Multiple sessions of systolic blood pressure biofeedback: Its effects on ability to control systolic pressure during training,after training,and its effects on pulse rate

Seventy-one normotensive subjects participated in four training sessions in which they were either (a) instructed to increase their blood pressure, (b) instructed to decrease their blood pressure, or (c) not instructed to change their blood pressure. The subjects either (a) were provided with biofeedback concerning systolic blood pressure or (b) were not provided with biofeedback concerning systolic blood pressure. After the last training session, subjects participated in a transfer session in which they were again instructed concerning changes in pressure but were not provided with biofeedback. Analyses conducted on data from the training and transfer sessions indicated that subjects who were instructed to increase pressure and given biofeedback to aid them showed higher pressure than subjects in other conditions and that there were no differences among those other conditions; that is, biofeedback was effective for teaching subjects to increase pressure but was not effective for teaching subjects to decrease pressure. Additional training sessions did not add to the effect achieved in the first training session. During training sessions, subjects who were instructed to increase pressure showed higher heart rates than subjects in other conditions. The results raise questions concerning the interpretation of earlier experiments that did not include no-treatment, instructions-only, and attention control conditions.     

Development of physiological response patterns concomitant with the learning of voluntary heart rate control.

Thirty-six male undergraduate students were instructed to raise or lower heart rate in a multiple-session biofeedback experiment. Systolic and diastolic blood pressure, frontalis electromyographic activity, and skin conductance level were simultaneously recorded throughout biofeedback training. Principal axes factor analyses showed that physiological response patterning concomitant with the development of heart rate control was different early in training (Training Session 1) than it was late in training (Training Session 4) for both speeding and slowing conditions. These results indicate that different heart rate control strategies were used by the subjects early and late in training. The factor patterns also indicated a tendency for greater heart rate response specificity as training progressed for both speeding and slowing. Heart rate speeding sessions were also found to be associated with a significant increase in perceived state anxiety as measured by the State-Trait Anxiety Inventory. No significant change in perceived anxiety state, however, was associated with heart rate slowing.     

Medlemsaktivitet i BTF

Abstract

EMG-biofeedback assisted relaxation training was used in the treatment of tension headache. Two groups of subjects were treated with either a “standard biofeedback” method, or a “biofeedback with generalization training” method. The latter included procedures which were aimed at maximizing voluntary control of frontal muscle activity in the absence of external feedback, as well as the ability to use the self-regulation skills in every-day life. The results indicated that only the “standard biofeedback” group showed evidence of increased relaxation abilities. However, these greater achievements were not accompanied by comparable superiority regarding headache decreases. These results are discussed and some hypothetical explanations are put forward.     

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.     

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.     

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.     

MODIFICATION OF COMBINED MIGRAINE-MUSCLE CONTRACTION HEADACHES USING BVP AND EMG FEEDBACK

The effect of blood volume pulse (BVP) and frontalis muscle action potential (EMG) feedback on control of vasoconstriction of the temporal artery and frontalis muscle activity in combined migraine-muscle tension subjects was investigated in a multiple baseline design (across subjects and responses). The data indicated: (a) both subjects obtained an ability to control BVP during BVP feedback and EMG during EMG feedback; (b) there were decreases in frequency of migraine headaches during BVP feedback and decreases in muscle contraction headaches during EMG feedback. The results of this study supported the theoretical explanation of two pain mechanisms involved in combined muscle contraction-migraine headaches as well as the effectiveness of biofeedback procedures that target directly the specific pain mechanism in the elimination of the two types of head pain.     

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.     

Temperature self-regulation and relaxation with migraine patients and normals

Ten migraine headache subjects and 10 non-migraine subjects were divided equally into two groups: a progressive relaxation group and a finger temperature biofeedback group. Finger temperature, temporal artery pulse amplitude and forehead blood flow were monitored for all subjects during two baseline and six treatment sessions.

The biofeedback group achieved greater (albeit low magnitude) increases in finger temperature than the relaxation group, but no improvement in headache activity was obtained. However the relaxation group improved significantly in terms of headache intensity.

There was no significant difference in the ability to achieve finger temperature control, nor in stability point temperatures, between the migraine and non-migraine subjects.

