Biofeedback-assisted Relaxation Research Articles

Feasibility and impact of multidisciplinary training of an evidence-based intervention within a pediatric psychiatry consultation service.

To train clinicians on a multidisciplinary pediatric consultation-liaison (CL) psychiatry service to administer an evidence-based intervention, biofeedback-assisted relaxation training (BART), in the inpatient medical setting and obtain their opinions about BART's utility and feasibility in the CL setting. Attendings and trainees on a multidisciplinary pediatric CL service received 3 h of BART training and completed a 10-item questionnaire designed to assess opinions about BART at two time points: after training but prior to using the intervention with patients and again 3 months after implementing the intervention in their clinical practice. Nineteen clinicians administered BART with 28 patients across the study period, and clinicians rated BART positively after training and significantly more positively after utilizing BART in the clinical setting. From post-training to post-implementation, trainees reported significant increases in their opinions that BART increased parent and patient receptiveness to psychiatric consultation (p<0.05) and attendings reported significant increases in their opinions that BART enhanced clinical intervention (p<0.05). BART training on a multidisciplinary CL service was well received by clinicians and patients and may enhance psychiatry trainees' repertoire of cognitive-behavioral and evidence-based interventions.

Cognitive Behavioral Therapy for Chronic Migraine

Research Article| March 01 2014 Cognitive Behavioral Therapy for Chronic Migraine AAP Grand Rounds (2014) 31 (3): 27. https://doi.org/10.1542/gr.31-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Cognitive Behavioral Therapy for Chronic Migraine. AAP Grand Rounds March 2014; 31 (3): 27. https://doi.org/10.1542/gr.31-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amitriptyline, chronic migraine, cognitive-behavioral therapy, headache, migraine disorders Source: Powers SW, Kashikar-Zuck SM, Allen JR, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013; 310(24): 2622– 2630; doi: https://doi.org/10.1001/jama.2013.282533Google Scholar Investigators at the Headache Center at Cincinnati Children’s Hospital conducted a randomized clinical trial to compare the efficacy of cognitive behavioral therapy (CBT) combined with amitriptyline to headache education plus amitriptyline for children with chronic migraine headaches. Youth 10 to 17 years old, with at least 15 headaches per month and a Pediatric Migraine Disability Assessment Score (PedMIDAS) >20, were randomized to either the CBT or headache education treatment group. Participants received 1 mg/kg of amitriptyline daily, and either 10 sessions of CBT or headache education. The main outcomes were reduction in number of headaches per 28 days and change in PedMIDAS scores. Outcomes were compared between the 2 groups at 20 weeks and 12 months postintervention. A total of 135 children and adolescents (79% female) were enrolled, and 124, including 57 in the CBT group and 67 in the headache education group, completed the study. At baseline, participants had a mean of 21 ± 5 days with headache per 28 days and a mean PedMIDAS of 68 points. At the 20-week end point, days with headache were reduced by 11.5 days for the CBT group versus 6.8 days for the education group (difference, 4.7; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group versus 38.6 points for the education group (P = .01). In the CBT group, 66% of participants had a 50% or greater reduction in headache days versus 36% in the education group (OR = 3.5; P = .001). At 12-month follow-up, 86% of participants in the CBT group had a 50% or greater reduction in headache days versus 69% of participants in the education group; 88% of participants in the CBT group had a PedMIDAS of <20 points versus 76% in the headache education group. The authors conclude that use of CBT plus amitriptyline provides a greater reduction in days with headache and disability compared to headache education plus amitriptyline, in children and adolescents with chronic migraine. Dr Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Chronic migraine is defined as having at least 15 days of headache per month, with the majority of these characterized by moderate to severe intensity and pulsating quality, and associated with nausea, vomiting, phonophobia, and photophobia.1 No pharmacological intervention for chronic migraine in children is approved by the US Food and Drug Administration. Amitriptyline, a tricyclic antidepressant, is recommended for the prevention of migraine, based on open-label studies and meta-analysis.2 CBT, which includes coping skills training and biofeedback-assisted relaxation, has been shown to benefit children with chronic headache, including migraine.3 The benefits of CBT in childhood migraine may be... You do not currently have access to this content.

Physiological Monitoring and Biofeedback-Assisted Relaxation Training for Panic Disorder in a Case of Complex Developmental Trauma

This article describes the effective use of physiological monitoring and biofeedback-assisted relaxation training as primary interventions for the treatment of panic disorder in a 31-year-old woman with a history of complex developmental trauma. A biopsychosocial perspective of panic disorder grounded in learning theory and informed by trauma practice was used to examine the role of multiple causational factors in the development of panic disorder and to discuss intervention strategies addressing the interconnected nature of the biological and psychosocial realms of the human experience. The client participated in 2 pretreatment (intake interview and formal testing) and 14 outpatient therapy sessions at a biofeedback clinic over a period of 6 months. Treatment-outcome data indicated a marked decrease in acute symptoms as measured by the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory–Second Edition (MMPI-2).

Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

Background. Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance. Method. A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training. Results. Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training. Conclusion. Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

Single-session Biofeedback-assisted Relaxation Training in Children With Sickle Cell Disease

Sickle cell disease (SCD) pain remains difficult to manage. This pilot study evaluated single-session biofeedback-assisted relaxation training (BART) for SCD pain in children. Ten participants (mean = 12.1 y) completed a 1-hour BART session using thermal biofeedback and home practice. Participants demonstrated changes in peripheral body temperature after the training session (d = 1.08) and at 6-week follow-up (d = 0.97) relative to their baseline visit. Reductions in patient-reported pain frequency were found after completing BART. Health-related quality of life and pain-related disability improvements were observed; however, effect sizes were small to minimal. Single-session BART may be a promising, complementary approach to medical management of pediatric SCD pain.

Biofeedback in headache: An overview of approaches and evidence

Biofeedback-related approaches to headache therapy fall into two broad categories: general biofeedback techniques (often augmented by relaxation-based strategies) and methods linked more directly to the pathophysiology underlying headache. The use of general biofeedback-assisted relaxation techniques for headache has been evaluated extensively by expert panels and meta-analyses. Taken together, these reviews indicate that (1) various forms of biofeedback are effective for migraine and tension-type headache; (2) outcomes with biofeedback rival outcomes with medication therapy; (3) combining biofeedback with medication can enhance outcomes; and (4) despite efficacy in many patients, biofeedback fails to bring significant relief to a sizeable number of headache patients. Biofeedback methods that more directly target headache pathophysiology have focused chiefly on migraine. These headache-specific approaches include blood volume pulse biofeedback, which has considerable supportive evidence, and electroencephalographic feedback.

Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance. A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training. Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training. Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

A Pilot Study to Assess the Efficacy of Biofeedback-Assisted Relaxation Training as an Adjunct Treatment for Pediatric Functional Dyspepsia Associated with Duodenal Eosinophilia

To conduct a pilot study examining whether adding biofeedback-assisted relaxation training (BART) to medication treatment results in better clinical outcomes than medication treatment alone for children with functional dyspepsia (FD) associated with duodenal eosinophilia, a subgroup of children with recurrent abdominal pain. Twenty children were randomly assigned to receive a standardized medication treatment or medication plus 10 sessions of BART. Children and parents completed psychosocial functioning and quality of life measures at baseline, posttreatment, and 6 months. Children rated pain daily via PDA. Physicians provided biweekly assessments of clinical improvement. Children receiving medication plus BART demonstrated better outcomes on pain intensity, duration of pain episodes, and clinical improvement than children receiving medication alone. BART is a promising adjunctive treatment for pediatric FD associated with duodenal eosinophilia. Electronic daily diaries appear to be a useful approach to assessing changes in self-reported pain ratings in this population.

Internet-Based Biofeedback-Assisted Relaxation Training in the Treatment of Hypertension: A Pilot Study

The effectiveness of biofeedback-assisted behavioral treatment with Internet-based client-therapist contact for hypertension was tested in outpatient settings. A pilot study with a randomized controlled design was adopted with two conditions (treatment versus passive controls), lasting for 8 weeks. There were two assessment time points (pre-treatment and post-treatment) measuring clinic systolic and diastolic blood pressure (SBP and DBP) and administration of a questionnaire collecting demographic and subjective data. Participants included 19 Swedish adults diagnosed with hypertension. The treatment group lowered their SBP 5.9 mm Hg and their DBP 7.6 mm Hg while the control group lowered their SBP 0.8 mm Hg and DBP 3.0 mm Hg. The effect of treatment was significant for DBP but not for SBP. There were no other significant effects of treatment. This pilot study shows encouraging results regarding Internet-based biofeedback treatment for hypertensive adults. However, further research using a larger sample is needed.

The Biofeedback Program at Children's Mercy Hospitals and Clinics

Abstract The following article provides a description of the history and development of the biofeedback-assisted relaxation training (BART) program at Children's Mercy Hospitals and Clinics. Biofeedback is an integral component of the multidisciplinary Abdominal Pain and Integrative Pain Management programs. A description of currently employed biofeedback-assisted relaxation training protocols, including alternative training tools (e.g., novel biofeedback games) intended to improve practice compliance is provided. Finally, biofeedback implementation strategies and barriers are considered also.

