Applied Psychophysiology Research Articles

ABSTRACTS: Abstracts of Papers Presented at the 53rd Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback

ABSTRACTS: Abstracts of Papers Presented at the 53rd Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback

ABSTRACTS: Abstracts of Posters Presented at the 53rd Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback

ABSTRACTS: Abstracts of Posters Presented at the 53rd Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback

An Undergraduate Program with Heart: Thirty Years of Truman HRV Research.

This article celebrates the contributors who inspired Truman's heart rate variability (HRV) research program. These seminal influences include Robert Fried, Richard Gevirtz, Paul Lehrer, Erik Peper, and Evgeny Vaschillo. The Truman State University Applied Psychophysiology Laboratory's HRV research has spanned five arcs: interventions to teach diaphragmatic breathing, adjunctive procedures to increase HRV, HRV biofeedback (HRVB) training studies, the concurrent validity of ultra-short-term HRV measurements, and rhythmical skeletal muscle tension strategies to increase HRV. We have conducted randomized controlled trials, primarily using within-subjects and mixed designs. These studies have produced eight findings that could benefit HRVB training. Effortful diaphragmatic breathing can lower end-tidal CO2 through larger tidal volumes. A 1:2 inhalation-to-exhalation (I/E) ratio does not increase HRV compared to a 1:1 I/E ratio. Chanting "om," listening to the Norman Cousins relaxation exercise, and singing a fundamental note are promising exercises to increase HRV. Heartfelt emotion activation does not increase HRV, enhance the effects of resonance frequency breathing, "immunize" HRV against a math stressor, or speed HRV recovery following a math stressor. Resonance frequency assessment achieved moderate (r = 0.73) 2-week test-reliability. Four weeks of HRVB training increased HRV and temperature, and decreased skin conductance level compared with temperature biofeedback training. Concurrent-validity assessment of ultra-short-term HRV measurements should utilize rigorous Pearson r and limits of agreement criteria. Finally, rhythmical skeletal muscle tension can increase HRV at rates of 1-, 3-, and 6-cpm. We describe representative studies, their findings, significance, and limitations in each arc. Finally, we summarize some of the most interesting unanswered questions to enable future investigators to build on our work.

Introducing a Special Issue in Biofeedback Magazine

The spring 2022 issue of Biofeedback magazine featured a special issue on evidence-based practice. This summer issue continues the emphasis of that spring issue, featuring book chapters from the upcoming fourth edition of the Association for Applied Psychophysiology and Biofeedback (AAPB) book, Evidence-Based Practice in Biofeedback and Neurofeedback (Khazan, Shaffer, Moss, Lyle, & Rosenthal, in press).Each of these articles applied the AAPB/International Society for Neuroregulation & Research efficacy standards to an application area for biofeedback and neurofeedback. Complete details of the efficacy standards are available in LaVaque et al. (2002). The efficacy ratings are as follows, based on the credibility of current published research on specific disorders:Lower ratings for an application area may result from poor outcomes in research studies but can also arise from a lack of research studies in emerging areas of biofeedback and neurofeedback treatment.This special issue opens with an article by Zachary M. Mehan, Fredric Shaffer, and Christopher I. Zerr, summarizing the abundant research on both biofeedback and neurofeedback interventions for depression. Based on the evidence for therapeutic benefit, supported by a growing number of randomized controlled trials (RCTs) on both biofeedback and neurofeedback, the chapter rates both treatment of depression using biofeedback and neurofeedback as Level 5 (efficacious and specific) for depression.Next, this special issue includes an article by Lauren Christine Frey on neurofeedback treatment for epilepsy. Dr. Frey reviewed one available RCT and several quasi-experimental studies and case studies for several different forms of neurofeedback treatment. She rated sensorimotor rhythm (SMR) neurofeedback and slow cortical potential neurofeedback as Level 4 (efficacious) for seizure reduction. She rated SMR-based neurofeedback as Level 3 (probably efficacious) for nonseizure manifestations of epilepsy. She rated two more recently emergent forms of neurofeedback, LORETA Z-score neurofeedback and connectivity-based training protocols, as Level 1 (not empirically supported) for both seizure and nonseizure manifestations of epilepsy.This issue also includes a book review by Patrick Steffen of the fourth edition of a classic book on stress management. Paul M. Lehrer and Robert L. Woolfolk (2021) have produced an outstanding update for the encyclopedic text, Principles and Practice of Stress Management. Lehrer and Woolfolk are major leaders in the field of stress management. Their text Principles and Practice of Stress Management has long provided the most comprehensive and research-informed resource for understanding stress and stress management. The fourth edition updates the scientific research and introduces new topics.

