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.     

Thermal biofeedback and lower extremity blood flow in adults with diabetes: is neuropathy a limiting factor?

Thermal biofeedback may be a useful adjunctive technique for enhancing cutaneous blood flow in patients with lower-extremity vascular complications of diabetes. However, autonomic, sensory, and/or motor neuropathies may impair vasomotion and limit the ability to alter blood flow and achieve significant foot warming with thermal biofeedback. We examined nerve function associated with four common types of diabetic neuropathy (sympathetic–autonomic, vagal–autonomic, sensory, and motor), hypothesizing that both sympathetic–autonomic and sensory neuropathies would limit the acquisition of biofeedback-mediated foot warming. Twenty-four participants with diabetes mellitus (19 with type II and 5 with type I) received a nerve conduction study and neurological evaluation of the upper and lower extremities. Hand temperature, foot temperature, and electrodermal gradient at the toes were monitored across six thermal biofeedback sessions. Participants were able to significantly raise p < .01) foot temperatures across sessions, an average of 2.2°F. Consistent with our hypotheses, 41% of the variance in foot warming was explained by lower-extremity sympathetic–autonomic and sensory nerve function tests. This study demonstrated that a general diabetic population, including patients with mild-to-moderate neuropathy, can increase skin perfusion with thermal biofeedback. As hypothesized, lower-extremity sympathetic–autonomic and sensory neuropathies interfered with foot warming.     

Plasma catecholamine levels during temperature biofeedback training in normal subjects

Thirty-nine normal volunteers of both sexes were randomly assigned to receive 8 sessions of temperature biofeedback or autogenic training to increase finger temperature. Temperature biofeedback subjects produced significant elevations in finger temperature during training, whereas those who received autogenic training did not. Temperature feedback subjects had significantly higher heart rates and diastolic blood pressures during training compared to autogenic subjects. There were no significant changes or group differences in plasma catecholamine levels. These data do not support the hypothesis that feedback-induced vasodilation is accompanied by decreased sympathetic activation in normal populations, when only temperature biofeedback is employed.Supported by research grant No. HL-30604 from NHLBI. Dr. Angela McGuady served as Action Editor for this paper.     

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.     

Direction of Temperature Control in the Thermal Biofeedback Treatment of Vascular Headache

In order to test for the specific therapeutic effects of thermal biofeedback (TBF) for hand warming on vascular headache (HA), 70 patients with chronic vascular HA were randomly assigned to TBF for hand warming, TBF for hand cooling, TBF for stabilization of hand temperature, or biofeedback to suppress alpha in the EEG. Patients in each condition initially had high levels of expectation of therapeutic benefit and found the treatment rationales highly credible. Participants in each condition received 12 treatment sessions on a twice-per-week basis. Based on daily HA diary data gathered for 4 weeks prior to treatment and 4 weeks after treatment, HA Index was significantly (p=.003) reduced as was HA medication consumption. There were no differential reducations in HA Index or Medication Index among the four conditions. Global self-reports of improvement gathered at the end of the post-treatment monitoring period also did not differ among the four conditions. We were unable to demonstrate a specific effect of TBF for hand warming on vascular HA activity.     

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.     

beta blockade and intermittent claudication: placebo controlled trial of atenolol and nifedipine and their combination.

OBJECTIVE--To determine the effects of the beta 1 selective adrenoceptor blocker atenolol, the dihydropyridine calcium antagonist nifedipine, and the combination of atenolol plus nifedipine on objective and subjective measures of walking performance and foot temperature in patients with intermittent claudication. DESIGN--Randomised controlled double blind four way crossover trial. SETTING--Royal Hallamshire Hospital, Sheffield. SUBJECTS--49 patients (40 men) aged 39-70 with chronic stable intermittent claudication. INTERVENTIONS--Atenolol 50 mg twice daily; slow release nifedipine 20 mg twice daily; atenolol 50 mg plus slow release nifedipine 20 mg twice daily; placebo. Each treatment was given for four weeks with no washout interval between treatments. MAIN OUTCOME MEASURES--Claudication and walking distances on treadmill; skin temperature of feet as measured by thermistor and probe; blood pressure before and after exercise; subjective assessments of walking difficulty and foot coldness with visual analogue scales. RESULTS--Atenolol did not significantly alter claudication distance (mean change -6%; 95% confidence interval 1% to -13%), walking distance (-2%; 4% to -8%), or foot temperature. Nifedipine did not alter claudication distance (-4%; 3% to -11%), walking distance (-4%; 3% to -10%), or foot temperature. Atenolol plus nifedipine did not alter claudication distance but significantly reduced walking distance (-9%; -3% to -15% (p less than 0.003)) and skin temperature of the more affected foot (-1.1 degrees C; 0 to -2.2 degrees C (p = 0.05)). These effects on walking distance and foot temperature seemed unrelated to blood pressure changes. CONCLUSIONS--There was no evidence of adverse or beneficial effects of atenolol or nifedipine, when given singly, on peripheral vascular disease. The combined treatment, however, affected walking ability and foot temperature adversely. This may have been due to beta blockade plus reduced vascular resistance, which might also explain the reported adverse effects of pindolol and labetalol on claudication.     

