Muscular response to the therapist and symptomatic improvement during biofeedback for tension headache.

The relationship between muscular response to the therapist's presence and symptomatic improvement was studied during biofeedback. Thirty-two patients suffering from tension headaches received muscular biofeedback training of six sessions plus a follow-up session two months later. Patients' electro-myographic frontal response was measured prior to treatment both with and without the therapist present. A relationship was found between symptomatic improvement at follow-up and muscular response to the therapist's presence before treatment: patients showing a decrease of at least 10% in muscular tension response to the presence of their future therapist improved more regarding headache intensity than the patients showing increase or smaller variation of their EMG. A significant correlation of .59 was found between the frontal EMG response to therapist presence during the evaluation session and headache improvement at follow-up. The results suggest that the decrease of muscular tension during the first contact with the therapist could be an indicator of good prognosis, possibly because of an immediate positive therapeutic relationship and/or favorable expectancies concerning future benefit of treatment.     

A preliminary analysis of EMG variance as an index of change in EMG biofeedback treatment of tension-type headache

The effectiveness of EMG biofeedback training for tension headache has been well established. Previous studies evaluating changes in an average EMG activity score from pre- to posttreatment have not consistently found a relationship between a reduction in average EMG activity and headache improvement at posttreatment. The current study is a preliminary analysis of the utility of EMG variance as another possible mechanism of change. Frontalis EMG average activity and variances from 6 chronic tension-type headache sufferers who demonstrated significant improvement in headache activity at posttreatment (at least 70%) and 6 chronic tension-type headache sufferers who did not demonstrate improvement (less than 30%) were examined across 6 sessions of biofeedback treatment. The improved group demonstrated larger time-specific EMG variance in relation to mean EMG amplitudes during all treatment sessions. A dramatic decline in time-specific variance was observed during the later treatment sessions for improved participants; this pattern was not observed in the group who demonstrated little or no improvement. Results from the current study suggest that the inclusion of both average EMG activity and EMG variance may provide a more comprehensive measure to evaluate possible physiological changes responsible for improvement in headache activity following EMG biofeedback training.     

Change Mechanisms Associated with Combined Relaxation/EMG Biofeedback Training for Chronic Tension Headache

Therapeutic mechanisms hypothesized to underlie improvements in tension headache activity achieved with combined relaxation and eleclromyographic (EMG) biofeedback therapy were examined. These therapeutic mechanisms included (1) changes in EMG activity in frontal and trapezii muscles, (2) changes in central pain modulation as indexed by the duration of the second exteroceptive silent period (ES2), and (3) changes in headache locus of control and self-efficacy. Forty-four young adults with chronic tension-type headaches were assigned either to six sessions of relaxation and EMG biofeedback training (N = 30) or to an assessment only control group (N = 14) that required three assessment sessions. Measures of self-efficacy and locus of control were collected at pre- and posttreatment, and ES2 was evaluated at the beginning and end of the first, third, and lost session. EMG was monitored before, during, and following training trials. Relaxation/EMG biofeedback training effectively reduced headache activity: 51.7% of subjects who received relaxation/biofeedback therapy recorded at least a 50% reduction in headache activity following treatment, while controls failed to improve on any measure. Improvements in headache activity in treated subjects were correlated with increases in self-efficacy induced by biofeedback training but not with changes in EMG activity or in ES2 durations. These results provide additional support for the hypothesis that cognitive changes underlie the effectiveness of relaxation and biofeedback therapies, at least in young adult tension-type headache sufferers.     

The effectiveness of EMG biofeedback training in low back pain.

Eighteen patients with chronic low back pain (lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial (high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.     

Crosscultural differences in frontalis muscle tension levels: An exploratory study comparing Japanese and Westerners

This paper describes a comparison between Japanese (N=20) and Westerners (N=20) in their respective frontal EMG levels and their ability to relax during one 5-minute biofeedback training session. The data indicated a significantly lower baseline muscle tension level in Japanese than in Westerners. After EMG biofeedback, however, no significant difference was found between the two groups. Japanese females showed significantly higher tension levels both during baseline and biofeedback phases than did Japanese males.     