No systematic relationship was found between finger temperature, forehead blood volume and temporal artery pulse amplitude. Possible mechanisms of the therapeutic effects of finger temperature training are examined in the light of these results.     

Effects of instructions, biofeedback, reward, and cognitive mediation on the control of heart rate and the application of that control in a stressful situation

Subjects in Phase 1 of this experiment were (a) instructed to try to either increase or decrease their heart rate, (b) with or without the use of biofeedback, and (c) with or without the promise of money for successful performance, whereas no-treatment subjects were given no instructions, no biofeedback, and no promise of reward. Results indicated that (a) when simply instructed to do so, subjects could increase but not decrease their heart rates relative to no treatment controls, (b) the promise of money for good performance aided subjects in increasing but not decreasing heart rate, and (c) biofeedback did not aid subjects in either increasing or decreasing heart rate. Various cognitive strategies employed by subjects in controlling their heart rates are discussed.In Phase 2, subjects in a stress condition were told that they would receive a series of painful electric shocks, whereas subjects in a no stress condition were not told about shocks. All subjects were instructed to try to decrease their heart rates during the “shock” period. Heart rate and self report data revealed that (a) the manipulation was successful in increasing stress, and (b) previous training in decreasing heart rate, with or without biofeedback, did not aid subjects in decreasing their heart rates in the face of the stress.     

Effects of active and passive EMG biofeedback training on performance of motor and cognitive tasks.

The goal of this study was to compare the effects of general relaxation (passive group) and neuromuscular tension control (active group), both using EMG biofeedback techniques, on the performance of memorization, simple reaction time, and rotary pursuit. 18 subjects were given five consecutive daily sessions of training or were placed under control conditions, after which their performance on these various tasks was evaluated. Results indicate that control of neuromuscular tension seemed to facilitate performance on all tasks over that of the control group. Except for simple reaction time, there was no difference between the "active" and "passive" groups. The results are interpreted in terms of factors in selection of subjects and experimental conditions.     

Awareness of the response after feedback training for changes in heart rate and sudomotor laterality

What is the relation between the ability to control visceral responding on a biofeedback task and the ability to report behaviors actually contributing to this performance? Subjects received biofeedback training for unidentified visceral responses and then gave written reports about what they had done to control the feedback displays. Independent judges were given these reports and, on the basis of knowledge about activities known to contribute to visceral activity, were asked to determine the visceral responses for which the subjects had been trained. The reports of subjects who succeeded at bidirectional control of heart rate (Experiment 1) or sudomotor laterality (Experiment 2) showed awareness of behaviors related to feedback as assessed by this procedure, whereas the reports of subjects who failed at bidirectional control did not. Subsequent experiments indicated that these results did not depend on a learning strategy that might have been specific to the initial studies. These findings call into question the view that people are unaware of what they have done to produce the response after training on biofeedback tasks. Earlier studies reporting lack of awareness in biofeedback are discussed in light of factors that affect the measurement of biofeedback learning and response awareness.     

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.     

The Impact of Biofeedback-Manipulated Physiological Change on Emotional State

In the present study, subjects were administered 16 biofeedback sessions, during which they were trained to significantly increase and decrease their heart rates. Before and immediately following each biofeedback training session, state anxiety was evaluated in subjects by use of the State-Trait Anxiety Inventory. Results indicated that heart-rate slowing performance was associated with a significant decrease in state anxiety; heart-rate speeding performance was associated with an increase in state anxiety. The implications of these findings for further investigation of theories of emotion, and the role played by physiological arousal, are discussed.     

Alpha enhancement: a comparison study of biofeedback, open focus training, and control procedures

Alpha wave production has been related to affective and physiological arousal states since Berger's (1929) initial research. More recently, the possibility of subjects' control of alpha production has been investigated via the innovation of biofeedback procedures. Research conducted by Kamiya in the 1960s and others led to the early conclusion that alpha-wave production could be controlled and that such control could facilitate enhancement of a person's state of physical and psychological well-being. Subsequent research data have questioned these conclusions. The present study focused upon alpha-wave production with or without a procedure for relaxation called "open-focus training." Twenty subjects were divided into four equal groups and seen for three 20-min. sessions. Results suggested a deterioration of alpha production with all groups combined, no significant differences between the biofeedback and no biofeedback control groups (without "open-focus training"), and greater decrease in alpha production during each session in the "open-focus" groups (with or without biofeedback). These unusual results and their implications are discussed.     

