Course Descriptions
The coursework includes 25 separate courses (15 hours each), consisting of seven courses in Physiology (Series 100), eight courses in Psychology (Series 300), eight courses in Interventions (Series 400), and two courses in Business (Series 500). Courses are held in two one-day sessions, on a Saturday or a Sunday, two weeks apart, to provide time for completing assignments, taking examinations, and reviewing relevant material.
PHYSIOLOGY (7 Series 100 Courses, for 7 units)
101 Respiratory Structure & Function
Proper functioning of the respiratory system is essential for bringing oxygen into the body for metabolism and excreting or utilizing the byproducts of cellular respiration, e.g. CO2. This course includes: Anatomy of the pulmonary system - the lungs, airways, pulmonary arteries, veins and bronchial arteries; Histology of the lungs - with emphasis alveolar, bronchial network; Physiology of the pulmonary system - including Mechanics of breathing - how air enters and is expelled from the lungs; Lung Volumes and their significance; Alveolar respiration - how gas exchange occurs; Ventilation and perfusion - ratios and pulmonary circulation; Cellular respiration - how cells utilize O2 ; Central control - neuronal mechanisms; Blood gases - how they are derived and what they mean.
102 Cardiopulmonary Physiology
The Cardiovascular system is essential for life. PART 1 of this course includes: Anatomy of the Heart - gross and microscopic; Cardiac conduction system - the electrical system that controls the heart rhythm; External nervous system - influences on the heart; Peripheral vascular system - arteries, veins and lymphatic systems; PART 2 of this course will demonstrate how the anatomy enables function of the heart, including: Heart as a pump - the cardiac cycle, cardiac metabolism, electrical conduction, and control of the cardiac cycle; EKG’s - the electrical signals generated by the heart; Cardiac output - the volume of blood pumped, how it is measured, and what influences it; Arrhythmias - abnormalities of conduction; and Cardiac diseases.
104 Muscle Physiology & Breathing
Breathing serves respiration when muscles that regulate inhalation and exhalation are in concert with respiratory reflexes. These muscles must be balanced for normal respiration to occur and can be easily influenced by injury, pain and emotion. This course includes: Muscle anatomy - cellular physiology, gross anatomy, myofascial relationships; Physiology - aerobic and anaerobic metabolism, response to hypocapnia; Innervation - specific muscles used for breathing, situations that impact recruitment and mechanics; Pathomechanics - indicators of poor mechanics, effects on breathing when chest wall mechanics are altered through injury, posture, or habit, and when muscle timing and recruitment is negatively affected; Response to exercise - how breathing pattern changes to accommodate increased metabolic demands during exercise, optimizing the aerobic envelope during endurance exercise, impact of overtraining on breathing, relevance of breathing to optimal performance in sport.
105 Breathing & Homeostasis
Enzymatic reactions essential to body functioning require pH to be within specific and narrow limits. This course will over: pH - how it is derived; Acid and Bases - definitions, the Henderson-Hasselbach equation as it is used to determine extracellular pH; Buffers - their definition, their roles; Buffer systems - protein, intracellular bone, bicarbonate, hemoglobin, and phosphate buffer systems; Bicarbonate buffer system - the conversion of carbonic acid to bicarbonate, the role of CO2; Kidney physiology - how the kidneys and lungs work together to maintain pH; Respiratory pH regulation - the role of breathing in causing electrolyte imbalances and in restoring pH balance; Oxyhemoglobin dissociation curve - what is it, how is it influenced, and what does it mean about O2 delivery? Alkalemia and acidemia - metabolic and respiratory, how they occur.
107 Neurophysiology & Behavior
The interaction of “breathing for respiration” with other demands on the respiratory system, both physiological and psychological, involve complex Central Nervous System and Peripheral Nervous System activities, conscious and unconscious. Despite the normally reflexive nature of respiration, neuronal function represents the nexus where learned breathing patterns interact with innate rhythms. This course includes: (1) Nervous system structure and function - the Central, Peripheral, and Autonomic Nervous Systems; (2) Integration of respiratory centers with the autonomic nervous system; (3) Chemoreceptors and other sensory elements sensitive to changes of pH and gases; (4) Neurotransmitters, including nitric oxide; (5) Innervation of respiratory muscles by neurons from the connectome of the ventrolateral medulla (VLM) system for respiratory rhythms - breathing centers and other circuits; and (6) Neuroendocrine interactions - hormonal influences that impact respiratory function.
