sessions. 

Mental health professionals often suggest or encourage their patients to create a personal journal expressing openly and with emotion their thoughts and feelings. These expressions can be and often are therapeutic. There are books about this topic and considerable research supporting the potential value of such journaling. (See Resources at the end of this blog for selected references.) Most people, including mental health professionals, consider such journaling documents as “confidential” for the person journaling or between the patient/client and their therapist. Even for those people who learn of these references and read some of them such as for “self-help” or hear about the recommendations and techniques and then proceed with journaling, the writer has the right to consider the content as confidential, even considering the motivation and desire of parents and other people in similar roles in their lives. Of course, most people write expressively about their thoughts, feelings, and experiences without a therapist’s direction or reading one or more books or articles about this type of journaling. 

This blog does not address the privacy issues, such as HIPAA statutes, about family members gaining access to their family member’s journalling that could be in the possession of mental health or medical providers. It is not about the parents of preadolescents or early adolescent children whose diaries might contain important information about their possible illegal activities, risky activities, or vital information that could affect people’s safety. I need to be more knowledgeable or qualified to write about these topics. 

Furthermore, when someone, the author of the personal journal, wants to share their written documents with a friend or family, that is their right to do so as if they were sending a letter/email to the other person. However, I typically caution such people to edit and reflect on how other people, the recipient in particular but others as well, might interpret the content, react to the content, or their interpretation of the content. I also often caution the author to think carefully about their intent in sharing the content with another person. Too often, people journal or write communication content to others (e.g., spouse, other family, or other person) without sufficient reflection and consideration of potential and often unintended misinterpretations and ramifications. 

I understand, of course, as I assume most or all blog readers understand, the curiosity, the perceived “need to know” about the other person’s (that is, the writer’s) personal thoughts, feelings, and behaviors. These “other” people include their offspring and their spouses/life partners, parents, and various other people in our lives. Humans want and perceive a “need to know” to “understand,” even if not fully or verified. Humans feel more comfortable when they think they “understand” even when the reality of the “understanding” is “as if” it were true, accurate, complete, and sufficient. (See my blog on the topic of “as if” and noting “effectance” motivation” as a fundamental need to understand). 

Another influence on this theme in my ideas is the work by Robert White (1959), referred to as Effectance Motivation. Briefly, this is the need by humans to experience competence, thus believing that they understand and are correct. According to this reasoning, humans strive to think that we know and are right in our beliefs. From one perspective, it does not matter whether the ideas are accurate and correct. It only matters that the person has enough knowledge, even fictional knowledge that makes sense to them, to believe they are right. It is “as if” they are saying to themselves, “I know; therefore, I am.” “I am correct; therefore, I am okay.” “I have enough information; therefore, I am okay.” “My knowledge makes sense to me; therefore, I am okay.” “Do not confuse me or complicate matters with information that I might not be able to understand.” “Keep it simple.” “Don’t create inconsistencies or other information, including your “facts,” that could negate or contradict my knowledge and understanding.” (Blog 3: Schwartz, M.S. (2020). Believing and behaving “as if,” Facing “reality,” understanding oneself better, managing many stressors, and accepting the “bad” and the “good” sides..) 


It is “as if” the information in the other person’s journal provides me, the reader, logical and presumably sufficient information and explanations that very often seem sufficient. Humans also prefer simple or relatively simple explanations and interpretations and often do not reflect and consider the variety of possible explanations, meaning, and validity of the writer’s content. It is, unfortunately, often accepted “at face value.” 

           “Did I do something to contribute?” “Did I say something?” “Could I have done something to have prevented the writer’s thoughts, feelings, and behaviors?” These are among the myriad of reasons and perceived reasons why we might want to read someone else’s journal. I want to know. I need to know!

           A significant rationale for not reading the personal journal or diary of another person includes avoiding being misled, thus avoiding the distress and consequences of reading unedited, inaccurate thoughts and feelings contained in the content of the other person’s journalling or diary and then living with incorrect interpretations, mistaken beliefs, and unintended consequences.   

Remember that interpretations of even great historical authors vary among experts reading and interpreting the same content. Varied interpretations exist even for the Bible, the US Constitution, and other documents. The intent and meaning of the same content varies among readers, including those academics and experts who read and interpret the same content and the authors. 

This variability of interpretations also exists for the interpretations and applications to individuals based on the Diagnostic and Statistical Manual from the American Psychiatric Association. Thus, when presented with the same patient, history, behaviors, and symptoms, various Psychiatrists, Psychologists, and other Mental Health Professionals often provide varied matches with varied diagnoses. Thus, diagnoses often differ. One aspect of this variability is the complexity and limited reliability of interpreting text content.