Regarding Mari Swingle's Editorial on Neurofeedback Practice

It was encouraging to read Dr. Swingle's article, “Neurofeedback, Where Are We and Where Are We Going?” (2021, Biofeedback, Vol. 49, No. 3, pp. 59–70). Dr. Swingle believes that well-trained and well-informed providers are necessary in order to provide appropriate neurofeedback services. She notes that providers should be well informed about research, presumably applied research. We would like to elaborate that providers should be skilled in the critical assessment of research, including why different research designs are necessary to draw valid conclusions.One disappointment in Dr. Swingle's otherwise excellent article is that she implies that double-blind randomized controlled trials are not necessary. She suggests that there are imperatives to perform double-blind controlled research that are spurred by the pharmaceutical industry, and she additionally discounts the use of placebo controls. She does not consider that research designs are not imperatives or laws, they are ways to reduce threats to validity, especially in cases of biofeedback and neurofeedback study, where nonspecific factors can play a huge role in outcomes. In addition, treatment providers can subtly (and not so subtly) influence the outcome of an experiment if they know which condition a subject received. Applied psychophysiology is already thriving in neurology and psychiatry in the form of electroencelphogram assessments for seizure disorders and polysomnography for sleep staging and sleep disorders. In the area of treatment, electroconvulsive therapy and repetitive transcranial magnetic stimulation (rTMS) have thousands of controlled research articles accessible in PubMed. The question is whether people who want to have a meaningful role in behavioral healthcare and optimal functioning would be interested in including neurofeedback among their efforts.Consider the following: (a) people will not believe that neurofeedback works simply because we believe it does; (b) getting meaningful funding for studies that do not contain control, and especially blinded ones, is very difficult; (c) many nascent fields such as contact thermography have died on the vine or become vestigial due to a lack of convincing evidence supporting their assertions or were dropped because properly performed studies showed their techniques were ineffective; and (d) many fields such as rTMS have become widely accepted because they provide adequate evidence of efficacy using accepted techniques such as placebo-controlled studies or longitudinal studies with objective outcome measures. Such techniques are not tools of the pharmacological industry nor were they developed by it. Rather, the pharmacological industry has adopted placebo-controlled studies because they are the best designs to show that a technique, process, medication, and so forth may work better than placebo factors alone.Graduate programs, such as the Applied Psychophysiology program at Saybrook University, the Applied Psychophysiology program at the College of Certified Psychophysiologsts, or the Clinical Psychophysiology elective diploma program at the Advance Education Institute and Research Center (AEIRC), would be major vehicles for accomplishing the objectives of developing clinicians and trainers who are broadly knowledgeable in anatomy and physiology and the fundamentals of psychophysiology, as well as what research designs are available and why they are important. Students are expected to demonstrate their critical reasoning and research skills in papers, theses, and dissertations. With this rich background providing tools for critical thinking, students proceed to master skills at applying psychophysiology for assessment, stimulation, and biofeedback/neurofeedback training. In that light, Dr. Swingle's article seems to be making a good case for graduate-level education as the next step in the applied science of neurofeedback.

One Distinguishing Characteristic of AAPB from Many Other Specialized Fields Is That of Inclusion

