Appl Psychophysiol Biofeedback (2007) 32:121–140 DOI 10.1007/s10484-007-9035-9

Abstracts of Papers Presented at the 38th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback

Published online: 20 June 2007
Springer Science+Business Media, LLC 2007

The 38th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback (AAPB) was held at the Hyatt Regency Monterey, Monterey, CA, February 15–18, 2007. The theme of the meeting was ‘‘Biofeedback: Challenging the Boundaries of Technology.’’ The meeting included diverse program offerings, consisting of platform and poster presentations, symposia, invited keynote and special addresses, a research scientist address, the presidential address, workshops, short courses, section and division programs, a meet the editors forum, plus a full array of exhibits. Abstracts for the platform and poster presentations follow, with the first seven being accorded the distinction of ‘‘Citation Award Papers/Posters.’’ More extended abstracts, as well as summaries for other offerings, are available for a limited time on the AAPB website (www.aapb.org). The Program Committee members were Chair Fred Shaffer, Susan Antelis, Jeffrey Bolek, Thomas Collura, Aubrey Ewing, Chris Gilbert, Jay Gunkelman, Richard Harvey, David Kaiser, Susan Middaugh, Doil Montgomery, Randy Neblett, Richard Sherman, Richard Soutar, Carolyn Yucha, and AAPB President Richard Gevirtz. The 39th Annual Meeting will be held May 13–15, 2007, at Daytona Beach, FL. Citation Award Paper Enhancing the Diagnostic Accuracy of ADHD Robert Coben Massapequa Park, NY Attention Deficit/Hyperactivity Disorder (ADHD) can be characterized as a neurobehavioral syndrome with

developmentally inappropriate levels of inattentiveness, impulsivity, and hyperactivity (Adesman 2001). The Center for Disease Control (CDC 2003) reported rates of ADHD ranging from 4.1% to 9.7%. Some have questioned the accuracy of the diagnosis and in at least one study misdiagnosis rates as high as 51% was evident (DuPaul et al. 1998). Two hundred patients were seen in our office for comprehensive evaluation in which ADHD was a possible diagnosis. Diagnostic interviews were administered to each patient by two independent sources; an outside physician and a neuropsychologist within our office. Patients received a battery of neurobehavioral, neuropsychological testing, infrared (IR) imaging, and QEEG assessment. The sensitivity (percent of correct diagnoses) and specificity (percent of individuals correctly identified without a disorder) were investigated for all assessment measures. Multiple regression analyses identified the additive value of all assessment approaches. The greatest predictive value was evident when neuropsychological and neurophysiological measures were combined. The least accurate form of assessment was the diagnostic interview alone. It is recommended when evaluating ADHD that such assessments be comprehensive and involve multiple measures including neuropsychological and neurophysiological data. Communications should be addressed to: Robert Coben, Ph.D. 1035 Park Blvd Suite 2b Massapequa Park, NY 11762, USA E-mail: [email protected] Keywords: Attention deficit hyperactivity disorder, Diagnosis, Neurophysiological assessment

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Citation Award and Best Student Paper

Citation Award Paper

LORETA Neurofeedback: A cortical—Subcortical Comparison

ERP Study of Medial Frontal Deficits of Error Processing in PTSD

Rex Cannon and Joel Lubar

Tato Sokhadze and Michael Hollifield

University of Tennessee

University of Louisville

This study examined the efficacy of LORETA neurofeedback training (LNFB) in three regions of interest (ROIs); a 7-voxel cluster of neurons in the cognitive division of the anterior cingulate gyrus (ACC), a threevoxel cluster of neurons in the left dorsolateral prefrontal cortex (LPFC), and a four-voxel cluster of neurons in the right dorsolateral prefrontal cortex (RPFC). We trained participants to increase 14–18 Hz activity in each of the ROIs over twenty sessions. This study was conducted with fourteen non-clinical students with a mean age of 22. We utilized electrophysiological measurements and subtests of the WAIS-III for pre- and post-measures to assess the influence of this training protocol. We compared sessions 1, 5, 10, 15, and 20 for analysis. We also compared pre- and post-eyes-closed and eyes-opened baselines. The data indicate significant differences in activation patterns within these regions and throughout the cortex. More specifically the data indicate that the ACC shares a significant association with the RPFC, while the LPFC shows significantly different activation patterns from both the RPFC and ACC. The AC and RPFC appear to influence a specific frontal circuit in the trained frequency as compared to the LPFC. The AC initiates regions that do not appear to be influenced by either of the other ROIs. There are significant differences that occur relative to ROI within areas of the medial, ventral and orbital-frontal cortices during this training. The data offer further support to the theory of moderation of the central executive by the dorsolateral prefrontal cortex, particularly in the right hemisphere and AC. There are significant improvements in both working memory (WMI) and processing speed index (PSI) scores. Communications should be addressed to: Rex Cannon, B.A. Department of Psychology University of Tennessee Knoxville, TN 37996, USA E-mail: [email protected] Keywords: Neurofeedback, LORETA, EEG

The goal of this psychophysiological approach, based on dense-array event-related potential (ERP) and dipole source localization (BESA) techniques, was to determine if deficits in response error monitoring functions during a speeded forced-choice task (Eriksen’s flanker test) in patients diagnosed with posttraumatic stress syndrome (PTSD) are mediated by a dysfunctional interaction of executive prefrontal cortical networks with medial frontal (e.g., anterior cingulate cortex [ACC]) structures. This preliminary study was aimed at investigating the functional chronometry of ERPs associated with response error monitoring in patients with PTSD and matched control subjects. The specific aim of the study was to determine the differences in ERP indices of visual signal processing and action monitoring in this forced choice task in patients with PTSD (N = 6) and matched healthy controls (N = 6). In this speeded reaction time (RT) task with interferences we used the fronto-central N200 and N450 components of stimulus-locked ERPs and the response-locked errorrelated negativity (ERN) as measures of response conflict and action monitoring. The dipole sources of these ERP measures (N200, N450, ERN) using BESA-based technology are known to be localized in the ACC. All subjects had EEG measurements from 128 scalp loci during performance on a fixed choice RT task with flanker distracters. This speeded RT task requires motor responses to congruent and incongruent stimuli and is known to evoke response conflict, and can be used to assess response error monitoring function in psychopathology. Decrement in performance in flanker task is thought to result from activation of the conflicting response by the incongruent flankers. The experiment was designed to test the hypothesis that in patients with PTSD, compared to controls, the medial frontal conflict monitoring system is over-responsive to response interferences, while action monitoring is under-responsive to errors. Patients with PTSD are predicted to have slower RT, higher error rate and altered and prolonged anterior N200 and N450 ERP components in an incongruent flanker condition indicating over-reactivity to

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potential response conflict, and smaller ERN on error trials indicative of lowered capacity of response monitoring function. Another important aim of our pilot study was an investigation of feasibility using above ERP measures for functional assessment of frontal action monitoring neural networks in PTSD patients enrolled in cognitive-behavioral therapy. Communications should be addressed to: Tato Sokhadze, Ph.D. Department of Psychiatry University of Louisville 500 S. Preston Street, bldg A, #210 Louisville, KY 40292, USA E-mail: [email protected] Keywords: Posttraumatic stress disorder, Event-related potentials, Error monitoring function

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Communications should be addressed to: Erik Sowder, Ph.D. Alliant International University 5107 Narragansett Avenue, Suite 203 San Diego, CA 92107, USA E-mail: [email protected] Keywords: Pain, HRV, Pediatrics

Citation Award Poster Inpatient versus Day Hospital Withdrawal for Medication Overuse Headache Frank Andrasik University of West Florida, Pensacola

Citation Award Paper HRV Biofeedback for Patients with Recurrent Abdominal Pain Erik Sowder, Richard Gevirtz, and Warren Shapiro Alliant International University, San Diego, CA Recurrent Abdominal Pain (RAP) has been hypothesized to be associated with a deficit in autonomic nervous system recovery to stress and an enhanced behavioral and subjective response to pain. Most currently empirically validated treatments make use of this hypothesis to some extent. This study investigates cardio-respiratory physiology, a measure of sympathetic activation, in children with RAP and asymptomatic children. Patients diagnosed with RAP were referred for Heart Rate Variability (HRV) Biofeedback by a pediatric gastroenterologist at Kaiser Permanente in San Diego. The patients were referred to and seen by one of three doctoral interns in the pediatric gastroenterology department at Kaiser Permanente. Patients were monitored with ambulatory physiological monitoring equipment (VivoMetrics LifeShirt) for 6–12 h pre- and post-treatment. Asymptomatic children also wore the LifeShirt for 6–12 h. The ambulatory physiological measures used for this study include several cardio-respiratory parameters. Thirty children have worn the LifeShirt, twenty of which have been diagnosed with RAP and 10 of which have no RAP symptoms. Preliminary analysis reveals differences in RSA between groups. Ambulatory monitoring revealed considerable differences in RSA between patients with RAP and asymptomatic children. Ambulatory data also supported changes in RSA pre and post treatment.

