Effects of biofeedback-assisted attention training in a college population

A program of stress management employing open-focus attention-training workshops was developed at Baruch College to bring the benefits of stress reduction to students. The purpose of the research reported here was to evaluate the results of the open-focus attention-training technique. Open-focus technique without biofeedback training was used for two semesters. Biofeedback training was incorporated in the third semester. In the first study, changes in grade point average (GPA), stress-related symptoms, and physiological measures were examined. The experimental subjects' stress data for this study was reported previously (Valdés, 1985). In the second study, changes in the same variables for experimental and control subjects were evaluated. Students in the control group showed decreased GPA, while those who participated in open-focus training showed a trend toward improved GPA. Stress-related symptoms associated with anxiety and management of emotional problems showed significant posttraining improvement, as did physiological measures in all of the biofeedback modalities in which the experimental subjects were specifically trained. The results support the hypothesis that the workshops were successful in reducing stress levels, and suggest that further controlled research be conducted to verify these findings, and to identify the most effective components of the training procedure.Portions of this report were presented at the Fifteenth Annual Meeting of the Biofeedback Society of America, Alburquerque, March 1984. Special thanks and acknowledgement are due to Dr. Manus Rabinowitz, professor of statistics and computer information systems; Ms. Angela Anselmo, M. S. Ed., of the Department of Compensatory Programs, and Mr. Eric Laner, a graduate assistant. Professor Rabinowitz was responsible for the study, development, and evaluation of statistical data, tests, and computer programs. Ms. Anselmo assisted in conducting the workshops.     

Effects of Relaxation Training on Glucose Tolerance and Diabetic Control in Type II Diabetes

The present study examined the effects of progressive relaxation training and EMG biofeedback on acute glucose disposal in diabetic subjects, as measured by glucose tolerance and three other measures of diabetic metabolic control. Twenty subjects with non-insulin-using Type II diabetes took part in progressive relaxation training and EMG biofeedback in a pre-post treatment versus wait-list experimental design. Treatment effects were assessed on glucose tolerance along with three measures of diabetic control: fasting blood glucose, two-hour postprandial blood glucose, and fructosamine. Stress reduction and relaxation was assessed with two physiological measures and two subjective questionnaires. The training program produced significant reductions in stress, as measured by State Anxiety, and significant changes in physiological measures of muscle activity and skin conductance compared to the control condition. However, no changes were found in glucose tolerance (while practicing relaxation) nor in any of the three measures of general diabetic metabolic control. The major implication of this study is that relaxation training does not appear to directly improve diabetic control in mildly stressed non-insulin-using Type II diabetic patients.     

Pre-service Teachers and Stress During Microteaching: An Experimental Investigation of the Effectiveness of Relaxation Training with Biofeedback on Psychological and Physiological Indices of Stress

Pre-service teacher stress is an understudied research area, with the majority of research focusing on subjective reports of stress. The present study sought to examine the influence of stress-reduction techniques on both subjective and objective indicators of stress during microteaching in preservice teachers. A sample of 44 preservice teachers were randomly assigned to one of three intervention groups; biofeedback, relaxation, or control. Participants in the biofeedback group received relaxation-assisted biofeedback training designed to teach participants the physiological signs of the stress response using HeartMath monitor, along with the HeartMath Quick Coherence® technique. Those in the relaxation group were given training in the HeartMath Quick Coherence relaxation technique, with no biofeedback training. Finally, those in the control group did not receive any relaxation or biofeedback training. Using a repeated-measures design, both psychological and physiological indices of stress were measured before and after students engaged in microteaching approaches. Examination of the psychological ratings identified that feelings of calm increased across time; this showed that participants were more comfortable with the microteaching situation with repeated practice. However, none of the physiological interventions were effective in reducing stress. The present study highlights practice as a useful strategy to reduce stress in microteaching situations and points to the importance of employing evidence-based interventions when attempting to reduce stress.     

