Biofeedback as a treatment for childhood hyperactivity: a critical review of the literature

Hyperactivity is a significant problem for which no causal theories have been unequivocally substantiated and one in which treatment approaches have met with limited success. Recent research in behavioral medicine has brought biofeedback into use as a treatment for disorders that are mediated by physiologic functioning, with hyperactivity as one such disorder. 36 studies are reviewed in which biofeedback was used as a treatment for hyperactivity. This review indicated that biofeedback treatments alone have not been effectively evaluated, and methodological problems with the current studies severely limit generalizations that may be made to hyperactive populations. Biofeedback in conjunction with other techniques appears to have promise for reducing some of the behavioral symptoms of the hyperactivity syndrome. Directions for further research are presented.     

The efficacy of relaxation training with children

This paper reviews studies that have examined the efficacy of relaxation training techniques in the treatment of childhood disorders. Methodological problems encountered in doing research in this area resemble those found in working with an adult population: imprecise definitions of subject populations and use of a variety of dependent variables from one study to another. Findings suggest that relaxation training is at least as effective as other treatment approaches for a variety of learning, behavioral, and physiological disorders when it is continued over an extended period of time and is augmented by other supportive measures. Needs for future research include better follow-up studies and further investigations with a behaviorally disruptive population.The author would like to express his appreciation to Tricia O'Malley, Shirley Vickery, and Jim Evans for their useful suggestions in an earlier version of this paper, and particularly to Kathy Paget and two anonymous reviewers for their valuable editorial assistance and comments in preparing the final draft.     

Prospective payment: its impact on psychology's role in health care

This article describes the new Medicare payment system based on diagnosis-related groups (DRGs) and its impact on professional psychology. DRGs represent medically oriented notions about how many inpatient days a prudent physician needs to effectively treat a patient who suffers from a specified disease. However, for the most part, DRGs ignore the behavioral variables that moderate entry into the tertiary care system and the subsequent use of hospital resources. Under DRGs, the development and use of behavioral treatments for somatic disorders could be discouraged. For example, many newer behavioral medicine techniques may be more time-consuming and/or expensive than traditional treatment options (e.g., bed rest vs. biofeedback for low back pain) and thus not fall within the time period or "trim points" alloted for such disorder, regardless of comparative effectiveness. Also, under the new system, psychologists can no longer bill separately for their inpatient services. It is argued that the framers of health care policies should recognize and support health psychologists in light of the fact that many of their techniques can reduce the cost and consumption of health care through programs that: reduce behavioral risk factors, increase compliance with medical regimens, and prepare patients psychologically for stressful medical procedures.     

OPERANT TREATMENT OF OROFACIAL DYSFUNCTION IN NEUROMUSCULAR DISORDERS

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.     

Computers in biofeedback research and therapy

While biofeedback is being used extensively in the clinic and the laboratory, a great deal of variability exists among biofeedback users with respect to instrumentation, treatment protocols, techniques of data acquisition, and methods of data analysis. It is argued that the use of computers in biofeedback will help reduce some of this variability. Other advantages of computers in biofeedback are discussed. Several presently available automated systems are reviewed. Implications for future biofeedback research are also discussed.     

Recall in Infancy: A Neurodevelopmental Account

ABSTRACT— Relations between developments in neural structures and changes in memory in infancy are a relatively recent focus of research. Greater knowledge about brain development, as well as methodological advances such as combined use of behavioral and electrophysiological techniques, have led to the generation and testing of specific hypotheses regarding sources of age-related change. Theory and data converge to suggest that the early-stage processes of encoding and consolidation are a significant source of age-related variability in memory early in life. Additional research is needed to determine how these processes change and interact with myriad other determinants of recall.     

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.     

Early detection of handicapping conditions in infancy and early childhood: Toward a multivariate model

The major purpose of this study was to relate to infancy the occurence of significant learning or behavioral problems in adolescence. Original participants in the National Collaborative Perinatal Project in Rhode Island, who were also judged as handicapped after school entry, comprised the sample for this study. Environmental factors and child performance data collected at birth and at 4, 8, and 12 months of age were examined in terms of their power to predict handicapping conditions in the adolescent. Our results indicated that maternal education was a more accurate predictor of later learning and behavioral competency than the child's own developmental status up to 12 months of age. Furthermore, combining child-centered data and maternal education did not enhance predictive accuracy beyond that of maternal education considered in isolation. These findings underscore the critical role of molar environmental variables as antecedents of school failure, and suggest that models for screening in the first year of life and of multidisciplinary team diagnosis for handicapped children should include both environmental and child-focused dimensions to minimize overall classification error.     

