EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain

24 patients with chronic low back pain were randomly assigned to three treatment conditions: EMG biofeedback, relaxation training, and a placebo condition. Patients were seen for eight sessions and were evaluated before Session 1 and after Session 8. Eight analyses of covariance which were adjusted for age and pretest scores were computed on the final scores to find which variables could detect significant difference between treatments. Age was included as a covariate because the differences in age between conditions were significant. Four variables with significant and nearly significant differences were chosen for analysis. The second set of analyses identified the nature of the differences among the three conditions. These included a priori planned comparisons among conditions, and paired t tests. Relaxation-trained subjects were significantly superior to subjects in the placebo condition, in decreasing pain during the function test, increasing relaxation, and decreasing Upper Trapezius EMG. They were superior to EMG Biofeedback training in increasing reported activity. Both Relaxation and EMG trained subjects were able to reduce Upper Trapezius EMG by Session 8. Relaxation-trained subjects showed significant change on eight of the 14 possible comparisons for each treatment condition. EMG biofeedback training showed significant favorable results in only one condition; the placebo condition showed no significant results. Relaxation training gave better results in reducing EMG and pain, and in increasing relaxation and activity than either EMG biofeedback alone or a placebo condition.     

The treatment of tension headache—II. EMG ‘normality’ and relaxation

A selected group of patients complaining of severe and chronic tension headache (without muscular abnormality) were given a short 3-week course of relaxation treatment. Half of the subjects received progressive relaxation instructions, while the other half received relaxation plus calming imagery. Both groups showed substantial improvements in pain behaviour and in pain experience. The improvements were synchronous and still present at the 6–8 week follow-up assessment. Although no significant differences were found between the groups, the addition of imagery appeared to produce larger improvements on a number of measures. These results were compared with those reported obtained in a previous biofeedback study and the implications of both the studies were discussed with respect to tension headache and its treatment.     

The relationship between frontalis muscle activity and self-reports of headache pain

The relationship between levels of frontalis muscle activity and self-reports of pain was evaluated in two studies. In Study I frontalis muscle activity and self-reports of pain collected during biofeedback treatment of muscular contraction headache clients were correlated. In Study II frontalis EMG activity was increased and decreased using biofeedback techniques while concurrent reports of headache pain were recorded. The results of Study I indicated a significant relationship between EMG activity and reported headache pain for only two of the five subjects studied. The biofeedback procedures in Study II were associated with reliable increases and decreases in EMG activity. Concordance between EMG and pain reports occurred only during the EMG increase condition. Overall correlations were significant for one of the 2 subjects. The results suggest that EMG activity may not be sufficient to account for pain reports in all chronic headache clients, and variables other than EMG activity may be influencing reports of pain in some patients.     

Physiological changes after biofeedback and relaxation training for multiple-pain tension-headache patients

This paper is concerned with the psychophysiology of "muscle-contraction" headaches in a group of Compensation patients suffering from multiple pain problems in addition to headaches. A total of 55 of these patients were divided into 4 groups which received frontalis EMG biofeedback, relaxation training, combined biofeedback-relaxation training, or no treatment. Differences were observed among the 3 experimental treatments and the control group with respect to headache changes, but there were no differences among groups with respect to the changes observed in four underlying physiological responses as a function of time or practice. While the subjects who showed the largest changes in headache characteristics were those who exhibited the largest decreases in frontalis EMG, these were also the subjects whose initial frontalis EMG levels were the highest. It is concluded that, in keeping with a growing literature, the link between frontalis EMG and "muscle-contraction" headaches is a tenuous one and that the changes brought about in headache symptomatology through biofeedback or relaxation training are most likely attributable to a generalization of feelings of mastery over the environment or of self-efficacy brought about in the subjects through apparent success at the task.     

