Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42California Biofeedback — Fall 2016 13 Additional studies show other behav- ioral modalities to optimize performance and address anxiety. For instance, one study reviewed the evidence for CBT and psychodynamic therapy with perfor- mance anxiety; the researcher concluded that both CBT and psychodynamic ther- apy improved performance anxiety. Im- portantly, long lasting changes were noted for psychodynamic therapy (Nagel, 2010) but less so for CBT. Over the last 16 years, major efforts have been made to integrate modern cog- nitive and behavioral psychotherapy ap- proaches with meditation practice. This is also known as the “third-wave” of CBT. These efforts include acceptance-based approaches such as mindfulness and acceptance and commitment therapy (ACT). Acceptance-based interventions, such as mindfulness practices, have been empirically shown to enhance creativi- ty and enjoyment, and improve musical performance, as well as to improve the audience preference of music composed in a mindfulness way versus a non-mind- ful way (Langer, 2005; Langer, Russell, & Eisenkraft, 2008). Table 1 summarizes biofeedback and behavioral approaches that a specialist can implement to im- prove their client’s performances. When implementing multiple behav- ioral approaches that have varying philo- sophical conceptualizations, it is easy for the specialist, and sometimes the client, to get confused about core issues. Adopting a theoretical frame of thinking about mul- tiple behavioral interventions can help us better guide the intervention and client conceptualization. The behavioral medi- cine version of the Y-Model (Ramezani, Rockers, Wanlass, & McCarron, 2016) can assist in understanding the theoretical underpinnings of behavioral interven- tions as they are applied in an adjunctive manner with biofeedback approaches. The behavioral medicine version of the Y-Model (Bmed Y-Model) conceptually frames foundational interventions as the stem of the Y-Model while specialized in- terventions as the branches of the Y-Mod- el. Motivational interviewing/supportive therapy interventions are conceptually Affect Regulation • Recognizing emotions before, during, and after performance • Use of emotions to modify arousal related to peformance Table 1. Performance-Based Be- havior Domain Biofeedback Intervention Behavioral Intervention Sports Performance HRV, EMG, EEG Beta Alpha CBT, PT, ACT, and Mind- fulness Musical Performance HRV, EMG CBT, PT, ACT, and Mind- fulness CBT=cognitive-behavioral therapy; PT=psychodynamic therapy; ACT=acceptance and commitment therapy; HRV=heart rate variability; EMG=electromyogra- phy (surface); EEG=electroencephalography