Characteristics of stress clinic attendees

Increasing numbers of self-referral stress management programs are using relaxation and biofeedback techniques, but few data are available on the characteristics of the clients upon which one might base the design or improvement of a self-regulation program. The type, duration, and severity of stress problem, medication, and demographic information were obtained from 423 adults who attended a university-based stress clinic. The clients were classified into four symptom groups (anxiety, muscle tension headache, muscle tension, and other) and one asymptomatic (personal growth) group. Ten sessions of cognitive and somatic relaxation techniques were provided, followed by a posttreatment improvement questionnaire. The asymptomatic group was significantly different from the stress groups, whereas the latter exhibited more similarities than differences. The groups reported an average improvement in well-being of 67%, and the majority of clients equally preferred the autogenic and progressive muscle relaxation therapies.     

A comparison of treatment modes in the management of myofascial pain dysfunction syndrome

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.     

The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension

The effect of EMG biofeedback-assisted relaxation on blood pressure and selected biochemical parameters was evaluated in 38 patients with essential hypertension. Training consisted of 8 weeks of biofeedback and home practice of relaxation exercises. Mean blood pressure decreased in the experimental group from 144/90 to 133/84 mm Hg while the control group remained unchanged. Statistically significant decreases in the experimental group also occurred in muscle tension levels, in plasma aldosterone, and in urinary cortisol. Both aldosterone and cortisol are secreted by the adrenal cortex. It was concluded that the technique taught to the experimental group produced a reduction in skeletal muscle tension and a decrease in stress responding mediated by the adrenal cortex.     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r = .854), followed by the mixed headache group (r = .785), and finally the tension headache group (r = .732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r = .75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r=.854), followed by the mixed headache group (r=.785), and finally the tension headache group (r=.732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r=.75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.This research was supported by a grant from NINCDS, NS-15235.     

Effects of high-pressure acclimatization on silver eel (Anguilla anguilla, L.) slow muscle contraction

As the spawning migration of the eel is supposed to correspond to a long swimming activity at depth, patterns of slow red muscle contraction have been investigated in European silver eel (Anguilla anguilla L.) exposed for 3 weeks to 10.1 MPa hydrostatic pressure. The results show that pressure-acclimated eels (male and female) show a three-fold decrease in maximum isometric stress of twitch and tetanic contractions while time to peak force, time from peak force to 90% relaxation and ratio of twitch tension to tetanic tension remain unchanged. The observed modifications in slow red muscle mechanical properties do not impede the spawning migration of the eel and are possibly partially compensated by an improvement in the efficiency of oxidative phosphorylation. Effects of changes in membrane fluidity are also discussed.     

The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension

The effect of EMG biofeedback-assisted relaxation on blood pressure and selected biochemical parameters was evaluated in 38 patients with essential hypertension. Training consisted of 8 weeks of biofeedback and home practice of relaxation exercises. Mean blood pressure decreased in the experimental group from 144/90 to 133/84 mm Hg while the control group remained unchanged. Statistically significant decreases in the experimental group also occurred in muscle tension levels, in plasma aldosterone, and in urinary cortisol. Both aldosterone and cortisol are secreted by the adrenal cortex. It was concluded that the technique taught to the experimental group produced a reduction in skeletal muscle tension and a decrease in stress responding mediated by the adrenal cortex.This work was supported by the Northwestern Ohio Heart Association Grant No. 93298. It was presented as a citation paper at the meetings of the Biofeedback Society in 1979 and 1980.     

The relative effectiveness of three techniques to induce the trophotropic response.

The purpose of this study was to examine the relative effectiveness of electromyographic biofeedback training (EMG BFT), meditation, and progressive muscle relaxation (PMR) in eliciting a relaxation or trophotropic response as measured by frontalis muscle tension, heart rate, electrodermal response, respiration rate, and skin temperature. Fifty-four college students were randomly assigned to one of five groups: (1) control, (2) placebo control, (3) EMG BFT, (4) meditation, (5) PMR. After baseline measures were obtained subjects were trained in 10 30-minute training sessions and posttested. Comparisons by ANOVAs indicated there was a significant decrease in muscle tension in the EMG BFT and meditation groups and significant decreases in respiration rate in the meditation and PMR groups. No other changes were attributed to treatment.     

Effects of variation in physical effort on frontalis EMG activity

The physiological mechanisms underlying forehead muscle biofeedback for stress reduction are not well understood. A common hypothesis considers the frontales to be "key muscles" uniquely indexing the degree of tension present in the general musculature. We tested this hypothesis under conditions ranging from relaxation to maximum physical effort. The hypothesis was not supported. Changes in forehead muscle activity were limited primarily to reflecting changes in head and neck muscle tension.     

The relationship between muscle discrimination ability and response to relaxation training in three kinds of headaches

Accurate discrimination of changes in physiological response has been noted as an important element in learning to control that response. Using a magnitude production procedure involving forearm isometric contractions, it was found that the ability to discriminate muscle tension varied across headache groups, with the no-headache control group (r=.76) being most accurate, followed by the tension group (r=.68), the mixed tension and migraine group (r=.60), and finally the migraine group (r=.51). The most important result, however, was that muscle discrimination ability significantly predicted clinical outcome from treatment by relaxation training for tension headache subjects (r=.50) but did not predict outcome for migraine or mixed headache subjects.This research was supported by a grant from NINCDS, NS-15235.     

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.     

Relative efficacy of Ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.     

Relative efficacy of ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.     

The effect of stressful life events on EMG biofeedback and relaxation training in the treatment of anxiety

The present study evaluated the effect of frontal EMG biofeedback and relaxation training on a group of 20 anxious patients experiencing stressful life events. The patients were divided into two groups, high and low in stress, based on their life change score on the Recent Life Changes Questionnaire. Patients were evaluated at pre, post, and 6-week follow-up. Treatment consisted of 10 sessions of biofeedback-assisted relaxation. Results indicated that the high stress group showed pre to post changes on anxiety, depression, symptoms, and EMG, while low stress showed no change. Post to follow-up comparisons showed maintenance of improvement for the high stress group and no change for low stress. From pre to follow-up assessment, the high stress group showed significant changes. Both groups reported internal attributions following biofeedback and relaxation training. The high stress group attributed their improvement to the belief they were in control of their minds and bodies, while the low stress group most frequently reported the effort put into the task. The results indicate support for a cognitive explanation for some of biofeedback's effects.     

Posttraumatic Headache: An Exploratory Treatment Study

Fourteen patients with posttraumatic headache (PTHA) were treated with a comprehensive treatment package targeting headache symptoms along with associated posttraumatic stress symptoms. Treatment consisted of some or all of the following depending on headache features: thermal biofeedback, electromyography biofeedback targeting the forehead and/or neck muscles, progressive muscle relaxation, education and cognitive–behavioral therapy. Mean improvement for the treatment group was 21%, whereas mean improvement for the wait-list group was –14% indicating a worsening of headache; however, the difference between groups was not statistically significant. There was a significant between groups difference on headache-free days. Within group results were modest with 29% mean improvement by the end of treatment. The reduction in headache index was significant. Minor reductions in psychopathology, most notably anxiety, were found after treatment. This study confirmed the treatment difficulties seen in this understudied population of headache sufferers, but offered hope for symptom relief.     

EMG stability as a biofeedback control.

Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.     

Effects of NaCl on vascular responsiveness in male rats

The effect of chronic salt treatment on systolic blood pressure and vascular adrenergic responsiveness was studied in rats. Vascular reactivity of aortic smooth muscle to potassium chloride and sodium nitrite was similar in both groups, indicating that salt treatment did not alter the regular contraction and relaxation process of the smooth muscle. Isoproterenol-induced relaxation was similar for both treated and control groups demonstrating that salt treatment had no effect on vascular beta-adrenergic responsiveness. However, when aortic smooth muscle was incubated with angiotensin II or norepinephrine, a significant increase in responsiveness was observed in the aortic smooth muscle of the salt-treated group compared to the control group. Collectively, these results suggest that salt, per se, does not affect systolic blood pressure or peripheral beta-adrenergic responsiveness, but does result in a significantly enhanced alpha-adrenergic responsiveness. The implication of these results for experimental hypertension are discussed.     

A comparison of treatment modes in the management of myofascial pain dysfunction syndrome

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.This article is based on a thesis submitted in partial fulfillment of the requirement for a master's degree from the University of British Columbia by the second author. This research was facilitated by National Health and Welfare Grant NAHS 30-9625 and provincial government Youth Employment Program project #1225-01 made to Drs. Crockett and Alden, respectively. The authors would like to thank J. Dory, D.D.S., M.Sc. and B. Lundgren, B.P.T. for their help in completing this project. The authors also would like to thank S. Edwards and J. Snyder for their assistance in the preparation of this paper.     

EMG stability as a biofeedback control

Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.This research was supported by NIH-Grant HL 27402. We are grateful to Paul Schnitter who constructed the EMG stability feedback device.     

Mechanical properties of a slow muscle in the cockroach

The mechanical properties of the metacoxal muscle, 177d, in the cockroach, Periplaneta americana, was investigated. The muscle exhibited a mean resting tension of 2.6 ± 1.3g SD. Neurally evoked tension summed with the resting tension and the relaxation phase of the evoked tension varied from less than 1 s to several minutes. This residual tension varied not only in duration but also in amplitude. Stimulation of inhibitory axons increased the rate of relaxation and thereby abolished the residual tension. However, inhibitory stimulation never reduced the resting tension. Stimulation of the main leg nerve at several times the threshold of the inhibitory axons could evoke residual tension. Recording of synaptic potentials from the two histochemically different fiber types (dorsal and ventral groups) revealed large hyperpolarizations in the ventral fibers and decreased duration and amplitude of excitatory potentials in the dorsal fibers. These results suggest that there are a variety of ways in which tension can be evoked, maintained, and controlled in these muscles.