Comparative effectiveness of patterned biofeedback vs meditation training on EMG and skin temperature changes

This study examined whether a low arousal, relaxation pattern of frontalis EMG decreases and peripheral skin temperature increases could be attained more effectively through biofeedback or meditation training. Thirty female subjects, ranging in age from 21 to 59, were randomly assigned to one of three groups: patterned biofeedback, clinically standardized meditation or control. Prior to training, subjects were administered the EPI. Each subject was seen weekly for seven sessions. Subjective experiences and time spent practising at home were also recorded. Repeated measures ANCOVA's performed on the EMG and skin temperature means indicated that the meditation group showed significantly lower EMG levels at the end of treatment than the control group. No group had significant temperature increases nor were there any significant differences in practice time. The biofeedback group had difficulty in patterning the two feedback signals simultaneously. Extraverts in the control group had the highest EMG levels. The most positive subjective reports came from subjects in the meditation group. Meditation offers a viable alternative as a relaxation procedure, requiring little time to learn and devoid of any performance criteria levels.     

肌间隙入路与传统入路经椎间孔腰椎椎体间融合术治疗腰椎滑脱症的比较研究

为改良经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎滑脱症的手术入路,对两组共41例患者分别经多裂肌与最长肌间隙入路和传统后正中骶棘肌剥离入路行TLIF手术,随访6个月。结果显示肌间隙入路组术中出血量、术后引流量、切口区域疼痛、腰腿痛功能障碍恢复情况均优于传统入路组。因此,经肌间隙入路行TLIF手术治疗腰椎滑脱症可以明显降低手术创伤造成的多裂肌退变和术后慢性腰背疼痛的发生率,提高临床疗效。     

The treatment of tension headache—I. Muscular abnormality and biofeedback

The specificity and efficacy of a short EMG biofeedback treatment were assessed in a selected group of chronic tension-headache cases—those having significantly elevated levels of muscle tension. The effects of training patients to raise/maintain EMG levels were compared to those obtained from patients who were trained to lower tension levels. The results showed little evidence of increased self-control of the muscle despite successful EMG control during six bio-feedback sessions. A progressive and significant reduction in resting level was found only in the groups trained to reduce EMG levels. The treatment proved ineffectual in reducing headache. The implications of the dissociation of muscle tension and headache are discussed both with respect to current views of tension headaches and the role of biofeedback in their treatment.     

A comparison of stress-reduction behavioral counseling and contingent nocturnal EMG feedback for the treatment of bruxism

This study compared the efficacy of two treatment modalities (stress-reduction behavioral counseling and contingent nocturnal EMG biofeedback) on night-time bruxism. The 16 subjects (Ss) were assigned sequentially to one of four treatment groups: (1) stress-reduction behavioral counseling: (2) nocturnal biofeedback; (3) stress-reduction behavioral counseling and nocturnal biofeedback; and (4) waiting-list control group. A portable EMG unit was used to record the nightly total of electrical activity (?20 μV) from the masseter muscle 10 days before and after treatment. The three treatment procedures were found to be significantly superior to no-treatment control group. The outcome of the two treatments which made use of stress-reduction behavioral counseling, although better than the treatment which solely used nocturnal biofeedback, was not significantly better. This study demonstrates that stress-reduction skills learned while awake can have a generalized effect on stress-induced muscle activity during sleep. Implications for further research are discussed.     

Spatial and temporal characteristics of the spine muscles activation during walking in patients with lumbar instability due to degenerative lumbar disk disease: Evaluation in pre-surgical setting

Our purpose was to investigate the spatial and temporal profile of the paraspinal muscle activation during gait in a group of 13 patients with lumbar instability (LI) in a pre-surgical setting compared to the results with those from both 13 healthy controls (HC) and a sample of 7 patients with failed back surgery syndrome (FBSS), which represents a chronic untreatable condition, in which the spine muscles function is expected to be widely impaired.Spatiotemporal gait parameters, trunk kinematics, and muscle activation were measured through a motion analysis system integrated with a surface EMG device. The bilateral paraspinal muscles (longissimus) at L3-L4, L4-L5, and L5-S1 levels and lumbar iliocostalis muscles were evaluated.Statistical analysis revealed significant differences between groups in the step length, step width, and trunk bending and rotation. As regard the EMG analysis, significant differences were found in the cross-correlation, full-width percentage and center of activation values between groups, for all muscles investigated.Patients with LI, showed preserved trunk movements compared to HC but a series of EMG abnormalities of the spinal muscles, in terms of left-right symmetry, top-down synchronization, and spatiotemporal activation and modulation compared to the HC group. In patients with LI some of such EMG abnormalities regarded mainly the segment involved by the instability and were strictly correlated to the pain perception. Conversely, in patients with FBSS the EMG abnormalities regarded all the spinal muscles, irrespective to the segment involved, and were correlated to the disease’s severity. Furthermore, patients with FBSS showed reduced lateral bending and rotation of the trunk and a reduced gait performance and balance.Our methodological approach to analyze the functional status of patients with LI due to spine disease with surgical indications, even in more complex conditions such as deformities, could allow to evaluate the biomechanics of the spine in the preoperative conditions and, in the future, to verify whether and which surgical procedure may either preserve or improve the spine muscle function during gait.     