The Association for Applied Psychophysiology and Biofeedback (AAPB) has several components, and it encourages diversity of development of knowledge in an array of physiological and psychophysiological fields. The Biofeedback magazine is a focus of expression of the different components of the biofeedback science. This issue comprises different aspects of development of biofeedback in time.Heart rate variability (HRV) is the latest fashion of interest in the biofeedback world. Leah Lagos presents a report of the relationship between postconcussion syndrome and healing of the autonomic nervous system (ANS) and HRV. The subject of ANS and disease is only in the incipient developmental phase in medicine and psychophysiology, and this article is a real eye opener to clinicians and scientists alike.Conditioning and learning are old subjects in need of further development. As a student of Donald Hebb back at McGill University in Montreal in the 60s, I was well aware of the many gaps in behaviorism inherited by Hebb and his student Melzak from Lashley. The article in this issue by Ehrenreich, Rolnick, and Leighton is a scholarly event. It is very well referenced and comprehensive. Much remains to be learned about this gap or chasm, and the article goes a long way to bridge the lack of development or knowledge.Surface electromyography was for a long time a prime subject of interest of the biofeedback world. The interrelationships (agonism and antagonism) among the different muscles of each joint were investigated by myself and published over time.My article in this issue shows the agonism and antagonism relationships of the elbow joint muscles. The knowledge of those relationships is highly relevant in the basic science of muscle physiology and the clinical rehabilitation and physiotherapy aspects. Furthermore, the knowledge is relevant in ergonomics and optimal functioning science.The subject of the relationship between the calf muscles' (gastrocnemius and soleus) function of pumping venous and lymphatic blood return to the heart against gravity gave rise to the description of these muscles as “the second heart.” This subject forms the discussion of Monica Almendras and Erik Peper in the present issue. Although this is not strictly biofeedback related, it is nonetheless an important contribution to the understanding of vascular physiology and ergonomics. At the subjective level, it is relevant to understand the need for movement rather than sedentariness in our society and that a number of clinical conditions are directly or indirectly related to the lack of standing and walking.In the past few months, the world of biofeedback has lost suddenly the presence of a few pillars of our society. Two have been memorialized in the present issue. They include Joe Kamiya and Lawrence Klein. They have been warmly eulogized by Cynthia Kerson and Tom Collura, and by Leah Lagos, Erik Peper, and Hal Myers, respectively. It will be strange from now on to be at the AAPB meetings and not to greet Joe or Larry. Their contributions were many and are not replaceable. We will miss you, old friends! Ars longa, vita brevis!

A Method for More Accurate Determination of Resonance Frequency of the Cardiovascular System, and Evaluation of a Program to Perform It.

This study validated a more exact automated method of determining cardiovascular resonance frequency (RF) against the "stepped" protocol described by Lehrer et al. (Appl Psychophysiol Biofeedback 25(3):177-191, https://doi.org/10.1023/a:1009554825745 , 2000; in Foundations of heart rate variability biofeedback: A book of readings, The Association for Applied Psychophysiology and Biofeedback, pp 9-19, 2016). Thirteen participants completed a 15-min RF determination session by each method.The "stepped" protocol assesses HRV in five 3-min stationary windows from 4.5 to 6.5 breaths per minute (bpm), decreasing in 0.5bpm steps. Multiple criteria, subjectively weighted by the clinician, determines RF. For this study, the proposed method used a sliding window with a fixed rate of change (67.04ms per breath) at each of 78 breath cycles ranging from 4.25 to 6.75bpm. Its algorithm analyzes IBI to locate the midpoint of the 1-min region of stable maximum peak-trough variability. RF is quantified from breath duration at that point. The software generates a visual display of superimposed HR and breathing data. Thus, the new method fully automates RF determination. Eleven of the 13 matched pairs fell within the 0.5bpm resolution of the stepped method. Comparisons of LF power generated by the autoregressive (AR) spectral method showed a strong correlation in LF power production by the stepped and sliding methods (R = 0.751, p = 0.000). The "sliding" pacing protocol was favored by 69% of participants (p < 0.02). The new, fully-automated, method may facilitate both in-person and remote HRV biofeedback training. Software is available open-source.

Federation of Associations in Behavioral and Brain Sciences

The Association for Applied Psychophysiology and Biofeedback (AAPB) is a member organization in the Federation of Associations in Behavioral &amp; Brain Sciences (FABBS). FABBS is our representative in Washington for researchers in the brain and behavioral sciences. I have been AAPB's representative to FABBS. AAPB members with a research interest are asked to pay a small sum with AAPB registration to support AAPB's involvement in FABBS.FABBS had a Zoom meeting on December 7, 2020. Issues of interest and relevance to AAPB members included the following.FABBS also has been a repository of advice and networking among societies on methods to reach out to members and conduct meetings during the current pandemic crisis. This service is available to AAPB.FABBS also is reaching out to the incoming administration about their funding priorities.Actually, despite fears of the administration's attacks on big government, funding for NIH and behavioral research has been gradually increasing over the years, with a particularly large increase in 2019 (see Figures 1 and 2).

