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.     

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 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.     

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.     

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.     

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。     

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.     

Force irradiation effect of kinesiotaping on contralateral muscle activation

We aimed to determine the force irradiation effect of kinesiotaping (KT) on contralateral muscle activity during unilateral muscle contraction. Forty healthy (26 females, 14 males) subjects were divided into two groups: KT and control groups. KT was applied on the biceps brachii at the contralateral limb (non-dominant limb) in the KT group, whereas no taping was applied to the control group. All participants performed unilateral isometric, concentric, and eccentric contractions with their dominant upper limbs (exercised limb) by means of an isokinetic dynamometer, while the contralateral limb was in the resting condition, neutral position, and motionless during the testing procedure. During the exercise, contralateral biceps brachii muscle activity was recorded by surface electromyography (EMG). To quantify the muscle activation, EMG signals were expressed as a percentage of the maximal isometric voluntary contraction, which is referred to as %EMG_max. The KT group showed significantly higher %EMG_max in the biceps brachii compared to the control group at the contralateral limb during the isometric, concentric, and eccentric contractions (p = 0.035, p = 0.046, and p = 0.002, respectively) The median values of the contralateral muscle activity were 2.74 %EMG_max and 6.62 %EMG_max during the isometric contraction for the control and KT groups, respectively (p = 0.035). During the concentric contraction, the median values of the contralateral muscle activity were 1.61 %EMG_max and 9.39 %EMG_max for the control and KT groups, respectively (p = 0.046). The median values of the contralateral muscle activity were 4.49 %EMG_max and 22.89 %EMG_max for the eccentric contraction for the control and KT groups, respectively (p = 0.002). In conclusion, KT application on the contralateral limb increased the contralateral muscle activation in the biceps brachii during the unilateral isometric, concentric, and eccentric contractions.     

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.     

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.     

Stimulus control of EMG burst duration in human locomotion

To better understand constraints on EMG activity, burst duration was restricted for the rectus femoris (RF) muscle as subjects walked on a motor-driven treadmill. Once in each step cycle (touchdown to touchdown of the left foot) a computer-activated light discriminated a short burst (if green) and silence (if red). All four subjects rapidly met the criterion of 90% success in 50 cycles for a burst 100–300 msec long within a performance duration, PDUR, of 700 msec. In contrast, two of the four failed to reduce the burst to conform to a 100–200 msec requirement. Several variables were ruled out as bearing on these between-subject performance differences: (1) complete failure to produce a short burst within the PDUR, since many were successful; (2) a differential effect upon subjects of two “reinforcer” types (a high tone after success and a low tone after failure, or else audible EMG biofeedback before the high or low tone); (3) appreciable differences in cycle duration or swing/stance ratios; (4) the presence or absence of concomitant activity in other leg muscles whose EMG was recorded. The frequent failure to accurately terminate the burst was suggested to be due to a greater susceptibility, whether reflexive or conditioned, to simulation arising in the contracting RF muscle itself.     

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.     

Influencia del placebo en el tratamiento de la cefalea

Resumen

El objetivo de este trabajo es estudiar la acción del efecto placebo en el tratamiento de la cefalea mediante biofeedback EMG. Un total de 22 pacientes de cefalea fueron asignados a tres condiciones experimentales: a) biofeedback EMG placebo con control interno; b) biofeedback EMG placebo con control externo; y c) biofeedback EMG real. Los resultados señalan que el biofeedback EMG placebo es tan eficaz como el real para reducir la frecuencia de la cefalea. Se discuten, por último, las distintas variables medidas en el estudio para determinar la naturaleza y eficacia del efecto placebo.     

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.     

Evaluation of a psychological treatment for inflammatory bowel disease

Inflammatory bowel disease (IBD) encompasses two related gastrointestinal-tract diseases, ulcerative colitis (UC) and Crohn's Disease (CD). This study, a randomized controlled trial, compared the effectiveness of a multi-component behavioral treatment package (n = 11), which included IBD education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, to the effectiveness of symptom-monitoring (n = 10) as a control condition; 8 controls subsequently completed treatment. At posttreatment, the treatment group showed mean reductions on 5 symptoms, while the symptom monitoring controls showed mean reductions on all 8 symptoms. On a measure of Total Symptomatic change, the controls showed more improvement than the treated group; the treated controls at posttreatment, showed increases on all 8 symptoms. However, treated subjects perceived themselves as coping better with IBD, as feeling less IBD-related stress, and as experiencing less depression and anxiety. It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses.     