Using Relaxation Techniques with Individuals and with Groups

The use of biofeedback, meditation, deep breathing relaxation, and imagery relaxation with individuals and with groups is described. The physical and mental well-being of people depends on learning ways to relax. Relaxation techniques reduce high levels of stress by facilitating the mind to switch from dwelling on day-to-day concerns to instead dwcll on relaxing themes. The body always responds to thinking processes; when the mind switches from dwellir~g on distressing thoughts to relaxing thoughts, the body becomes more relaxed.     

The Attitude–Behavior Relationship: A Test of Three Models of the Moderating Role of Behavioral Difficulty1

The moderating role of behavioral difficulty in the attitude–behavior relationship remains a controversial topic in social psychology. Previous research has been unclear in establishing the direction of this moderation, and 3 theoretical models have been proposed: positive and linear; negative and monotonic; and quadratic. The current paper reports analyses of survey data from 5 different studies that afford measures of environmental attitude, behavior, and behavioral difficulty. Across these studies, we found a substantial and unmoderated average attitude–behavior relationship (r = .54). The data also show that the attitude–behavior relationship is weaker for extremely easy and extremely difficult behaviors. Additional analyses suggest, however, that these reductions in the attitude–behavior relationship are probably because of methodological reasons.     

Editorial overview: Analytic and methodological innovations for suicide‐focused research

This editorial overview provides an introduction to the Suicide and Life‐Threatening Behaviors Special Issue: “Analytic and Methodological Innovations for Suicide‐Focused Research.” We outline several challenges faced by modern suicidologists, such as the need to integrate different analytical and methodological techniques from other fields with the unique data problems in suicide research. Therefore, the overall aim of this issue was to provide up‐to‐date methodological and analytical guidelines, recommendations, and considerations when conducting suicide‐focused research. The articles herein present this information in an accessible way for researchers/clinicians and do not require a comprehensive background in quantitative methods. We introduce the topics covered in this special issue, which include how to conduct power analyses using simulations, work with large data sets, use experimental therapeutics, and choose covariates, as well as open science considerations, decision‐making models, ordinal regression, machine learning, network analysis, and measurement considerations. Many of the topics covered in this issue provide step‐by‐step walkthroughs using worked examples with the accompanied code in free statistical programs (i.e., R). It is our hope that these articles provide suicidologists with valuable information and strategies that can help overcome some of the past limitations of suicide research, and improve the methodological rigor of our field.     

Learning to stand tall: Idiopathic scoliosis,behavioral electronics,and technologically-assisted patient participation in treatment,c. 1969–1992

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.     

Primary prevention of secondary disorders: A proposal and agenda

This paper calls for consideration of a new class of preventive interventions designed explicitly to prevent comorbidity of psychiatric disorders. Epidemiologic data show that successful interventions of this type could be extremely valuable, as up to half of lifetime psychiatric disorders and an even larger percent of chronic and seriously impairing disorders occur to people with a prior history of some other disorder. Furthermore, a review of etiologic hypotheses concerning the causes of comorbidity suggests that interventions aimed at primary prevention of secondary disorders might be feasible. However, more basic risk factor research is needed on the causes of comorbidity before we can make a clear assessment of feasibility and discover promising intervention targets. A number of methodological problems arise in carrying out this type of formative research. These problems are reviewed and suggestions are offered for solutions involving innovations in measurement, design, and data analysis.     

Delay of Gratification,Psychopathology, and Personality: Is Low Self-Control Specific to Externaiizing Problems?

We assessed the delay of gratification behavior of 428 twelve and thirteen-year-old boys, half of whom were known to manifest symptoms of behavioral disturbance. Consistent with the hypothesis that low self-control is a risk factor specific to externalizing (aggressive and delinquent) disorders, boys who showed signs of externalizing disorders tended to seek immediate gratification in a laboratory task more often than both nondisordered boys and boys who showed signs of internalizing (anxious and depressed) disorders. In addition, children who were able to delay immediate gratification were described by their mothers as ego controlled, ego resilient, conscientious, open to experience, and agreeable. These results suggest that poor delay of gratification may be one of a select number of specific risk factors for externalizing     

A review of research methods in IO/OB work-family research

A methodological review was conducted of work-family (WF) research published in industrial-organizational psychology and organizational behavior journals over a period of 24 years (1980-2003). Content analysis was conducted on 225 individual studies published in 210 articles to categorize methodological features, including the research design, sources of data used, data analysis techniques, reliability and validity of measures used, and sociodemographic characteristics of the samples. Results support many of the criticisms of WF research and suggest that scholars publishing WF research in industrial-organizational psychology and organizational behavior journals could make greater use of longitudinal and experimental research designs, gather more multisource data, and move beyond the individual level of analysis. Adopting more diverse conceptualizations of family, including a greater proportion of racial and ethnic minorities, and studying workers in occupations other than managerial or professional positions also appear warranted. Finally, methodological trends varied across specific WF content areas, which suggests that distinct methodologies might be useful to advance knowledge of specific WF topics.     

