Biofeedback treatments of generalized anxiety disorder: Preliminary results

Forty-five individuals with generalized anxiety (38 with GAD as defined by DSM-III) were randomized to 4 treatment conditions or a waiting list control. Patients received 8 sessions of either frontal EMG biofeedback, biofeedback to increase EEG alpha, biofeedback to decrease EEG alpha, or a pseudomeditation control condition. All treated subjects showed significant reductions in STAI-Trait Anxiety and psychophysiologic symptoms on the Psychosomatic Symptom Checklist. Only alpha-increase biofeedback subjects showed significant reductions in heart rate reactivity to stressors at a separate psychophysiological testing session. Decreased self-report of anxiety was maintained at 6 weeks posttreatment.     

The Influence of Voice Volume, Pitch, and Speech Rate on Progressive Relaxation Training: Application of Methods from Speech Pathology and Audiology

Vocal characteristics of therapists, including voice volume, pitch and timbre of speech, and rate of speech have been hypothesized to facilitate the therapeutic process, particularly during procedures like progressive relaxation training (PRT). Very little empirical work, however, has examined the relation between vocal characteristics and treatment process or outcome. The purpose of this study was to examine the role of vocal characteristics during a single session of PRT applying technological innovations devised for speech pathology and audiology settings for evaluating therapist's vocal characteristics. Forty-eight high anxious young adult women were randomly assigned to one of four conditions for training: PRT with the recommended therapist voice (RV) that decreased in tone, volume, and rate across the session, PRT with conversational therapist voice during the session (CV), a credible treatment control called systematic self-relaxation (SR), or no treatment control (NT). All subjects participated in a single PRT session during which heart rate, EMG, self-report measures of tension (SRT) and anxiety, and treatment credibility ratings were obtained. Results revealed significant reductions in SRT, self-reported anxiety, and heart rate for participants in all groups. Only the RV group displayed significant reductions in EMG when compared with the other three groups. Participants in the RV group also rated the therapist's voice as “more facilitating” of relaxation when compared to the CV group. These results suggest that methods employed for evaluating the quality of vocal characteristics in speech and audiology clinics may be useful for evaluating the quality of therapist's voice when conducting PRT.     

Effectiveness of multiple muscle-site EMG biofeedback and relaxation training in reducing the aversiveness of cancer chemotherapy

A 44-year-old female cancer patient was given progressive muscle relaxation training and multiple muscle-site EMG biofeedback to reduce the conditioned negative responses she had apparently developed to her chemotherapy treatments. Following three baseline chemotherapy sessions, the patient was given relaxation training and biofeedback during four consecutive chemotherapy treatments and was asked to practice her relaxation skills daily in the hospital or at home. After the patient felt able to relax on her own, relaxation training and biofeedback were terminated and three follow-up sessions were held. Results indicated that during the chemotherapy sessions in which the patient received relaxation training and biofeedback, she showed reductions in physiological arousal (EMG, pulse rate, systolic blood pressure, and diastolic blood pressure) and reported feeling less anxious and nauseated. Moreover, these changes were maintained during the follow-up sessions. These results suggest that relaxation training plus multiple muscle-site biofeedback may be an effective adjunctive procedure for reducing some of the adverse side effects of cancer chemotherapy.     

Visceral perception versus visceral detection: Disentangling methods and assumptions

A within-subject experiment compared three paradigms commonly used in visceral perception: self-report, heartbeat tracking, and signal detection. Eighteen undergraduates estimated heart rate using each technique while engaging in a number of separate tasks conducted a week apart. Although all three techniques significantly tapped accuracy of heart rate perception, only the self-report and signal detection methods were reliable over time. Most important, there was no relationship involving any of the methods in measuring accuracy. The findings suggest some fundamental differences in the assumptions and perceptual properties of the various paradigms. A distinction is made between visceral perception and detection. Perception implies the subject's use of both internal physiological and external environmental information in the perception of visceral state. Detection connotes the subject's use of only physiological information — to the exclusion of all other factors. The relevance of these approaches for biofeedback and real-world symptom perception is discussed.     