Licia Grazzi, Susanna Usai, Domenico D’Amico, and Gennaro Bussone National Neurological Institute C. Besta, Milan, Italy Patients with chronic migraine and medication overuse are particularly difficult to treat, with no one approach being universally accepted. Some type of withdrawal program, however, is typically implemented before beginning a pharmacological prophylaxis treatment. The purpose of this study was to determine (1) the clinical course of two samples of chronic migraine patients with medication overuse 24 months following two different treatment interventions (inpatient or day hospital withdrawal); (2) whether functional impairment, assessed by the MIDAS questionnaire, improved upon treatment. Two groups of patients were treated: 80 patients were treated by inpatient withdrawal, while 104 received outpatient withdrawal (day hospital schedule). Patients of both groups improved significantly at the 12 and 24 months follow up: days of headache per month decreased (Inpatient treatment: 29.1 vs. 11.2 vs. 10.6; Day Hospital treatment: 28.4 vs. 12 vs. 10), medications/month decreased (Inpatient treatment: 51.5 vs. 11.1 vs. 9.9; Day Hospital treatment: 43 vs. 11.4 vs. 9.9), and a measure of functional impact from the MIDAS questionnaire improved (MIDAS total score: Inpatient treatment: 73.6 vs. 31.7 vs. 3.1; Day Hospital treatment: 68.9 vs. 16.2 vs. 8.1). From these results the outpatient withdrawal by periodic clinical meeting seems to be as helpful for this category of patients as inpatient withdrawal. Day hospital treatment may be a more costeffective alternative to inpatient treatment. Communications should be addressed to: Frank Andrasik, Ph.D.

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Department of Psychology, University of West Florida 11000 University Parkway Pensacola, FL 32514-5751, USA E-mail: [email protected] Keywords: Chronic migraine, Medication overuse, MIDAS, Day Hospital

Citation Award Poster Validation of a Heart Rate Variability Tracking Test Adam Kabins, Torin Brenner, and Robbie Pacanowski

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The significant increase of three of four HRV measurements during the serial-sevens stressor supports its use as a tracking test during HRV biofeedback. Communications should be addressed to: Adam Kabins c/o Dr. Shaffer McClain 214 Social Science Division Truman State University 100 E. Normal Kirksville, MO 63501, USA E-mail: [email protected] Keywords: Tracking test, Heart rate variability, Serialsevens stressor

Truman State University, Kirksville, MO Citation Award Poster Tracking tests ensure that physiological measurements mirror client activity. While there are well-established tracking tests for sEMG and temperature, there is no standardized procedure for heart rate variability (HRV). The present study compared the effects of a modified serial-sevens stressor and silence on self-rated stress and four HRV measures (HR max-min, very low frequency amplitude, low frequency amplitude, and high frequency amplitude) using a within-subjects design. Fifty-seven undergraduates (35 men and 22 women), aged 18–23, volunteered for academic credit. To simulate clinical practice, following a 5-min stabilization, participants were randomly assigned to one of two orders of a serial sevens stressor and silence separated by a 2-min buffer period. In the serial sevens condition, they counted backwards out loud from 1,000 by 7 for 90 s. In the silence condition, they sat quietly for 90 s. Participants sat upright with eyes open in all conditions. A Likert rating scale (1–7) measured selfrated stress. A Thought Technology ProComp Infiniti data acquisition system using Infiniti 2.5 software measured HRV using a PPG sensor placed on the thumb of the nondominant hand. A GLM Repeated Measures analysis found that self-rated stress was higher during the serialsevens stressor than silence; F(1, 55) = 243.0, p = .001, eta squared = 0.82. The main findings were that HR max–min, low frequency amplitude, and high frequency amplitude were higher during the serial sevens stressor than silence. HR max–min was higher during the serial-sevens stressor than silence; F(1, 55) = 15.44, p = .001, eta squared = 0.22. Very low frequency amplitude did not significantly change. Low frequency amplitude was higher during the serial-sevens stressor than silence; F(1, 55) = 6.67.0, p = .013, eta squared = 0.11. High frequency amplitude was higher during the serial-sevens stressor than silence; F(1, 55) = 13.63.0, p = .001, eta squared = 0.20.

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Effect of the Acceleration Sound Biofeedback on the Resting Tremor Yoshinobu Matsumoto, Nobukazu Yamada, Yusuke Hasegawa, Shinya Hirakawa, Takahiro Yoshii, Ichiro Fukumoto, and Yasuhiro Kawase Nagakoa University of Technology, Niigata, Japan The purpose of this study was to regulate the tremor amplitude of patients with Parkinson’s disease (PD) by biofeedback (BF). The tremor is defined as the involuntary rhythmic oscillation of a body part. For the treatment of tremor, L-DOPA as a precursor of dopamine has been used. However it has serious side effects, such as ON-OFF phenomena or delusion. Therefore, we chose the biofeedback to control the tremor amplitude without using medication. The acceleration sound BF system consists of two accelerometers, a laptop and a set of headphones. Signals from the accelerometer were recorded to the laptop and were analyzed. Root mean square (RMS) of the acceleration signal was calculated every 0.1 s. 1 kHz pure tone was sounded from the headphones at the volume corresponding to the RMS. A total of 18 patients with PD were investigated. All patients were randomly divided into BF group and control group. In the BF group, participants could hear the sound from the attached headphones but in the control group, participants could not hear anything. We measured the accelerations of the upper limbs of the patients in the rest condition, while they sat on the chair. The patients in the BF group significantly decreased the RMS of tremor acceleration compared with the patients in the control group. This result suggests that the acceleration sound BF system can be regulated the resting tremor of the PD patients.

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Communications should be addressed to: Yoshinobu Matsumoto Radioisotope Center Nagakoa University of Technology 1603-1 Kamitomioka Nagaoka, Niigata 940-2188 Japan E-mail: [email protected] Keywords: Biofeedback, Resting tremor, Acceleration

Autistic Spectrum Disorders, Especially Asperger’s Syndrome

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(SMR) using neurofeedback appears to have a stabilizing effect (Sterman 2000). Communications should be addressed to: Lynda Thompson, Ph.D. ADD Centres Ltd. 50 Village Centre Place Mississauga, Ontario, Canada L4Z 1V9 E-mail: [email protected] Keywords: Autistic disorder, Aspergers, EEG

A Phase Synchrony Model of Consciousness

Lynda Thompson and Michael Thompson

Russell John Hebert, Gabriel Tan, and Michael E. DeBechey

Add Centres Ltd., Mississauga, Ontario

Maharishi University of Management, Houston, TX

This paper reviews our EEG, QEEG and LORETA findings that correspond to known functional neuroanatomical sites associated with the symptoms of Asperger’s. We show how we use that information to guide successful neurofeedback interventions. Theoretical formulations arise from work with EEG analysis and neurofeedback results with more than 140 of these clients. Before NFB we used medications, behavior therapies, psychotherapies, education and speech therapies (Thompson and Havelkova 1982). When neurofeedback became available clients were trained to decrease slow wave activity and beta spindling and raise 13–15 Hz often at FCz. Pre- and posttesting used the WISC, WRAT, TOVA, IVA, questionnaires and QEEG changes. A selection of these clients has had 19 channel EEG assessments and analysis using LORETA. Chart reviews of 142 Asperger’s clients showed significant improvement on all measures. Brain maps were done on a sample of the clients. These revealed low activation at P4 and T6 in Asperger’s cases and decreased activation Cz and Pz in the Autistic group. LORETA showed anterior cingulate Brodmann area 24 dysfunction in Asperger’s and dysfunction in the posterior cingulate Brodmann area 31 and in the cuneus and precuneus in the autistic cases. Findings to date suggest an axis of disturbed functioning (anterior and posterior cingulate Brodmann areas 24, 31) often with high amplitude 3–10 Hz and spindling beta (>20 Hz) and low amplitude 13–18 Hz usually at FCz (LORETA abnormalities seen in the cingulate, medial and orbital frontal and/or prefrontal cortex). Similar findings are seen with anxiety disorders. Asperger’s is unique in also having right temporal-parietal cortex inactivity corresponding to sensory aprosodia. Beta spindling suggests that the cortex is irritable, unstable and/or easily kindled. Increasing sensorimotor rhythm

Several lines of research suggest that the timing of EEG phase activity in the alpha frequency is important for cortical integration and information transfer. Tight functional coupling of alpha EEG between anterior and posterior brain areas and phase-resetting of alpha to stimulus is becoming increasingly important in studies of performance, in clinical models and in the development of theories of consciousness. In the clinical arena, lower levels of long-range alpha phase synchrony have been tied to pathology in Alzheimer’s, seizure and mania patients. In performance studies the amount of long-range alpha phase coherence has been tied to visual-tactile test performance levels, and tight functional connectivity in alpha between frontal and occipital areas is seen during a visual-spatial working memory task. Because of previous findings on EEG alpha coherence in transcendental meditation (TM), we investigated the technique as a method for enhancing alpha phase synchrony. Fifteen long-term TM practitioners showed enhanced anterior–posterior alpha phase synchrony in 30 of 49 long-range electrode pairs during meditation as compared to eyes-closed resting. Control subjects showed no change over the same time period. In meditation there was a shift from traveling waves of ~50 ms lag frontto-back to apparent standing waves of zero-lag. Stationary oscillations over the whole cortex set up a unique environment for phase-coupling of resonant frequencies and long-range functional integration or ‘‘binding’’. Stationary standing waves in alpha frequencies may give a new basis for understanding the neurophysiology of sensation, perception, cognition and insight. Communications should be addressed to: Russell John Hebert, M.A. Maharishi University of Management 317 Telephone Rd.