108 Sleep Physiology and Breathing
What is sleep -sleep stages, sleep cycle by age and gender; Sleep careers - sleep doctors, dentists, techs; Sleep regulators - homeostasis, circadian, adaptive, sleep wake neurotransmitters; Why we sleep - sleep needs, sleep deprivation effects; What happens during sleep - physiological changes; Sleep and breathing - anatomy of airways and sleep; Sleep disorders - ICSD-2 classification; Insomnia - types, sleeping pills, alcohol, CBTi; Sleep related breathing disorders - snoring, apneas, hypoventilation, sleep study, CPAP, oral appliances; Hypersomnia - Fatigue vs. sleepiness, Epworth scale, narcolepsy; Circadian disorders - delayed sleep phase, shift work, jet lag; Parasomnias - sleep walk, nightmares, anxiety, panic attacks; Sleep related movement disorders – RLS, PLMD, bruxism, catathrenia.
109 Instrumentation & Measurement
Technology for measurement of static and dynamic parameters of both respiratory physiology and breathing behavior, make for objective evaluation of dysfunctional breathing and the outcomes of self-regulation interventions. This course includes: Principles - basic hardware physics, measureable physiological parameters, clinical applications, and educational applications; Measurement - respired volumes, ventilatory volumes, ventilatory capacity, respiratory muscles, metabolism, PO2, SaO2, SpO2, PaCO2, HbCO2, HHb, ETCO2, pH, and electrolytes; Instrumentation - capnometry, pH meters, spirometry, strain gauges, thermistors, thermocouples, CO-oximetry, pulse oximetry, brain oximeters, pneumotachography, polarography, respirometers, impedance pneumography, electromyography (EMG), calorimetry, amplifiers, and electrodes; Precautions - measurement misunderstandings, data misinterpretations, instrumentation limitations, and error analysis.
PSYCHOLOGY (8 Series 300 Courses, for 8 units)
301 Respiratory Psychophysiology
Breathing is behavioral and respiration is reflexive. Breathing behavior is subject to the basic principles of learning that govern self-regulation, including motivation, attention, memory, emotion, and cognition. Applied breathing science is about the role of these principles in the acquisition of breathing habit patterns and their effects on health and performance, that is, the practical integration of respiratory physiology with breathing psychology. This course will provide an overview of the relevant sciences, as follows: Physiology - pulmonary anatomy, cellular respiration, internal respiration, external respiration, muscle physiology, neurophysiology, pulmonary diseases; Psychology - behavioral analysis, behavior modification, cognitive learning, interviewing, stress psychophysiology, behavioral disorders; Interventions - educational capnography, EMG biofeedback, HRV training, behavioral counseling, awareness training, habit assessment, habit modification, measurement instrumentation.
302 Behavioral Physiology
Physiology is smart. It is motivated and reconfigures itself through learning. Included in this course are: the Anatomy of behavior - bits and wholes; Self-regulation learning - intelligent homeostasis and meaning; Behavioral genetics - learning probabilities, epigenetics, natural self-selection; Perceptual learning - internal and external “realities;” Biological learning - with and without a nervous system; Learned responses - autonomic, somatic, and central; Behavioral triggers - stimuli, contexts, and states; Kinds of learning - classical, operant, cognitive; Biological reconfiguration - mediated and direct; Dysfunctional learning - same principles, different configurations; Placebo effects - symptoms and relief; Cases - breathing and respiration.