            The same can and is said about interpreting the oral content of what people say. Interpretation can and is improved considerably when the author takes great care in selecting words and sentences and when the person is very sophisticated and erudite in their use of language. Of course, most people lack these language advantages. Even when they have a reasonable degree of such skills, they likely will not choose to apply such skills in their journaling. 

Then, consider that many, if not most, of the journal content, when written, is done so during or soon after stressful and emotionally challenging periods and experiences. This writing happens when applying erudite and carefully worded language is not foremost in a writer’s priorities. Another primary consideration when considering reading someone’s journal is that they wrote it without awareness or intent that someone else will read it or that someone else might understand it differently than intended. 

For all the above reasons, why would a potential reader consider that they, the unexpected reader, will even remotely interpret the content correctly and sufficiently, understand the intent, and gain meaningful and unambiguous intent and meaning from the other person’s journaling? 

Also, consider that when speaking and writing, most people soon or often immediately reflect on what they have said or written and edit, clarify, and revise what they said or wrote. Essentially, all authors do this routinely. The first draft is seldom, if ever, the final draft. 

Even listening to people speak often shows rapid changes in the use of specific words and phrases to reflect better their thoughts, intent, and accuracy. So, why would we consider that the same process is needed when writing yet often omitted for various reasons, e.g., time constraints, emotions, and circumstances? 

So, what do you do? Not surprisingly, the answers are sometimes complex. However, reasonable answers also can be relatively simple. If I am in your place, what do I do with the motivation and temptation to read the personal journal of that person in my life? Can I ignore or forget it? I understand that option is not feasible. One does not “walk away” and forget something as potentially informative and potentially emotionally charged as the personal journal of someone who is or was so close to you. 

           You are already pursuing one option in managing the motivation and temptation to read it. You are reading this blog. I intended this blog to be helpful to you, the readers, faced with this significant challenge. 

The motivation and temptation will likely persist to some significant degree. Periodic reflection and self-talk with ongoing cognitive reframing (cognitive restructuring) will likely persist. That is not fundamentally different from our managing a wide variety of other stressful challenges that we all face. We all go through this ongoing process when faced with stressors such as various losses and adjusting to relationships for which factors support various options, with a choice of behavior being the best or least problematic. 

We often elect our political leaders after choosing the “least problematic” of multiple choices. And there are many other examples of avoiding, minimizing, or otherwise adapting to restraining ourselves from some otherwise strong motivations. I know I do, and often. I will not elaborate.  

Is there valid, factual, and accurate content in the personal journals and diaries? Of course, but that is not the point of this blog. I am not suggesting or intending to imply or state that the contents of that “other” person’s journal do not contain valid, accurate content with or without careful writing, sufficient reflection, and thoughtful and competent editing. I state this in case some readers of this blog interpreted other parts as implying, even from my omission, anything that might suggest that such an omission could reflect my dissing the accuracy, valid, and helpful content of this journaling. 

Even mentioning this might seem absurd to some readers. Of course, such an omission would not mean or imply such a viewpoint by me. Yet, omissions sometimes raise eyebrows and offer fodder for those readers who disagree with me regarding the rest of this blog. And, I am not naïve that there will be readers who disagree with the overall and specific intent and content of this blog. That disagreement could be motivated by various reasons, a discussion beyond this blog’s scope, or at least a reasonable space allocation.  

           In conclusion, if you, the reader of this blog, are faced with the availability of the personal written journal of another important person in your life and have the opportunity, the motivation, the strong temptation, the perceived need, the perceived justification, the encouragement to do so by other people in your life, be careful, be very careful, before proceeding. Think about the ethical considerations, of course. Think about the risks as well as the potential advantages and cautions. Consider discussing it with trusted, well-trained, and experienced professionals, e.g., a mental health professional. Consider your motivations. Consider the potential consequences, especially if you find content that is ambiguous or upsetting to you. Consider whether you would want anyone reading your journal in a reversed situation.  


Resources (Selected therapeutic writing (“journaling”)


Pennebaker, James W. & Smyth, Joshua M. (2016). Opening up by writing it down: How

expressive writing improves health and eases emotional pain (3rd Ed.). New York: The Guilford Press. 

Lepore, Stephen J. & Smyth, Joshua M. (2002). The writing cure: How expressive writing

promotes health and emotional well-being (1st Ed.). Washington, DC: American Psychological Association.