Crosscultural differences in frontalis muscle tension levels: an exploratory study comparing Japanese and Westerners

This paper describes a comparison between Japanese (N = 20) and Westerners (N = 20) in their respective frontal EMG levels and their ability to relax during one 5-minute biofeedback training session. The data indicated a significantly lower baseline muscle tension level in Japanese than in Westerners. After EMG biofeedback, however, no significant difference was found between the two groups. Japanese females showed significantly higher tension levels both during baseline and biofeedback phases than did japanese males.     

Effect of therapist's active presence on EMG biofeedback training of headache patients

Sixteen patients suffering from tension or mixed headaches participated in a frontalis EMG treatment schedule of 15 sessions where the therapist was either actively present or almost completely absent. The aim of this study was to evaluate the impact of the therapist's active presence on the subject's ability to lower the EMG level. The active presence of the therapist consistently led to higher frontalis EMG level than that during the therapist's absence. Data also show that the EMG feedback administered was apparently effective in reducing subjective headache intensity along with EMG levels. The findings raise the question of an optimal dosage of presence and activity of the therapist during EMG feedback training.     

A therapeutic alternative for tension headache in children: Treatment and 1-year follow-up results

Ten young subjects, ranging in age from 12 to 15 years, suffering from tension headache were treated by electromyographic biofeedback (EMG-BFB) twice a week for 12 sessions. The Pain Total Index (PTI) was recorded every month from the beginning to the end of the treatment. At the end of the treatment the PTI decreased significantly in all our patients and, at the same time, the muscular tension values also decreased. This result supports the hypothesis of a correlation between clinical symptom and muscular tension level. We saw our patients for follow-up sessions, and the clinical improvement was confirmed to 1 year from the completion of the treatment; however, the muscular tension values were increased with respect to the last-session values.     

A therapeutic alternative for tension headache in children: treatment and 1-year follow-up results

Ten young subjects, ranging in age from 12 to 15 years, suffering from tension headache were treated by electromyographic biofeedback (EMG-BFB) twice a week for 12 sessions. The Pain Total Index (PTI) was recorded every month from the beginning to the end of the treatment. At the end of the treatment the PTI decreased significantly in all our patients and, at the same time, the muscular tension values also decreased. This result supports the hypothesis of a correlation between clinical symptom and muscular tension level. We saw our patients for follow-up sessions, and the clinical improvement was confirmed to 1 year from the completion of the treatment; however, the muscular tension values were increased with respect to the last-session values.     

A comparison of frontal EMG biofeedback and neck EMG biofeedback in the treatment of muscle-contraction headache

EMG biofeedback from the frontal area (FFB) was compared to EMG biofeedback from the neck (NFB) in the treatment of chronic muscle-contraction headache. Both treatment groups (N=10) evidenced significant decreases in reported headache activity, with the NFB group also significantly reducing medication consumption. An analysis of EMG changes suggested that subjects were able to produce large within-session changes in EMG activity during initial sessions, with the major effect of additional training being an increase in speed with which these changes occurred. In neither group, however, did changes in EMG activity correspond closely to changes in reported headache activity.     

Electromyographic biofeedback for tension control during fine motor skill acquisition

