Applied Psychophysiology

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed

Nine hundred and forty practitioners of massage, abbreviated progressive muscle relaxation (PMR), yoga stretching, breathing, imagery, meditation, and various combination treatments described their technique experiences on an 82-item wordlist. Factor analysis yielded lO interpretable relaxation categories: Joyful Affects and Appraisals (Joyful), Distant, Calm, Aware, Prayerful, Accepted, Untroubled, Limp, Silent, and Mystery. The relaxation response and cognitive~somatic specificity models predict Calm and Limp, which account for only 5.5% of the variance of relaxation experience. Unlike much of previous relaxation research, we found important technique differences. PAIR and massage are associated with Distant and Limp; yoga stretching, breathing, and meditation with Aware; meditation with Prayerfid, and all techniques except PAR with Joyfid. Results are consistent with cognitive-behavioral relaxation theory and have implications for relaxation theory, treatment, training,

This paper presents a series of 12 cases of chronic tinnitus patients who participated in 4 weeks of auditory discrimination training either close to or far removed from the tinnitus frequency. The training was based on the assumption that tinnitus is related to a shift of the representation of the tinnitus frequency in auditory cortex outside of the normal tonotopic map and that training close to but not removed from the tinnitus frequency should result in a reduction in the severity of the tinnitus. Tinnitus severity was measured 4 times per day during the entire treatment and other tinnitus-related variables were assessed 1 week before and 1 month posttreatment. The comparison of the training close to as compared to remote from the tinnitus frequency did not yield a statistically significant difference. However, a post hoc analysis revealed that patients who engaged in regular training as compared to those who practiced irregularly were significantly more successful in reducing tinnitus severity independent of the trained frequencies. Treatment success was best predicted by days of training and general activity levels. The data suggest that auditory dicrimintion training shows a dose response effect irrespective of training location and that treatment success is also related to psychological variables. For more substantial changes in multiple variables an extended training period with additional consideration of emotional variables would be necessary. In addition, controls for nonspecific training effects need to be implemented.

This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger's Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroncephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the key symptoms of AS in order to encourage further research and clinical work to refine the use of NFB plus BFB in the treatment of AS. All charts were included for review where there was a diagnosis of AS or ASD and pre-and posttraining testing results were available for one or more of the standardized tests used. Clients received 40-60 sessions of NFB, which was combined with training in metacognitive strategies and, for most older adolescent and adult clients, with BFB of respiration, electrodermal response, and, more recently, heart rate variability. For the majority of clients, feedback was contingent on decreasing slow wave activity (usually 3-7 Hz), decreasing beta spindling if it was present (usually between 23 and 35 Hz), and increasing fast wave activity termed sensorimotor rhythm (SMR) (12-15 or 13-15 Hz depending on assessment findings). The most common initial montage was referential placement at the vertex (CZ) for children and at FCz (midway between FZ and CZ) for adults, referenced to the right ear. Metacognitive strategies relevant to social understanding, spatial reasoning, reading comprehension, and math were taught when the feedback indicated that the client was relaxed, calm, and focused. Significant improvements were found on measures of attention (T.O.V.A. and IVA), core symptoms (Australian Scale for Asperger's Syndrome, Conners' Global Index, SNAP version of the DSM-IV criteria for ADHD, and the ADD-Q), achievement (Wide Range Achievement Test), and intelligence (Wechsler Intelligence Scales). The average gain for the Full Scale IQ score was 9 points. A decrease in relevant EEG ratios was also observed. The ratios measured were (4-8 Hz) 2 /(13-21 Hz) 2 , (4-8 Hz)/(16-20 Hz), and (3-7 Hz)/(12-15 Hz). The positive outcomes of decreased symptoms of Asperger's and ADHD (including a decrease in difficulties with attention, anxiety, aprosodias, and social functioning) plus improved academic and intellectual functioning, provide preliminary support for the use of neurofeedback as a helpful component of effective intervention in people with AS.

There is a need for effective interventions to address the core symptoms and problems associated with autistic spectrum disorder (ASD). Behavior therapy improves communication and behavioral functioning. Additional treatment options include psychopharmacological and biomedical interventions. Although these approaches help children with autistic problems, they may be associated with side effects, risks or require ongoing or long-term treatment. Neurofeedback is a noninvasive approach shown to enhance neuroregulation and metabolic function in ASD. We present a review of the literature on the application of Neurofeedback to the multiple problems associated with ASD. Directions for future research are discussed.

