The relative efficacy of autogenic phrases and autogenic-feedback training in teaching hand warming to children

There are few well-controlled biofeedback temperature training studies in the literature that have used children as subjects. The purposes of this study were (1) to evaluate whether children can learn to increase hand temperature, controlling for methodological factors that have been overlooked in previous experiments, and (2) to determine whether adding thermal biofeedback to autogenic phrases results in improved ability to produce voluntary increases in hand temperature over the use of autogenic phrases alone. Twenty-six subjects (ages 9–11) were divided into two groups of 13 subjects each. All subjects participated in four 35 to 45-minute sessions consisting of a stabilization phase, a training phase, and a post-training phase on 4 consecutive days. One group was trained to increase finger temperature with autogenic phrases only, and the other was trained with autogenic phrases plus thermal feedback. None of the subjects in either group learned to increase hand temperature significantly within sessions. There was a consistent and reliable decreasing trend within each session; however, finger temperature did increase (.27° F) for the first 8 minutes of the training phase. There was a significant increase in hand temperature from day 1 to days 3 and 4, and there were significant increases in temperature during the stabilization phase alone. There were no differential effects of treatments. Methodological issues concerning stabilization, the potential confounding effect of boredom and fatigue, and different training methods for children are discussed.     

Physiological mechanism of digital vasoconstriction training

Recent work in our laboratory has shown that vasodilation produced during temperature biofeedback training is mediated through a nonneural, beta-adrenergic mechanism. Here we sought to determine if the effects of feedback training for vasoconstriction are produced through a neural or nonneural pathway and whether other measures of physiological activity are correlated with these changes. Nine normal subjects received temperature feedback vasoconstriction training in which feedback was delivered only during periods of successful performance. In a subsequent session, the nerves to one finger were blocked with a local anesthetic while finger blood flow was recorded from this and other fingers. Vasoconstriction occurred during feedback in the intact fingers but not in the nerve-blocked finger and was accompanied by increased skin conductance and heart rate. These data demonstrate that temperature feedback vasoconstriction training is mediated through an efferent, sympathetic nervous pathway. In contrast, temperature feedback vasodilation training is mediated through a nonneural, beta-adrenergic mechanism.     

Physiological mechanism of digital vasoconstriction training

Recent work in our laboratory has shown that vasodilation produced during temperature biofeedback training is mediated through a nonneural, beta-adrenergic mechanism. Here we sought to determine if the effects of feedback training for vasoconstriction are produced through a neural or nonneural pathway and whether other measures of physiological activity are correlated with these changes. Nine normal subjects received temperature feedback vasoconstriction training in which feedback was delivered only during periods of successful performance. In a subsequent session, the nerves to one finger were blocked with a local anesthetic while finger blood flow was recorded from this and other fingers. Vasoconstriction occurred during feedback in the intact fingers but not in the nerve-blocked finger and was accompanied by increased skin conductance and heart rate. These data demonstrate that temperature feedback vasoconstriction training is mediated through an efferent, sympathetic nervous pathway. In contrast, temperature feedback vasodilation training is mediated through a nonneural, beta-adrenergic mechanism.This work was supported by research grant HL-30604 from the National Heart, Lung, and Blood Institute.     

Thermal biofeedback in the treatment of intermittent claudication in diabetes: A case study

The objective of the present case study was to examine the therapeutic effects of thermal biofeedback-assisted autogenic training on a patient with non-insulin-dependent diabetes mellitus (NIDDM), vascular disease, and symptoms of intermittent claudication. The patient received thermal biofeedback from the hand for five sessions, then from the foot for 16 sessions, while hand and foot skin temperature were monitored simultaneously. In addition, the patient was instructed in autogenic training and practiced daily at home. Follow-up measurements were taken at 12 and 48 months. Within-session foot temperature rose specifically in response to foot temperature biofeedback and starting foot temperature rose between sessions. Posttreatment blood pressure was reduced to a normal level. Attacks of intermittent claudication were reduced to zero after 12 sessions and walking distance increased by about a mile per day over the course of treatment. It would appear that thermal biofeedback and autogenic training are potentially promising therapies for persons with diabetes and peripheral vascular disease.Preparation of this article was supported in part by NIDDK grant No. R0128288 and the Commonwealth of Virginia Diabetes Clinical Research Institute.     

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.     

Stress management techniques: Are they all equivalent,or do they have specific effects?