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

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

Heart rate variability biofeedback as a method for assessing baroreflex function: a preliminary study of resonance in the cardiovascular system

This study describes the use of a biofeedback method for the noninvasive study of baroreflex mechanisms. Five previously untrained healthy male participants learned to control oscillations in heart rate using biofeedback training to modify their heart rate variability at specific frequencies. They were instructed to match computer-generated sinusoidal oscillations with oscillations in heart rate at seven frequencies within the range of 0.01–0.14 Hz. All participants successfully produced high-amplitude target-frequency oscillations in both heart rate and blood pressure. Stable and predictable transfer functions between heart rate and blood pressure were obtained in all participants. The highest oscillation amplitudes were produced in the range of 0.055–0.11 Hz for heart rate and 0.02–0.055 Hz for blood pressure. Transfer functions were calculated among sinusoidal oscillations in the target stimuli, heart rate, blood pressure, and respiration for frequencies at which subjects received training. High and low target-frequency oscillation amplitudes at specific frequencies could be explained by resonance among various oscillatory processes in the cardiovascular system. The exact resonant frequencies differed among individuals. Changes in heart rate oscillations could not be completely explained by changes in breathing. The biofeedback method also allowed us to quantity characteristics of inertia, delay, and speed sensitivity in baroreflex system. We discuss the implications of these findings for using heart rate variability biofeedback as an aid in diagnosing various autonomic and cardiovascular system disorders and as a method for treating these disorders.     

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.     

Learned Cardiac Control with Heart Rate Biofeedback Transfers to Emotional Reactions

Emotions involve subjective feelings, action tendencies and physiological reactions. Earlier findings suggest that biofeedback might provide a way to regulate the physiological components of emotions. The present study investigates if learned heart rate regulation with biofeedback transfers to emotional situations without biofeedback. First, participants learned to decrease heart rate using biofeedback. Then, inter-individual differences in the acquired skill predicted how well they could decrease heart rate reactivity when later exposed to negative arousing pictures without biofeedback. These findings suggest that (i) short lasting biofeedback training improves heart rate regulation and (ii) the learned ability transfers to emotion challenging situations without biofeedback. Thus, heart rate biofeedback training may enable regulation of bodily aspects of emotion also when feedback is not available.     

Heart rate and blood pressure biofeedback

The experimental literature on the use of biofeedback with heart rate and blood pressure, published since 1972, was reviewed and summarized along several dimensions: magnitude of change, effects of extended training, type of feedback, temporal feedback factors, motivational factors, instructional effects, individual differences, and the mediation/specificity issue. The research on biofeedback and heart rate was found to be fairly well developed. Research on biofeedback and blood pressure, however, was found to be much less advanced. Moreover, most of the studies were done with hypertensive subjects.     

Effects of Heart Rate Variability Biofeedback on EEG Alpha Asymmetry and Anxiety Symptoms in Male Athletes: A Pilot Study

Heart rate variability biofeedback (HRV-BFB) has been shown as useful tool to manage stress in various populations. The present study was designed to investigate whether the biofeedback-based stress management tool consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device induce changes in athletes’ HRV, EEG patterns, and self-reported anxiety and self-esteem. The study involved 41 healthy male athletes, aged 16–21 (mean 18.34 ± 1.36) years. Participants were randomly divided into two groups: biofeedback and control. Athletes in the biofeedback group received HRV biofeedback training, athletes in the control group didn’t receive any intervention. During the randomized controlled trial (days 0–21), the mean anxiety score declined significantly for the intervention group (change-4 p < 0.001) but not for the control group (p = 0.817). In addition, as compared to the control, athletes in biofeedback group showed substantial and statistically significant improvement in heart rate variability indices and changes in power spectra of both theta and alpha brain waves, and alpha asymmetry. These changes suggest better self-control in the central nervous system and better flexibility of the autonomic nervous system in the group that received biofeedback training. A HRV biofeedback-based stress management tool may be beneficial for stress reduction for young male athletes.     