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

This study explores the physiological correlates of a highly practiced Kundalini Yoga meditator. Thoracic and abdominal breathing patterns, heart rate (HR), occipital parietal electroencephalograph (EEG), skin conductance level (SCL), and blood volume pulse (BVP) were monitored during prebaseline, meditation, and postbaseline periods. Visual analyses of the data showed a decrease in respiration rate during the meditation from a mean of 11 breaths/min for the pre- and 13 breaths/min for the postbaseline to a mean of 5 breaths/min during the meditation, with a predominance of abdominal/diaphragmatic breathing. There was also more alpha EEG activity during the meditation (M = 1.71 μV) compared to the pre- (M = .47 μV) and postbaseline (M = .78 μV) periods, and an increase in theta EEG activity immediately following the meditation (M = .62 μV) compared to the pre-baseline and meditative periods (each with M = .26 μV). These findings suggest that a shift in breathing patterns may contribute to the development of alpha EEG, and those patterns need to be investigated further.

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 au...

Listening to classical and self-selected relaxing music after exposure to a stressor should result in significant reductions in anxiety, anger, and sympathetic nervous system arousal, and increased relaxation compared to those who sit in silence or listen to heavy metal music. Fifty-six college students, 15 males and 41 females, were exposed to different types of music genres after experiencing a stressful test. Several 4 · 2 mixed design analyses of variance were conducted to determine the effects of music and silence conditions (heavy metal, classical, or self-selected music and silence) and time (pre-post music) on emotional state and physiological arousal. Results indicate listening to self-select or classical music, after exposure to a stressor, significantly reduces negative emotional states and physiological arousal compared to listening to heavy metal music or sitting in silence.

Nine hundred and forty practitioners of massage, abbreviated progressive muscle relaxation (PMR), yoga stretching, breathing, imagery, meditation, and various combination treatments described their technique experiences on an 82-item wordlist. Factor analysis yielded lO interpretable relaxation categories: Joyful Affects and Appraisals (Joyful), Distant, Calm, Aware, Prayerful, Accepted, Untroubled, Limp, Silent, and Mystery. The relaxation response and cognitive~somatic specificity models predict Calm and Limp, which account for only 5.5% of the variance of relaxation experience. Unlike much of previous relaxation research, we found important technique differences. PAIR and massage are associated with Distant and Limp; yoga stretching, breathing, and meditation with Aware; meditation with Prayerfid, and all techniques except PAR with Joyfid. Results are consistent with cognitive-behavioral relaxation theory and have implications for relaxation theory, treatment, training,

This paper reviews the symptoms of Asperger's Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

This review aimed to critically evaluate the literature on the efficacy of biofeedback for functional anorectal disorders, rate these biofeedback applications according to established guidelines, and make recommendations for this field based on the literature. The Medline and PsychInfo databases were searched to obtain all papers published from 1975 to 2003 that included the terms "biofeedback" and either "constipation," "pelvic floor dyssynergia," "fecal incontinence," or "anorectal pain." Adult and pediatric papers in any language were screened. Prospective studies with five or more participants and a description of the treatment protocol and outcome were selected for review. Seventy-four studies qualified for review: 33 trials on fecal incontinence (FI), 38 on pelvic floor dyssynergia (PFD) or functional constipation, and 3 on anorectal pain. Only 20% of studies were controlled outcome trials. Treatment protocols, etiological subgroups studied and outcome measures varied greatly. The overall average probability of successful treatment outcome for patients treated with biofeedback was 67.2% for functional FI and 62.4% for constipation. There were insufficient data to warrant such calculation for anorectal pain. According to standard efficacy rating criteria, biofeedback treatment is efficacious for functional constipation or PFD in children and probably efficacious in adults; probably efficacious for functional FI; and possibly efficacious for anorectal pain. Utilizing data from all applicable studies, we found that success rate per subject is significantly higher for biofeedback treatment than for standard medical care for PFD/functional constipation, and FI (p < .001 for both). Biofeedback treatment may therefore be viewed as a valuable adjunct to medical management of functional PFD/constipation and incontinence. A number of recommendations for future investigations are made based on the review.