Psychophysiological Therapy from a Distance: The Art of Sharing

Psychophysiological Therapy from a Distance: The Art of Sharing

The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review.

This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.

Improving the Rigor and Replicability of Applied Psychophysiology Research: Sample Size, Standardization, Transparency, and Preregistration

Scientific research across a number of areas, including applied psychophysiology, biofeedback, and neurofeedback, is facing considerable scrutiny for poor replication rates, high numbers of false-positive findings, and insufficient scientific rigor. There are many factors underlying this replication crisis in scientific research; yet incentives for more rigorous research practices at the institutional and editorial levels lag behind the need for improvement. The author provides examples of replication and rigor difficulties in scientific research with an eye toward psychophysiological research, including researcher flexibility in data analysis, “p-hacking,” insufficient sample sizes, and lack of availability and implementation of rigorous methodological and publication guidelines. Subsequently, the author highlights examples and opportunities for improvement, including decreasing researcher flexibility, reporting sample size information, increasing sample sizes through collaboration, improving reporting standards/following established guidelines for reporting psychophysiological data, and increasing adoption of preregistration and registered reports. The author concludes that the Association for Applied Psychophysiology and Biofeedback (AAPB) can improve clinical practice and perception of public and scientific credibility by implementing rigorous and transparent research practices with a focus on replicability and clear methodological and reporting techniques and standards.

THE FUTURE OF BIOFEEDBACK: Four Important Questions from Biofeedback Pioneer Lilian Rosenbaum

THE FUTURE OF BIOFEEDBACK: Four Important Questions from Biofeedback Pioneer Lilian Rosenbaum

Biofeedback for treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a prevalent condition that currently lacks highly effective therapies for its management. Biofeedback has been proposed as a therapy that may help individuals learn to exert conscious control over sympatho-vagal balance as an indirect method of symptom management. Our primary objective was to assess the efficacy and safety of biofeedback-based interventions for IBS in adults and children. We searched the Cochrane Inflammatory Bowel Disease (IBD) Group Specialized Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Allied and Complementary Medicine Database (AMED) from inception to 24 July 2019. We also searched reference lists from published trials, trial registries, device manufacturers, conference proceedings, theses, and dissertations. We judged randomized controlled trials to be eligible for inclusion if they met the Association for Applied Psychophysiology and Biofeedback definition of biofeedback, and if they compared a biofeedback intervention to an active, sham, or no-treatment control for the management of IBS. Two authors independently screened trials for inclusion, extracted data, and assessed risk of bias. Primary outcomes were IBS global or clinical improvement scores and overall quality of life measures. Secondary outcome measures were adverse events, assessments of stool frequency and consistency, changes in abdominal pain, depression, and anxiety. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI. We used GRADE criteria to assess the overall certainty of the evidence. We identified eight randomized trials with a total of 300 adult participants for our analysis. We did not identify any trials in children. Four trials assessed thermal biofeedback. One trial assessed rectosigmoidal biofeedback. Two trials assessed heart rate variability biofeedback. Two trials assessed electrocutaneous biofeedback. Comparators were: no treatment (symptom monitoring group; three studies), attention control (pseudomeditation; two studies), relaxation control (one study), counseling (two studies), hypnotherapy (one study), standard therapy (one study), and sham biofeedback (one study). We judged all trials to have a high or unclear risk of bias. Global/Clinical improvement The clinical benefit of biofeedback plus standard therapy compared to standard therapy alone was uncertain (RR 4.20, 95% CI 1.40 to 12.58; 1 study, 20 participants; very low-certainty evidence). The same study also compared biofeedback plus standard therapy to sham biofeedback plus standard therapy. The clinical benefit in the biofeedback group was uncertain (RR 2.33, 95% CI 1.13 to 4.80; 1 study, 20 participants; very low-certainty evidence). The clinical benefit of heart rate biofeedback compared to hypnotherapy was uncertain when measured with the IBS severity scoring system (IBS-SSS) (MD -58.80, 95% CI -109.11 to -8.49; 1 study, 61 participants; low-certainty evidence). Compared to counseling, the effect of heart rate biofeedback was unclear when measured with a composite symptom reduction score (MD 7.03, 95% CI -51.07 to 65.13; 1 study, 29 participants; low-certainty evidence) and when evaluated for clinical response (50% improvement) (RR 1.09, 95% CI 0.48 to 2.45; 1 study, 29 participants; low-certainty evidence). The clinical benefit of thermal biofeedback used in a multi-component psychological intervention (MCPI) compared to no treatment was uncertain when measured with a composite clinical symptom reduction score (MD 30.34, 95% CI 8.47 to 52.21; 3 studies, 101 participants; very low-certainty evidence), and when evaluated as clinical response (50% improvement) (RR 2.12, 95% CI 1.24 to 3.62; 3 studies, 101 participants; very low-certainty evidence). Compared to attention control, the effects of thermal biofeedback within an MCPI were unclear when measured with a composite clinical symptom reduction score (MD 4.02, 95% CI -21.41 to 29.45; 2 studies, 80 participants; very low-certainty evidence) and when evaluated as clinical response (50% improvement) (RR 1.10, 95% CI 0.72 to 1.69, 2 studies, 80 participants; very low-certainty evidence). Quality of life A single trial used overall quality of life as an outcome measure, and reported that both the biofeedback and cognitive therapy groups improved after treatment. The trial did not note any between-group differences, and did not report any outcome data. Adverse events Only one of the eight trials explicitly reported adverse events. This study reported no adverse events in either the biofeedback or cognitive therapy groups (RD 0.00, 95% CI -0.12 to 0.12; 29 participants; low-certainty evidence). There is currently not enough evidence to assess whether biofeedback interventions are effective for controlling symptoms of IBS. Given the positive results reported in small trials to date, biofeedback deserves further study in people with IBS. Future research should include active control groups that use high provider-participant interaction, in an attempt to balance non-specific effects of interventions between groups, and report both commonly used outcome measures (e.g. IBS-SSS) and historical outcome measures (e.g. the composite primary symptom reduction (CPSR) score) to allow for meta-analysis with previous studies. Future studies should be explicit in their reporting of adverse events.