The value of everyday examples in the teaching of learning: a comment prompted by machado and silva (1998)

Why are so few psychology students and professors interested in the study of learning? Part of the answer lies in the techniques we use for teaching behavioral psychology and communicating its relevance to numerous aspects of life. We add to this journal's discussion of the teaching of learning by explaining the importance of using examples drawn from everyday life: Numerous familiar examples provide powerful pedagogical tools for showing the importance of learning theory and helping students learn behavior principles. This approach does not exclude using other strategies and techniques in our quest to communicate the value of learning theory and teach our behavioral science in meaningful and thought-provoking ways.     

Biological and caregiver correlates of behavioral inhibition

The aim of this study was to explore the relationships among measures of behavioral inhibition, physiological reactivity, and caregiver attitudes. Measures comprised of heart rate; survey assessments of caregiver empathy with the child, appropriateness of caregiver developmental expectations of the child, and use of positive discipline techniques; and observational measures of behavioral inhibition were gathered in a laboratory setting on 72, 5–6‐year old children. It was found that heart rate and behavioral inhibition were positively correlated (0.595), whereas behavioral inhibition was negatively correlated with caregiver attitudes of empathy (?0.356), appropriate expectations (?0.366), and use of positive discipline techniques (?0.275). However, there was no correlation between heart rate and caregiver attitudes. These data suggest that physiological reactivity to novel stimuli and caregiver attitudes of empathy, appropriate expectations, and use of positive discipline techniques conjointly influence behavioral inhibition in early childhood. Further, these three caregiver variables accounted for significant variance in children who had high reactive physiological profiles associated with inhibited behavior patterns, but did not display such patterns. Copyright © 2003 John Wiley & Sons, Ltd.     

Book Reviews

For inexperienced sales representatives, success provides an important learning opportunity from which to build confidence and hone strategies. Such learning is derived from the attributions one makes for success and how those attributions shape future behavior. This research investigates the interpretation and behavioral intentions of inexperienced sales representatives following a successful sales call using a sample of financial services representatives. Surprisingly, we found that achieving success did not assure the adoption or future use of the strategy that garnered that success. These results suggest that inexperienced sales representatives may require managerial attention to fully understand and appropriately assimilate their sales successes. Implications for managers and future research are discussed.     

A learning theory account of depression

Learning theory provides a foundation for understanding and deriving treatment principles for impacting a spectrum of functional processes relevant to the construct of depression. While behavioral interventions have been commonplace in the cognitive behavioral tradition, most often conceptualized within a cognitive theoretical framework, recent years have seen renewed interest in more purely behavioral models. These modern learning theory accounts of depression focus on the interchange between behavior and the environment, mainly in terms of lack of reinforcement, extinction of instrumental behavior, and excesses of aversive control, and include a conceptualization of relevant cognitive and emotional variables. These positions, drawn from extensive basic and applied research, cohere with biological theories on reduced reward learning and reward responsiveness and views of depression as a heterogeneous, complex set of disorders. Treatment techniques based on learning theory, often labeled Behavioral Activation (BA) focus on activating the individual in directions that increase contact with potential reinforcers, as defined ideographically with the client. BA is considered an empirically well‐established treatment that generalizes well across diverse contexts and populations. The learning theory account is discussed in terms of being a parsimonious model and ground for treatments highly suitable for large scale dissemination.     

An examination of learning processes during critical incident training: implications for the development of adaptable trainees

Three experiments are reported that examined the process by which trainees learn decision-making skills during a critical incident training program. Formal theories of category learning were used to identify two processes that may be responsible for the acquisition of decision-making skills: rule learning and exemplar learning. Experiments 1 and 2 used the process dissociation procedure (L. L. Jacoby, 1998) to evaluate the contribution of these processes to performance. The results suggest that trainees used a mixture of rule and exemplar learning. Furthermore, these learning processes were influenced by different aspects of training structure and design. The goal of Experiment 3 was to develop training techniques that enable trainees to use a rule adaptively. Trainees were tested on cases that represented exceptions to the rule. Unexpectedly, the results suggest that providing general instruction regarding the kinds of conditions in which a decision rule does not apply caused them to fixate on the specific conditions mentioned and impaired their ability to identify other conditions in which the rule might not apply. The theoretical, methodological, and practical implications of the results are discussed.