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 ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS1

Forty normal male volunteers were randomly assigned to one of four experimental conditions and instructed to raise and lower their systolic blood pressure. Subjects received either beat-to-beat feedback contingent on pressure changes, noncontingent beat-to-beat feedback, noncontingent feedback presented randomly with respect to the occurrence of each heart beat, or instructions alone. The order of increase and decrease trial blocks was counterbalanced across groups. Subjects receiving contingent feedback were monetarily rewarded for appropriate pressure changes. Subjects receiving noncontingent feedback received rewards and feedback equal to the mean received by the contingent group. Subjects in the instructions-only condition were also paid this bonus but were informed of their earnings only at the conclusion of the experiment. Results indicated that in the presence of instructions, feedback, whether contingent or noncontingent, added little to subjects' ability to control pressure during a single session. Theoretical and clinical implications are discussed.     

MODIFICATION OF HUMAN GASTRIC ACID SECRETION WITH OPERANT-CONDITIONING PROCEDURES1

In an attempt to control gastric acid secretion with operant-conditioning techniques, four normal women were given visual feedback on gastric pH plus money reinforcers. When money was made dependent on increased secretion in a differential-reinforcement-of-high-rates schedule, the rate of secretion of three of the four subjects increased to three times baseline. When money was then made dependent on decreased secretion in a differential-reinforcement-of-other-behaviors schedule, the rate of secretion of these three subjects returned to baseline levels. Heart rate, respiratory frequency, abdominal electromyographic activity, and stomach motility (measured by the electrogastrogram method) were not consistently correlated with acid secretion across subjects, although individual subjects showed substantial correlations between acid secretion and one or more other physiological response.     

Varieties of relaxation methods and their unique effects

This paper reviews literature on specific effects of various relaxation methods, and of differences between varieties of two widely-used (and widely modified) methods: progressive relaxation and autogenic training. There is considerable evidence for modality-specific effects. Muscularly-oriented methods have the greatest effects on the musculoskeletal system, autonomically-oriented methods on the autonomic nervous system, etc. Modified methods of Jacobson's progressive relaxation technique have a greater cognitive and less muscular focus than Jacobson's original method, and Norris and Fahrion's autogenic feedback training de-emphasizes hypnotic components of autogenic training compared with Schultz and Luthe's original method. Hypotheses are presented regarding differential effects of these modifications on clinical outcome, on their appeal and usefulness to individuals with various personality profiles, and on possible negative side effects.     

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.     

MODIFICATION OF ACTIVITY LEVEL THROUGH BIOFEEDBACK AND OPERANT CONDITIONING1

The biomotometer, an electronic device that simultaneously measures activity and provides auditory feedback to the subject, was used in combination with material reinforcers in two experiments attempting to modify activity level in children. In the first study the activity level of an 11-year-old highly active boy was decreased below mean baseline during conditioning in a classroom setting. His level of activity returned to baseline when feedback was withdrawn. In the second study, activity level of a 10-year-old hypoactive boy was increased over mean baseline level during conditioning in a free-play setting, and returned to slightly below baseline during five extinction trials. Results of these studies indicate that the biomotometer is a useful instrument for modification of activity level.     

ACQUISITION,DISCRIMINATIVE STIMULUS CONTROL,AND RETENTION OF INCREASES/DECREASES IN BLOOD PRESSURE OF NORMOTENSIVE HUMAN SUBJECTS1

The aims of this study of 24 normotensive subjects were: to compare a free-operant with a discrete-trials training format; to determine the most effective training procedure by comparing instrumental conditioning with instructional set and a control; to see if both increases and decreases in blood pressure could be brought under discriminative control, and to examine the maintenance of acquired self-control of blood pressure. A 2 × 3 design was employed in which two trial formats (free operant and discrete trials) were factorially compared with three training conditions (instrumental conditioning, instructional set, and control). Instrumental conditioning was found superior to both the instructional set and control conditions in producing increases and decreases in mean diastolic blood pressure. The free-operant format led to a greater degree of learned BP control in that subjects were able to increase and decrease their blood pressure by 10% to 15% of basal value and to maintain the blood-pressure operant after contingent auditory feedback/reinforcement was removed. Training was discontinued when subjects in the other five groups failed to reach criterion after 10 consecutive acquisition sessions.     

Assessment,Treatment, and Rehabilitation for Interpersonal Violence Victims

Abstract

Psychotherapists who have received minimal training in neuropsychology do not consider cognitive rehabilitation among the treatment options for their clients who have mild traumatic brain injury (mTBI). Historical perspectives on mTBI did not acknowledge brain plasticity and/or rehabilitation, yet rehabilitation might provide a necessary foundation for a client to be able to benefit from traditional feminist psychotherapy. This article provides an overview of two treatment modalities, biofeedback and neuropsychologically-informed feminist psychotherapy, for women with mTBI who sought relief from interstitial cystitis and headaches. Assessment for neuropsychological treatment planning and monitoring is illustrated with employment of the Ackerman-Banks Neuropsychological Rehabilitation Battery. Clinical examples are provided to demonstrate a variety of manifestations of mTBI and responses to treatment.     

A wearable vibrotactile biofeedback system improves balance control of healthy young adults following perturbations from quiet stance

Maintaining postural equilibrium requires fast reactions and constant adjustments of the center of mass (CoM) position to prevent falls, especially when there is a sudden perturbation of the support surface. During this study, a newly developed wearable feedback system provided immediate vibrotactile clues to users based on plantar force measurement, in an attempt to reduce reaction time and CoM displacement in response to a perturbation of the floor. Ten healthy young adults participated in this study. They stood on a support surface, which suddenly moved in one of four horizontal directions (forward, backward, left and right), with the biofeedback system turned on or off. The testing sequence of the four perturbation directions and the two system conditions (turned on or off) was randomized. The resulting reaction time and CoM displacement were analysed. Results showed that the vibrotactile feedback system significantly improved balance control during translational perturbations. The positive results of this preliminary study highlight the potential of a plantar force measurement based biofeedback system in improving balance under perturbations of the support surface. Future system optimizations could facilitate its application in fall prevention in real life conditions, such as standing in buses or trains that suddenly decelerate or accelerate.     

'Hearts on their sleeves': the use of systemic biofeedback in school settings

This article describes how a biofeedback device is used to 'externalize' internal physiological states. Heart rate monitors, emitting audible signals when a specific threshold is reached, are fitted to children and members of the family. This can help all those present to make connections between problematic behaviours and internal states of emotional/physical arousal. Devices may be worn for up to twenty-four hours and computer graph printouts of fluctuating heart rates can assist in contextualizing problematic interactions, particularly if other family members are also fitted with heart rate monitors. In this way biofeedback becomes 'systemic' as people are alerted to the interconnectedness of each others' states. Participants are not only helped to identify stressors leading to heightened states of emotional arousal and resulting 'out-of-control' behaviours, but also to find ways of employing (self-)calming strategies. This article outlines the application of systemic biofeedback in school settings with children at risk of exclusion. With the help of these biofeedback devices pupils begin to manage themselves in situations which would previously have resulted in stressed, angry or violent behaviours.