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 and blood pressure biofeedback: II. A review and integration of recent theoretical models.

The theoretical models put forth separately by Bremer, Lang, and Schwartz to account for the data on biofeedback and cardiovascular responses are summarized and evaluated in light of recent empirical studies. Although each model makes some use of the idea that learning to control heart rate, particularly heart rate acceleration, is like motor skills learning, each model also emphasizes different sets of factors or variable. An attempted integration of these three models is presented.     

The production and generalization of large-magnitude heart rate deceleration by contingently faded biofeedback

Eight subjects were taught to decrease their heart rates via biofeedback training. Four of these received contingently faded, beat-by-beat analogue feedback and contingent reinforcement each time their performance met a specified and adjusting criterion. The other four received continuous, beat-by-beat analogue feedback, but not the contingent reinforcement. Subjects in the two groups were yoked to ensure equal densities of reinforcement. Subjects in the first group were asked to decrease heart rates 15% from baseline and were then trained using only 75%, 50% and 25% of beat-by-beat feedback. It was hypothesized that the immediate reinforcement of appropriate behavior and the contingent fading(following mastery) of feedback would aid in the generalization of the response. Following completion of all criterion steps or 10 training sessions, whichever came first, all subjects were tested with no feedback and no contingent reinforcement. The group receiving contingently faded feedback training showed a significantly greater heart rate decrease in the training sessions and also the test session. These results were interpreted as indicating that biofeedback can be conceptualized as an operant conditioning paradigm, and that the use of operant techniques may help subjects produce clinically significant changes.This research was supported in part by a grant to Robert J. Gatchel from the National Heart, Lung, and Blood Institute (Grant No. NIH HL 21426-01).     

Voluntary control of sexual responding in men and women: Implications for the etiology and treatment of sexual dysfunctions

Recent psychophysiological investigations have shown that biofeedback and operant conditioning procedures are associated with changes in genital vasomotor activity in men and women. Although the exact role played by biofeedback or operant contingencies in the establishment of genital vasomotor control has not been conclusively established, some degree of voluntary control has been reliably demonstrated over a response that is traditionally viewed as an involuntary component of the human sexual response cycle. The present article critically reviews the experimental literature pertinent to the issue of voluntary self-control of sexual responding and makes recommendations concerning future research. The implications of this literature for traditional etiological theories and treatment approaches for sexual dysfunctions are discussed. The potential of biofeedback and operant techniques for shaping genital responses, increasing discriminability, enhancing body awareness, and facilitating cognitive labeling of genital sensations are discussed as they relate to the stated goals of sex therapy.     

The effects of the distribution of training on learning feedback-assisted cardiac acceleration

In order to test a hypothesis derived from a motor skills learning model of cardiac acceleration control, groups of subjects were given biofeedback training for four sessions to learn cardiac acceleration under four different training schedules: (1) all sessions in one day, (2) daily sessions, (3) sessions every other day, and (4) weekly sessions. Ability to accelerate heart rate both with and without feedback was determined at each session. Also ability to accelerate heart rate without feedback was determined 1 week after the last training session as a measure of retention. Although there was highly significant (p less than.0001) evidence of heart rate control both with and without feedback, there were no differences in degree of control attributable to distribution of training sessions. There was, however, a trend (p less than .10) for subjects trained under the most distributed training schedule (weekly) to show more retention than subjects trained under a less distributed schedule (daily).     

Common Factors in Biofeedback Administered by Psychotherapists

Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82–96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors—including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring—may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.

     

Constructive integration of learning theory and phenomenological approaches to biofeedback training

Two major sources of theoretical development for biofeedback as an intervention paradigm are considered. An integration of cognitive learning theory approaches to the potential regulation of autonomic processes in an information-processing framework and the phenomenological information-processing approach of Kelly's personal construct theory suggest a new methodological paradigm for biofeedback as a tool of psychotherapeutic intervention, especially for the discipline of behavioral medicine. Biofeedback is reconstructed as a sequence of allocating attention to automatic cognitive processes until cognitive control has been mastered. This sequence is also seen as a circumspection-preemption-control cycle that Kelly (1955) suggested was essential to all problem solving. In light of Kelly's fundamental assumptions regarding the nature of constructs, it is suggested that controlled processing approaches to biofeedback require the biofeedback trainee to investigate both ends of psychophysiological dichotomies instead of demonstrative constructs of traditional biofeedback methodology. Other psychotherapeutic techniques are reviewed to validate this new theoretical approach. Finally, treatment within this paradigm is discussed as a recircumspection of relevant constructs that were routinized during the alarm reaction phase of Selye's general adaptation syndrome.     

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.     