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Houston, TX 77023, USA E-mail: [email protected] Keywords: Binding, Consciousness, Phase synchrony

Physiological Effects of Gambling in Women

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University of Nevada, Las Vegas 4505 Maryland Parkway Box 453018 Las Vegas, NV 89154, USA E-mail: [email protected] Keywords: Physiological response, Gambling, Females

Carolyn B. Yucha, Bo Bernhard, and Catherine Prato University of Nevada, Las Vegas The objective was to describe the physiological responses occurring during slot gambling in females (1) with and without gambling addiction and (2) at a casino using their own money and at UNLV’s gambling laboratory. Twentythree healthy females, aged 26–69, volunteered: 18 Caucasian, two African-American, three Hispanic. Using the National Opinion Research Center Diagnostic Screen (NODS): 12 were non-gamblers; five were ‘‘at risk’’; three were ‘‘problem gamblers’’; and three were ‘‘pathological gamblers.’’ Participants were studied first in a Las Vegas neighborhood casino and then in UNLV’s Gambling Laboratory, where no money is exchanged. The Biograph Infiniti data acquisition system measured and stored skin temperature (ST), skin conductance (SC), heart rate (HR), and respiratory rate (RR). Blood pressure (BP) was measured every 2 min using a Dynamap Pro 100. Physiological parameters were collected for 5 min prior to gambling (baseline), 10 min while playing a standard slot machine, and 5 min post-gambling (recovery). Data were analyzed using repeated measures ANOVA with alpha set at .05 and corrected for six tests. The following results were obtained: (1) Casino, comparing subjects using NODS category. SBP rose during gambling and fell during recovery (p = .001); RR rose during gambling and fell during recovery (p = .004); ST rose throughout the study (p = .006). DBP, SC, and HR did not change over time. There were no differences by NODS category. (2) All subjects, comparing location. SBP rose during gambling and fell during recovery (p = .004); DBP rose during gambling and fell during recovery (p = .001); SC rose during gambling and fell during recovery (p = .002); RR rose during gambling and fell during recovery (p = .001); and ST rose throughout the study (p = .006). HR did not change over time. There were no differences by location. The observed effects suggest that non-gambling and gambling females find slot play stressful because changes were consistent with a stress response. These changes were similar whether they were using their own money or not, suggesting that slot play is no more stressful than playing a video game. Communications should be addressed to: Carolyn B. Yucha, Ph.D.

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Stress Inoculation with and without Biofeedback: A Comparison Yuval Oded The Israeli Association for Applied Psychophysiology & Biofeedback, Tel Aviv The debilitating effects of stressors on military performance, and their effects on the soldiers’ mental health and well-being have been long recognized. The present study examined the effectiveness of two training programs given before exposure to an extremely stressful event. Seventyseven soldiers aged 18–21 were randomly assigned into three groups. The first group was not given any psychological preparation before the stressful event (controls). The two remaining groups were given very similar training programs. These training programs were based on the same psychological stress inoculation procedure but in one program Heart rate variability (HRV) and electrodermal response (EDR) biofeedback were added to training in self-regulation techniques. Six weeks after the soldiers completed these programs they were exposed to a very stressful event that is considered to be the most stressful event in their two-year military training program. Effects of being exposed to acute stress were measured through self report (SCL-90, self-efficacy questionnaire, IES-R), physiological indicators recorded before, during and after the event, and performance evaluations given by instructors who did not know which soldiers belonged to the control or experimental group. Results showed that soldiers belonging to the group prepared by stress inoculation with biofeedback had significantly less psychopathological symptoms compared to soldiers from the control and competing treatment groups. Other interesting findings will also be discussed. Communications should be addressed to: Yuval Oded, M.A. The Israeli Association for Applied Psychophysiology & Biofeedback Har nevo 3 Tel Aviv 62747 Israel E-mail: [email protected]

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Keywords: Stress inoculation, Biofeedback, Performance

Patient Speech Alters Respiration Rate, Blood Pressure, and Heart Rate Joseph Goedde, Adam Kabins, and Richard Koenig

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c/o Dr. Shaffer Social Science Division McClain 214 Truman State University 100 E. Normal Kirksville, MO 63501, USA Hospital Affiliation: Truman State University E-mail: [email protected] Keywords: Blood Pressure, Respiration, Speech

Truman State University, Kirksville, MO This study explored the effects of patient speech on respiration rate, blood pressure, and heart rate, utilizing a within-subjects design with complete counterbalancing for order. Fifty-five undergraduates (28 men and 27 women), aged 19–34, volunteered for academic credit. Participants were randomly assigned to one of six orders of three 30-s speech conditions during automated blood pressure measurement, separated by 3-min buffer periods. The three conditions were silence, reading a positive personal health description while breathing continuously, and reading the same description while taking as few breaths as possible. An Omega 1400 automated sphygmomanometer measured blood pressure and heart rate, and a ProComp Infiniti system assessed respiration rate. Data were analyzed using a GLM Repeated Measures procedure with Helmert contrasts. The experimental instructions successfully manipulated breath-holding as indexed by respiration rate. Speech decreased respiration rate and increased blood pressure and heart rate compared to silence. Breath-holding slightly amplified these effects on diastolic blood pressure and heart rate. Respiration rate was higher during silence than both speech conditions, F(1, 49) = 60.9, p = .001, MD = 3.3 bpm, and was higher during speech with continuous breathing than with breath-holding, F(1, 49) = 8.7, p = .004, MD = 1.1 bpm. Systolic blood pressure was lower during silence than both speech conditions, F(1, 49) = 88.4, p = .001, MD = 11.4 mmHg. Diastolic blood pressure was lower during silence than both speech conditions, F(1, 49) = 174.4, p = .001, MD = 11.6 mmHg, and was lower during speech with continuous breathing than with breath-holding, F(1, 49) = 7.5, p = .009, MD = 2.6 mmHg. Heart rate was slower during silence than both speech conditions, F(1, 49) = 101.3, p = .001, MD = 14.1 bpm, and was slower during speech with continuous breathing than with breath-holding, F(1, 49) = 4.4, p = .04, MD = 2.4 bpm. Because patient speech significantly decreases respiration rate and increases blood pressure and heart rate, we recommend that clinicians not solicit conversation when taking these vital signs. Communications should be addressed to: Joseph Goedde

Heart-Rate Variability Biofeedback for Music Performance Anxiety Myron R. Thurber University of North Texas, Denton Student musicians were recruited to participate in an experimental repeated measures research design study to identify effects of heart rate variability (HRV) biofeedback training and emotional self-regulation techniques, as recommended by HeartMath Institute, on music performance anxiety (MPA) and music performance. Fourteen students were randomly assigned to a treatment or control group following a 5-min unaccompanied baseline performance. Treatment group participants received 4–5 HRV training sessions of 30–50 min each. Training included bibliotherapy, using the computerized Freeze-Framer 2.0 interactive training software, instruction in the Freeze-Frame and Quick Coherence techniques of emotional regulation, and also use of an emWave portable heart rate variability training device for home training. Measures included the State-Trait Anxiety Inventory (STAI), Performance Anxiety Inventory (PAI), Flow State Scale (FSS), average heart rate (HR), and heart rate variability (HRV). Quade’s rank transformed ANCOVA was used to evaluate treatment and no-treatment group comparisons. Combined MPA scores showed statistical significance at p = 0.05 level with large effect size of partial eta2 = 0.320. Individual measurements of trait anxiety showed a small effect size of eta2 = 0.001. State anxiety measurement showed statistical significance at the p = 0.10 level with a large effect size eta2 = 0.291. PAI showed no statistical significance and a large effect size eta2 = 0.149. HR showed no statistical significance and a large effect size eta2 = 0.143. HRV showed statistical significance at p = 0.001 level and a large effect size eta2 = 0.698. This study demonstrated statistical, practical/ clinical significance of a relatively quick and inexpensive biofeedback training that had large effect at decreasing mental, emotional, and physiological symptoms of MPA for university students.