Abstracts of Posters Presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.

Abstracts of Posters Presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.

AAPB Endorses the APA's Authoritative Diversity/Inclusivity Guidance Framework

Beginning in 2015, the Association for Applied Psychophysiology and Biofeedback (AAPB) leadership considered the continuing evolution of the study and practice of the biofeedback modality in consideration of psychology and other disciplines, changes in society at large, and emerging data about the different needs for particular individuals and groups historically marginalized or disenfranchised within and by psychology based on their ethnic/racial heritage and social group identity or membership.To that end, AAPB has formally endorsed the components of the American Psychological Association (APA) “Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists.” As an organization that crosses professional disciplines, AAPB applies and encourages these principles and guidelines to all respective disciplines that utilize the application of applied psychophysiology and biofeedback. All AAPB volunteers and members are expected to follow these guidelines.The AAPB Board of Directors' enthusiastic endorsement of the APA's Guidance on behalf of our members reflects our commitment to the highest standards of practice, care, knowledge, competency, excellence, and professionalism.This special issue of Biofeedback magazine is a compilation of diversity/cultural resource material to serve as a reference to our members.

Abstracts of Posters Presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.

Abstracts of Posters Presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.

Abstracts of Papers Presented at the 47th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback

Abstracts of Papers Presented at the 47th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback

Review of Michael and Lynda Thompson, The Neurofeedback Book: An Introduction to Basic Concepts in Applied Psychophysiology

Review of Michael and Lynda Thompson, <i>The Neurofeedback Book: An Introduction to Basic Concepts in Applied Psychophysiology</i>

In Memoriam: Michael G. McKee, PhD, BCB

Michael G. McKee, PhD, a past president of the Association for Applied Psychophysiology and Biofeedback, died on October 26, 2015. Dr. McKee served for many years at the Cleveland Clinic as the vice chairman of the Department of Psychiatry and Psychology and chair of the Section of Health Psychology and General Psychology, directing a program that focused on diagnosis and treatment of stress-related disorders and enhancement of health and performance. He was internationally recognized for his expertise in biofeedback and served as a consultant to business, health care, education, and athletics. Two of his closest colleagues provide tributes here to Michael G. McKee, the man and his work.

Abstracts of Papers Presented at the 46th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback

Abstracts of Papers Presented at the 46th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback