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.     

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.     

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.     

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.     

Reliability of psychophysiological assessment

In order to assess the reliability of psychophysiological recording, 15 subjects were assessed on multiple response measures (forehead EMG and forearm flexor EMG, heart rate, skin resistance level, hand surface temperature and cephalic vasomotor response), under multiple stimulus conditions (baseline, self-control, cognitive and physical Stressors), on multiple occasions (Days 1, 2, 8 and 28). Three forms of reliability coefficients were computed for each response measure: coefficients on absolute scores, coefficients on change scores from baseline to stressful conditions and coefficients on percent change from baseline. Only frontal EMG appeared to have consistently high absolute reliability coefficients, with hand surface temperature having high reliability if sessions are repeated within 1 week. Heart rate was less consistently reliable. Treating the responses as relative measures did not increase their reliability; indeed, hand surface temperature was completely unreliable when examined in this fashion. Implications of this study for behavioral medicine, biofeedback and anxiety-based disorders research, as well as Lang's tripartite response system model of fear and emotion, are discussed.     

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.     

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.     

Heterogeneity of biofeedback training effects in spasmodic torticollis: a single-case approach

Data from 184 biofeedback sessions are presented, in which 10 subjects with spasmodic torticollis had been trained to reduce pathologic activity in the hypertrophied sternocleidomastoid muscle. Each session was conducted as a single case experiment with nine successive trials. Attempts were made to distinguish motor learning processes which can be elicited independently from the biofeedback-condition from the effects of specific biofeedback information. Results showed dramatic decreases of muscle activity under biofeedback. Contrary to expectation, action potentials did not decrease across a course of 14 training sessions. Instead, effects were exhibited in an all-or-none fashion early in the training. Single-case ARIMA intervention analysis has shown that in 59% of the sessions EMG decreases demonstrated under biofeedback could be elicited prior to biofeedback in a condition of instructed control. Case studies revealed complex interactions of instructed control, specific biofeedback effects, unspecific effects of the biofeedback setting, and cognitive processes. Effects obtained within experimental sessions varied highly between subjects. Results are discussed in terms of newer concepts of basal ganglia dysfunction, and conclusions for the use of biofeedback paradigms in torticollis subjects are outlined.     

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.     

Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache

Sixty-four headache sufferers were allocated randomly to cognitive-behavioral therapy (CBT), temporal pulse amplitude (TPA) biofeedback training, or waiting-list control. Fifty-one participants (14M/37F) completed the study, 30 with migraine and 21 with tension-type headache. Treatment consisted of 8, 1-hour sessions. CBT was highly effective, with an average reduction in headaches from pre- to posttreatment of 68%, compared with 56% for biofeedback, and 20% for the control condition. Headaches continued to decrease to 12 month follow-up for CBT. Improvement with CBT was associated with baseline coping skills, social support, and physiological measures at rest and in response to stress, particularly TPA. Changes on some of these measures were correlated with changes in headaches. No significant predictors of response to biofeedback emerged.     

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.     

Long-term follow-up of migraine treatment: do the effects remain up to six years?

Fifty migraine subjects (constituting 79% of the originally treated sample) participated in a follow-up study to 6 yr after the end of treatment. Subjects had been treated with different forms of biofeedback methods (skin temperature, BVP of the temporal artery) and applied relaxation training. The assessment included 4 weeks of continuous self-monitoring of headache activity and medication usage, as well as a retrospective self-rating scale. The main results indicated that, on a group basis, headache reductions achieved at the end of treatment persisted for up to 6 yr, and were indeed enhanced during the follow-up period.     

The effects of muscle relaxation on blood pressure of essential hypertensives

Muscle relaxation and noncontinuous biofeedback were investigated as potential nonpharmaceutical treatments for essential hypertension. The two procedures were compared to a waiting list control group. Predictions were made regarding the overall treatment effect, sessions within treatment effect, and periods within session effect. The results of this experiment reveal that biofeedback significantly lowers diastolic blood pressure between premeasures and postmeasures. It was also shown that muscle relaxation has a significant effect upon lowering diastolic and systolic blood pressures between premeasures and postmeasures and has a significant effect upon lowering diastolic and systolic blood pressures as subjects progress from the first period of a treatment session to the last period of a treatment session.     

Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. Overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation.

After a 4-week waiting period 21 obsessive-compulsives were randomly allocated to two treatment conditions (1) Rational Emotive Therapy (RET) and (2) exposure in vivo. RET consisted of analysing irrational thoughts; exposure in vivo was self-controlled. After six sessions and another 4-week waiting period all patients received six sessions of exposure in vivo. Both treatments resulted in significant improvement on anxiety/discomfort, Maudsley Obsessional Compulsive Inventory, and Dutch Obsessional Compulsive Questionnaire and in a reduction of scores on the Irrational Beliefs Test. Results were maintained to a follow-up 6 months later. No significant differences were found between the two conditions.     

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.     

Hemispheric alpha asymmetries during an electromyographic biofeedback procedure for stuttering: A single-subject experimental design

A single-subject “double-reversal” experimental design was used to investigate the use of electromyographic (EMG) biofeedback on the dysfluent behaviors of a right-handed male stutterer. A systematic decrease in EMG amplitude accompanied a progressive approximation of increased verbal complexity resulting in increased fluent behavior. Electroencephalographic (EEG) alpha data (8–12 Hz) gathered during baseline and pre- and post- treatment sessions appeared to co-vary with changes in fluency with right hemispheric suppression associated with greater dysfluencies and left hemispheric alpha suppression with decreased dysfluencies. The results are discussed relative to stutterer's adoption of differing behavioral production strategies for fluent speech that are associated with hemispheric information processing strategies.     

Clinical effects of biofeedback treatment in migraine: The relation to achieved self-control and pretreatment predictors

Abstract

Factors contributing to the headache reduction six months after treatment of sixty-three migraine subjects were examined in three different studies. Subjects had originally been treated with either peripheral skin temperature biofeedback, biofeedback for blood-volume-pulse amplitude of the temporal artery, or applied relaxation. In Study 1 it was found that biofeedback subjects who had achieved self-control of the trained physiological parameter had significantly greater headache reductions than “nonlearners”. In Studies 2 and 3, potential predicting factors of clinical effects were studied. Age and whether subjects had achieved self-control emerged as (weak) predictors in different analyses using discriminant analysis. Using “PLS” (partial least squares projections to latent structures) a model emerged which gave a more complex picture, and which might indicate for example that there are different sets of factors which predict success and predict nonsuccess in treatment.     

Task performance and electromyopotential as functions of task difficulty and EMG feedback

The dearth of empirical research in the application of biofeedback is discussed. Exp. 1 assessed relationships among biofeedback EMG training, EMG levels, cognitive task performance, and task difficulty. 72 subjects (male or female college students) were administered 1 trial on an iconic memory task with either EMG audio feedback, sham EMG audio feedback, or no feedback. Three levels of task difficulty were used. One 20-min. training session significantly lowered EMG responses, and task performance was inversely related to task difficulty. No relationship between EMG level and task performance was observed. Exp. 2 investigated the effect of increased EMG responses on cognitive task performance for one level of difficulty. One biofeedback training session did not significantly increase frontalis EMG, and there was no relationship between increased EMG and task performance.