Daily relaxation modifies serum and salivary immunoglobulins and psychophysiologic symptom severity

This study investigated the effect of daily relaxation on concentrations of serum immunoglobulins A, G, and M and secretion rates of salivary immunoglobulin A (S-IgA). Twenty-four volunteers were randomly assigned to practice a relaxation technique daily for 3 weeks and 16 to a waiting list control condition. Blood and saliva samples were collected before and after a supervised 20-min relaxation session at the beginning and end of the 3-week practice period. S-IgA secretion rate increased significantly (p less than .001) after 20 min of relaxation. A longer-term practice effect also occurred in that the increase in secretion rate in "before to after" relaxation samples was higher (p = .014) in subjects who had practiced relaxation once a day for 3 weeks than in waiting list control subjects practicing for the first time. Serum IgA (p less than .001), IgG (p less than .001), and igM (p less than .05) increased significantly over the 3-week practice period. Relaxation may be a self-regulating strategy affecting both humoral and cellular divisions of the immune system.     

Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children

We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each child's condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the followup period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.This research was supported by NIH grant No. HL27402. We are grateful to Anita D. Baker, Lisa Barclay, Deborah L. Harm, and Douglas J. Miller for serving as experimenters and to Constance K. Cottrell and Cindy Stout for compiling summaries of the data.     

Biofeedback-assisted relaxation training for the aging chronic pain patient

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55–78 yr; N=17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29–48 yr; N=20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values=.04 to .0001) with no differences between age groups (p>.05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.This research was supported in part by NIDRR grant No. H133G90085, Department of Education, DHEW, and by the Medical University of South Carolina General Clinical Research Center under NIH grant No. RR1070.     

A provisional model to predict blood pressure response to biofeedback-assisted relaxation

Blood pressure (BP) response to biofeedback-assisted relaxation is not uniform among hypertensive individuals. The purpose of this exploratory study was to determine if selected psychophysiological variables could be used to identify individuals able to lower blood pressure using biofeedback-assisted relaxation. Responders were defined using a preset criterion of 5 mm Hg or greater decrease in mean arterial pressure. A logistic regression model derived from five variables (heart rate, finger temperature, forehead muscle tension, plasma renin response to furosemide, and mean arterial pressure response to furosemide) provided significant predictive power for BP response, exhibiting a sensitivity of 84.6% and a specificity of 80.0%. With future validation, the proposed model may provide useful information to identify patients likely to benefit from biofeedback-assisted relaxation.     

Age and gender differences in the relationship between heart rate reactivity and elevated serum lipids

Data on serum lipids and heart rate reactivity to a standardized mental arithmetic stressor were collected on 54 healthy men and 73 healthy women. Subjects' ages ranged from 18 to 61 years, allowing analysis of data from both young and older subgroups. MANOVA revealed that age was directly associated with elevated lipids in men and women. There was no significant relationship between reactivity and lipids for either older or young men. Conversely, young women showed a significant direct relationship between reactivity and Total Cholesterol and LDL, but this was not present for older women. Implications of these data for the previously reported hypothetical relationship between reactivity and lipids are discussed. Limitations of the study are examined, and future directions for research suggested.I wish to thank Dianne Vella for her assistance in aspects of data-collection. This research was supported by grant No. 900946 from the National Health & Medical Research Council.     

Preliminary results from the self-regulatory treatment of high-medication-consumption headache

Data are presented from a prospective clinical replication series of ten consecutive high-medication headache patients who presented for nondrug treatment of their headaches. For the first eight, an attempt was made to withdraw the patients from medication, with the assistance of relaxation training, prior to entering a comprehensive self-regulatory treatment program. For the last two, drug withdrawal accompanied the treatment. Six of the ten patients showed clinically significant reductions in headache activity, which held up over follow-ups of up to 12 months. Psychological tests provide some discrimination between success and failures.This research was supported in part by a grant from NINDS, No. NS-23340. Appreciation is expressed to Dr. Kenneth A. Appelbaum and Ms. Denise Michultka for their roles in this study.     

Behavioral strategies for the reduction of pain and anxiety associated with orthopedic trauma

This study examined the efficacy of behavioral strategies in alleviating pain and anxiety associated with severe orthopedic trauma. Sixty-four patients with multiple fractures were divided into four groups: (1) control, (2) attention only, (3) EMG biofeedback-assisted relaxation, and (4) audiotaped relaxation training. All were measured over at least six sessions, or as long as hospital stay permitted. Significant between group differences were found on the following: systolic blood pressure, pheripheral temperature, subjective units of discomfort, state anxiety, with a trend for use of sleep medications. No differences were found on other vital signs, EMG recordings, or other medications. EMG-biofeedback relaxation and relaxation training were relatively equivalent for all measures, and little or no change was observed for those patients who received attention only or served as controls.     

Clinical observations on behavioral treatment of a patient with insulin-dependent diabetes mellitus

This report uses a single case format to describe clinical observations on the use of biofeedback-assisted relaxation in Type I insulin-dependent diabetes mellitus. It is suggested that treatment based on relaxation training may be utilized in diabetics provided that certain conditions are met and that the relaxation procedure is modified to conform to the special requirements of persons taking insulin. Since both client characteristics and type of training protocol can markedly affect outcome, it may be especially important to tailor the training protocol for each insulin-dependent diabetic patient, based on careful and continuous monitoring of treatment effects.     

The analysis of a blood pressure diary for a patient report

In order to make a more valid assessment of blood pressure (BP), self-monitoring of BP by the patient is generally advised. Self-monitoring usually results in a lower BP level. We are currently investigating whether the BP lowering effect of self-monitoring may be enhanced by not only monitoring BP but also monitoring physical and emotional status at the moment of and activity prior to the BP measurement in a diary. In this article we focus on the individual feedback that the participating patients received. Various methods that can be used for this purpose are described. For our individual reports we first assessed linear trends in the variables. When a trend was present, residuals were calculated. Then a principal-components analysis on BP measurements, BP estimates, symptoms, moods, and activities was performed. Results are presented for two hypertensive patients.     