303 Applied Behavior Analysis
Behavior analysis provides the basis for identifying dysfunctional habits, and their histories, triggers, motivations, and reinforcements. It means addressing learning excesses and deficits with the basic principles of the major learning paradigms: Respondent, or classical conditioning- understanding the nature of reflexive behavior and the importance of temporal contiguity; Operant, or instrumental conditioning - the effects of the application or removal of consequences on learning; and the combination of the two to establish a functional assessment of behavior - the ways in which behaviors function to alter the environment of an individual with a particular problem. In addition, the course will focus on single subject experimental designs - ABAB reversal/withdrawal designs, and multiple baseline designs across participants, settings, and behaviors.
304 Behavioral Counseling
Interviewing is fundamental to self-discovery by clients. This course will cover the basic tenants and techniques in behavioral counseling, including: Establishing the teaching/learning alliance - basic listening skills, empathy, clarification, non-judgmental listening; Behavioral interviewing - choosing and operationally defining target behaviors, and getting a history of the particular learning deficit(s) or excess(es); Behavioral assessment - developing hypotheses about the function of excesses and deficits, and identifying factors that trigger and sustain dysfunctional habits; Developing a learning plan - developing the therapeutic contract, enhancing compliance, and choosing the most effective techniques to produce the desired outcome; and Behavioral evaluation - devising an appropriate data system to evaluate overall effectiveness of the learning plan.
305 Psychophysiology, Anxiety & Stress
In emergencies, physical or psychological, our dependence on optimal cardiopulmonary function can be vital to short term survival. In the long term, our learned physiological and psychological responses to stress, such as breathing, may have profound effects on health and performance. This course includes: (1) The CNS as the neural substrate for stress - Papez circuit, limbic system, amygdala; (2) Features and functions of the sympathetic and parasympathetic divisions of the ANS; (3) Emotions - physiological correlates and respiratory concomitants; (4) Drugs of abuse and breathing; (5) Biometric ANS relationships, e.g., GSR and HRV and autonomic balancing processes that involve breathing, e.g., meditation, yogic pranayama, tai chi, and qigong; (6) Endocrine considerations - behavioral and hormonal factors; and (7) Consequences of stressful conditions, e.g., chronic fatigue, chronic stress, fibromyalgia, depression, learned helplessness, and PTSD.
306 Breathing & Behavioral Disorders
Recognizing signs of compromised psychological health is fundamental to effectively assisting clients learn new breathing habits. This course will present a contemporary behavioral model, based on Rational Frame Theory, of conceptualizing, assessing, and treating psychological disorders. Special attention will be paid to emotional and somatic disorders commonly seen among people suffering with dysfunctional breathing habits, e.g., anxiety, panic, phobia, anger, chronic pain, chronic stress, depression, dissociation, trauma, attention (ADD, ADHD), learning disabilities, and performance deficits. These disorders will be conceptualized from a learning analysis perspective and its implications for therapy and behavior change explained. Other disorders will be briefly reviewed from the same perspective, including: addictions, obsessive-compulsive disorder, personality disorders, psychotic disorders, sexual disorders, eating disorders, and attachment disorders.
307 Behavior Therapy Case Histories
Learning self-management strategies is fundamental to overcoming dysfunctional breathing habits. Behavior modification is about the implementation of operant and respondent conditioning techniques for the extinction of dysfunctional habits and the acquisition of new more functional ones. Techniques to be covered include systematic desensitization, shaping and reinforcement, generalized conditioned reinforcers, punishment, extinction, time out, response cost, fading and leaning, procedures to enhance generalization, and ways to address cognitive distortions. Combinations of these techniques will also be covered, including assertion training, social skills training, and relapse prevention. A survey of many of the classic studies in behavior modification with children and adults will be reviewed, such as: learning disabilities, ADHD, anxiety, schizophrenia, problem solving, depression, aggression, and academic/learning deficiencies.
308 Cognitive Behavior Modification
Thinking habits, belief systems, and personal interpretations play a major role in triggering and perpetuating dysfunctional breathing. This course addresses the relationship of behavior with automatic thoughts. It provides an overview of the structure of the assessment session and the fundamental elements of formulating a learning plan. It includes: Cognitive and behavioral triggers - identifying specific places, times, tasks, people, and emotional states that engage dysfunctional habits; Motivation and reinforcement - emotions, self-esteem, sense of control, primary and secondary gain; Mediated effects - associated physiological & psychological symptoms/deficits; Cognition – thinking styles, belief systems and personal interpretations of circumstances and behaviors; Techniques - assertiveness skills, relaxation skills, thought monitoring, comprehensive cognitive restructuring, behavioral activation.