A Pilot Study of the Efficacy of Heart Rate Variability (HRV) Biofeedback in Patients with Fibromyalgia

Fibromyalgia (FM) is a non-inflammatory rheumatologic disorder characterized by musculoskeletal pain, fatigue, depression, cognitive dysfunction and sleep disturbance. Research suggests that autonomic dysfunction may account for some of the symptomatology of FM. An open label trial of biofeedback training was conducted to manipulate suboptimal heart rate variability (HRV), a key marker of autonomic dysfunction. Methods: Twelve women ages 18–60 with FM completed 10 weekly sessions of HRV biofeedback. They were taught to breathe at their resonant frequency (RF) and asked to practice twice daily. At sessions 1, 10 and 3-month follow-up, physiological and questionnaire data were collected. Results: There were clinically significant decreases in depression and pain and improvement in functioning from Session 1 to a 3-month follow-up. For depression, the improvement occurred by Session 10. HRV and blood pressure variability (BPV) increased during biofeedback tasks. HRV increased from Sessions 1–10, while BPV decreased from Session 1 to the 3 month follow-up. Conclusions: These data suggest that HRV biofeedback may be a useful treatment for FM, perhaps mediated by autonomic changes. While HRV effects were immediate, blood pressure, baroreflex, and therapeutic effects were delayed. This is consistent with data on the relationship among stress, HPA axis activity, and brain function.     

Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension

One hundred and one patients, 70 experimental and 31 controls, with a diagnosis of essential hypertension, were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures: heart rate, forehead muscle tension, finger temperature, depression, anxiety, plasma aldosterone, plasma renin activity, and plasma and urinary cortisol. Eighty percent of the participants were medicated. Treatment yielded a short-term success rate, defined as a decrease in mean arterial pressure of 5 mm Hg, of 49% in the experimental group. Other significant short-term changes included a reduction of forehead muscle tension, state anxiety, plasma aldosterone, and increased finger temperature. Follow-up measurements were made approximately 10 months after treatment in 36 patients, 51% of the treatment completers. Twenty of the 36 were short-term treatment failures, while 16 were treatment succeeders. Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up. In short-term succeeders, continued practice of relaxation may influence long-term maintenance of decreased blood pressure. It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension in selected individuals.I greatly appreciate the assistance of Minda Sogocio, Judy Stewart, and Kay Gerstenmaier from the Toledo Health Department, and Ilona Jurek, Carrie Wakai, and Robert Spain from the Medical College of Ohio at Toledo. This research was supported by a grant to A. McGrady through the Hypertension Control Program of the City of Toledo Health Department, from the Ohio Department of Health.     

Frontal EMG-biofeedback training of athetoid cerebral palsy patients

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

Expectancy effects on relaxation instructions: physiological and self-report indices

Two sessions of relaxation instructions were administered under high and low expectancy conditions. Fifty-four college students scoring high on a self-report measure of anxiety served as subjects. Live and taped abbreviated progressive muscle relaxation instructions and a self-relaxation condition were equally effective in reducing within-session self-report and physiological indices of anxiety. High expectancy instructions led to greater reductions in heart rate than did low expectancy instructions. Factors controlling anxiety reduction during relaxation therapies are discussed.     

An Examination of Psychopathology and Daily Impairment in Adolescents with Social Anxiety Disorder

Although social anxiety disorder (SAD) is most often diagnosed during adolescence, few investigations have examined the clinical presentation and daily functional impairment of this disorder exclusively in adolescents. Prior studies have demonstrated that some clinical features of SAD in adolescents are unique relative to younger children with the condition. Furthermore, quality of sleep, a robust predictor of anxiety problems and daily stress, has not been examined in socially anxious adolescents. In this investigation, social behavior and sleep were closely examined in adolescents with SAD (n = 16) and normal control adolescents (NC; n = 14). Participants completed a self-report measure and an actigraphy assessment of sleep. Social functioning was assessed via a brief speech and a social interaction task, during which heart rate and skin conductance were measured. Additionally, participants completed a daily social activity journal for 1 week. No differences were observed in objective or subjective quality of sleep. Adolescents with SAD reported greater distress during the analogue social tasks relative to NC adolescents. During the speech task, adolescents with SAD exhibited a trend toward greater speech latency and spoke significantly less than NC adolescents. Additionally, SAD participants manifested greater skin conductance during the speech task. During the social interaction, adolescents with SAD required significantly more confederate prompts to stimulate interaction. Finally, adolescents with SAD reported more frequent anxiety-provoking situations in their daily lives, including answering questions in class, assertive communication, and interacting with a group. The findings suggest that, although adolescents with SAD may not exhibit daily impaired sleep, the group does experience specific behavioral and physiological difficulties in social contexts regularly. Social skills training may be a critical component in therapeutic approaches for this group.     