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

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

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.     

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

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

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.     

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.     

2 型糖尿病下肢血管病变评估方法的研究进展

2型糖尿病的发病率逐年增高,下肢血管病变是其严重并发症之一,其临床特点主要有间歇性跋行、静息痛、缺血性坏疽等,严重者可发生肢端坏疽,一旦出现以上症状,治疗相当困难,甚至导致截肢。因此尽早发现并预防该并发症的发生,对于改善患者预后有着极重要的临床价值[1]。目前临床上对于2型糖尿病下肢血管病变的评估方法众多,包括间歇性跛行、静息痛等临床表现,足部动脉搏动检查,踝-肱血压指数,经皮氧分压检查,彩色多普勒超声检查,CT血管成像,MR血管成像,数字减影血管造影等。在现今超声及影像设备和技术飞速发展的大背景下,本文对以上方法的价值、局限性及其最新研究进展作一综述。     

Impact of a walking program in people with down syndrome

The purpose of this study was to evaluate the efficacy of a pain-free treadmill walking program in intellectually disabled (ID) adults with arterial occlusive disease. Fourteen participants with mild ID participated in the walking program. Six patients showed stable intermittent claudication. A control (nontreadmill, n = 12) group consisted of 4 individuals with intermittent claudication. Noninvasive determinations of lower-limb hemodynamics included photoplethysmography and ankle-brachial pressure. Pain levels were measured according to a pain pathophysiology index. The treadmill program consisted of individually prescribed low-endurance walking at a 0% incline done at a comfortable speed 3 times per week. All participants completed the 15-week walking program and showed significant improvements (p < 0.05) in walking speed, distance, and duration. Pain levels were reduced in individuals suffering from intermittent claudication. Blood hemodynamic parameters also showed significant improvements. In conclusion, low-intensity treadmill walking significantly improved the functional capacities of adult individuals with mild ID with vascular occlusion and reduced pain levels.     

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.     

Thermal feedback in Raynaud's phenomenon secondary to systemic lupus erythematosus: long-term remission of target symptoms

Thermal feedback shows promise when applied to Raynaud's phenomenon secondary to systematic lupus erythematosus (SLE). A female subject was followed over an 8-year period that included initial training, 1-year follow-up, and 8-year follow-up. Peripheral circulation was initially very poor, as evidenced by low basal fingertip temperatures and trophic lesions at the fingernails. An intensive 5-week training regimen in thermal self-regulation yielded evidence of hand warming, followed by an increase in basal finger temperature. Reported vasospasms were markedly reduced and the lesions healed in the ensuing weeks. As of the 1-year follow-up, the skill was intact. Symptoms remained in substantial remission throughout the 8-year period during which the subject practiced somatic relaxation and hand warming without electronic feedback. Objective temperature measurement at the 8-year juncture yielded results similar to the initial acquisition, gradual manifestation of control over the first 4 days. The subject also reported diminution of vascular headache, another symptom of SLE. While much of the biofeedback literature is focused on stress-related disease, research of this kind affirms the value of self-regulatory technique in illnesses whose causes are primarily physical.     

Thermal feedback in Raynaud's phenomenon secondary to systemic lupus erythematosus: Long-term remission of target symptoms

Thermal feedback shows promise when applied to Raynaud's phenomenon secondary to systematic lupus erythematosus (SLE). A female subject was followed over an 8-year period that included initial training, I-year follow-up, and 8-year follow-up. Peripheral circulation was initially very poor, as evidenced by low basal fingertip temperatures and trophic lesions at the fingernails. An intensive 5-week training regimen in thermal self-regulation yielded evidence of hand warming, followed by an increase in basal finger temperature. Reported vasospasms were markedly reduced and the lesions healed in the ensuing weeks. As of the 1-year follow-up, the skill was intact. Symptoms remained in substantial remission throughout the 8-year period during which the subject practiced somatic relaxation and hand warming without electronic feedback. Objective temperature measurement at the 8-year juncture yielded results similar to the initial acquisition, gradual manifestation of control over the first 4 days. The subject also reported diminution of vascular headache, another symptom of SLE. While much of the biofeedback literature is focused on stress-related disease, research of this kind affirms the value of self-regulatory technique in illnesses whose causes are primarily physical.     

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.     

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.