Effects of Biofeedback Training on Voluntary Heart Rate Control During Dynamic Exercise

The aims of this study were to (1) compare the effect of biofeedback with that of verbal instructions on the control of heart rate during exercise on a treadmill, (2) test the possible effect of workload on this control, and (3) examine the effect of workload on baseline heart rate at rest and during exercise. The study involved 35 participants who were randomly assigned to each of 4 experimental conditions generated by combining the 2 independent variables: training strategy for heart rate control (heart rate biofeedback or verbal control instructions) and work level (30 or 50% of maximal heart rate). By the end of 5 experimental sessions, participants trained with heart rate biofeedback showed a greater attenuation of the increase in heart rate produced by exercise than participants trained with verbal control instructions. The workload did not influence the voluntary control of heart rate, nor did it affect resting baseline heart rate, but it did affect exercise baseline heart rate.     

Conditioning of fine motor control in neonatally undernourished rats

The literature indicates that the effects of developmental undernutrition on the rat nervous system are disproportionally found in the cerebellum, an organ involved in motor coordination and control. In this experiment, rats who had been developmentally undernourished did not show increased variability of forces placed on a bar by the paw in an operant learning paradigm, indicating normal motor control function. However, deficits were obtained when reinforcement was made contingent on bar press force regulation. Experimental rats shifted bar pressing forces to meet criterion more slowly than controls and received fewer reinforcements over training trials. The data are discussed in terms of recent suggestions that the cerebellum is directly involved in motor learning processes.     

Virtual Reality as an upper Limb Rehabilitation Approach

Cerebrovascular diseases seriously reduce the quality of life of patients. One of the priority tasks of restoring individual independency, daily living and social activity of patients is to restore basic motor skills such as the reaching, manipulating, and bimanual tasks an coordination. For successful recovery of movement necessary to conduct training in real environment, active participation of the patient, and interactive biofeedback that allows the patient to control the correct performance of motor tasks and adjust their own efforts. Evolution of computer technology gives an opportunity to improve the classical approaches in stroke rehabilitation. To make rehabilitation process met necessary terms, in everyday practice often used high technological devices, such as virtual reality (VR) systems. The technical basis of VR is an artificial three-dimensional environment that is created with computer and displayed on the screen. These technologies allow recreating the necessary training environment for motor skills relearning, as well as to provide interactive biofeedback and make rehabilitation process more intensive. This review present an information about history of VR technology developments, experience of upper limb rehabilitation using VR systems and comparative analysis of different VR based rehabilitation approaches.     

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 optimizing psychomotor reactivity: I. Comparison of biofeedback and common performance practice

To estimate the role of biofeedback technology in the optimization of psychomotor reactivity, 29 healthy young (aged 22.3 ± 1.5 years) musical performers were examined. On the first day of the study, they followed instructions for the voluntary control of finger motor comfort when performing musical passages for the right hand during standard performance practice without an adaptive feedback. On the second day, biofeedback was used, the muscle tone and EEG α-rhythm power being voluntarily controlled. Eventually, a biofeedback method was developed that simultaneously stimulated the activity of the EEG α rhythm and decreased the tone of the muscles not involved in the playing movement. This improved the performance in 75.8% of musicians (versus 13.8% using commonly practiced methods). The changes in the EEG parameters after effective biofeedback training were the same as in the case of successful traditional performance practice: an increase in the frequency, width, and power of the α activity and a decrease in the powers of the θ and β rhythms. The biofeedback method developed in this study can be recommended as an approach to the formation of the skills necessary for voluntarily controlling psychomotor reactivity and has prognostic implications for improving performance skills.     

Constructive integration of learning theory and phenomenological approaches to biofeedback training

Two major sources of theoretical development for biofeedback as an intervention paradigm are considered. An integration of cognitive learning theory approaches to the potential regulation of autonomic processes in an information-processing framework and the phenomenological information-processing approach of Kelly's personal construct theory suggest a new methodological paradigm for biofeedback as a tool of psychotherapeutic intervention, especially for the discipline of behavioral medicine. Biofeedback is reconstrued as a sequence of allocating attention to automatic cognitive processes until cognitive control has been mastered. This sequence is also seen as a circumspection-preemption-control cycle that Kelly (1955) suggested was essential to all problem solving. In light of Kelly's fundamental assumptions regarding the nature of constructs, it is suggested that controlled processing approaches to biofeedback require the biofeedback trainee to investigate both ends of psychophysiological dichotomies instead of demonstrative constructs of traditional biofeedback methodology. Other psychotherapeutic techniques are reviewed to validate this new theoretical approach. Finally, treatment within this paradigm is discussed as a recircumspection of relevant constructs that were routinized during the alarm reaction phase of Selye's general adaptation syndrome.The author would like to express his appreciation to Kevin Kennelly and Joe Doster for their theoretical training, and to Wes Wenrich for his expert editorial commentary.     