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Communications should be addressed to: Myron R. Thurber, M.S. University of North Texas 817 Juno Ln Denton, TX 76209, USA E-mail: [email protected] Keywords: HRV, Performance, Anxiety

Effects of Biofeedback Therapy on Stress Levels of Working Mothers Diana Valdez Fort Worth, TX This study was designed to determine the effectiveness of biofeedback-assisted relaxation therapy on reducing psychophysiological stress levels of working professional mothers. Participants were 14 professional mothers working at a major daily newspaper. Reported stress levels were measured with the 123-question Stress Profile (Nowack 1990) three times during the eight-week treatment study that was held at the women’s workplace. A repeated measure ANOVA was used to analyze the data and a partial eta squared was used to calculate effect size. As hypothesized, the study found a statistically significant reduction of reported stress levels (F = 8.62; p = .001) and a statistically significant (F = 3.65; p = .01) reduction in measured muscle tension across subjects. Practical significance (effect size) was found for reduction in reported stress levels (n = 0.39) and reduction in muscle tension (n = 0.21). Communications should be addressed to: Diana Valdez, Ph.D. 3055 Bellaire Ranch Drive Apt. 1038 Fort Worth, TX 76109, USA E-mail: [email protected] Keywords: Biofeedback, Stress, Working mothers

Neurofeedback and Meditation Music for Children with ADHD Jeongil Kim Lotus Flowers Children Center & Daegu University The present study examined the effect of neurofeedback, structured meditation with oriental music, structured meditation with western music, and positive auditory

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message in increasing attention to academic tasks for children with ADHD. Three boys, aged from 6 to 10, with ADHD participated in the study, using an alternating treatment design. Significant improvements on attention span to academic tasks were found with the neurofeedback program and meditation with oriental music. The interventions however benefited attention to academic tasks in different ways. Communications should be addressed to: Jeongil Kim Lotus Flowers Children Center & Daegu University 754-45, Shinjeong 4-dong Namgu, Ulsan 680-014 Korea (ROK) E-mail: [email protected] Keywords: Neurofeedback, Meditation, Attention

Mind-body Therapies Use by Women with Breast Cancer in Hawaii Dianne M. Shumay and Linda Downey VA Palo Alto HCS Mind-body therapy use was surveyed at two time points after diagnosis as part of a larger longitudinal study of CAM use in women with breast cancer in Hawaii (the BCCAM study). Participants (N = 70) were women of Caucasian, Native Hawaiian, Japanese and other Asian (Chinese, Filipino and Korean) ethnicities recruited through two breast cancer clinics and the American Cancer Society. Self-report questionnaires included the State-Trait Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, the Mental Adjustment to Cancer Scale, a measure of CAM use designed for the study and questions about demographics and treatment history. Sixtyseven percent of participants used one or more types of mind-body techniques at 3 months post-diagnosis. Types of techniques included relaxation techniques, meditation, guided imagery, prayer, yoga and hypnosis. Age, education, marital status, coping style, and levels of emotional functioning were related to mind body therapy use in multiple regression analysis. Participants reported perceived benefits and reasons for use of mind-body therapies including symptom relief, improved immune function, stress reduction and help in coping with aversive medical treatments. Communications should be addressed to: Dianne M. Shumay VA Palo Alto HCS 212 Oxford Street

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San Francisco, CA 94134, USA E-mail: [email protected] Keywords: Cancer, Emotional functioning, Mind-body therapies

The Relationship Between Physiological States and SelfReport Steven W. Lee, Melissa Janik, and Patricia Lowe University of Kansas Self-report ratings of physical or psychological status (PPS) are frequently used as the basis for diagnosis and treatment within the medical and psychological professions. PPS scales are brief measures to assess an individual’s current mental or physical state as a response to life events. While an individual’s self-report is certainly beneficial in helping to diagnose and treat symptoms, it relies heavily on the accuracy of the individual’s perception of their physical and psychological status. This relationship between measured physiologic arousal and self-report of PPS is the focus of the current study. While self-report has been considered to be the best measure of symptoms such as pain in children aged five and older (Yoos et al. 1999), the accuracy of self-report of stressful events has not been systematically examined. The objective of the current study was to compare children and adolescents’ accuracy of their perception of PPS state using a Visual Analog Scale (VAS) with actual levels of physiological arousal in controlled stress and rest conditions. Similar correlations between participants grouped by age and gender were also investigated. Using the Children’s Psychophysiological Stress Profile (CPSP), 183 children and adolescents from the suburban Midwest in grades 4–12 underwent a 60-min biofeedback session as part of a CPSP that alternated between periods of rest and stressful activities. Physiologic data from four modalities (skin temperature, electrodermal response, heart rate, and respiration) were taken during the session and compared with the subject’s self-report of their perceived level of stress after each of the eight phases. Stress conditions were randomly counter-balanced to control for order effects of the three stress conditions. A repeated measures analysis of variance confirmed that significant physiological changes occurred in all modalities by conditions. However, no significant correlations were found between the participant’s self-reported stress levels and actual levels of physiologic arousal across all modalities for the combined gender, male–female or grade level comparisons. These data suggest that children and adolescents’ perceptions of their physiologic responses to

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stressful events do not match their levels of physiological arousal as stimulated under laboratory conditions. Limitations and future research will be discussed. Communications should be addressed to: Steven W. Lee, Ph.D. University of Kansas 112 West Campus Rd. PRE Dept. Lawrence, KS 66045, USA E-mail: [email protected] Keywords: Self-report ratings, Stress profiling, Children and adolescents

How Entertainment Media Can be Effective in EEG Training Corwin Bell and Karen Sadenwater Inner Key, Boulder CO This paper discusses how some of the common aspects of the entertainment media can be used in a home-based EEG trainer program. The topics include emotional involvement (non-chemistry based), investment in the narrative, commitment to the outcome and tele-presence. We will also address how simple protocols can be applied that work on a whole mind in conjunction with entertainment media by using situational narratives to impact the moods, sense of self and discovery in the user. These positive mental states further impact neurochemistry by effectively applying contextual rewards for performance and improvement. Metaphors and visual content have the ability to shift psychological states and moods. When perception of interactive immersion in a virtual or simulated environment is created, this is tele-presence. The design of such a tool holds the basic philosophy that the platform of a healthy mind must be created for any real improvement to be effective and long lasting. The design includes a simple protocol that looks at more root psychological optimal performance and that is based on focusing and redirecting the mind while using visual metaphors to shift psychological states and moods. Through experience gained by developing two interactive biofeedback games, the Journey to Wild Divine and The Wisdom Quest, there is a potential to create a wellness based interactive tool with an EEG input device. Creating the games have given us results in how imagery, sound and metaphor have the ability to positively effect a persons state of mind. Home-based EEG technology has an adjunct to neurofeedback practitioners, having an effectiveness to essentially train a person to have the ability to

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focus and redirect the mind while being immersed in a healthy virtual environment. Communications should be addressed to: Corwin Bell Inner Key 3631 Eldorado Springs Boulder, CO 80303, USA E-mail: [email protected] Keywords: Entertainment, Neurofeedback, Media

Communications should be addressed to: Steven W. Lee, Ph.D. University of Kansas 1122 W Campus Rd. PRE Dept. Lawrence, KS 66045, USA E-mail: [email protected] Keywords: Physiological anxiety, Children and adolescents, RCMAS validity

Assessing the Validity of the Physiological Subscale of the RCMAS

Reading Difference Topography as an Aid to Neurofeedback Training

Steven W. Lee, Bethany A Mildren, and Patricia A. Lowe

Jonathan Edward Walker and Robert Lawson Neurotherapy Center of Dallas

University of Kansas The purpose of this study was to examine reactivity correlation of physiological measurement of anxiety (via heart rate and skin conductance activity) as it relates to the Physiological subscale of the RCMAS. Another aim of the study was to examine the convergent and discriminant validity of the Physiological subscale of the RCMAS. Selfreport measures of areas including externalizing behavior, anxiety, and intelligence were administered to children ranging from 9 to 19 years old. Two weeks later, participants participated in a 60-min biofeedback session using the ProComp+ computer-assisted biofeedback equipment in order to compile a Children’s Psychophysiological Stress Profile (CPSP) (Lee and Guck 1990). This study’s CPSP procedure involved obtaining physiological measures during one adaptation period, one rest (baseline) period, and three different stressful conditions with three subsequent recovery phases. Physiological responses including skin conductance activity and heart rate were measured. The effects of the stress conditions were confirmed using a one-way within-subjects ANOVA that showed an overall significant effect for the CPSP conditions on heart rate and skin conductance. Correlations between RCMAS Physiological subscale scores and physiological responses indicated no relationship between heart rate and the RCMAS Physiological subscale and moderate/limited correlation for skin conductance activity. Results indicated a lack of convergent validity for the RCMAS Physiological subscale. Correlations between RCMAS Physiological subscale scores and other RCMAS subscales indicated a relationship between the subscales. Correlations between RCMAS Physiological subscale scores indicated divergent validity; no relationship seems to exist between the RCMASPhysiological subscale and externalizing emotional problems or intelligence (as measured within the study).