Effect of EMG-biofeedback training in reduction of muscle tension for individuals displaying type A behavior patterns

This study investigated the effect of EMG biofeedback training in reducing muscle tension among subjects who displayed Type A behavior. 22 Type A college students (19 to 22 yr. old) were randomly assigned to either a biofeedback group or a control group. After 6 wk. of training, Type A subjects showed a significant reduction in muscle tension for both resting and aroused states; however, the reduction of muscle tension did not result in reduction of Type A behavior patterns.     

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.     

Cortical alpha rhythm, biofeedback, and the determinants of subjective state

A critical assumption in the rationale for the clinical application of voluntary control over central nervous system (CNS) activity is that there exists a direct relationship between specific CNS activities and specific subjective mood states. The experiment reported here was based on the idea that a joint manipulation of both cognitive and physiological (i.e., alpha electroencephalographic [EEG]) variables would provide information required for an explication of the processes involved in subjective mood change. Three main variables were considered in the present experiment. First, the instructions were designed to induce a "set" or expectations for either positive or negative changes in subjective mood. Second, the type of feedback (alpha or not alpha) was varied. Those in the not-alpha feedback condition received feedback contingent on the absence of alpha activity, whereas those in the alpha feedback condition received feedback contingent on the presence of alpha activity. Third, an estimate of each individual's baseline alpha density was obtained, and on this basis subjects were classified as high-baseline or low-baseline subjects. Baseline alpha density, alpha density during training, and subjective mood were all considered as continuous variables. The results of the present study indicate that biofeedback of the cortical alpha rhythm is neither a sufficient nor a necessary condition for changes in subjective mood. In addition, the type of instructions designed to set subjects for positive or negative alterations in subjective states is predictive of changes in subjective state reported during alpha biofeedback training as well as of success at controlling and changing EEG during feedback training. The data presented here permit a direct examination of the actual relationship of EEG changes to changes in subjective mood state. Similar shifts in subjective mood state can be obtained with either increases or decreases in alpha activity. Further, both positive and negative subjective experiences can be associated with increases in alpha activity.     

Anxiety management and applied relaxation in reducing general anxiety

Sixty-three generally anxious subjects were assigned to anxiety management training, applied relaxation training, relaxation-only, placebo and untreated control conditions. After 6 weeks of treatment, anxiety management training led to reductions on a variety of self-report measures of state and trait anxiety and decreases in maladaptive cognitions during a laboratory stress procedure. On several measures, subjects in anxiety management training differed from relaxation-only and placebo subjects as well as untreated controls. However, treatment effects did not extend to performance and physiological measures of anxiety. Applied relaxation training, which in contrast to anxiety management training lacks structured rehearsal involving the recognition and reduction of tension cues during the treatment sessions, resulted in less consistent decreases in measures of general anxiety.     

Effects of instructions and biofeedback on EEG-alpha production and the effects of EEG-alpha biofeedback training for controlling arousal in a subsequent stressful situation

In Phase One, 44 subjects participated in a 2 (instructions to increase alpha, no instructions to increase alpha) × 2 (alpha biofeedback, no alpha biofeedback) factorial experiment. Results indicated that increases in alpha production were due to instructions to increase alpha and that biofeedback had no effect on alpha production. In Phase Two, the 44 subjects from Phase One were exposed to a threat of shock whereas 11 additional subjects in a control condition were not. The design employed in Phase Two was a 2 (previous instructions and stress, no previous instructions and stress) × 2 (previous biofeedback and stress, no previous biofeedback and stress) plus 1 (no previous instructions/no previous biofeedback, no stress). Results indicated that the threat of shock was effective in increasing arousal (as measured by heart rate and skin resistance) but previous EEG-alpha biofeedback training was not effective in helping subjects decrease arousal while in the stressful situation. The results indicate that it is the instructions (and related information concerning alpha) rather than the biofeedback that is critical in alpha biofeedback training and that this training does not appear to have utility for controlling arousal under stress.