Individual differences in motor skills ability affect the self-regulation of heart rate

Twenty males who scored relatively high on the rotor-pursuit motor skills task (High performance group) were given seven 2-minute trials to increase heart rate and seven 2-minute trials to decrease heart rate, as were 20 males who scored relatively low on the rotor-pursuit task (Low performance group). Visual analogue feedback was not provided during the first and last acceleration and deceleration trials but was presented during all other trials. Both groups of subjects were able to decrease heart rate significantly with and without feedback. Subjects in the High performance group were able to increase heart rate significantly with feedback and could generalize this increase to a no-feedback trial following feedback trials. Subjects in the Low performance group could not increase heart rate with or without feedback. Changes in respiration rate paralleled those noted for heart rate, but changes in chin electromyographic activity generally did not parallel the heart rate results. The heart rate data are discussed in terms of motor skills theories of self-regulation of heart rate.     

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 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.     

Specific effects and biofeedback versus biofeedback-assisted self-regulation training

In any field, clear and logical conceptualizations are the basis of accurate models----correct research design----correct results----correct conclusions----advancement in the field. Faulty conceptualizations----faulty models----faulty research design----faulty results----faulty conclusions----confusion. In analyzing the conceptualizations of "biofeedback" as expressed by John Furedy (1987) in, "Specific versus Placebo Effects in Biofeedback Training: A Critical Lay Perspective," we focus on two issues: Does biofeedback have a treatment effect? Is biofeedback necessary for the training effect? In discussing issue (1) we describe the multiple meanings of "biofeedback" and raise the fundamental question: Is biofeedback a treatment? We argue that faulty conceptualizations of clinical biofeedback (1) assume that the treatment in clinical biofeedback is "biofeedback" with specific effects, (2) assume that the scientific basis of biofeedback is dependent upon demonstrations of these specific effects through double-blind design that distinguish "specific" from "placebo effects," and (3) trivialize clinical research by attempting to determine the usefulness of biofeedback information--usefulness that is already understood logically by professionals and consumers and demonstrated by clinical studies in the laboratory and in the clinic. We further argue that accurate conceptualizations of clinical biofeedback (1) identify self-regulation skills as the treatment with specific effects of physiological change and symptom reduction, and (2) describe the use of information from biofeedback instruments as scientific verification of self-regulation skills. Finally, the scientific basis of clinical biofeedback is based on (1) evidence from experimental and clinical control studies that have demonstrated the effectiveness of self-regulation skills for symptom alleviation, and (2) the use of biofeedback instruments to verify the acquisition of self-regulatory skills, thus fulfilling the scientific dictum of verifiability.     

Individual differences in motor skills ability affect the self-regulation of heart rate

Twenty males who scored relatively high on the rotor-pursuit motor skills task (High performance group) were given seven 2-minute trials to increase heart rate and seven 2-minute trials to decrease heart rate, as were 20 males who scored relatively low on the rotor-pursuit task (Low performance group). Visual analogue feedback was not provided during the first and last acceleration and deceleration trials but was presented during all other trials. Both groups of subjects were able to decrease heart rate significantly with and without feedback. Subjects in the High performance group were able to increase heart rate significantly with feedback and could generalize this increase to a no-feedback trial following feedback trials. Subjects in the Low performance group could not increase heart rate with or without feedback. Changes in respiration rate paralleled those noted for heart rate, but changes in chin electromyographic activity generally did not parallel the heart rate results. The heart rate data are discussed in terms of motor skills theories of self-regulation of heart rate.Some of the results reported in this article are based on a doctoral dissertation submitted to the Graduate School of Northern Illinois University by the second author. The heart rate data were presented at the Convention of the American Psychological Association, Anaheim, 1983.     

The conditioned avoidance reflex and intersignal movements: the correlation of the cardiac and motor components]

In five dogs correlation was studied of heart rate (HR) and motor component of conditioned avoidance reflex (CAR), elaborated by Petropavlovski? method. Stable CAR was expressed in lifting and long (not less than 5-10 sec) holding of the paw on definite height (5-10 cm) for the avoidance of painful electrocutaneous paw stimulation in response to conditioned acoustic stimulus. The level of defensive excitation, evaluated by heart rate change was maximum before the beginning of the conditioned motor reaction. Immediately after lifting and placing the paw in the zone of security a sharp decrease of defensive excitation level ("drive" reduction) took place. Intertrial motor reactions of two types were revealed. The first type imitated the conditioned motor reaction, the second one the usual phasic bending of the paw. Against the background of intertrial movement of the first, operant type a decrease of defensive motivation took similarity as it occurred against the background of CAR during the performance response.