Reorganised anticipatory postural adjustments due to experimental lower extremity muscle pain

Automated movements adjusting postural control may be hampered during musculoskeletal pain leaving a risk of incomplete control of balance. This study investigated the effect of experimental muscle pain on anticipatory postural adjustments by reaction task movements. While standing, nine healthy males performed two reaction time tasks (shoulder flexion of dominant side and bilateral heel lift) before, during and after experimental muscle pain. On two different days experimental pain was induced in the m. vastus medialis (VM) or the m. tibialis anterior (TA) of the dominant side by injections of hypertonic saline (1 ml, 5.8%). Isotonic saline (1 ml, 0.9%) was used as control injection. Electromyography (EMG) was recorded from 13 muscles. EMG onset, EMG amplitude, and kinematic parameters (shoulder and ankle joint) were extracted. During shoulder flexion and VM pain the onset of the ipsilateral biceps femoris was significantly faster than baseline and post injection sessions. During heels lift in the VM and TA pain conditions the onset of the contralateral TA was significantly faster than baseline and post injection sessions in bilateral side. VM pain significantly reduced m. quadriceps femoris activity and TA pain significantly reduced ipsilateral VM activity and TA activity during bilateral heel lift. The EMG reaction time was delayed in bilateral soleus muscles during heels lift with VM and TA pain. The faster onset of postural muscle activity during anticipatory postural adjustments may suggest a compensatory function to maintain postural control whereas the reduced postural muscle activity during APAs may indicate a pain adaptation strategy to avoid secondary damage.     

Evaluating cognitive–behavioral group counseling to improve elementary school students' self‐esteem,self‐control,and classroom behavior

The objective was to evaluate the effectiveness of cognitive–behavioral group counseling provided to behaviorally disruptive elementary school children. Fifty‐two referred children received protocol‐based cognitive–behavioral group counseling provided by the first author, a school social worker. Students were randomly assigned to receive either immediate (IT) group counseling or delayed treatment (DT). The two groups were roughly equivalent on most demographic and outcome measures at the first assessment. Following group counseling, the IT groups' self‐esteem, perceived self‐control, teacher, and teacher aide grades of classroom comportment significantly improved, while similar measures of the DT children did not appreciably change. The DT children then received the same group program the IT group was exposed to three months earlier, and when group counseling was completed (third assessment) the IT groups' gains had been maintained, and the DT group gained improvements similar to those obtained by the IT group. In conclusion, cognitive–behavioral group work can be an effective intervention with behaviorally disruptive elementary school students. Copyright © 1999 John Wiley & Sons, Ltd.     

Outcome predictors in the behavioral treatment of stuttering

The MMPI and subscales of the Stuttering Severity scale were utilized to predict motivation and success in the behavioral treatment of 32 stutterers. Subjects spent a mean of 10 individual sessions in criterion-oriented learning of fluent speech based on speech-muscle relaxation aided by EMG visual biofeedback. Judged motivation and judged success were strongly related to each other and significantly related to MMPI K and Es scores and negatively to F and Sc. Actual success was negatively related to Sc and Pd, completely unrelated to Es, and (if anything) negatively related to K. Results are consistent with previous studies, and show that global judgements of progress were only minimally related to a measure of actual progress.     

Influence of wearing an unstable shoe construction on compensatory control of posture

This study investigated the influence of wearing unstable shoe construction (WUS) on compensatory postural adjustments (CPA) associated with external perturbations. Thirty-two subjects stood on a force platform resisting an anterior-posterior horizontal force applied to a pelvic belt via a cable, which was suddenly released. They stood under two conditions: barefoot and WUS. The electromyographic (EMG) activity of gastrocnemius medialis, tibialis anterior, rectus femoris, biceps femoris, rectus abdominis, and erector spinae muscles and the center of pressure (CoP) displacement were acquired to study CPA. The EMG signal was used to assess individual muscle activity and latency, antagonist co-activation and reciprocal activation at joint and muscle group levels. Compared to barefoot, WUS led to: (1) increased gastrocnemius medialis activity, (2) increased total agonist activity, (3) decreased antagonist co-activation at the ankle joint and muscle group levels, (4) increased reciprocal activation at the ankle joint and muscle group levels, and (5) decrease in all muscle latencies. No differences were observed in CoP displacement between conditions. These findings demonstrate that WUS led to a reorganization of the postural control system associated to improved performance of some components of postural control responses.     

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.