渐进性肌肉放松训练对急性心肌梗死病人焦虑状态的影响

为了确定渐进性肌肉放松对急性心肌梗死患者焦虑情绪是否有缓解作用,本研究选取2016年4月至2019年4月期间在曲靖市第一人民医院心内科治疗的患者274例作为研究对象,随机分为对照组和观察组,每组137例,平均年龄(53.27±10.3)岁。对照组在治疗期间给予常规护理,而观察组在常规护理的基础上给予渐进性肌肉放松治疗。放松治疗每天2次,每次10组,一周4天,共治疗4周。分别于患者入院48 h和治疗后1个月对患者的血压、心率、并发症以及焦虑水平进行记录评估。研究显示,入院治疗1个月后,患者的血压、心率均有所下降,但无统计学差异;相较于对照组,观察组的并发症发病患者均明显下降(p<0.05);此外,患者入院时均有不同程度的焦虑情绪,经过一个月的治疗后患者的焦虑评分均明显下降,且在观察组中焦虑得分更显著低于对照组(p<0.05)。本实验在较大的临床样本中证实渐进性肌肉放松训练能明显降低患者的焦虑情绪并有助于降低患者并发症,能在治疗急性心肌梗死患者时提供较大帮助,为临床应用放松训练辅助治疗心肌梗死提供了较为可靠的实验证据,有重要的实用价值。     

Comparisons of high, medium, and low feedback sensitivity for the control of heart-rate acceleration

Thirty-four student volunteers were randomly assigned to one of three feedback sensitivity conditions: high sensitivity, medium sensitivity, or low sensitivity. Each subject received four sessions of biofeedback training with instructions to accelerate heart rate. In each condition, analogue feedback was provided during heart-rate acceleration trials. In addition to heart rate, frontal EMG and digital skin temperature were also recorded. Results replicated and extended the findings of a previous study in that medium and low sensitivity feedback was found to be superior to high sensitivity feedback during the final training session. These results confirm previous findings that a high sensitivity feedback produces very poor control of heart-rate acceleration. These data were discussed in terms of motor skills theory and in terms of possible effects of feedback sensitivity upon the motivation of subjects.     

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.     

EMG biofeedback treatment of torticollis: a controlled outcome study.

Successful treatment of torticollis with electromyographic (EMG) biofeedback has been reported in a number of single case and single group studies. The present investigation represents the first controlled outcome study. Twelve torticollis patients were randomly assigned to EMG biofeedback or relaxation training and graded neck exercises (RGP). The procedure involved three sessions of baseline assessment, 15 sessions of EMG BF or RGP, 6 sessions of EMG BF or RGP plus home-management, 6 sessions of home-management alone, and follow-up 3 months after the end of treatment. A variety of outcome measures were used including physiological (EMG from the two sternocleidomastoid muscles, skin conductance level), behavioral (angle of head deviation, range of movement of the head), and self-report (depression, functional disability, body concept), therapist and "significant other" reports and independent observer assessment of videos. In both groups, neck muscle activity was reduced from pre- to posttreatment. This reduction was greater in the EMG biofeedback group. There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group. Therefore, the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects. Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of "arousal." Significant improvements of extent of head deviation, and range of movement of the head, as well as reductions of depression were present, which were not different in the two groups. At the end of treatment, no patient was asymptomatic. Any therapeutic benefit was generally maintained at follow-up. The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one. Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger samples are required.     

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.