Effects of Electromyography Biofeedback-Assisted Relaxation on Pain in Patients With Advanced Cancer in a Palliative Care Unit

Most patients with advanced cancer experience pain. However, many cancer patients do not find satisfaction with conventional treatment of pain relief. This study examined the effect of electromyography (EMG) biofeedback-assisted relaxation on cancer-related pain in advanced cancer patients. We hypothesized that changes in EMG activity in frontal muscles underlie the efficacy of EMG biofeedback-assisted relaxation. This was a randomized control study. The experimental group (n = 12) received 6 EMG biofeedback-assisted relaxation sessions over a 4-week period, whereas the control group (n = 12) received conventional care. The primary efficacy measure was the level of pain, measured by the Brief Pain Inventory. Findings from this study show that relaxation training supplemented with visual and auditory EMG biofeedback signals is effective in reducing cancer-related pain in advanced cancer patients, possibly through a mechanism of attenuation of physiological arousal. Electromyography biofeedback-assisted relaxation training may be used along with medications for effective pain management in patients with advanced cancer.

Clinical Benefits of Training Patients to Voluntarily Increase Peripheral Blood Flow

The purpose of this article is to introduce a training program that can help diabetes educators get a fresh approach to assist their clients with the diabetes complication of limited peripheral blood flow. Biofeedback-assisted relaxation training is an educational and integrative intervention that supplements traditional medical care. Biofeedback-assisted relaxation training can be taught to the patient in a single setting. The relaxation training allows peripheral blood vessels to widen, providing enhanced circulation to peripheral tissues, including nerves. The training includes an explanation of relaxation and its effects on the patient, after which the technique is practiced with the assistance of thermal biofeedback. Biofeedback is an effective physiological training modality that teaches the patient what is going on in his or her own body. As the patient relaxes correctly, peripheral blood vessels dilate and blood flow improves, resulting in increased skin temperature. The change in skin temperature is measured with a small alcohol thermometer. Consistent relaxation yields significant outcomes such as improved peripheral blood flow, a reduction in peripheral pain, enhanced healing, improved ambulation, and increased coping skills in the patient's life.

A Cognitive-Behavioral, Biofeedback-Assisted Relaxation Treatment for Panic Disorder With Agoraphobia

A 39-year-old man diagnosed with panic disorder with agoraphobia, comorbid with depression, was treated successfully with cognitive-behavioral, biofeedback-assisted relaxation therapy. Treatment consisted of 22 individual sessions over the course of 10 months. Of those, 18 sessions included biofeedback with electrodermal response as the primarymodality and finger temperature monitored as a general index of relaxation. The core interventions utilized during treatment included psychophysiological monitoring, relaxation techniques, cognitive restructuring, and exposure to feared cues. Results were cessation of panic attacks, full remission of agoraphobia, and alleviation of depressive symptoms. Assessments used during the course of treatment included the Beck Anxiety Inventory, State-Trait Anxiety Inventory Form Y-2, Agoraphobic Cognitions and Body Sensations Questionnaires, and the Beck Depression Inventory-II. A treatment formulation that combined the most effective interventions with cognitive-behavioral underpinnings is discussed along with recommendations for practice.

Efficacy of Biofeedback-Based Treatments for Temporomandibular Disorders

Bibliographic searches identified 14 controlled and uncontrolled outcome evaluations of biofeedback-based treatments for temporomandibular disorders published since 1978. This literature includes two randomized controlled trials (RCTs) of each of three types of biofeedback treatment: (1) surface electromyographic (SEMG) training of the masticatory muscles, (2) SEMG training combined with adjunctive cognitive-behavioral therapy (CBT) techniques, and (3) biofeedback-assisted relaxation training (BART). A detailed review of these six RCTs, supplemented with information from non-RCT findings, was conducted to determine the extent to which each type of intervention met treatment efficacy criteria promulgated by the Association for Applied Psychophysiology and Biofeedback (AAPB). We conclude that SEMG training with adjunctive CBT is an efficacious treatment for temporomandibular disorders and that both SEMG training as the sole intervention and BART are probably efficacious treatments. We discuss guidelines for designing and reporting research in this area and suggest possible directions for future studies.

Biobehavioral Treatment, Disability, and Psychological Effects of Pediatric Headache

Headache is a common condition among children and adolescents, and it can result in considerable pain, distress, and functional disability. Lacking proper care, many children will continue to experience headaches into adulthood. These considerations point to the importance of prompt, effective, and early intervention for pediatric headache. Biobehavioral treatments are central to such intervention. From promotion of adherence to optimal use of abortive and prophylactic medications to health behaviors that reduce headache activity to biofeedback-assisted relaxation training, the addition of biobehavioral treatment components to a comprehensive pediatric headache care plan can lead to better initial clinical outcomes, may lessen the need for medication, and may help maintain effects over the long term. Attention to the effects of headache and the accompanying psychological distress is an equally important part of treatment. Indeed, outcomes should be measured in terms of pain parameters (headache frequency, duration, severity) and effect on functional disability and quality of life (school absences, mood, satisfaction with pain relief). Optimal care for children and adolescents with headache can be realized with collaboration among primary care practitioners and headache specialists such as child neurologists and pediatric behavioral medicine experts. Biobehavioral treatment is a foundation for provision of such care.