Biodesensitization: Biofeedback-controlled systematic desensitization of the stress response to infant crying

Infant crying can be a source of parental stress both psychologically and physiologically and also may be an antecedent to physical child abuse or neglect. Biodesensitization is a new therapeutic technique that allows people to control the source of stress and develop self-control over their physiological responses to the stress-eliciting stimuli. Randomly assigned between three groups, 15 female participants were either given EEG biofeedback pretraining without stress, pretraining while listening to infant crying, or no stress management pretraining while listening to crying. After the pretraining manipulation all participants had biodesensitization training while listening to infant crying. Compared to control participants who were habituated to crying, stress management training significantly reduced the EEG cortical arousal as well as perceived arousal, and anxiety associated with listening to infant crying. The shift in participants' EEG power spectrum produced by infant crying was significantly correlated with perceived arousal and this relationship was strengthened after biofeedback training. In conjunction with other research, the experimental results suggest that stress management training may help ameliorate an aversive response to infant crying and possibly prevent child abuse as a response to physiological hyperreactivity.The author is grateful to Stan Sadava, Shoshana Tyson, and Joanna Manning for their helpful comments on this paper.     

Effectiveness of emWave Biofeedback in Improving Heart Rate Variability Reactivity to and Recovery from Stress

The current study examined the efficacy of heart rate variability (HRV) biofeedback using emWave, a publicly available biofeedback device, to determine whether training affected physiological tone and stress responses. Twenty-seven individuals aged 18–30 years were randomized to a treatment or no-treatment control group. Treatment participants underwent 4–8 sessions of emWave intervention, and all participants attended pre-treatment and post-treatment assessment sessions during which acute stressors were administered. Physiological data were collected at rest, during stress, and following stress. emWave treatment did not confer changes in tonic measures of HRV or in HRV recovery following stress. However, treatment participants exhibited higher parasympathetic responses (i.e., pNN50) during stress presentations at the post-treatment session than their control counterparts. No treatment effects were evident on self-reported measures of stress, psychological symptoms, or affect. Overall, results from the current study suggest that the emWave may confer some limited treatment effects by increasing HRV during exposure to stress. Additional development and testing of the emWave treatment protocol is necessary before it can be recommended for regular use in clinical settings, including the determination of what physiological changes are clinically meaningful during HRV biofeedback training.     

Biofeedback treatment of dysmenorrhea

Nine dysmenorrheic women were run in EMG and thermal biofeedback procedures with concurrent autogenic relaxation practice. Significant reductions in subjective estimates of symptomology associated with dysmenorrhea were noted in all subjects. EMG levels correlated positively with the reductions in symptoms. Thermal levels did not correlate with EMG. In fact no consistent patterns in thermal measures were noted. However, thermal biofeedback cannot be ruled out as an effective treatment for dysmenorrhea since reductions in symptoms occurred during thermal biofeedback training. Another significant aspect of the present study is the effectiveness of long treatment procedures. A six month period was employed and significant reductions in symptoms were noted following two months of biofeedback treatment. Finally, the importance of beginning biofeedback treatment prior to onset of menstrual symptoms is indicated.     

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.     

Biofeedback in medicine: who,when, why and how?

Biofeedback is a mind-body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions, and many Americans are turning to biofeedback and other less traditional therapies for their routine healthcare.Clinical biofeedback training is growing increasingly popular in the USA, as many people are seeking out relatively new approaches to healthcare. This article provides an overview of clinical biofeedback training, outlines two models of training, details research which has established how effective biofeedback is in patients with a given disease, and describes who should be referred for biofeedback training.     

Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety

We present a method for training subjects to control activity in a region of their orbitofrontal cortex associated with contamination anxiety using biofeedback of real-time functional magnetic resonance imaging (rt-fMRI) data. Increased activity of this region is seen in relationship with contamination anxiety both in control subjects¹ and in individuals with obsessive-compulsive disorder (OCD),² a relatively common and often debilitating psychiatric disorder involving contamination anxiety. Although many brain regions have been implicated in OCD, abnormality in the orbitofrontal cortex (OFC) is one of the most consistent findings.^{3, 4} Furthermore, hyperactivity in the OFC has been found to correlate with OCD symptom severity⁵ and decreases in hyperactivity in this region have been reported to correlate with decreased symptom severity.⁶ Therefore, the ability to control this brain area may translate into clinical improvements in obsessive-compulsive symptoms including contamination anxiety. Biofeedback of rt-fMRI data is a new technique in which the temporal pattern of activity in a specific region (or associated with a specific distributed pattern of brain activity) in a subject''s brain is provided as a feedback signal to the subject. Recent reports indicate that people are able to develop control over the activity of specific brain areas when provided with rt-fMRI biofeedback.^7-12 In particular, several studies using this technique to target brain areas involved in emotion processing have reported success in training subjects to control these regions.^13-18 In several cases, rt-fMRI biofeedback training has been reported to induce cognitive, emotional, or clinical changes in subjects.^{8, 9, 13, 19} Here we illustrate this technique as applied to the treatment of contamination anxiety in healthy subjects. This biofeedback intervention will be a valuable basic research tool: it allows researchers to perturb brain function, measure the resulting changes in brain dynamics and relate those to changes in contamination anxiety or other behavioral measures. In addition, the establishment of this method serves as a first step towards the investigation of fMRI-based biofeedback as a therapeutic intervention for OCD. Given that approximately a quarter of patients with OCD receive little benefit from the currently available forms of treatment,^20-22 and that those who do benefit rarely recover completely, new approaches for treating this population are urgently needed.     

Improving Managers’ Psychophysical Well-Being: Effectiveness of Respiratory Sinus Arrhythmia Biofeedback

High work stress has been consistently associated with disturbed autonomic balance, specifically, lowered vagal cardiac control and increased sympathetic activity, which may lead to increased cardiovascular risk. Stress management procedures have been proposed to reduce autonomic dysfunctions related to work stress in different categories of workers exposed to heightened work demands, while a limited number of studies addressed this issue in managers. The present study was aimed at evaluating the effectiveness of a respiratory sinus arrhythmia (RSA) biofeedback (BF) intervention on psychological and physiological outcomes, in managers with high-level work responsibilities. Thirty-one managers leading outstanding private or public companies were randomly assigned to either a RSA-BF training (RSA-BF; N = 16) or a control group (N = 15). The RSA-BF training consisted of five weekly 45 min sessions, designed to increase RSA, whereas controls had to provide a daily stress diary once a week. After the training, managers in both groups reported reduced heart rate at rest, lower anxiety levels and improvement in health-related quality of life. More importantly, managers in the RSA-BF group showed increased vagal control (as indexed by increased RSA), decreased sympathetic arousal (as indexed by reduced skin conductance and systolic blood pressure) and lower emotional interferences, compared to managers in the control group. Results from this study showed that RSA-BF training was effective in improving cardiac autonomic balance at rest. Moreover, findings from this study underline the effectiveness of biofeedback in reducing psychophysiological negative outcomes associated with stress in managers.     

Biofeedback-based stress management training with a population of business managers

A biofeedback-based stress management training program was experimentally evaluated using populations of middle-level managers from a large corporation. The training program, once-weekly 1-hour sessions for 6 weeks, combined frontal and other site EMG biofeedback, progressive relaxation and breathing exercises, cognitive stress management, and generalization techniques. Control groups participated in either the assessment procedures only or the assessment procedures and six once-weekly discussions of stress and the job on both an individual(two sessions) and group(four sessions) basis. Significant effects were found in self-report measures, state and trait anxiety, experience of stress; in physiological measures, basal frontal EMG and frontal EMG during recovery from stress, and finger temperature; and in ratings of overall job performance. However, no consistent advantage for the training group or either control group was found. Several possible explanations for the failure of the biofeedback-based stress management training condition to achieve a consistent advantage over the control conditions are presented.     