EVALUATION OF BIOFEEDBACK IN THE TREATMENT OF BORDERLINE ESSENTIAL HYPERTENSION1

Direct biofeedback of blood pressure was compared with frontal EMG biofeedback and with self-instructed relaxation for the treatment of essential hypertension in a controlled group outcome study. Patients were followed up for four months after the end of treatment. Generalization of treatment effects was assessed through pre- and posttreatment measurements of blood pressure under clinical conditions in a physician's office. There were no significant reductions in diastolic blood pressure. The systolic blood pressure (SBP) of the patients receiving blood pressure biofeedback decreased 8.1 mm mercury (p = 0.07) and the SBP of the patients in the relaxation condition decreased 9.5 mm mercury (p = 0.05). In the generalization measures, there were significant reductions in SBP for the relaxation group. The results are discussed in terms of the general lack of replicability within the area of biofeedback treatment of hypertension.     

Effects of electromyographic biofeedback on reaction time and movement time

The effects of electromyographic (EMG) biofeedback on reaction time (RT) and movement time (MT) were investigated utilizing 42 right-handed, male subjects from a university population. Subjects were randomly divided into three groups, a control group and two experimental groups. Both experimental groups were exposed to their EMG signals from their triceps brachii during the task, one experimental group received written information explaining the purpose of the EMG was to improve performance through biofeedback. Reaction times of the first block of 25 trials were significantly faster than those on the subsequent three blocks of trials for all groups. This provided evidence of learning. No other significant effects for reaction times were observed. Mean movement time for the EMG-only group was significantly slower than the means of either the Control group or EMG-Biofeedback group, with no difference between the latter two. The differences between experimental groups may have been related to alteration of strategy, anxiety, motivation.     

Relief of phantom limb pain after EMG biofeedback-assisted relaxation : a case report

Both EEG and EMG biofeedback were used to treat severe, chronic phantom limb pain in a 54 yr-old man. Although EEG biofeedback was ineffective, EMG biofeedback-assisted relaxation of the muscles in the stump allowed the patient to greatly reduce the frequency and intensity of the pain after about 4 h of practice. Both somatic and cognitive variables may have contributed to the effectiveness of the procedure.     

BIOFEEDBACK AND RATIONAL-EMOTIVE THERAPY IN THE MANAGEMENT OF MIGRAINE HEADACHE

Twenty-four migraine patients were randomly assigned to one of four conditions: (a) self-monitoring of headache activity (waiting list), (b) frontalis EMG biofeedback, (c) digit temperature biofeedback, and (d) digit temperature biofeedback plus Rational-Emotive Therapy (RET). Bidirectional control over the target physiological response was assessed through a reversal design in each session. Following at least a four-week baseline, the three biofeedback groups received 8 to 10, 30-minute sessions of bidirectional biofeedback training, scheduled twice a week. Subjects in the combined digit temperature biofeedback plus RET group received three 40-minute sessions of RET as an addition to the third, fifth, and seventh biofeedback sessions. Records of daily home practice were kept throughout treatment and three-month followup. Subjects on the waiting list monitored headaches for at least five months, corresponding to “baseline”, “treatment”, and three-month followup. Digit temperature biofeedback alone and in conjunction with RET did not prove to be more effective than the control conditions. All the EMG subjects reduced headache activity to two-thirds or less of the baseline level by the third month of followup. Bidirectional digit temperature performance did not improve with training, was demonstrated in only 33% of the biofeedback sessions, was not maintained over time, and was unrelated to improvement in headache activity. EMG subjects reported biofeedback performance to be an easier task and met the performance criterion on 85% of the sessions. The frequency of home practice contributed over 55% of the variance in retrospective estimates of headache improvement but was not related to changes in daily records of headache activity.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Biofeedback to enhance psychophysiological effects of imagery

