Biofeedback Society of California Conference 2014 – George Fuller: Wearables and Apps

by Siegfried Othmer | November 12th, 2014


by Siegfried Othmer, PhD

BSC Conference 2014
G eorge Fuller von Bozzay spoke about new developments in the area of wearables, apps, and other consumer-oriented devices. As it happens, he has himself been involved in one of these developments in the past. One of his neighbors is (or was) Ryan Gordon of Atari fame, and at a time when he was looking for projects he became intrigued with George Fuller’s idea for the development of video feedback for a GSR signal. Gordon insisted, however, that it be in the form of a game, and thus emerged the first such product, “Mind Drive.”

Some $6M had been sunk into its development before Mind Drive itself sunk in the marketplace. The public was not yet attuned to such a product. By now the response might well be different. Devices for tracking physiological measures are popping up all over, mostly in connection with the physical fitness market. What’s breaking the cost barrier here is the interface to standard imaging devices, such as the iPad. All of a sudden the workhorse measures in traditional biofeedback can be inexpensively tracked with non-clinical devices.

Developers of professional instrumentation might well make the argument for accuracy that behooves a research-grade physiological monitor, but such accuracy is largely wasted on such flaky measures as one is dealing with here. One does not need to know the GSR to within 3%, as one is interested mainly in trends anyway. Precision is of interest, but accuracy less so. If one cared about accuracy in determining heart rate, then one would not choose to use photoplethysmography on an extremity—whether finger or earlobe—in the first place. One certainly does not need to track EMG with any accuracy, either. The only measure where accuracy matters at all is in temperature sensing, and there it is easy to get. In sum, then, consumer-grade devices should be adequate for all of our feedback and monitoring purposes.

I was particularly intrigued by two devices under discussion. The first is the new “Inner Balance” from Heartmath. I have nothing to go on yet that would justify a recommendation, but I harbor great hopes that this iteration of their designs may meet our needs for clinical use as well.

The second device is the “Up24 jawbone,” a fitness tracker that is worn on the wrist. Rather single-mindedly I am only interested in the sleep mode of the device. Using nothing more than information related to movement of the arm, the unit appears to be able to distinguish fairly reliably between the different sleep states, and thus the Up24 could possibly be a stand-in for the much-mourned Zeo, yet another device that may have surfaced before its time. We badly need an objective means of tracking sleep quality in our clients.

The device communicates with a smartphone via Bluetooth, so one has to be content with the emfs involved. However, we would be asking only that it be used while training is ongoing. Reviews indicate that the sleep tracking mode still leaves room for improvement, but we don’t need perfection in order to be a lot better off than we are at present. Self-report is notoriously unreliable when it comes to sleep.

In the course of his discussion of the new technology options, George also tossed out a number of observations that I will simply pass on: He feels that GSR gives one the best introduction to standard biofeedback. This is likely because of its high responsiveness to any emotionally laden inputs, a matter that is easily confirmed with the client.

In the discussion of breathing, George called into question the advice that is commonly given even by medical professionals to a person struggling with acute anxiety: “Just take a deep breath and relax.” That just happens to be very bad advice indeed. The in-breath should not be accentuated. In fact it is best not to focus on the in-breath at all, but rather on the outbreath. The focus should be on extending the outbreath, and then simply letting the inbreath happen as it will, without deliberate augmentation.

“With the focus on the outbreath you can peel a panic attack off the ceiling,” said George. It is the best emergency measure for acute anxiety. The target mechanism is clear: One wants to have an immediate impact on the CO2 level in the brain. The mere instruction to slow one’s breathing may well lead inadvertently to a hyper-ventilation status unless the emphasis is placed exclusively on the outbreath.

George observes that HRV is becoming baseline in biofeedback as a training tool. “It used to be EMG,” he said. This surprised me because, as he himself acknowledged, “not everyone is muscularly tense.” But if the signal is responsive, it does make a good training tool. (My comment: In this connection, it should also be mentioned that muscle tension has the curious property that the body can accommodate to a new ambient readily without the person having much of a sense of the existence of muscle tension. In consequence, it may well be the case that even if a person is taken to calm states with the use of neurofeedback, muscle tension nonetheless persists.)

In reflection on George’s talk, one can project that the likely course of events will see the broad acceptance of physiological monitoring in an optimum performance context, which then leads naturally to the acceptance of biofeedback as a tool of augmentation of functional competence. We may find ourselves entering a virtuous circle in which self-regulation strategies come to be seen as one of our ongoing obligations as we confront the strains of a Western-style existence. Whereas a deficit focus leads one to expect a finite course of remediation, a focus on optimum functioning is an ongoing concern. Self-regulation status should be a lifetime pre-occupation.

In this development, the standard biofeedback methods stand in the first rank because of their face validity, accessibility, robustness of signal, and low cost. As these technologies diffuse out into the culture, one might well wonder what will be the role of the clinician in all of this. All along it has been true in biofeedback that a great deal of reliance had to be placed on home training. One does not need many sessions with a therapist to be instructed on temperature training. The ongoing role of the clinician is to assure compliance, a coaching role, and to monitor progress. It occurs to me that these technologies lend themselves well to remote monitoring and remote guidance from a clinician, since the end goal is to transfer the competence entirely to the trainee in any event.

Photo: (L to R) George Fuller, Brian Milstead

Siegfried Othmer, PhD

2 Responses to “Biofeedback Society of California Conference 2014 – George Fuller: Wearables and Apps”

  1. Robin Hyman, M.S. Clinical Therapist says:

    I am preparing a presentation to a state facility I work at that treats incarcerated violent sex offenders. The latest research is saying the use of neuro-biofeedback is able to help these offenders better regulate their emotions. I believe state and private facilities will soon be purchasing these machines, across the country, due to “best practices” research currently being done about the effectiveness of this treatment. Do you do presentations, know of someone who could present at my facility, or loan a machine so I can demonstrate how it works at my presentation?
    I am writing from my personal email (

    Thank you so much.

    Robin Hyman, M.S. Clinical Therapist

  2. Good news on all counts.
    Indeed neurofeedback has been used successfully with violent offenders in general, and with violent sexual offenders in particular. Such success has been documented going all the way back to the 1970’s, where the earliest training protocols were applied. Since that time, methods have further matured and elaborated.
    Extensive work was done in the Kansas prison system in the eighties, until budget stringencies cut off the work.

    As you know, much of sexual violence is traceable in to a multi-generational issue in which the current generation’s violent propensities trace back to abuse in early childhood. How can that be addressed in the present day, after behavioral patterns have become thoroughly established?

    Our own approach to this problem, which has evolved over the last dozen years, has been found to be particularly helpful in application to the consequences of early trauma, irrespective of whether this means physical trauma or emotional.

    The good news notwithstanding, some violent offenders may be reluctant at the outset to commit to this kind of brain training program. It has been found useful in the past to introduce them to the concept of self-regulation by means of conventional biofeedback techniques. These techniques may be helpful in kicking off the process, and also in accompanying the process of neurofeedback with self-training.

    We are certainly available for talks to professional audiences. As you are in Illinois, you may want to get in touch with our marketing person in Chicago, Stephanie Lounds (

    Siegfried Othmer, Ph.D.
    Chief Scientist

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