The presence of residual muscular tension has been implicated as a detrimental influence on the performance and learning of motor skills. A method for reducing muscular tension has been provided by the advent of biofeedback training. This study investigated the effects of tension-control training by electromyographic (EMG) biofeedback on learning and performance of the pursuit-rotor backing task. Thirty young adult males were pretested for pursuit-rotor (PR) tracking skill, ranked by performance scores, and divided into identical triplicates to form two experimental groups and a control group. After a total of 3 hours of EMG biofeedback training for the experimental groups, all subjects were reevaluated on the PR test. One experimental group received biofeedback during the posttests. Analysis of variance of pretest-posttest difference means andt tests of scores representing performance and tension indicated that the EMG biofeedback training (1) significantly reduced tension induced by the novel motor skill and (2) significantly improved performance of the motor skill. Transfer of tension-control training was shown to facilitate learning and performance more than direct EMG biofeedback during performance. Residual tension reduction during learning was particularly facilitated by EMG biofeedback training, a profound implication for the management of stress in a variety of situations.This investigation formed part of a Ph.D. dissertation research (1976) conducted by the author under the guidance of Dr. Donald E. Campbell, Department of Physical Education, and Dr. Carol A. Saslow, Department of Psychology, at Oregon State University.     

The effectiveness of EMG biofeedback training in low back pain

Eighteen patients with chronic low back pain(lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial(high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.We wish to express our thanks to Marijke Höweler-van Dalen for supervising this investigation, to Arnold Goedhart for statistical advice, to Dr. Orlebeke for his critical remarks, and to Dr. Penders for referring the patients in Amsterdam. We are particularly indebted to the general practitioners Paul Kreutzer and Jan Huls for referring the Andijk patients. Without their support this investigation would not have been possible.     

Electromyographic biofeedback training for tension headache in the elderly: a prospective study.

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%-45%) in three of the remaining four subjects. Significant clinical and/or statistical pre-post differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.     

Frontal EMG-biofeedback training of athetoid cerebral palsy patients

Six athetoid cerebral palsy patients participated in the following: speech and motor prebiofeedback training evaluation; frontal EMG biofeedback training, 6 wk; speech and motor postbiofeedback training evaluation, Frontal pretraining levels for the subjects averaged 28.9 µV p-p. Subjects' feedback consisted of an auditory signal(clicks) varying proportionately with frontal EMG activity. A visual meter display of the integrated EMG was also provided. Self-regulation of frontal EMG was evident for all subjects within session 1. Throughout all sessions, EMG levels of 2–4 µV were often attained. Trend analysis of EMG acquisition curves showed significant reduction in frontal tension across sessions for all but one subject. Frontal posttraining levels averaged 13.0 µV p-p. Parents or subjects, or both, reported subtle improvements in various speech and motor functions, a finding confirmed by objective postbiofeedback training evaluation. Only the 2 most severely impaired subjects, JA and DS, failed to improve significantly on the speech measures. All subjects improved significantly on those measures that tapped fine and gross motor skills. Collectively, these results indicate that EMG biofeedback training shows promise as an additional treatment modality in the habilitation of cerebral palsy patients.     

Treatment of posttraumatic stress disorder with relaxation and biofeedback training

This study investigated the use of biofeedback and relaxation training on six patients with posttraumatic stress disorder (PTSD) referred routinely for biofeedback treatment in a VA medical center. Subjects received between 8 and 14 sessions of training overall, as well as concurrent individual and group therapy. Measures used to assess treatment outcome include pre- and posttreatment MMPI, State-Trait Anxiety Inventory, Beck Depression Inventory, and Multidimensional Health Locus of Control scores, as well as electromyographic and subjective measures of tension within each session. Additionally, an overall posttreatment clinical rating of change and 1- to 2-year follow-up data were obtained for each subject. Slight to marked improvements were demonstrated for each subject, as evidenced by improvements on the State Anxiety Inventory Scale and the Beck Depression Inventory, a decrease in overall MMPI scores, and lowered EMG and subjective tension ratings for all participants. Possible alternative explanations for improvement (situational demand characteristics, regression toward the mean, lack of independent subject evaluation) are described, along with other study limitations. This preliminary investigation suggests that the use of relaxation training and biofeedback may be a particularly useful component within a comprehensive treatment program for this disorder.     