INTERVENTIONS (8 Series 400 Courses, for 8 units)
401 Autonomic Biofeedback
Feedback is a fundamental learning principle. Biofeedback is about identifying habits and learning new ones that regulate basic physiology, habits that may compromise or enhance human health and performance. Feedback modalities - brain waves (EEG), muscles (EMG), temperature, skin response (GSR), blood pressure (BP), heart rate (HR, heart rate variability (HRV), respiration (RESP), carbon dioxide (PCO2); Electronics & software - hardware, feedback displays, feedback controls, data acquisition; Applications - psychotherapy, physiotherapy, medicine, education, sports; Autonomic regulation - fight & flight, vascular, cardiovascular, pulmonary, gastric, systemic; Somatic regulation - dysponesis, muscle pain, muscle dysfunction, headache; Central regulation - attention, anxiety, anger, stress, mood, consciousness; Protocols - learning vs. treatment, mediated vs. direct regulation, autonomic regulation, generalization of learning, case studies.
402 Educational Capnography
Capnography, measurement of partial pressure carbon dioxide (PCO2) in the lungs and in the blood, uniquely provides a real- time window for identifying dysfunctional breathing and then assisting clients overcome self-defeating habits. Are learned breathing patterns in concert with optimal respiration, e.g., pH regulation and oxygen transport? This course includes: Measurement - blood gases, capnographic measurement parameters, artifacts, data misinterpretation, ventilation/perfusion mismatch, instrumentation (ETCO2, PACO2, PaCO2); Medical capnography - anesthesia, mechanical ventilation, sleep, acid-base assessment, CO2 pathophysiology; Physiology - gas exchange, transport of CO2, effects of CO2 on physiology; CO2 regulation at altitude; Oxygen - PaO2, SaO2, O2 content, hemoglobin; Educational capnography - parameters of interest (e.g., aborted breaths), behavioral assessment (e.g., overbreathing), CO2 biofeedback (e.g., negative practice, desensitization), self-regulation learning, trigger testing (e.g., deliberate hypocapnia), group work, real-time coaching, data interpretation.
403 Somatic Biofeedback
Dysfunctional breathing habits not only compromise respiratory physiology, but they frequently have direct, immediate, and profound effects on other physiological systems, especially the musculoskeletal system: Dysponesis - misplaced muscle effort, e.g., bracing with the jaw while inhaling; Functional disorders - identifying dysponesis with symptoms like headaches, visual disturbances, dizziness, nausea, unstable gait, coughing, intestinal upset; Origins - understanding how repetitive patterns of misplaced effort become dysponetic habits; Conditioning - approaching dysponesis as a conditioned flexor-withdrawal response to painful stimuli; Trigger points - .development of painful knots of muscle in muscle groups that "splint" the injured area; EMG biofeedback – the role of relaxing unrelated muscle groups; Chronic dysfunctional breathing habit retraining - reversing abnormal EMG patterns in breathing accessory muscles, due to dysponetic postural adaption; Integrated approaches.
404 Breathing Habit Assessment
Dysfunctional behaviors - identifying specific behaviors that compromise physiology; Learning history - pinpointing the evolution of vicious circle learning patterns; Behavioral Triggers - identifying specific places, times, tasks, people, & states that engage dysfunctional habits; Motivation & reinforcement - emotions, self-esteem, sense of control, dissociation, secondary gain; Mediated effects - associated physiological & psychological symptoms/deficits; Cognition - belief systems, personal interpretation of symptoms; Information gathering - history taking, behavioral checklists, symptom checklists, breathing interview, phenomenological exploration, psychophysiological testing, breathing mechanics analysis; Guided exploration – intentional manipulation, memory & imagery challenges, en vivo testing, breathing mechanics challenges, negative practice, overbreathing, anaerobic testing; Types of evaluation - short form, long form, guidelines for referrals by colleagues.
