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.     

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.     

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.     

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—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.     

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.     

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.     

Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy.

Assessed the effectiveness of electromyographic (EMG) and skin-temperature (ST) biofeedback and relaxation training (RT) in reducing the aversiveness of cancer chemotherapy. Eighty-one cancer patients, equated on several individual-difference variables, were randomized to one of six groups formed by a 3 (EMG Biofeedback, ST Biofeedback, No Biofeedback) x 2 (RT, No RT) factorial design. Outcome was assessed with physiological, patient-reported, and nurse-reported indices taken over five consecutive chemotherapy treatments. RT patients showed decreases in nausea and anxiety during chemotherapy and physiological arousal after chemotherapy. EMG and ST biofeedback reduced some indices of physiological arousal but had no other effects on chemotherapy side effects. These findings suggest that RT can be effective in reducing the adverse consequences of chemotherapy and that the positive effects found for biofeedback in prior research were due to the RT that was given with the biofeedback, not to the biofeedback alone.     

Treatment of handwriting problems utilizing EMG biofeedback training.

The effects of EMG biofeedback training on cursive handwriting were investigated for 4 girls and 5 boys in Grade 4. A significant reduction in EMG between the first baseline session and the last training session was obtained. Four of 5 characteristics of handwriting improved significantly. The need for carefully designed research comparing EMG biofeedback training and relaxation training was indicated. A self-control factor in handwriting was hypothesized.     

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.     

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.     

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 training of relaxation: The effects of false feedback and the influence of suggestibility

The effect of contingent and non-contingent (false) biofeedback upon heart rate (HR) and subjective reports of relaxation was investigated, and the role played by suggestibility as an individual difference was examined. There were four experimental groups. One received true contingent HR biofeedback and another received no feedback at all. There were also two non-contingent groups. One received false information suggesting that HR was going down and one group received information suggesting that HR was going up. Ss' level of suggestibility was also assessed. Comparisons between the feedback conditions and the no feedback group confirmed the efficacy of biofeedback in relation to the reduction of HR. However, non-contingent feedback was found to be as effective as contingent feedback in HR reduction. Suggestibility as an individual difference was not found to be related to HR reduction but did play a complex role in the subjective report of relaxation. Results are discussed emphasising the non-specific component of the biofeedback paradigm and thus questioning the operant-conditioning model.     

Relationship between self-reported intensity of headache and magnitude of surface EMG

The study was designed to examine the relationship between self-reported intensity of headache and surface EMG. 98 patients, diagnosed by their neurologists with "muscle-contraction headaches" (tension-type headaches) were referred to evaluate their suitability for biofeedback therapy. At the time of examination, they were asked to rate their average headache intensity on a 10-point scale. Surface EMG data were collected to assess actual muscle contraction. Analysis indicated that among patients diagnosed with muscle contraction headache, there is a positive significant correlation between self-reported intensity of headache and actual muscle-contraction. The current data lend support to the hypothesis that the tension in the headaches currently described as "tension-type" may in fact refer to actual muscular tension or contraction.     

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.     

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.     

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.     

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.     

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.     

Are obsessive-compulsive tendencies related to reliance on external proxies for internal states? Evidence from biofeedback-aided relaxation studies

This article presents two studies that examine the hypothesis that obsessive-compulsive (OC) tendencies are associated with a general deficiency in subjective conviction, which leads to seeking and reliance on external proxies to compensate for that deficiency. We examined this hypothesis using a biofeedback-aided relaxation procedure. In Study 1 low OC participants performed better on a relaxation task than high OC participants. More importantly, viewing the biofeedback monitor (an external proxy for the internal state of relaxation) had a different effect on the two groups: Whereas high OC participants performed better, low OC participants did not. In addition, when given the opportunity, high OC participants requested the biofeedback monitor more than did the low OC participants. In Study 2 high OC participants were more affected by false biofeedback when judging their level of relaxation compared to low OC participants. Real relaxation level differences between the two false biofeedback phases among the two groups were not found. These results provide preliminary support for the hypothesis that obsessive-compulsive disorder is associated with deficient subjective conviction in internal states and increased reliance on external proxies. Implications for the understanding of OCD-related rules and rituals as well as for cognitive therapy for OCD are discussed.