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THE PURPOSE OF THIS PAPER is to discuss the contributions and limitations of biofeedback mechanisms in a case of hypertension. My presentation will focus on the role of cognition in mediating autonomic behavior in the laboratory and in psychotherapy. Since interpersonal dynamics are implicit in any therapeutic intervention, the importance of this aspect in biofeedback will be stressed. It is my view that where biofeedback research fails to consider cognitive, interpersonal, and attitudinal factors, its effectiveness is limited.
During the past two decades therapeutic techniques derived from learning theory (e.g., behavior modification therapy), have increased enormously. Research in biofeedback, as a special case of behavior modification, currently occupies a prominent position, thus adding autonomic responses to the list of behaviors that can be modified. The delay in the application of biofeedback techniques awaited the development of biomedical technology (Ezios, 1973). To modify essential hypertension, for example, a practical continuous monitoring device had to be designed to provide feedback at each heartbeat for variations in blood pressure.
"Biofeedback, " in the sense used in this paper, and in the current literature, is information derived from internal monitoring which is transmitted to an otherwise not physiologically utilizable sensory channel. Thus blood pressure variations can be "heard", or "seen." It was not until certain sophisticated electronic devices were developed that biofeedback could be a force in modifying behavior. How the person uses this information to modify his responses will be discussed here. In my view how the person uses the information has essentially to do with cognitive events (Ortof, 1973).
Behaviorists such as Skinner (1950), (1971) do not concern themselves with mediating variables, e.g., cognitive events. While