Applied psychophysiology and biofeedback of event-related potentials (brain waves): historical perspective, review, future directions

This paper reviews the efforts of workers in the 1960s-1980s to demonstrate voluntary control of exogenously evoked (event-related) potentials in visual, somatic sensory, and auditory systems in rats, cats, and humans. The first part of the paper reviews the conceptual foundation and development of the work--it actually arose from traditional sensory coding and neural correlates of behavior studies. The second part summarizes recent applications of the method in the area of pain control. In reviewing these matters, the major effort is directed at revealing how the ideas unfolded in very human, day-to-day, anecdotal terms. There is not much of an attempt to formally review the literature, which is cited for consultation elsewhere. In the same spirit, many possible future experiments are suggested by way of elucidating the key remaining questions in the area.     

Interaction of oddball probability and primary task type on P300 in the dual-task paradigm

Using a dual-task paradigm with an oddball secondary task, P300 amplitude and latency were studied as a function of factorially manipulated oddball probability (low = .22, high = .44) and primary task type. In addition to a Baselinecondition (oddball task only), three primary tasks were used: (1) Pure Sensory;watching a movie; (2) Pure Motor (manipulating a flashlight); and (3) Sensory/Motor(using the flashlight to trace the outlines of characters in a movie). The findings included the usual significant effects of probability on amplitude. There was also a significant effect of task type on amplitude, and a significant interaction of oddball probability with task type. In the low but not high probability condition, a pure Sensory task depressed P300 amplitude. In both probability conditions, the Sensory/motortask depressed P300 amplitude. Only task type had a significant effect on P300 latency. The results confirm the ability of other labs (using Sensory/motor primary tasks) to demonstrate P300 depression at high oddball probability, in view of the difficulty in our lab of achieving P300 depression with pure sensory tasks and high oddball probabilities. The results are discussed in terms of partial overlap of processing resource pools. A preliminary report of these data was presented at the 1990 meetings of the Society for Psychophysiological Research.     

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.     

Generalization of EMG biofeedback training

Five young adults received audio biofeedback training to reduce trapezius EMG levels while they engaged in reading in an office, seated at a table. A multiple-baseline-across subjects design was employed in two separate studies. After training, all subjects demonstrated reduced EMG levels while reading in a home or library setting. The first study suggested that subjects reduced EMG levels by minimizing movements and altering their postures; the second study systematically demonstrated changes in such behavior, which was correlated with EMG levels. The data provide evidence that EMG biofeedback resulted in response generalization across several motoric classes, and in stimulus generalization from the training setting to the natural environment. The importance of assessing generalization is discussed.     

Frequency characteristics of signals and instrumentation: Implication for EMG biofeedback studies

Signals can be analyzed in either the time or frequency domain. In the time domain, the analysis consists of manipulating and measuring one or more characteristics of the signal that may vary with time. One can, for instance, rectify a signal, filter it, calculate its mean value, display the histogram of its amplitude, and so forth. Frequency analysis is less well understood because it requires a lengthy mathematical treatment most easily done by computer. However, it gives exclusive information on a signal. For instance, when the frequency content of a signal is known, it is easy to specify which characteristics an amplifier must have in order to amplify the signal without distortion, or to set the cutoff frequencies of filters to eliminate noise. Also, in many circumstances, frequency spectra are more easily interpreted than the original raw data. Such is the case with the EMG where the random aspect of the signal makes some form of processing (i.e., rectification, filtering, etc.) necessary, but not always as meaningful as we would like. Thus we present here the principal characteristics of frequency analysis, and discuss its usefulness in analyzing EMG signals and its application to biofeedback, clinical practice, and research.The authors acknowledge the technical assistance of F. Kemp, M. Goyette, and C. Goulet. T. Milner kindly reviewed the final version of the text. The preparation of this paper was supported through funds from Health and Welfare Canada (NHRDP) and the Centre de recherche, Institut de réadaptation de Montréal.     

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.     

Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache

Sixteen children and adolescents with migraine headache were treated with thermal biofeedback. Seven were seen individually in the clinic while the other nine participated in a limited-contact, partly home-based regimen. Evaluation of headache diary data from 4-week monitoring periods before and after treatment showed significant (p<.01) reduction in headaches, with no significant difference in efficacy between the two conditions.This research was supported in part by grants from NIMH, MH-41341, and NINCDS, NS-23440.     

Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: Preliminary report

Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of the external anal sphincter (EAS) muscle during attempted defecation. This inappropriate contraction can lead to delayed, impacted, painful, and infrequent bowel movements. Standard Medical Care (SMC) involves disimpaction with enemas, followed by laxative therapy and diet modification, to maintain frequent soft stools. Using the case control method, the efficacy of SMC alone was compared with SMC plus EAS electromyographic biofeedback aimed at eliminating paradoxical contraction. Thirteen consecutive chronically constipated children received SMC plus biofeedback, and were compared with 13 age- and sex-matched children who received only SMC. Biofeedback subjects demonstrated post-treatment elimination of EAS paradoxical constriction. At 16 months follow-up parents of biofeedback children reported significantly greater improvement in constipation, encopresis, laxative use, and painful bowel movements compared to SMC.This research report was supported by the NIH under grant No. RO1 HD 28160.     