405 Breathing Habit Modification
Habit modification is client-centered, not treatment oriented. Objective - learning new unconscious breathing habits vs. imposing conscious breathing exercises; Crisis interventions - breathing techniques, cognition, band aids devices; Cognitive learning - new thoughts, new interpretations of symptoms, new understandings; Desensitization - of conditioned emotional & motivational responses associated with breathing mechanics & breathing mediated symptoms; Extinction - removal of reinforcements for dysfunctional habits, reinforcement for adaptive competing responses, deactivating behavioral triggers; Negative practice - intentional engagement of dysfunctional habits, e.g., chest breathing; Reinforcements - establishing new reinforcements, changing behavioral preferences; New Habits - allowing for respiratory reflexes (trust), diaphragmatic breathing, quiet breathing; Biofeedback - EMG and CO2 feedback; Generalization - learning in the field.
406 Heart Rate Variability Biofeedback
Heart rate and breathing are inextricably related. The variability of heart rate (HRV) and its patterns reflect states of emotion, arousal, and health. Included in this course are: HRV physiology - cardiac inputs and outputs, myths about heart rate, HRV as a measure of health and conditioning, effects of stress, and demographic differences; HRV measurement - specific frequencies and spectral analysis of multiple frequencies; HRV and emotions – coherence, resonant frequency, and breathing; HRV assessment - research findings; breathing (capnography) and HRV monitoring; HRV flexibility training - optimizing autonomic balance for emotional self-regulation, health risk reduction, and performance enhancement.
407 Survey of Breathing Interventions
This course will describe a number of programs, techniques, and approaches to changing breathing patterns. Instructing individuals to modify their breathing in order to improve some mental or physical condition is popular among those engaged in human services, but there is some lack of agreement among the myriad methods, and the basic science underlying breathing regulation is often neglected. Breathing is probably the biologic function most alterable by conscious intent and this leverage over deeper body processes offers access to change of many kinds. Techniques such as yoga, bioenergetics, holotropic breathing, Gindler, biofeedback, Buteyko, Reichian, respiratory therapy, diaphragmatic breathing, and rebirthing will be described as to their methods, goals, and (where available) supportive research.
408 Consciousness & Breathing
Conscious breathing, also known as breath awareness, provides an intimate pathway into ourselves. Breath awareness will be practiced as an overall work in meditative, somatic and therapeutic disciplines’ for health, self-discovery and self-transformation. Self-awareness and conscious breathing are the keys to integral change for health, well-being and living a life that is authentic. In this class students will learn to identify their own habits of mind that shape the lens through which they view themselves and the world. The course will provide students with a key element for successful partnering with clients to overcome dysfunctional breathing habits: opportunities to expand understandings of their own relationships with colleagues, clients, and themselves.
BUSINESS (2 Series 500 Courses, for 2 units)
501 Business Plan
Students will develop a working business plan tailored to the services offered to their clients. Each of the major components of creative business planning will be reviewed and discussed, including goals and objectives, legal structure, tax and regulatory issues, a description of services and their evolution over time, pricing, an initial marketing plan supported by market research and competitive analysis, financial requirements, and a financial plan complete with operating budget, cash flow, and income projections. Students will learn which aspects of their business plans are most important to specific audiences, and how then to continuously update their plans based on changing circumstances. The feedback and contributions from student colleagues will be an invaluable part of the learning process.
502 Marketing Plan
Traditional marketing concepts will be explored in the context of working with clients who have dysfunctional breathing and developing an understanding of a service /market fit and how well services offered match market needs. Using clinical examples, we will study the key differences between educating vs. treating clients. The role of marketing materials including brochures and promotional materials will be covered as well as the role of cross-selling. Students will experience the importance of launching a Minimum Viable Service (MVS) and conducting ongoing testing to validate both the services offered and the methods for reaching prospective clients. Validation techniques will include client interviews, A/B testing, feedback forms, surveys, and other methods. The end result will be both a marketing plan and a business model for continuous service improvement based on client satisfaction.