Attention-deficit hyperactivity disorder (ADHD) is multidetermined and complex, requiring a multifaceted treatment approach. Nutritional management is one aspect that has been relatively neglected to date. Nutritional factors such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies have all been linked to ADHD. There is increasing evidence that many children with behavioral problems are sensitive to one or more food components that can negatively impact their behavior. Individual response is an important factor for determining the proper approach in treating children with ADHD. In general, diet modification plays a major role in the management of ADHD and should be considered as part of the treatment protocol. KEY WORDS: ADHD; diet; nutrition.

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 au...

Research has found hyperactivity, poor impulse control, impaired sustained attention and low self-concept to be behavioral deficits common to juvenile delinquents. Limited opportunities for exercising self-control while incarcerated may encourage helplessness. If biofeedback training enhances self-regulation skills, then perhaps these behaviors can be taught in confinement. A sample of 12 felonious juvenile residents (aged l5-18) from a highly restricted environment were assigned randomly to a biofeedback or video game group and trained for 10 half-hour sessions. Results indicated virtually no significant differences between biofeedback and video game training. However, pre and post differences for both groups combined demonstrated significant gains in impulsivity, EMG, and self-concept. Both groups rated themselves equally on self-control ability, regardless of training. Further comparisons between other institutionalizedresidents (N = l4) and staff counselors (A/ = l0) as non-treatment controls were made. On each measure, both training groups improved consistently and became more like their less restricted counterparts. Rehabilitation programs for juvenile delinquents often introduce therapies designed to improve a youth's personal and social functioning with an emphasis on nurturing individual responsibility for behavior. Recent research on the evaluation of various behavioral interventions has indicated that flexible methods and individually tailored applications tend to maximize the likelihood of achieving successful results (Rutter & Giller, 1984). The unique nature of individual differences in offense, personality, social, and institutional variability makes program evaluations or recommendations exceedingly difficult. Developing specific cause-and-effect interventions equally efficacious with all delinquents seems virtually impossible. Although differences exist among young offenders, there is growing evidence of common psychophysiological characteristics associated with probable contributions to delinquency. For instance, research has found hyperactivity, poor impulse control, stimulus seeking, and impaired sustained attention to be frequently identifiable behavior deficits found in juvenile delinquents (Douglas & Peters, 1979; Olweus, 1980; Weiss, 1983). Furthermore, inattentiveness and impulsivity typically are linked to antisocial conduct disorders (American Psychiatric Association, 1980; Cantwell, 1980; Stewart, Cummings, Singer, & De Blois, 1981). Some social learning theorists (Cairns, 1979; Feldman, 1977) emphasize early learning processes as instrumental in establishing personalities predisposed to delinquent activities. If these psycho-socio-physiological characteristics are in fact critical determinants of antisocial behavior, then behavioral approaches may want to initiate specific selfcontrol skill acquisition rather than merely seek to suppress deviant behavior (Patterson, 1980; Rutter & Giller, 1984). The structured nature of the social environment for incarcerated or institutionalized individuals unintentionally may promote and sustain Reprint requests should be sent to

Alpha-theta neurofeedback has been shown to produce professionally significant performance improvements in music students. The present study aimed to extend this work to a different performing art and compare alpha-theta neurofeedback with another form of biofeedback: heart rate variability (HRV) biofeedback. Twenty-four ballroom and Latin dancers were randomly allocated to three groups, one receiving neurofeedback, one HRV biofeedback and one no intervention. Dance was assessed before and after training. Performance improvements were found in the biofeedback groups but not in the control group. Neurofeedback and HRV biofeedback benefited performance in different ways. A replication with larger sample sizes is required.

This study investigated the impact of a new stress management program on physiological and psychological stress and health risk factors among 75 correctional officers. The experimental group received training in emotion self-regulation techniques intended to reduce stress and health risk factors. Practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn and sustain use of the self-management tools. Measures of physiological stress included cortisol, DHEA, cholesterol, triglycerides, fasting glucose levels, 10-min resting electrocardiogram, heart rate variability, and blood pressure. Three psychological questionnaires assessed emotional stress and work-related variables. There were significant improvements in the experimental group in cholesterol, glucose, heart rate, blood pressure and positive outlook and significant reductions in overall psychological distress. There were significant increases in productivity, motivation, goal clarity, and perceived support. The mean difference between pre-and post-intervention projected health care costs was calculated to be $1,179 per employee per year.

In this paper we examined plan continuation error (PCE), a well known error made by pilots consisting in continuing the flight plan despite adverse meteorological conditions. Our hypothesis is that a large range of strong negative emotional consequences, including those induced by economic pressure, are associated with the decision to revise the flight plan and favor PCE. We investigated the economic hypothesis with a simplified landing task (reproduction of a real aircraft instrument) in which uncertainty and reward were manipulated. Heart rate (HR), heart rate variability (HRV) and eye tracking measurements were performed to get objective clues both on the cognitive and emotional state of the volunteers. Results showed that volunteers made more risky decisions under the influence of the financial incentive, in particular when uncertainty was high. Psychophysiological examination showed that HR increased and total HRV decreased in response to the cognitive load generated by the task. In addition, HR also increased in response to the financially motivated condition. Eventually, fixation times increased when uncertainty was high, confirming the difficulty in obtaining/interpreting information from the instrument in this condition. These results support the assumption that risky-decision making observed in pilots can be, at least partially, explained by a shift from cold to hot (emotional) decision-making in response to economic constraints and uncertainty.

This paper describes a comparison between Japanese (IV = 20) and Westerners (N = 20) in their respective frontal EMG levels and their ability to relax during one 5-minute biofeedback training session. The data indicated a significantly lower baseline muscle tension level in Japanese than in Westerners. After EMG biofeedback, however, no significant difference was found between the two groups. Japanese females showed significantly higher tension levels both during baseline and biofeedback phases than did Japanese males.

. Twenty-four volunteers were randomly assigned to practice a relaxation technique daily for 3 weeks and 16 to a waiting list control condition. Blood and saliva samples were collected before and after a supervised 20-min relaxation session at the beginning and end of the 3-week practice period. S-IgA secretion rate increased significantly (p < . 001) after 20 min of relaxation. A longer-term practice effect also occurred in that the increase in secretion rate in "before to after" relaxation samples was higher (p = .014) in subjects who had practiced relaxation once a day for 3 weeks than in waiting list control subjects practicing for the first time. Serum " IgA (p < .001), IgG (p < .001), and igM (p < .05)increasedsignificantly over the 3-week practice period. Relaxation may be a self-regulating strategy affecting both humoral and cellular divisions of the immune system.

Previous investigations of electroencephalograms during relaxation have identified increases in slow wave band power, correlations between increased levels of alpha activity with lower levels of anxiety, and autonomic changes characterized by otherwise documented decreased sympathetic activity. This study was carried out to determine the overall changes in quantitative electroencephalographic activity and the current source as a result of an acute session of respiratory sinus arrhythmia (RSA) biofeedback in a population of subjects experiencing stress. This study's findings provide physiological evidence of RSA feedback effect and suggest that RSA training may decrease arousal by promoting an increase of alpha band frequencies and decrease in beta frequencies overall and in areas critical to the regulation of stress. It was of interest that novices could achieve these objective alterations in EEG activity after minimal training and intervention periods considering that the previous literature on EEG and meditative states involve experienced meditators or participants who had been given extensive training. Additionally, these effects were present immediately following the training suggesting that the intervention may have effects beyond the actual practice.

This study tested two theories about the relationship between voluntary changes in muscle tension and pulmonary function in asthma. Kotses has theorized that decreased facial muscle tension decreases respiratory impedance via a hypothesized vagaltrigeminal reflex, but that muscle tension in other muscle groups has no such effect. Others have suggested that decreased thoracic muscle tension improves pulmonary function. Subjects were

In the past three decades, behavioral interventions (chiefly relaxation, biofeedback, and stress-management) have become standard components of the armamentarium for management of migraine and tension-type headaches. Meta-analytic literature reviews of these behavioral interventions have consistently identified clinically significant reductions in recurrent headache. Across studies, behavioral interventions have yielded approximately 35-50% reduction in migraine and tension-type headache activity. Although we have only recently begun to directly compare standard drug and nondrug treatments for headache, the available evidence suggests that the level of headache improvement with behavioral interventions may rival those obtained with widely used pharmacologic therapies in representative patient samples. In recent years, some attempts have been made to increase the availability and cost effectiveness of behavioral interventions through alternative delivery formats and mass communications. Recent developments within diagnosis and classification are summarized, pointing out implications for behavioral researchers. Select future directions are discussed, which include impact of the triptans, cost and cost effectiveness, and integration of behavioral treatments into primary care settings, the place where the great majority of headache sufferers receive treatment.

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.

Previous investigations of electroencephalograms during relaxation have identified increases in slow wave band power, correlations between increased levels of alpha activity with lower levels of anxiety, and autonomic changes characterized by otherwise documented decreased sympathetic activity. This study was carried out to determine the overall changes in quantitative electroencephalographic activity and the current source as a result of an acute session of respiratory sinus arrhythmia (RSA) biofeedback in a population of subjects experiencing stress. This study's findings provide physiological evidence of RSA feedback effect and suggest that RSA training may decrease arousal by promoting an increase of alpha band frequencies and decrease in beta frequencies overall and in areas critical to the regulation of stress. It was of interest that novices could achieve these objective alterations in EEG activity after minimal training and intervention periods considering that the previous literature on EEG and meditative states involve experienced meditators or participants who had been given extensive training. Additionally, these effects were present immediately following the training suggesting that the intervention may have effects beyond the actual practice.

Listening to classical and self-selected relaxing music after exposure to a stressor should result in significant reductions in anxiety, anger, and sympathetic nervous system arousal, and increased relaxation compared to those who sit in silence or listen to heavy metal music. Fifty-six college students, 15 males and 41 females, were exposed to different types of music genres after experiencing a stressful test. Several 4 x 2 mixed design analyses of variance were conducted to determine the effects of music and silence conditions (heavy metal, classical, or self-selected music and silence) and time (pre-post music) on emotional state and physiological arousal. Results indicate listening to self-select or classical music, after exposure to a stressor, significantly reduces negative emotional states and physiological arousal compared to listening to heavy metal music or sitting in silence.

This study investigated the effects of a novel, classroom-based emotion self-regulation program (TestEdge) on measures of test anxiety, socioemotional function, test performance, and heart rate variability (HRV) in high school students. The program teaches students ...

Chronic pain is a common secondary problem associated with cerebral palsy (CP). This pain may be due to the musculoskeletal problems that often accompany CP, including spasticity, scoliosis, and bony deformity. The purpose of this study was to determine the effects of biofeedback-assisted relaxation training on self-reported pain and muscle tension in 3 adults with CP using a multiple baseline design across subjects. Two of 3 participants reported decreases in their pain experiences posttreatment. Their subjective reports, however, did not correspond with physiological changes. Complications in the use of progressive relaxation exercises and EMG biofeedback equipment are described and suggestions for future research provided.

This article evaluates the hypothesis that various stress management techniques have specific effects. Stud&s 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 fnger 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

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

Eight outpatients with sickle cell disease received six EMG and six thermal half-hour biofeedback training sessions. Statistically significant changes in the desired directions were obtained for the following variables: (a) frontalis muscle tension, (b) digital temperature, (c) frequency of headache as a crisis symptom, (d) frequency of analgesic use, (e) perceived pain intensity, (f) frequency of self-treated crises, and (g) state anxiety. Nonsignificant changes in hospital chart data were found. A 6-month posttreatment follow-up questionnaire revealed the continued effectiveness of the training received regarding headaches and mild pains.

The Use of Biofeedback, biological monitoring, and stress management principles in Psychotherapy (Moss D.) …………… 14 Neuroplasticity and the future role of Biofeedback (Brucker B.) …………………………… 19 The Story of the Trunk: Pain and SEMG Investigation and Rehabilitation (Sella G.)……..…… 22 Interesting abstracts: • Use of complementary and alternative medicine among United States adults: the influences of personality, coping strategies, and social support. (Honda K.) ……………. 26 • Applied psychophysiology, clinical biofeedback, and rehabilitation neuropsychology: a case study-mild traumatic brain injury and post-traumatic stress disorder (Ackerman R.)……..……………………………………………………………. 27 • Biofeedback treatment for asthma (Lehrer P. and others) ……………………………. 27 • Public and private heart rate feedback in social phobia: (Gerlach A.)……………………. 28 • Combined heart rate variability and pulse oximetry biofeedback for chronic obstructive pulmonary disease: preliminary findings.(Giardino N.) …….……………… 29 • Biofeedback-based psychophysiological treatment in a primary care setting: an initial feasibility study.(Ryan M./ Gevirtz R.