Yawning: A possible confounding variable in EMG biofeedback studies

An elderly hemiplegic patient participating in an EMG biofeedback training program was observed to produce a synergistic flexion movement of the plegic (determined by functional evaluations) upper limb while yawning. In the course of the training sessions the electrical activity of the anterior deltoid (the target muscle) was recorded during yawning. These peak EMG values were greatly facilitated in comparison with the session mean peak values obtained during an attempted maximum voluntary isometric contraction (shoulder flexion) of the same limb (e.g., Trial 1: 85.00 vs. 4.33 µV). The possibility of yawning as a confounding variable in EMG biofeedback studies is presented and discussed.This research was supported in part by Health and Welfare Canada (NHRDP).     

Subjective experiences associated with thermal biofeedback treatment of hypertension

Reports of subjective experiences of 73 hypertensive patients who were treated with thermal biofeedback for hand warming were obtained over 16 treatment sessions. Most of the differential responding in subjective report occurred in the first 5 sessions. Differences in reports of throbbing were associated with medication status during treatment (presence of sympatholytic antihypertensive agent). From 4 to 9% of patients report negative subjective experiences at any one session. When short-term clinical successes (either elimination of medication or reduction of BP) were compared with short-term failures, it was found that successes reported more warmth, more likelihood of falling asleep, and more dreamlike experiences. The latter were more likely to occur suddenly for the successes. Correlational analyses revealed consistent positive associations between reports of warmth and relaxation with highest temperature achieved in the session and consistent negative associations between experiencing physical sensations and degree of temperature change within the session.This research was supported in part by grants from NHLBI, HL-27622 and HL-31189.     

EMG stability as a biofeedback control

Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.This research was supported by NIH-Grant HL 27402. We are grateful to Paul Schnitter who constructed the EMG stability feedback device.     

Slow cortical potential biofeedback and the startle reflex

The negativity of slow cortical potentials (SCP) of the surface EEG is a measure of brain excitability, correlating with motor and cognitive preparation. Selfcontrol of SCP positivity has been shown to reduce seizure activity. Following SCP biofeedback from a central EEG electrode position, subjects gained bidirectional control over their SCP. The current study used a modified feedback methodology, and found a positive relationship between negativity and magnitude of EMG startle response (a measure of cortical and subcortical arousal, particularly aversive response disposition). Greater success in SCP differentiation was associated with self-report of less relaxation during negativity training.This research was supported by the Deutsche Forschungsgemeinschaft under grant No. SFB 307.     

A 1- and 2-year follow-up study of bowel sound biofeedback as a treatment for irritable bowel syndrome

Five patients initially treated with bowel sound biofeedback were assessed at 1- and 2-year follow-up. Although variable results were reported, subjects who improved to a clinically significant extent at posttreatment maintained their improvement through 1-year and in some cases 2-year follow-up. In light of these results, this form of treatment may prove effective for some patients in the long term.     

Biochemical changes associated with thermal biofeedback treatment of hypertension

Fifty-two hypertensive patients whose blood pressure (BP) was controlled on two medications received either 16 sessions of thermal biofeedback (n=30) for hand warming or 8 sessions of progressive muscle relaxation (n=22) prior to medication withdrawal. A number of biochemical measures, including plasma norepinephrine (NEPI) (supine and standing), plasma renin activity, plasma aldosterone, and urinary sodium and potassium, were taken before treatment and after treatment while medication remained constant. Results for the biofeedback-treated patients showed significant reductions in mean arterial pressure as well as in both supine and standing NEPI, while the other biochemical measures were unchanged. There were no significant changes on any variable for the relaxation-treated patients. Although the group data support a reduction in peripheral sympathetic tone as associated with the decrease in BP for the thermal biofeedback condition, dose-response relations were not significant.This research was supported by a grant from NHLBI, HL-27622.     

Variations in digital temperature during frontal EMG biofeedback training in normal subjects

During frontal EMG biofeedback training, the relationship between frontal EMG and digital skin temperature was investigated in two experiments, which varied the number of baseline and feedback sessions. The results of Experiment 1 suggested a general relaxation effect, where digital temperature increased as frontal EMG decreased, especially for subjects with initially low hand temperature. Experiment 2 extended the number of baseline and feedback sessions and qualified the results of Experiment 1. EMG and digital temperature did not simultaneously converge toward general relaxation over the extended baseline or feedback sessions in Experiment 2. Furthermore, when the feedback signal was introduced, digital temperature dropped quickly but recovered to baseline levels within three feedback sessions; this drop in digital temperature was interpreted within the context of attentional demands of the biofeedback task. The results appeared consistent with the view that frontal biofeedback training teaches a discriminative skill of lower frontal EMG, and that this skill does not readily generalize to digital skin temperature.This research was supported by Grant 2 S06RR08038-17 funded by the National Institutes of Mental Health.     

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.