Stress management and Gilles de la Tourette's syndrome

Tourette's syndrome is a lifelong disorder characterized by multiple motor and verbal tics. The present study examined relaxation training and desensitization training as a method of reducing the frequency and intensity of tics and the distress they caused in a young adult diagnosed with Tourette's syndrome. After a period of symptom monitoring the subject underwent 3 weeks of intensive training in relaxation skills and 5 weeks of desensitization training with situational cues previously identified as eliciting Tourette's symptoms. According to self-report monitoring, the experience of symptoms was decreased across 3 global dimensions: distress (48%), frequency (48%), and intensity (50%), and an hourly symptom count (50%). Collateral parental symptom report agreed with an observed decrease across distress (40%), frequency (41%), and intensity (40%). Inspection of data suggests that both components of stress management added to total treatment efficacy.     

The effect of clothing on inhalation volume

Diaphragmatic breathing is included as an important component of relaxation training protocols. In the present study, we report on the effectiveness of a simple behavioral technique to illustrate that choices of tight, restraining clothing significantly affect the inhalation volume of the breathing pattern. This study investigates the use of the incentive inspirometer to observe the effects of tight versus loose clothing on inhalation volume with 17 volunteer subjects. All had been trained in the use of the incentive inspirometer and slow diaphragmatic breathing (SDB) techniques. Inhalation volumes in the studies were measured with a 4000-ml incentive inspirometer and were recorded for one or two sequential breaths using SDB before and after loosening restrictive clothing. Loosening the subjects' clothing significantly increased inhalation volume. The results indicate that tight clothing significantly interferes with diaphragmatic breathing. We suggest that the demonstration of the effect of tight versus loose clothing can increase the clinician's awareness of the effects of clothing on breathing patterns. The technique also facilitates the acquisition of diaphragmatic breathing skills, and may raise the client's awareness that choices such as clothing can directly affect physiology.We gratefully acknowledge the assistance of Richard Steiner, Ph.D. for his comments and help with the statistical analysis in this article. We would also like to thank William MacHose for his assistance with the graphics for this article. The preliminary findings of this paper were presented at the Twenty-first Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.     

Biofeedback treatments of essential hypertension

Fifteen years of research in the self-regulatory treatment of hypertension by the author is summarized. A model relating expectations, task performance, home practice, and biochemical variables to the thermal biofeedback treatment of hypertension is presented.Essentially, all of the research reported herein was supported by various grants from NHLBI: HL-14906, HL-18814, HL-27622, and HL-31189.     

Prediction of early termination from the self-regulatory treatment of chronic headache

The ability of demographic, psychological testing and history information to predict which patients will terminate early from nonpharmacological treatment of headache (relaxation and biofeedback) was tested. Information from each of these areas was initially examined for differences between dropouts and treatment completers using univariate analyses. These analyses were followed by a canonical discriminate function analysis that predicted whether patients would complete treatment or drop out. Information from the three predictor sets combined resulted in 77.4% of the patients being correctly classified.This research was supported by a grant from the NINCDS, NS15235.     

Effect of music-assisted imagery on neutrophils and lymphocytes

The purpose of this study was to determine the effects of cell-specific mental imagery on neutrophil and lymphocyte cell counts. Subjects (N=30) were randomly assigned to one of two experimental groups that underwent a 6-week training program focusing on images of morphology, location, and movement of either neutrophils or lymphocytes. Music was used to enhance the imagery of the subjects. Peripheral white blood cell and differential counts were determined before and after the final 20-minute imagery session. Results indicated that neutrophils decreased significantly (p<.04) in the neutrophil-change group while lymphocytes did not. The reverse occurred in the lymphocyte-change group, with only the lymphocytes decreasing significantly (p<.03). The authors concluded that under the conditions of the present study, cell-specific imagery was associated with decreases in peripheral blood cell counts of lymphocytes and neutrophils.     

Integrating music in breathing training and relaxation: II. Applications

Psychophysiological observations, especially PETCO2 and EEG, during relaxation training with deep-diaphragmatic breathing and mental imagery, suggest that the addition of certain types of music deepens breathing and quickens relaxation: PETCO2 normalizes with decreased respiration rate, and EEG shows decreased average theta and increased alpha. The combined psychophysiological indices suggest that music potentiates the hypometabolic counterarousal state. And clients unanimously report that they enjoy it.     

Integrating music in breathing training and relaxation: I. Background,rationale, and relevant elements

Quasiformal reports of widespread use of music in counterarousal techniques abound despite little evidence of its psychophysiological effects. Some known effects are presented here, and they suggest, among other things, an influence on hemispheric dominance, changes in autonomic nervous system activity, and relaxation by paradoxical arousal patterns contrary to those in cognitive function and anxiety. Hypothetical subcortical reflexes are postulated as mediators. Different types of music and their effect are described. Of particular relevance is that some forms of music have been reliably shown to have a profound beneficial effect on breathing.A number of references cited in this report are based on anecdotal observations lacking empirical validation and should be interpreted in that vein. I thank Cheryl Marant for bringining to my attention several important articles on music and stress.     

Scientific and clinical biofeedback in the USSR

This paper describes the history of biofeedback research and application in the USSR. The approach of USSR scientists to the study of basic mechanisms of biofeedback and the status of clinical applications of biofeedback in the Soviet Union are described. Trends in the publication of biofeedback-related papers in Russian are presented, and the present state of the art described. Promising prospects for biofeedback research and application are discussed.