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The objective of this paper is to present a new approach to determine if reading activates or deactivates the various brain areas that need to be activated for efficient reading. This information can then be used to train the brain to normally activate in these areas using neurofeedback. If the reading topograph is normal, the client is or will usually become a good reader. If abnormalities on the reading topograph are remediated with neurofeedback, the client becomes more teachable, and reading becomes easier. In combination with QEEG-guided neurofeedback, it helps dyslexics become good readers. Several examples are presented. Communications should be addressed to: Jonathan Walker, M.D. Neurotherapy Center of Dallas 12870 Hillcrest Road Dallas, TX 75230, USA E-mail: [email protected] Keywords: Reading, Topography, Neurofeedback

A Journey to Wellness Following Sexual Molestation in Adolescence Margreta Klassen Newport Psychology Group, Santa Ana Heights, CA The purpose of this case study is an attempt by the author to apply an understanding of life span developmental psychology theory, social psychology, and social role theory as a framework for a using a memoir to explore one woman’s gender awareness and psychosocial sexual and occupational development. The subject is a 76-year-old woman. This case study is a psychobiography that attempts

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to portray her personal sexual and occupational development in the context of the society and times she grew up in and the people she interacted with throughout her life span. The author interviewed the subject over a period of two years. The subject utilized personal papers, psychological testing, unstructured interviews with men and women, in vivo observations and memorabilia to recall events that she feels were pivotal in these particular components of her bio-psycho-social development. She shared these insights and memorabilia in the course of the interviews with the author. Biofeedback training was a significant part of her healing process. Communications should be addressed to: Margreta Klassen, Ph.D. Newport Psychology Group 20371 Irvine Avenue Suite A-160 Santa Ana Heights, CA 926707, USA E-mail: [email protected] Keywords: Wellness, Longitudinal case study, Sexual molestation

Psychophysiolgy of Occupational Stress and Pain Symptoms Anu Kotay, Richard Gevirtz, Jim Spira, Erik Peper, and Chris Stockinger Alliant International University, San Diego, CA Work-related upper extremity (UE) disorders continue to take a significant toll on the U.S. workforce. There is ample evidence that job stress exacerbates UE musculoskeletal disorders. This study examined the relationship between stress, autonomic activity, and UE symptoms. Specifically, skin conductance was measured in a naturalistic setting and correlated with daily self-report measures of stress and pain. Thirty participants used a physiologically monitoring computer mouse at their workstations for 10 days. Throughout the day, they completed pop-up questionnaires that asked them to report their current symptoms and stressors. The findings of this study, including the relationship between daily fluctuations of autonomic activity and perceived stress and symptoms, will be reported. Communications should be addressed to: Anu Kotay, M.S. Alliant International University 427 Magnolia St. Apt 1-A Highland Park, NJ 08904, USA E-mail: [email protected] Keywords: Stress, Pain, Skin conductance

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Korean Parents’ Views on Neurofeedback for their Children Jeongil Kim Lotus Flowers Children Center, Korea This study aimed to investigate the Korean parents’ views on neurofeedback for their children with developmental delays and/or disabilities. Two hundred parents were explained about the basic theory of neurofeedback and its clinical outcomes. Then the parents were asked to respond to a structured questionnaire and the data were analysis using a factor analysis. The results showed the parents of children with ADHD, ADD, Asperger’s, mild mental retardation, and/or slight developmental delays considered neurofeedback as a positive and promising approach for their children. On the other hand, parents of children with cerebral palsy, autistic disorder, moderate-severe mental retardation, and/or other disabilities did not show significant expectation or hope towards neurofeedback. Communications should be addressed to: Jeongil Kim Lotus Flowers Children Center 754-45, Shinjeong 4-dong Namgu, Ulsan 680-014 Korea (ROK) E-mail: [email protected] Keywords: Neurofeedback, Korean parents, Developmental disabilities

The Benefits of Biofeedback Training for University Students Barbara Morrell, Michael Maughan, and Shannon Coetzee Brigham Young University This presentation will describe the biofeedback program at the Brigham Young University Counseling and Career Center and present the initial results of an outcome study of biofeedback training with university students. The BYU counseling center has operated a Biofeedback and Stress Management Lab for students for the past 32 years. Students are trained in biofeedback using eight basic relaxation techniques: Breathing, Autogenics, Progressive Muscle Relaxation, Visualization, Self-Hypnosis, Body Scan, Meditation, and Performance Rehearsal. Thermal and EMG Feedback are routinely used as well as the Heart Math Freeze-Framer system, Resperate modality, and GSR2 relaxation system. Over 350 students are seen each year for

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close to 900 biofeedback appointments. A weekly relaxation skills group is also held to teach the eight basic skills, and outreach is done across campus. Students are self-referred as well as referred by teachers, advisors, and clinical counselors. Clinical counselors often use the Biofeedback Lab as an adjunct resource to their treatment of students suffering from various anxiety disorders and depression. Students report stress-related symptoms such as anxiety, insomnia, TMJ, gastro-intestinal complaints, test anxiety, muscle tension, poor concentration, excessive worrying, and performance anxiety. A Counseling Center psychologist trains paraprofessionals to conduct the majority of biofeedback sessions. Students surveyed between March 2005 and April 2006 reported on average that their biofeedback sessions were: Informative (4.6 on a 5 point scale), Relaxing (4.6), and Useful (4.5). Changes in Thermal and EMG feedback readings recorded during sessions also indicate the effectiveness of biofeedback training for these students. Beginning with the Fall 2006 semester more extensive and formal outcome data on relaxation training will be collected. Data will be collected through self-report questionnaires and readings taken from biofeedback instruments. Outcome will be assessed by analyzing changes in Thermal and EMG feedback readings within sessions and over time. The effectiveness of relaxation techniques used by students in their daily activities will also be analyzed. Communications should be addressed to: Barbara Morrell, Ph.D. Brigham Young University Counseling and Career Center 1500 WSC Brigham Young University Provo, UT 84602, USA E-mail: [email protected] Keywords: Biofeedback training, University students, Outcome research Amitryptiline versus Behavioral Therapy for Juvenile Tension Headache Frank Andrasik

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episodic Tension-Type Headache. Patients were treated by behavioral therapy (limited contact group relaxation training, LCGR) or by amitryptiline (AMIT), 10 mg for 3 months. The clinical improvement was significant for both groups at 1- and 2-year follow-up (days of headache/ month: LCGR: 14.8 vs. 2.6 vs. 3.5; AMIT: 18 vs. 1.9 vs. 1.2). In the medication condition, 42 patients started treatment, 14 patients achieved the 24 months follow-up, while 22 patients did not achieve the last follow-up meeting. Further, eight patients did not come to the follow-up visit, 10 patients preferred psychotherapy and were thus reassigned, and four patients stopped therapy without accepting any other option. Six patients have yet to achieve the last follow up visit. In the CCGR group, of the 38 initial patients, 21 achieved the 2-year follow-up, while 12 dropped out (two of them for an organic disease onset, three were sent to psychotherapy, two were provided adjunctive pharmacological therapy, one patient moved to another town, one patient experienced no further headaches so stopped the protocol, and three patients did not come to the follow-up visit). Five patients have yet to achieve the last follow-up visit. All patients receiving LCGR came regularly for the sessions, practiced routinely, appeared to be compliant and accepting of treatment, although we did not assess this formally. Although the clinical results were similar in both groups, relaxation therapy seemed to be more accepted than medication. The limited contact modality seemed to be as useful as other behavioral approaches that require a greater investment of time (by patients and therapists), without unpleasant side effects. Because the sample sizes are small, these conclusions are tentative. Data collection will continue on a larger sample of patients. Communications should be addressed to: Frank Andrasik, Ph.D. Department of Psychology University of West Florida 11000 University Parkway Pensacola, FL 32514-5751, USA E-mail: [email protected] Keywords: Juvenile headache, Behavioral therapy, Pharmacological therapy, Amitriptyline

University of West Florida, Pensacola Licia Grazzi, Susanna Usai, Domenico D’Amico, and Gennaro Bussone

Rhythmical Muscle Tension Mimics Heart Rate Variability Biofeedback

National Neurological Institute C. Besta, Milan, Italy

Evgeny Vaschillo, Bronya Vaschillo, Marsha Bates, Paul Lehrer, Chris France, and Zina Trost

Recurrent headaches are common in children and adolescents. Most current investigations have employed limited modalities (either medication or behavioral) and few have included treatment comparisons. In this study relaxation training and amitryptiline were compared for juvenile

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Rutgers University Heart Rate Variability Biofeedback provides multiple beneficial effects by eliciting cardiovascular resonance