This article evaluates the hypothesis that various stress management techniques have specific effects. Studies comparing various techniques are reviewed, as well as previous literature reviews evaluating the effects of individual techniques. There is evidence that cognitively oriented methods have specific cognitive effects, that specific autonomic effects result from autonomically oriented methods, and that specific muscular effects are produced by muscularly oriented methods. Muscle relaxation and/or EMG biofeedback have greater muscular effects and smaller autonomic effects than finger temperature biofeedback and/or autogenic training. EMG biofeedback produces greater effects on particular muscular groups than progressive relaxation, and thermal biofeedback has greater finger temperature effects than autogenic training. Disorders with a predominant muscular component (e.g., tension headaches) are treated more effectively by muscularly oriented methods, while disorders in which autonomic dysfunction predominates (e.g., hypertension, migraine headaches) are more effectively treated by techniques with a strong autonomic component. Anxiety and phobias tend to be most effectively treated by methods with both strong cognitive and behavioral components.This work was supported by grants Nos. HL-34336 and HL-44097 from the Heart, Lung, and Blood Institute of the National Institutes of Health. Material in this article has been condensed and updated from three chapters in Lehrer, P. M., and Woolfolk, R. L. (1993).Principles and practice of stress management, Vol. 2, New York: Guilford Press.     

Racial and gender effects on the relaxation response: Implications for the development of hypertension

This study was designed to explore the effect of race and gender on the forehead muscle tension and finger temperature response to biofeedback-assisted relaxation training in individuals with normal blood pressure. Forty-five subjects—18 Black and 27 White, 25 males and 20 females—participated in eight sessions of autogenic relaxation training and thermal biofeedback. Multivariate analysis of variance of the variables measured at baseline (systolic BP, diastolic BP, sodium excretion, anxiety) was significant for gender. Univariate analysis showed males different from females in DBP, Na⁺ excretion, and trait anxiety. Pretest values of muscle tension were similar by gender, but pretest temperatures were lower in males than females. Repeated measures ANOVA for muscle tension showed a significant effect of period. For temperature, a significant effect of period, gender, and gender × period was observed. Males increased temperature more than females. There was no effect of history of hypertension on the relaxation response. Multiple regression performed on change in muscle tension and change in temperature showed that pretest muscle tension predicted change in muscle tension. Four variables contributed to the variance in change in temperature: pretest temperature, sodium excretion, and state and trait anxiety.     

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.     

The behavioral treatment of Raynaud's disease: A review

Raynaud's disease is a peripheral vascular system disorder characterized by episodes of vasoconstriction in the hands and feet resulting in a lowering of skin temperature and pain. Recent studies are reviewed that focus on the behavioral treatment of Raynaud's disease—in particular, biofeedback and autogenic training. Methodological problems and other difficulties include the measurement of skin temperature, schedules of reinforcement/feedback, and characteristics of the experimenter and subject. Studies in this area indicate some promise for certain behavioral interventions, especially finger temperature biofeedback under cold stress conditions. On the other hand, further research is needed to clarify the mechanisms, especially that of vasodilation, and the applications of temperature biofeedback, as well as the role of attitudinal, interpersonal, and cognitive factors.     

The behavioral treatment of Raynaud's disease: a review

Raynaud's disease is a peripheral vascular system disorder characterized by episodes of vasoconstriction in the hands and feet resulting in a lowering of skin temperature and pain. Recent studies are reviewed that focus on the behavioral treatment of Raynaud's disease--in particular, biofeedback and autogenic training. Methodological problems and other difficulties include the measurement of skin temperature, schedules of reinforcement/feedback, and characteristics of the experimenter and subject. Studies in this area indicate some promise for certain behavioral interventions, especially finger temperature biofeedback under cold stress conditions. On the other hand, further research is needed to clarify the mechanisms, especially that of vasodilation, and the applications of temperature biofeedback, as well as the role of attitudinal, interpersonal, and cognitive factors.     

Regulation of mental states and biofeedback techniques: Effects on breathing pattern

The purpose of the present study was to examine whether breathing pattern may be used as a reliable index for the effectiveness of techniques applied for the regulation of mental states. Heart rate (HR), breathing pattern, galvanic skin response (GSR), and electromyogram (EMG) of the frontalis muscle were measured in 39 male and female subjects aged 18–25 years during 10-minute treatment with relaxation technique (autogenic training and/or music) followed by 10 minutes of imagery training. In the first 7 sessions biofeedback (BFB) was not included, while during the last 6 sessions BFB was introduced and utilized by the subjects. Relaxation (music or autogenic training) led to a decrease in breathing frequency, attributed to lengthening of expiration time, as well as reduced HR, GSR, and frontalis EMG response. In most instances imagery training was related to an increase in these indices. Specifically, significant tachypnea was observed during imagery of sprint running. In most cases BFB substantially augmented the physiological responses. In conclusion, our data suggest that, compared with HR, GSR, and EMG responses, the breathing pattern is at least as sensitive to the mental techniques employed, and may be useful as a psychophysiological index for diagnosis and testing, especially in sport practice.     