Biofeedback-assisted Relaxation Training for Essential Hypertension

The main purpose of this study was to develop a way to predict which persons with essential hypertension would benefit most from biofeedback-assisted relaxation (BFAR) training. Second, the authors evaluated the effect of BFAR on blood pressure (BP) reduction, which was measured in the clinic and outside the clinic using an ambulatory BP monitor. Fifty-four adults with stage 1 or 2 hypertension (78% taking BP medications) received 8 weeks of relaxation training coupled with thermal, electromyographic, and respiratory sinus arrhythmia biofeedback. Blood pressure was measured in the clinic and over 24 hours using an ambulatory BP monitor pretraining and posttraining. Systolic BP dropped from 135.0 +/- 9.8 mmHg pretraining to 132.2 +/- 10.5 mmHg posttraining (F = 6.139, P = .017). Diastolic BP dropped from 80.4 +/- 8.1 mmHg pretraining to 78.5 +/- 10.0 mmHg posttraining (F = 4.441, P = .041). Data from 37 participants with baseline BP of 130/85 mmHg or greater were used to develop a prediction model. Regression showed that those who were able to lower their SBP 5 mm Hg or more were (1) not taking antihypertensive medication, (2) had lowest starting finger temperature, (3) had the smallest standard deviation in daytime mean arterial pressure, and (4) the lowest score on the Multidimensional Health Locus of Control-internal scale. Since these types of persons are most likely to benefit from BFAR, they should be offered BFAR prior to starting hypertensive medications.

Biofeedback-Assisted Relaxation, Exposure, and Cognitive-Behavioral Treatment of Gastric Bypass Surgery Related Anxiety

An unusual case of a “food phobia,” which developed more than a year after the patient underwent a gastric bypass procedure, is described. A brief description of the normal digestive process and Roux-en-Y procedure is presented followed by a discussion of common surgical outcome, the patient’s presenting difficulties, assessment data, case conceptualization, and course of treatment. The casewas challenging because, as with all clinical health psychology cases, it is often difficult to tease out the physical and psychological aspects of the problem. It was also difficult to establish an exposure hierarchy due to the satiation effect of food. Progress was made, however, by applying known principles of behavior change to this novel complaint. The case demonstrates the utility of a comprehensive functional analysis as well as the impact of incorporating the patient’s strengths into the treatment plan.

Biofeedback-Assisted Relaxation as Part of Preincident Stress-Management Training within a Model of Comprehensive Crisis Intervention: A Pilot Study

The purpose of this study was to explore the potential applicability of biofeedback-assisted relaxation training using frontalis EMG as it might be applied as part of a preincident stress-management training program within a model of comprehensive crisis intervention. For 4 consecutive weeks, 37 treatment participants were taught a different relaxation technique followed by six weekly sessions of frontalis EMG biofeedback. The 25 control participants did not receive the relaxation training, but they did attend six weekly sessions of yoked biofeedback training. Compared to the control group, the treatment group evidenced significant reductions in frontalis EMG readings and individual standard-deviation measures from baseline pretest to baseline posttest. These preliminary data support the use of preincident stress-management training as it might be applied to a systematic, multicomponent approach to crisis management. [Brief Treatment and Crisis Intervention 3:437–443 (2003)]

Behavioral and Pharmacologic Treatment of Transformed Migraine With Analgesic Overuse: Outcome at 3 Years

To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse. Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat. Sixty-one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback-assisted relaxation. All patients then were followed prospectively for 3 years. Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment. These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long-term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive-behavioral treatment, is required.

Biofeedback and behavioral treatment of persistent pain in the older adult: a review and a study.

Persistent pain is a common health problem for older adults, age 60+, with a prevalence twice that in younger adults. Yet, older adults with chronic pain and headache are underrepresented in behaviorally oriented clinical programs that have proven effective for younger adults. A review of the literature indicates that older adults develop multiple pain-related problems that are similar to those of younger individuals. When offered the opportunity, older pain patients accept and benefit from multidisciplinary pain programs, cognitive-behavioral therapies and biofeedback training. A study comparing 58 older and 59 younger adults in a multidisciplinary pain program indicates that older pain patients readily acquire the physiological self-regulation skills taught in biofeedback-assisted relaxation training, and achieve comparable decreases in pain for the pain program as a whole.