Treatment of posttraumatic stress disorder with relaxation and biofeedback training

This study investigated the use of biofeedback and relaxation training on six patients with posttraumatic stress disorder (PTSD) referred routinely for biofeedback treatment in a VA medical center. Subjects received between 8 and 14 sessions of training overall, as well as concurrent individual and group therapy. Measures used to assess treatment outcome include pre- and posttreatment MMPI, State-Trait Anxiety Inventory, Beck Depression Inventory, and Multidimensional Health Locus of Control scores, as well as electromyographic and subjective measures of tension within each session. Additionally, an overall posttreatment clinical rating of change and 1- to 2-year follow-up data were obtained for each subject. Slight to marked improvements were demonstrated for each subject, as evidenced by improvements on the State Anxiety Inventory Scale and the Beck Depression Inventory, a decrease in overall MMPI scores, and lowered EMG and subjective tension ratings for all participants. Possible alternative explanations for improvement (situational demand characteristics, regression toward the mean, lack of independent subject evaluation) are described, along with other study limitations. This preliminary investigation suggests that the use of relaxation training and biofeedback may be a particularly useful component within a comprehensive treatment program for this disorder.     

Feedback delays and relaxation expectancies in EMG biofeedback

The use of noncontingent feedback controls in studies of the efficacy and process of electromyographic (EMG) biofeedback may yield results confounded by differential expectancies for relaxation. Furthermore, the role of expectancies in producing psychological and physical relaxation as well as reducing muscle activity is unclear. This study investigated the effects of feedback delays and induced relaxation expectancies on EMG activity and experienced relaxation. One hundred four non-clinical subjects participated in one auditory frontal EMG biofeedback training session. Subjects were assigned to one of four computerized feedback delay conditions (0.0037, 0.7493, 2.2481, 6.7444 s) and to one of two relaxation expectancy conditions (positive or negative). During 20 minutes of biofeedback training, all groups decreased frontal activity. Feedback delays interacted with training epochs in affecting EMG; the longest delay group reduced frontal activity more slowly than the shortest delay group during training. Positive relaxation expectancies produced greater experienced relaxation than did negative relaxation expectancies. Instrumental and expectancy factors in EMG biofeedback appear to operate independently of each other by reducing physiological activity and producing psychological relaxation respectively.     

Cognitive skills training versus EMG biofeedback in the treatment of tension headaches

In an effort to study the role of cognitive skills training in the treatment of psychosomatic disorders, two single-case design experiments were conducted to assess the relative effectiveness of biofeedback procedures and cognitive coping techniques in the alleviation of tension headaches. For both subjects, biofeedback training influenced mean frontalis EMG levels, although such changes were not associated with concomitant reductions in headache activity. It was the presence or absence of cognitive skills training, however, that determined whether each subject reported changes in headache levels. These results suggest that a more efficient treatment approach for tension headaches would involve an increased emphasis on the modification of maladaptive cognitive activity. The present findings support the general view that a comprehensive approach in the treatment of stress-related disorders requires a concomitant focus on the cognitive, behavioral, and affective dimensions of the symptom. It was also suggested that biofeedback technology may be a useful tool for studying the physiological consequences of particular cognitive processes and in identifying particular cognitions with anxiety-provoking properties.     

Electromyographic biofeedback treatment of a woman with chronic dysphagia

In this case report, a 25-year-old female with chronic dysphagia spastica(difficulty swallowing because of constriction of the throat muscles) was treated with 20 sessions of frontal electromyographic(EMG) biofeedback and home-relaxation practice. The subject monitored on a 10-point scale her difficulty swallowing during meals for 2 months prior to treatment, during treatment, and after treatment. There was a significant decrease in reported difficulty swallowing associated with frontalis EMG feedback. Improvement was maintained at a 6-month follow-up.     

Electromyographic biofeedback training for tension headache in the elderly: A prospective study

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%–45%) in three of the remaining four subjects. Significant clinical and/or statistical prepost differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Department of Veterans Affairs. This study was supported by a Department of Veterans Affairs MERIT-Review awarded to the first author.