Biofeedback control of migraine headaches: a comparison of two approaches

In order to assess the relative effectiveness of finger warming and temporal blood volume pulse reduction biofeedback in the treatment of migraine, 22 female migraine patients were assigned to one of three experimental conditions: temporal artery constriction feedback, finger temperature feedback, or waiting list. Biofeedback training consisted of 12 sessions over a 6-week period. All patients completed 5 weeks of daily self-monitoring of headache activity (frequency, duration, and intensity) and medication before and after treatment. Treatment credibility was assessed at the end of Sessions 1, 6, and 12. Results showed that temporal constriction and finger temperature biofeedback were equally effective in controlling migraine headaches and produced greater benefits than the waiting list condition. Power analyses indicated that very large sample sizes would have been required to detect any significant differences between the two treatment groups. No significant relationships were found between levels of therapeutic gains and levels of thermal or blood volume pulse self-regulation skills. Likewise, treatment outcome was not found to be related to treatment credibility. Further analyses revealed that changes in headache activity and medication were associated with changes in vasomotor variability. Because blood volume pulse variability was not significantly affected by biofeedback training, questions about its role in the therapeutic mechanism are raised.     

Skin temperature biofeedback and migraine headaches

To assess the relative contribution of specific and nonspecific effects of skin temperature biofeedback upon migraine headache, 11 migraine patients were taught to increase the temperature of their hand. Training to decrease the skin temperature of the hand served as a control for 12 other migraine patients. An additional 11 control subjects were not trained but kept records of migraine activity. Under carefully controlled double-blind procedures, migraine patients who learned to raise finger temperatures showed statistically significant and clinically therapeutic improvement during a 6-week follow-up period. However, they were not significantly better than those trained to lower finger temperatures, those who did not meet a learning criterion, or those receiving no training. While these groups did show some significant improvement when compared to subjects who learned to decrease finger temperature, the results are most parsimoniously explained through nonspecific rather than specific factors. The necessity of using double-blind procedures in evaluating therapeutic effectiveness is again stressed.This article was presented as a Citation Award Paper at the Biofeedback Society of America meetings, San Diego, 1979. The work was supported in part by Rehabilitation Services Administration Grant No. 16-P-56810/5-17 to the University of Minnesota Medical Rehabilitation Research and Training Center and by a grant from the Division of Health Care Psychology, University of Minnesota. We would like to acknowledge the advice and support of Lee Willerman and John Belknap. We are grateful for the assistance of John Hendrickson, Dale Armin Miller, and Stephanie Waddingham in conducting the study and for the technical assistance of Robert Patterson, Steve Sheffield, P. Thain Marston, Kathy Guttormson, and Nancy Belknap.     

Biofeedback control of migraine headaches: A comparison of two approaches

In order to assess the relative effectiveness of finger warming and temporal blood volume pulse reduction biofeedback in the treatment of migraine, 22 female migraine patients were assigned to one of three experimental conditions: temporal artery constriction feedback, finger temperature feedback, or waiting list. Biofeedback training consisted of 12 sessions over a 6-week period. All patients completed 5 weeks of daily self-monitoring of headache activity (frequency, duration, and intensity) and medication before and after treatment. Treatment credibility was assessed at the end of Sessions 1, 6, and 12. Results showed that temporal constriction and finger temperature biofeedback were equally effective in controlling migraine headaches and produced greater benefits than the waiting list condition. Power analyses indicated that very large sample sizes would have been required to detect any significant differences between the two treatment groups. No significant relationships were found between levels of therapeutic gains and levels of thermal or blood volume pulse self-regulation skills. Likewise, treatment outcome was not found to be related to treatment credibility. Further analyses revealed that changes in headache activity and medication were associated with changes in vasomotor variability. Because blood volume pulse variability was not significantly affected by biofeedback training, questions about its role in the therapeutic mechanism are raised.This research was supported in part by grants from the Quebec Ministry of Education and the Quebec Ministery of Social Affairs to the first author, and an award from the Medical Research Council of Canada to the second author. The authors are indebted to Drs. Frank Andrasik, Howard Barbaree, Edward Blanchard, Martin Ford, and Patrick McGrath, as well as to two anonymous reviewers, for their helpful comments on an earlier draft of this paper.     

Biofeedback treatment of Raynaud's disease and phenomenon

Six Raynaud's disease and four Raynaud's phenomenon patients were treated with 12 sessions of finger temperature biofeedback. The mean frequency of vasospastic attacks was reduced to 7.5% of that reported during the pretreatment baseline and was maintained for a 1 year follow-up period. Significant control of digital temperature was demonstrated during laboratory training sessions. Raynaud's phenomenon patients showed significantly greater temperature increases during feedback periods than Raynaud's disease patients. Correlations between finger temperature and other physiological measures suggested that results could not be attributed to general physical relaxation. The role of imagery in self-control of digital temperature is considered.Portions of this paper were presented at the annual meeting of the Biofeedback Society of America, Albuquerque, March 1978.     

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.     

Biofeedback,relaxation training,and music: Homeostasis for coping with stress

This study compared the efficacy of five relaxation training procedures, four of which employed EMG auditory feedback: (1) biofeedback only (BF), (2) autogenic training phrases (ATP), (3) music (MU), (4) autogenic training phrases and music (ATP & MU), and (5) a control group, in developing self-regulation of a cultivated low arousal state as a countermeasure to tensed muscular reaction to stressful imagery. Twenty subjects established a pre- and posttraining frontalis region EMG biofeedback baseline measurement. Sixteen subjects were assigned at random to the 25-minute taped relaxation training procedure. After eight training sessions (4 weeks), MU and ATP & MU groups achieved highly significant differences when compared with the control group. The ATP & MU group attained the lowest postbaseline arousal level measured by the EMG. EMG as a physiological measure for transfer of training functioned well in detecting the psychophysiological affect of stressful imagery.This report is based on a thesis submitted in partial fulfillment of the requirements for the Master of Arts in Psychology degree by the author. The author extends his gratitude to Dr. Theodore Steiner, Dr. Paul Eskildsen, and Dr. Frank Hovell, who served on the committee, and to Rosemary Kolentus, for her help with this article.     

Psychophysiological effects of autogenic training and progressive relaxation

Although autogenic training and progressive relaxation are widely used relaxation techniques, little research has been conducted on their comparative effects. Twenty-two normal subjects received five sessions of instruction in either progressive relaxation or autogenic training over a 5-week period. Both types of training, when compared to the control group, significantly decreased SCL-90 scores on four scales: anxiety, depression, number of symptoms, and intensity of symptoms. Also, autogenic training appeared to produce specific effects on self-perception of heaviness and warmth in the limbs and depth of breathing. However, there were no significant differences between groups in pretest versus posttest changes in heart rate or skin conductance. These results are consistent with the results of other recent research on nonanxious individuals in this laboratory.This report is based on a Master of Science thesis at Rutgers University by the senior author. The research was supported in part by a General Research Support Grant from Rutgers Medical School to the junior author. The authors are indebted to Robert Edelberg for his generously supplied psychophysiological help and advice, and to Alan Jusko for his technical help.     

End organ changes associated with the self-regulatory treatment of mild essential hypertension?

M-mode echocardiograms were obtained on unmedicated males with mild hypertension before and after treatment with thermal biofeedback, autogenic training, or self-relaxation. Although patients for whom diastolic blood pressure (DBP) was successfully reduced showed trends toward reduction in left ventricular parameters while unsuccessful patients showed no changes, the results were not significant. For the four patients with borderline left ventricular hypertrophy, there was a strong trend (p = .06) for successful treatment to lead to a reduction in left ventricular mass. Moreover, across the whole sample, reduction in left ventricular mass was related (r = .30) to decrease in DBP.     

The Effect of the Definition of Menstrually-Related Headache on the Response to Biofeedback Treatment

Twelve women with either pure migraine headache (HA) or a combination of migraine and tension-type HA monitored HA activity over two menstrual cycles while noting onset of menstruation and onset of ovulation. They then received 12 sessions of thermal biofeedback (TBF) with adjunctive autogenic training. Six women with only tension-type HA participated in similar monitoring before receiving 9 sessions of progressive relaxation training.Results for those with vascular HA showed a significant reduction in HA activity and a reduction in medication taken for HAs. Those with tension-type HA did not respond significantly to the relaxation training. Depending upon how one defined menstrually-related HAs among those with vascular HA, there either was, or was not, a differential effect of TBF on menstrual-cycle-related HA.