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through breathing at the resonance frequency. We have theorized (Lehrer et al. 2003, 2004) that triggered by rhythmical stimuli, 0.1 Hz resonance in cardiovascular system can tone autonomic reflexes and improve autonomic regulation. Rhythmical Skeletal Muscle Tension (RSMT) techniques were created to avert vasovagal reactions. They involve rhythmical 0.1 Hz alteration of big muscles contraction and relaxation that strongly affects the cardiovascular system. The goal of the study was to ascertain whether RSMT procedures also produce cardiovascular resonance. Thirty-four healthy young adults completed two kinds of the RSMT procedures in a counterbalanced order for 3 min each, with 3-min rest periods before, between, and after the procedures. Participants were seated with their legs extended and supported parallel to the floor. In the first RSMT procedure, participants periodically, for 5 s contracted, then for 5 s relaxed, muscles of both legs and their left forearms. The second procedure included the same 10 s contraction/ relaxation cycles but for the muscles of the abdomen, buttocks, and upper and lower legs, and with the legs crossed. Measurements of heart rate (HR), current blood pressure (BP), and cerebral regional oxygen saturation were obtained continuously during the experiment. Statistical and spectral analysis of data was performed. Compared to rest periods, both RSMT procedures significantly increased HR (10.1 ± 0.7 bpm), and systolic (7.9 ± 0.9 mmHg) and diastolic (4.5 ± 0.4 mmHg) BP, while significant increases in cerebral oxygen were observed only in legs crossed procedure. Both procedures elicited high amplitude 0.1 Hz oscillations in HR, BP, and vessel tone. Phase shift between 0.1 Hz HR and BP oscillations was close to 180, i.e., when HR increased, BP decreased, and vice versa. The amplitude of oscillations was significantly higher during the legs crossed procedure. High amplitude 0.1 Hz oscillations and 180 phase shift are signs of cardiovascular resonance that RSMT procedures triggered. The findings suggest that RSMT procedures provide cardiovascular adjustments necessary to prevent vasovagal reactions, not only because of acute increases in BP and HR, but also due to resonant oscillations, which train autonomic reflexes. Communications should be addressed to: Evgeny Vaschillo, Ph.D. Rutgers University 607 Allison Road Piscataway, NJ 08854, USA E-mail: [email protected] Keywords: Vasovagal reaction, Cardiovascular resonance, HRV biofeedback

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Neurofeedback in Children with Behavioral and Emotional Problems Angele McGrady, Christine Prodente, Thomas Fine, and Joseph Donlin The University of Toledo Neurofeedback has been successfully used to treat children with attention deficit hyperactivity disorder (ADHD) in school or clinic settings (Lubar and Lubar 1999), but children with severe emotional problems are not the primary focus of most studies. However, neurofeedback may be a useful adjunct to integrated mental health and educational programming for children with severe behavioral and emotional problems in a school-based day-treatment setting. We report results from a controlled study of neurofeedback in a school-based day-treatment setting. The objectives were to integrate neurofeedback into existing programming and to explore the effects of neurofeedback on attention, concentration, and behavior. Forty-three children and their parents (guardians) provided assent (consent) and began the study. Twenty-one completed the intervention and 14 were controls. Outcome measures were EEG theta/beta ratio, Gorden Diagnostic System (GDS), Teachers’ Connors Inventory, and Behavioral Grades. Children in the intervention groups received 30 sessions of neurofeedback, three sessions per week for one semester. Training focused on theta inhibition and enhancement of SMR (sensory motor rhythm) beta. Data were analyzed using a repeated measures analysis of variance (group times period), wherein group was the fixed factor and period was pre-test and post-test. Children in the intervention group who completed the majority of the sessions showed improvements in distractility (decrease), hyperactivity (decrease), and attention (increase). Although these results are from a small sample, they are encouraging for the incorporation of neurofeedback into day treatment programs for children with severe emotional and behavioral disorders. Thus, this neurofeedback program was successfully integrated into the existing day treatment program for children with severe behavioral and emotional problems. Communications should be addressed to: Angele McGrady, Ph.D. The University of Toledo Department of Psychiatry Health Science Campus 3000 Arlington Ave. Toledo, OH 43614-2598, USA

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E-mail: [email protected] Keywords: Neurofeedback, Behavioral/Emotional problems, Children, Attention-deficit

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Effects of Heart Rate Variability Feedback in Reducing Blood Pressure Anke Reineke, Richard Gevirtz, and Lutz Mussgay Alliant International University

Neurofeedback Efficacy in Various Cases Victoria L. Ibric Therapy and Prevention Center, LLC/NNRI, Pasadena, CA Allopathic approaches to illness caused by Traumatic Brain Injury (TBI) of mechanical or chemical nature may be very helpful but not necessarily sufficient in permanently eliminating symptoms. Neurofeedback (NF) is a rehabilitation technique that must be used as well. In my 14 years experience in using NF with more than 120 patients, who suffered from TBI, I observed that when NF was planned and sufficiently practiced it produced permanent changes and sometimes complete cessation of symptoms. I will present four patient cases who suffered various types of TBI: one case, who overcame the symptoms of 30 years allopathically treated bipolar depression and subsequent addictions; a second one, who survived a Motor Vehicle Injury with post TBI symptoms such as, epilepsy, hemiplegia, depression, sleep disorder and speech/ cognitive dysfunctions; a third one, post-TBI and with chronic pain syndrome post-surgery, and kidney stones, and subsequent addiction to pain killers, and a fourth one with symptoms post-drug addictions, cataplexy-narcolepsy, sleep apnea, bruxism, and learning disabilities. The progress of all these cases has been evaluated and re-evaluated during the course of NF training, which has been modified accordingly. In previous presentations I have discussed their success stories. All these patients had stopped NF after completing various numbers of NF sessions (60–360 sessions per training interval). Some have taken the home trainer, pROSHIBB, and continue a home maintenance regimen. The progress of the first two cases I reported last year and they still continue to enjoy normal lives. The last two cases stopped NF 3 years and one year ago, respectively. Follow ups will continue on a yearly basis to assess their continued progress. Communications should be addressed to: Victoria L. Ibric, M.D., Ph.D. Therapy and Prevention Center, LLC/NNRI 65 N. Madison Ave Suite 405 Pasadena, CA 91101, USA E-mail: [email protected] Keywords: Neurofeedback efficacy, Bipolar depression and addictions, Traumatic brain injury

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More than 65 million Americans currently have hypertension. Although there is clear evidence that anti-hypertensive medications reduce blood pressure (BP), side effects and the cost of medication threaten patients’ adherence to the drug treatment. Non-pharmacological studies emphasizing autonomic balance and breathing retraining, to approximately six breaths per minute, produce moderately reliable reductions in BP levels. This study will examine if heart-rate-variability (HRV) biofeedback will decrease BP and increase resting baroreflex (BR) in patients with documented Stage I hypertension (140–159/90–99 mmHg) when compared to an attention control group. The primary goal of the study is to demonstrate the benefits of HRV biofeedback as an effective treatment to decrease blood pressure in people with hypertension. Forty-five participants between the ages of 18–60, that met the JNC7 criteria for Stage 1 hypertension, were recruited the Psychosomatic Hospital St.-Franziska-Stift in Bad Kreuznach, Germany. After, multiple baseline BP measurements, participants were randomly assigned to either the HRV biofeedback group or the attention control group. Both groups received ten individual sessions of biofeedback, each 45 min in duration. The HRV biofeedback group received training in pursed-lips abdominal breathing with prolonged exhalation at their optimal resonant frequency. Additionally, participants monitored their BP at home, as well as, to practice abdominal breathing for 20 minutes, twice a day. The attention control group received EEG biofeedback and participants were asked to enhance frontal EEG alpha and theta rhythms. Data were assessed at baseline, mid-treatment, post-treatment, and three months follow-up. The study is still in progress and data collection will be completed in October 2006. Results will be presented at the conference. As a preliminary conclusion, ten sessions of HRV biofeedback could be used to reduce BP levels and increase BR sensitivity in patients with Stage I hypertension. Advantages of this treatment are that it is inexpensive and has few if any negative side effects. Communications should be addressed to: Anke Reineke Alliant International University 4149 6th Ave #24 San Diego, CA 92103, USA E-mail: [email protected] Keywords: Heart rate variability feedback, Hypertension, Controlled study

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A Controlled Study of Vibroacustic Music and ANS Relaxation

HRV Biofeedback for College Students Living with Chronic pain

Carmen Vincent Russoniello, Nick Murray, and Shannon Paton

Ronald Laye, and Chelsea Pilling

East Carolina University

University College of the Fraser Valley, British Columbia, Canada

Stress can cause or exacerbate physical and mental symptoms, hinder treatment effectiveness, and negatively affect an individual’s quality of life. Hence, efficacious therapies are needed in treatment to reduce stress. Vibroacustic music has been reported to be an effective intervention for a variety of symptoms including depression, fatigue pain and anxiety. In this study ANS changes are being recorded and compared with controls to determine whether it is effective in producing ANS relaxation. This project involves 60 participants assigned to one of three groups: experimental, chair control and Web control. The experimental group participates in a 20-min vibroacustic music exercise using a Somatron FFM chair reclined in Trendelenburg’s position. Participants in the internet control group surf the Web for twenty minutes and students in the chair control sit in Trendelenburg’s position without vibroacustic music. Biocom’s HeartScanner ECG 1500 System records 5 min of baseline heart rate variability (HRV) data and 20 min during experimental and control group experiences. To date 14 experimental and 14 internet control subjects (20 females and eight males) have been enrolled (average age = 22). Preliminary results indicate significant differences between the groups in heart rate (p = .001); NN (p = .001); and HF Norm (p = .035). In addition the low frequency/high frequency ratio is nearing significance (p = .068). The preliminary data suggest that vibroacustic music significantly increases parasympathetic activity but does not concomitantly decrease sympathetic activity when compared to Web control. This finding may be due to the nature of the control as sympathetic activity may decrease while students leisurely surf the Web. Further analyses will include the chair control, which will help eliminate Trendelenburg’s position as a confounding variable. Communications should be addressed to: Carmen Vincent Russoniello, Ph.D. East Carolina University 115A Christenbury Greenville, NC 27858, USA E-mail: [email protected] Keywords: Vibroacustic music, Heart rate variability, Autonomic nervous system (ANS) relaxation

The objective of this study was to determine the value of Heart Rate Variability biofeedback as part of a cognitive behavioral program designed to enhance academic performance of students suffering from chronic pain. Eight college students diagnosed with chronic pain volunteered to participate in a six-session program designed to help them improve academic performance. Participants were randomly assigned to a cognitive-behavioral training group (CBT) or to a similar program with heart rate variability biofeedback added (HRV). Two subjects from the CBT group dropped out before the program began. For both groups, there were six half-hour individual sessions over three weeks. All subjects learned diaphragmatic breathing, modified progressive relaxation, activity pacing, empathic listening, and cognitive restructuring. The HRV group received less time to practice skills in order to incorporate HRV biofeedback using the Freeze-Framer (HeartMath) for approximately 10 min per session. All subjects practiced skills between sessions. The following measures were collected: HRV coherence scores in the first and sixth session and visual analog scales (VAS) of pain intensity, pain interference, and academic progress. Pre- and postprogram academic course grades were also recorded. As the groups were small and with only two remaining subjects in the CBT group, between-groups comparisons were not meaningful. Pre- post HRV data for the HRV group demonstrated a significant increase in coherence scores. The results are encouraging and warrant further study. Statistical power was low due to the sample size, but we still found that HRV increased in the biofeedback group. A further study, including students suffering from pain and/or stress, is underway, and results will be included in the conference presentation. Communications should be addressed to: Ronald Laye, Ph.D. University College of the Fraser Valley Psychology Department 33844 King Road Abbotsford, BC Canada V2S 7M8 E-mail: [email protected] Keywords: HRV, Pain, College students

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Using Biofeedback Assessment during Buddhist Monk Chanting Imei Lin National Chung Cheng University Erik Peper San Francisco State University This study explores psychophysiological and subjective experience correlates of chanting as well as the relationship of subjective experience and respiratory sinus arrhythmia (RSA). The participant was a 54-year-old female monk who has practiced twice daily 30–60 min Buddhist chanting for 25 years. The procedure consisted of monitoring respiration rate from the upper thorax, blood volume pulse from the left middle finger with heart rate derived from BVP, finger temperature from the right index finger, skin conduction (SC) from the left the index finger and the ring finger, and electromyographic (EMG) activity from the right trapezius and left throat muscles. After sensors were attached, she chanted in her traditional sequence. During chanting she wore the Kesa (The Buddhist liturgical robe) and sat crossed legged in front of the Buddhist statue. The chanting sequence consisted of: (1) talking, (2) pre-baseline sitting (eyes closed), (3) reading chanting with her eyes open and reading out loud (chanting) ‘‘The Samantamukha’’ (one of sutra), (4) internal chanting with the eyes closed in which she repeated the ‘‘The Heart Sutra’’ inside her mind, (5) control condition of reading neutral text out loud and (6) post-baseline (eyes closed). After chanting she reported feeling peaceful, more relaxed, and having a total focus of attention and consciousness–an experience that was similar to when she chanted in the temple with other monks. The most significant finding was that during the reading chanting her respiration rate was high (21.2 times/ min) as compared to her internal chanting when her respiration rate slowed and smoothed (6.0 br/min) as compared to pre-baseline (8.10 br/min) and post-baseline (7.34 br/min) and her heart rate was rapid (98.0 beats/min). During reading chanting her right trapezius EMG and left throat muscles EMG were higher than during internal chanting. SC was low. In both pre- and post-baseline situation, respiratory sinus arrhythmia (RSA) was significantly higher than during reading chanting and internal chanting. This study suggests that the subjective experience associated with chanting cannot be solely attributed to increased RSA and slower breathing as it depends upon the style of chanting. The spiritual experience associated with chanting appears to be evoked through the focused attention on the sutra. This process quiets the distractive mind

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and brings mind and body together. The result of the spiritual training through chanting is observed in the quietness during internal chanting and pre- and post-baseline when breathing rates were on average 6.79 times/per minute and RSA was enhanced. It appears that the release of the focused concentrations during the internal chanting and post baseline as shown in the decrease of heart rate and breathing and increase of RSA allowed the monk’s body and mind to calm down, so she could feel peaceful and relaxed. Further research should be conducted with a group of individuals who chant regularly and compare differences between chanting as singing and chanting as reading. Besides, if meditation could decrease psychophysiological response and increase personal well-being, it could be used to help others learn how to increase RSA. Communications should be addressed to: Imei Lin National Chung Cheng University 146 Granville Way San Francisco, CA 94127-1134, USA E-mail: [email protected] Keywords: Chanting, Buddhist monk, Biofeedback

Telemedicine Applications to Clinical Biofeedback: Review and Synthesis Jennifer Lind Stoddard and John Arena Walton Rehabilitation Health System, Augusta, GA Telemedicine is a relatively new type of treatment delivery that has become available over the past few years. This treatment medium makes it more feasible for patients in rural areas or with transportation or other limitations to receive needed intervention. Telemedicine involves the use of technology to deliver treatment over a distance. Specifically, high-resolution television cameras and monitors, and high-speed communications lines are utilized to deliver treatment over a distance. This technology offers several advantages, including saving provider and patient time, money, and effort by reducing travel time in order to receive treatment. The provider is able to remain in his or her office or medical institution, while the patient may remain at home or at work, which may be beneficial if the patient faces challenges such as a pre-existing physical disability, domestic or work constraints, or lack of transportation. It has become clear that overcoming the challenges of time and distance are paramount to the development of services that promote equity of access to care, regardless of location. This poster presentation will provide a comprehensive review of the literature demonstrating the application of telemedicine for psychiatric populations, as well as

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demonstrating the paucity of research data on the clinical effectiveness of telemedicine as compared to the more traditional, in-person approach to biofeedback. While there is a large theoretical and descriptive literature regarding the potential of the technique for a broad range of mental health problems, there are very few well-controlled clinical trials. A summary of videophone-based telemedicine studies conducted to date, which have documented the benefit of remote consultation services delivered to patients’ homes as compared to usual medical treatment by itself, will be discussed. Telemedicine approaches to biofeedback are showing great promise for the effective provision of therapeutic services for patients as it allows increased medical access in the patient’s local environment. However, there are potential challenges to this approach, such as concerns about effective encryption and issues regarding licensure of the psychologist in the state in which the patient resides. These and other potential problems will be discussed. Communications should be addressed to: Jennifer Lind Stoddard, Ph.D. Walton Rehabilitation Health System 1355 Independence Avenue Augusta, GA 30901, USA E-mail: [email protected] Keywords: Telemedicine, Clinical biofeedback, Chronic pain disorders

Biofeedback and Moderately to Severely Depressed Subjects Jennifer Marie Kretzschmar, Sharon Lewis, Paula Blackwell, Allen Novian, and Monica Escamilla

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20-min relaxation period. Percentage of natural killer (NK) cells was determined. Caregivers were divided into groups based on Center for Epidemiologic Studies-Depression scores: CES-D scores from 0 to 15 ‘No to Mild Depression’ (n = 40), 16–23 ‘Mild to Moderate Depression’ [MMD] (n = 20), and 24 and above ‘Moderately to Severe Depression’ [MSD] (n = 21) category. Participants were experiencing high stress and on average caregiving for 6.16 years. All groups responded to stressors and were able to relax. Interestingly, the MMD group responded with the highest EMG and SC readings and lowest TEMP readings. The MMD group was not able to relax as much during rest periods. The MMD group had the lowest NK percent and highest number of absolute natural killer cells. Even the highly stressed MSD group responded to stressors and was able to relax. Prior to doing the study, the assumption was severely depressed people would not show a favorable response to biofeedback. Measurements taken indicate an ability for these groups to use biofeedback to reach relaxation. An analysis is being conducted on longitudinal data to see what effects relaxation therapy has on these groups. It is important to investigate the effects of depression and its relationship to psychophysiological responses. Communications should be addressed to: Jennifer Marie Kretzschmar University of Texas Health Science Center at San Antonio 10511 Wind Walker Helotes, TX 78023, USA E-mail: [email protected] Keywords: Depression, Natural killer cells, Caregivers