Effect of voluntary EEG α power increase training on heart rate variability

The following objectives were set out to study the effect of EEG α power increase training on the heart rate variability (HRV) as an index of the autonomic regulation of cognitive functions: (1) to establish the interrelation between a voluntary increase in the α power in the individual upper α band and the HRV and related characteristics of cognitive and emotional spheres; (2) to determine the nature of the relationship between the α-activity indices and HRV depending on the resting α-frequency EEG pattern; and (3) to study how the individual α-frequency EEG pattern is reflected in the HRV changes as a result of biofeedback training. Psychometric indices of cognitive performance and the characteristics of EEG α activity and HRV were recorded in 27 healthy men 18–34 years of age before, during, and after ten training sessions of a voluntary increase in α power in the individual upper α band with the eyes closed. To determine the biofeedback effect in the α power increase training, the data of two groups were compared: the experimental, with a real biofeedback (14 subjects), and the control, with a sham biofeedback (13 subjects). The follow-up effect of the training was assessed one month after its end. The results showed that α biofeedback training increased the resting α frequency, improved cognitive performance, reduced psychoemotional stress, and increased HRV only in the subjects with a low baseline α frequency. In the subjects with a high baseline resting α frequency, the α biofeedback training had no effect on the resting α power and cognitive performance but reduced the HRV (judging by the pNN ₅₀ parameter). The positive correlation between the α peak frequency and HRV in subjects with initially low α frequency and the negative correlation in the subjects with a high baseline α frequency explains the opposite biofeedback effects on HRV in subjects with low and high α frequency. From the theoretical standpoint, the results of this study contribute to understanding the mechanisms of heart-brain neurovisceral relationships and their effect on the cognitive performance. From the applied standpoint, they suggest that EEG biofeedback can be used for improving autonomic regulation in healthy subjects and the development of individual approaches to the development of the biofeedback technology, which can be used both in clinical practice for treatment and rehabilitation of psychosomatic syndromes and in educational training.     

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 follow-up 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.     

The physiological effects of cigarette smoking: implications for psychophysiological research

The present study was designed to determine the specific physiological effects of two experimental conditions, smoking and mock smoking (puffing on an unlit cigarette), with smokers and nonsmokers. Two groups (smokers versus nonsmokers) with nine subjects each (five females, four males) participated in the present study. Physiological measures included alveolar carbon monoxide (COa) levels, skin resistance, heart rate, and finger temperature across a standard session sequence. The results of the COa assessment indicated increments only in the smoking condition. Multivariate analyses of variance (MANOVA) across skin conductance, heart rate, and hand temperature were initially performed, followed by univariate analyses of variance (ANOVA) for each physiological measure. Post hoc analyses were performed using orthogonal polynomial trend analyses. A number of significant differences were found. Discussion focuses on the need for experimental controls related to cigarette smoking in psychophysiological research in general, and in hand temperature biofeedback training in particular.     

Effectiveness of multiple-site EMG biofeedback in the reduction of arousal

During the training phase, 36 subjects received (a) EMG biofeedback from multiple muscle sites, (b) EMG biofeedback from the frontal site, or (c) no biofeedback. Results indicated that neither biofeedback procedure reduced self-reports of anxiety, but that multiple-site biofeedback was effective in reducing several indices of autonomic arousal (pulse rate, finger pulse volume, and skin temperature) while frontal biofeedback was not. During the generalization/stress phase, all subjects were threatened with and received electric shocks and were told to apply the relaxation techniques they learned during the training phase even though no additional biofeedback would be provided. Results indicated that multiple-site biofeedback was effective in reducing self-reports of anxiety and autonomic arousal but that frontal biofeedback was not. These results confirm previous data indicating that frontal biofeedback is not an effective procedure for controlling stress, but suggest that EMG biofeedback can be effective in reducing self-reported anxiety and autonomic arousal if a multiple muscle-site feedback procedure is employed.     

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.     

Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension.

Employees of a large industry were screened for the presence of coronary risk factors. A total of 204 employees, aged 35-64 years, with two or more such factors (serum cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), blood pressure greater than or equal to 140/90 mm Hg, and current cigarette consumption greater than or equal to 10 cigarettes a day) were randomly allocated to a biofeedback group receiving training in relaxation and management of stress or a control group. Both groups received simple health education literature. After eight weeks of training, and again eight months later, the biofeedback group showed a significantly greater fall in systolic and diastolic blood pressures than the control group (p less than 0.001). Plasma renin activity and plasma aldosterone concentration were measured in a subsample at entry to the study and again at eight weeks and eight months; both showed a greater reduction in the biofeedback compared with the control group at eight weeks'' follow-up. The greater reduction in blood pressure in the subjects in the biofeedback group compared with the control group (11.0 mm Hg systolic and 8.8 mm Hg diastolic), persisting eight months after the training, suggests that relaxation-based behavioural methods might be offered as a first-time treatment to patients with mild hypertension.     

Stress reduction treatment of severe recurrent genital herpes virus

Four individuals with high-frequency recurrences of genital herpes virus of at least 2 years' duration were treated with two behavioral stress-reduction treatments. Subjects were given 10 weekly sessions of frontalis EMG biofeedback (2 subjects) or progressive muscle relaxation treatment (2 subjects). Presession and postsession frontalis EMG measures were recorded for all subjects across treatment. Outcome was measured by daily and weekly symptom charting mailed in weekly over 6 months, or by telephone interview after 6 months. Results demonstrated substantial improvement in reported symptoms with both treatments. Relaxation treatment resulted in a 66% and 100% reduction in frequency of recurrences. Frontalis EMG biofeedback resulted in a 72% and 7% reduction in frequency of recurrences. Follow-up at 1-year posttreatment showed that treatment effects were maintained by one subject, partially maintained by two, and reversed in one subject. The need for controlled investigation is emphasized.The authors thank Stephen Ritz for his contribution to this study.     

The comparative effectiveness of heart rate biofeedback,speech skills training,and a combination of both in treating public-speaking anxiety

Forty-two speech-anxious undergraduate students (21 female, 21 male) were administered either heart rate biofeedback training, speech skills training, or a combination of both to aid in the alleviation of speech anxiety. Physiological (heart rate, tonic skin conductance level, systolic blood pressure, and diastolic blood pressure), overt motor, and self-report measures of anxiety were assessed during a pretreatment speech and two posttreatment speeches. Results indicated that all treatments were effective in lowering overt motor and self-report components of anxiety. However, only the biofeedback and combined group subjects demonstrated significantly less heart rate increase while speaking before an audience during the posttreatment assessment. Two individual difference variables examined in this study — cognitive/autonomic focus of anxiety and subjective confidence in treatment — were not found to significantly influence treatment effectiveness. Finally, factor analyses of the physiological data suggested that heart rate changes play a large role in the physiological component of anxiety.     

Heart-rate reactivity to cold pressor stress following biofeedback training

Three previous studies have shown that biofeedback training is useful in modifying heart-rate and pain ratings during ice water stimulation (cold pressor test). Subjects were given an initial cold pressor followed by heart-rate biofeedback training and a final cold pressor test in which they were instructed to control their heart rate in accordance with the prior training. It was assumed that a heart-rate control skill had been learned. In the present study, two groups of subjects (N = 9 each) were given either increase or decrease heart-rate biofeedback training following the same procedures as previously, but subjects were not instructed to control their heart rate during the final cold pressor test. Heart rate, skin conductance, electromyographic activity, and respiration were measured. The biofeedback training effects replicate the previous results. However, no heart-rate or pain rating differences were found between the two groups during the final cold pressor test. Thus, previous findings cannot be accounted for simply by a shift in heart rate and/or pain reactivity following training itself. The findings suggest that a biofeedback strategy may be useful in modifying physiological and subjective responses to painful stimuli but only if it can be used as an active coping skill.