A clinical protocol is reviewed, which utilizes supportive intervention, education, and surface EMG biofeedback to facilitate movement and to maximize effective stretching with chronic musculoskeletal pain patients. Support for this clinical protocol is provided with an overview of the physiological basis of stretching, surface EMG patterns associated with stretching, and the effects of pain and emotional factors on stretching and movement inhibition.

In the past three decades, behavioral interventions (chiefly relaxation, biofeedback, and stress-management) have become standard components of the armamentarium for management of migraine and tension-type headaches. Meta-analytic literature reviews of these behavioral interventions have consistently identified clinically significant reductions in recurrent headache. Across studies, behavioral interventions have yielded approximately 35-50% reduction in migraine and tension-type headache activity. Although we have only recently begun to directly compare standard drug and nondrug treatments for headache, the available evidence suggests that the level of headache improvement with behavioral interventions may rival those obtained with widely used pharmacologic therapies in representative patient samples. In recent years, some attempts have been made to increase the availability and cost effectiveness of behavioral interventions through alternative delivery formats and mass communications. Recent developments within diagnosis and classification are summarized, pointing out implications for behavioral researchers. Select future directions are discussed, which include impact of the triptans, cost and cost effectiveness, and integration of behavioral treatments into primary care settings, the place where the great majority of headache sufferers receive treatment.

The aim of the present review was to critically evaluate the documented evidence regarding the efficacy of biofeedback for the two most prevalent headache conditions-migraine and tension-type headache. Drawing upon two recently published meta-analyses, data from 150 outcome studies, including randomized controlled trials as well as uncontrolled quasi-experimental designs, were screened. Of these, 94 studies were selected for inclusion according to predefined criteria. Meta-analytic integrations were carried out separately for the two conditions of interest. The main results were medium-to-large mean effect sizes for biofeedback in adult migraine and tensiontype headache patients. Treatment effects remained stable over an average follow-up period of 14 months, both in completer and intention-to-treat analyses. Headache frequency was the primary outcome variable and showed the largest improvements. Further significant effects were shown for perceived self-efficacy, symptoms of anxiety and depression, and medication consumption. Reduced muscle tension in pain related areas was observed in electromyographic feedback for tension-type headache. Biofeedback was more effective than waiting list and headache monitoring conditions in all cases, while electromyographic feedback for tension-type headache showed additional significant effects over placebo and relaxation therapies. Levels of efficacy (migraine: efficacious, level 4; tension-type headache: efficacious and specific, level 5) and recommendations for future research are provided. Keywords Migraine Á Tension-type headache Á Biofeedback Á Relaxation Á Treatment efficacy Á Meta-analysis Á White paper This paper was prepared as a White Paper review, according to the template guidelines developed by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neurofeedback and Research (ISNR).

Functional myopia may be defined as the refractive condition of the eye due to spasm of the ciliary muscle. As a result of the ciliary muscle spasm, the crystalline lens becomes more convex, creating a myopic refractive condition. The normal increase and decrease in the refractive power of the crystalline lens is known as accommodation and is controlled by the autonomic nervous system innervation to the ciliary muscle. Previous studies have reported that voluntary control of accommodation is possible by biofeedback training (Cornsweet & Crane, 1973; Randle, 1970). The present research investigated the application of biofeedback control of accommodation to reduce functional myopia. A double-reversal, multiple-baseline design was used to conduct the experiment. The results revealed that the three adult male subjects achieved the preset criterion, a ½-diopter reduction from initial baseline to a subsequent baseline. Further analysis of the data revealed even greater changes between initial baseline and feedback periods. Although generalization to a nonexperimental environment was not trained, each subject showed a reduction in myopia and an increase in visual acuity. The results of the experiment clearly demonstrated that functional myopia is subject to voluntary control. 'The research presented in the text was submitted in partial fulfillment of the requirements for the degree of doctor of philosophy in the Ferkauf Graduate School, Yeshiva University. The author wishes to express appreciation to his dissertation committee, professors Carl Auerbach, Abraham Givner, and Allan C. Goldstein. Also, appreciation is given to Ralph Dippner and John Orzuchowski for their assistance.