When using BFRT, it is first necessary to determine if the client would benefit from such therapy. General relaxation may be helpful in a variety of conditions and it may also be useful as an incompatible response during such procedures as systematic desensitization. BFRT normally takes between 8 and 20 sessions, depending on the acquisition skills and the distress level of the client before and during therapy. After determination of the need for BFRT, the therapist must explain the rationale for biofeedback therapy, outline the basic aspects of the physiological processes that will be trained, and discuss the potential benefits and risks of the training. This author recommends conducting the first BFRT session with frontal EMG feedback, while monitoring other modalities such as finger temperature, SCA, and/or heart rate. The therapist may also find it beneficial to monitor additional physiological events that are connected to the specific conditions being treated. During the first biofeedback session, facial muscle discrimination training should be demonstrated and the client should be provided time to use his or her relaxation techniques to reduce frontal EMG levels. The therapist should monitor the other modalities during the session to observe the changes that occur as the client tries to reduce frontal EMG levels. An example of the value of monitoring other modalities is that by observing SCA, it can be determined if the client is engaging in arousing internal dialogue by noting if several SCRs are observed. If so, the therapist can interrupt the session and suggest a change in strategy by the client. During the interruption, the therapist should ask the client what strategy he or she is using and then encourage him or her to select a different strategy, such as diaphragmatic breathing or changes in imagery. The most responsive modality is usually selected as the target of therapy after frontal EMG levels are acceptable.
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