Unlike most applications of biofeedback, the outcome goal and the aim of the present investigation was to increase arousal by the provision of feedback. The ability to generate psychophysiological arousal during noxious imagery may be therapeutically beneficial to individuals receiving emotive imagery therapies, and in the present study we evaluated biofeedback as a means of correcting psychophysiological deficits in imagery. Thirty psychophysiologically unreactive undergraduates were randomly assigned to skin-resistance-level biofeedback, false-feedback, or no-feedback conditions for six sessions of assessment and treatment. The methodology controlled for placebo, practice, and initial value effects. Significant increases in skin resistance level, heart rate, and frontalis electromyography accrued to the biofeedback group but not the control groups, and these gains persisted when biofeedback was withdrawn. Subjective measures showed no changes. The results support the usefulness of biofeedback as a remedy for imagery underarousal.     

生物反馈疗法对大学生考试焦虑的治疗作用

探讨生物反馈疗法对大学生考试焦虑的治疗作用。在某大学随机抽取学生1500名,采用考试焦虑量表进行筛查,选取焦虑组和对照组各30名。利用生物反馈疗法进行干预,采用脑电α波相对功率、肌电和皮电导联进行检测,每周2次,持续4周。结果表明：1.经过4周的干预,焦虑组干预前后各生理指标存在差异;2.生物反馈疗法干预考试焦虑在疗效上存在性别差异。结论：生物反馈疗法能有效降低大学生考试焦虑水平,对其治疗取得良好的效果。     

Four process studies in the behavioral treatment of chronic headache

Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.     

Initial relaxation response: contrasts between clinical patients and normal volunteers

The effectiveness of EMG biofeedback, progressive muscle relaxation, autogenic training, and self-relaxation were compared using a within-subjects design. Thirteen clinical subjects and 48 normal volunteers participated in 4 counterbalanced relaxation sessions using one of the techniques. Frontalis EMG and surface skin temperature were monitored throughout the sessions. For reducing EMG, biofeedback was more effective than the other three techniques. A significant interaction of treatment X subjects was found for changes in skin temperature. Clinical subjects had the greatest increase in skin temperature with EMG biofeedback and analog subjects responded best to self-relaxation. There were no significant differences in initial measures of EMG or skin temperature for the two samples.     

Prior task failure as a determinant of biofeedback and cognitive task performance

In a study of the effects of controllability of outcomes upon behavior in a biofeedback context, 40 college students were assigned to four groups differing in pretreatment: (1) a success-failure group, given false feedback in a fictitious blood-vessel control task for two sessions designed to convey success followed by two sessions of failure feedback; (2) a failure-failure group, given false failure feedback throughout pretreatment; (3) a contingent failure group, receiving actual feedback in a temperature biofeedback task with criteria that assured failure throughout pretreatment; and (4) a control group, given no specific task during this phase. In a subsequent phase, all subjects received actual frontal (forehead) electromyographic (EMG) response training with biofeedback. In analyses of the results, during EMG training, the contingent failure group attained lower levels than the other three groups. By contrast, on a cognitive (anagram) task, interpolated between pretreatment and EMG training, the contingent failure group demonstrated relatively poorer performance than the other groups. The results are discussed in terms of reactance and learned helplessness theories of perceived loss of control in this context.Some of the data reported here were included in a thesis submitted by the second author in partial fulfillment of requirements for the master's degree in psychology, University of Hawaii, 1981. The entire paper was the basis for a presentation at the annual meeting of the Biofeedback Society of America, Albuquerque, 1984.     

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Objective

This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.

Method

Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.

Results

Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.

Conclusions

Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.