New Biofeedback-based Tool for Computer Vision Syndrome

University of Texas Health Science Center at San Antonio Aneel Ursani Aging baby boomers and longer life spans will lead to a demand for specialized geriatric care. Late-life depression has been studied extensively; however, the cause of it remains elusive. Depression is perhaps the most frequent cause of emotional suffering in later life and has ill effects on quality of life. The purpose of this study was to look at the stress reactivity results of caregivers with varying degrees of depression to see if biofeedback could be used as an intervention, especially for those with severe depression. Eighty-one family caregivers were enrolled. Instruments were used to collect emotional distress variables. Electromyography of trapezius (EMG-T) and frontalis (EMG-F), skin conductance (SC), skin temperature (TEMP), blood volume pulse (BVP), and heart rate (HR) readings were taken during acute laboratory stressors and a

UC Berkeley Naras Bhat and Joy Bhat Cybernetix Medical Institute Computers have become an inevitable part of our daily life. Their increasing use has lead to the spread of Computer Vision Syndrome (CVS). The American Optometric Association defines CVS as a collection of symptoms experienced by computer users in the course of their work. More than 143 million Americans work on a computer each day for a minimum of 2 h. According to studies done by the National Institute for Occupational Safety and

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Health (NIOSH), these 2 h of computer work lead to CVS in 80% of employees. Common symptoms of CVS include fatigue, headache, dry eyes, inability to maintain near focus, neck and shoulder discomfort, and changes in color perception. The most common symptom is the decrease of moisture in the eyes due to the lack of blinking, which moisturizes the eyes. It is known that a patient with CVS blinks their eyes 50–70% less when they are working on a computer than performing any other everyday task. We conducted a study involving 20 regular computer users, ranging in age from 18 to 60 years old. Each subject was required to read a short passage on a computer screen with multiple deliberately inserted spelling errors and asked to underline these errors. Next, the subject was asked to repeat the process with a new passage but by practicing Kum Nye breathing simultaneously. Psychologist Steve Randall has shown that this breathing technique reduces deadline time pressure. Kum Nye breathing is an ancient Tibetan method of breathing—it requires placing one’s tongue against the upper jaw behind the teeth and breathing slowly and naturally through the mouth and nose. We measured the subject’s autonomic balance (Heart-rate variability, HRV) using Biocom software and an ear-lobe sensor. We also calculated the blink rate using a hidden camera. We found that the practice of Kum Nye breathing relaxes oneself and dramatically increases the subject’s blink rate—in most cases, doubling it. Moreover, this practice relaxes the mind-body tension within an individual as measured by the autonomic ratio and power spectrum analysis of HRV. The detailed materials, methods, and statistical analysis will be presented on a poster. Communications should be addressed to: Aneel Ursani UC Berkeley 2182 East Street Concord, CA 94520, USA E-mail: [email protected] Keywords: Computer Vision Syndrome, Kum Nye breathing, Heart rate variability

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for characterizing ANS function and dysfunction, and has the added benefits of being simple and non-invasive. Currently, Electrocardiogarphy (ECG) is the standard method of measuring the rhythm of the heart by tracing electrical impulses as the heart contracts and relaxes. However, another method to measure HRV is a technique based upon more recent medical technology, called photoplethysmography (PPG). PPG was developed in the 1960s and 1970s by psychophysiology researchers. PPG measures pulse volume or phasic changes, which are related to beat variations in the force of blood flow. These beat-to-beat changes in peripheral blood flow reflect the heart’s interbeat intervals similar to ECG. Thus, PPG provides summary information that reflects both cardiac and blood vessel components. Currently, there is no database of normative results across multiple variables of age and gender derived from photoplethysmography signals. The purpose of this study was to establish a normative database on the variables of age and gender derived from photoplethysmography signals for each HRV parameter. We collected results of three autonomic assessment tests: Shortterm Resting HRV Test, Slow Metronome Breathing Test, and Orthostatic Test. Thus far we have tested 200 participants with the eventual goal of 400 participants for each test. In addition, we collected demographic data and minimal health information in order to build a sufficiently useful normative database of HRV results. Results are derived from two gender specific sets of age-dependent normative ranges for each HRV parameter utilizing linear regression analysis. The final actual value of each HRV parameter was compared to those normative values to identify whether parameters lie within the normative range or below/above the normal range. Communications should be addressed to: Nicholas Murray, Ph.D. East Carolina University 166 Minges Greenville, NC 27858, USA E-mail: [email protected] Keywords: Heart rate variability, Photoplethesmography, Norms

HRV Normative Database Utilizing Photoplethesmography Nicholas Murray, Carmen Russoniello, and Tami Maes

Three Fundamental Dimensions of Mental Processing and Prefrontal EEG

East Carolina University

Jonathan D. Cowan

The most sensitive, repeatable, and practical measure of autonomic function uses the measure of HRV in response to provocative stimuli such as deep breathing, blowing under pressure, or changing posture from supine or sitting reclined to standing. HRV has become the ‘‘gold standard’’

Peak Achievement Training, Goshen, KY

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This pilot study examined the relationships between EEG feedback for Focus, Alertness, and Awareness and the subjective experience of expert raters. The objective was to

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measure the strength of the relationship between these analyses of EEG data and the rater’s definitions of the descriptions used for each dimension. Participants were given a demonstration of the Peak Achievement Trainer’s neurofeedback protocols for Focus, Alertness and Awareness, and then asked to fill out the Three Dimensions of Mental Processing Questionnaire #3. For each dimension, a 7-point Likert scale was used to answer the question: ‘‘How strong do you think the relationship between your definition of single-pointed Focus and the Peak Achievement Trainer’s measurement of Focus is? Make a/anywhere along the line.’’ Responses were permitted anywhere along a continuous line from 1 (Extremely Strong Negative) to 7 (Extremely Strong Positive). This was a single group design in which the differences among the three ratings and their correlations were examined. Ten expert raters were recruited at a professional neurofeedback meeting. The following variables were examined: Focus, Alertness, and Awareness Ratings. A t-test was used to examine the hypothesis that the Likert scale ratings were significantly different from 4 (Neutral) and from each other. Each of the ratings was significantly different from Neutral. This pilot study is consistent with the hypothesis that the EEG signals from three different, fundamental dimensions of mental processing have been identified. EEG data, which will also be presented, indicate that these dimensions are not significantly correlated. Information suggesting that the 40 Hz rhythm, as measured by the Nuereka! Protocol, has the psychophysiological function of increasing awareness to enhance memory for an important event or discovery, and then increasing feelings of satisfaction will be summarized. Communications should be addressed to: Jonathan Cowan, Ph.D. Peak Achievement Training 1103 Hollendale Way Goshen, KY 40026, USA E-mail: [email protected] Keywords: Neurofeedback, Neureka!, 40 Hz rhythm

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surveyed 143 Poker and Asian game card dealers (43% female, 57% male; average age 46.4 years) from a single card room casino in California for factors that affect work related discomfort, frequency of self-reported discomfort and psychophysiological risk patterns as monitored from selected dealers. The respondents have been dealers for an average of 10.5 years and more than 40% smoked. The dealers reported that they experienced significant body discomfort: 7.2% experienced no symptoms, 18.0% experienced mild symptoms, 29.5% experienced moderate symptoms, and 45.3% experienced severe symptoms. Seventy-four percent of the dealers reported pain in the neck and shoulders, 72% reported tiredness, 68% reported lower back pain, 68% wrist and hand pain, 66% reported arm pain, 64% reported upper back pain, 55% reported problems with their eyes, 48% reported symptoms in their head, and 49% reported pain and discomfort in their legs. Females reported a higher incidence of neck and shoulder pain as well as cold hands, and there was an inverse correlation between height and the risk of neck and shoulder, arm, eyes, and head discomforts. Those with cold hands had a higher incidence of eye, head, neck and shoulder, arm, wrist and hand, upper and lower back discomfort, and tiredness. Analyses of additional risk factors included inappropriate ergonomics (the chairs were too big, lack of time to adjust the chair before having to deal), chronic muscle tension in the neck and shoulders while dealing and reaching for the pot across table and breath holding and rapid shallow breathing during dealing. In conclusion, the data suggest that card dealers are at very high risk for discomfort (repetitive strain injury) and that preventative intervention must include improved ergonomics, learning to reduce autonomic arousal, practicing micro-breaks and breathing during dealing. Communications should be addressed to: Delainya Kazarian San Francisco State University 877 Ashbury Street #1 San Francisco, CA 9411, USA [email protected] Keywords: Health, EMG, Poker

Health Risks for Poker Dealers Delainya Kazarian, Erik Peper, and Richard Harvey

Psychophysiology of Residual Affective Biases in Bipolar Disorder

San Francisco State University With the resurgence of poker, card club businesses and gambling are on the rise. At present, California has 3,325 table games, including 1,820 tribal, and 1,505 in card rooms (Simmons 2006). There are approximately 10,000 to 15,000 card dealers in California who are working in physically and socially stressful conditions. This study

Tato Sokhadze, Rif El-Mallakh, Shraddha Singh, and Allan Tasman University of Louisville Patients with bipolar disorder (BD) even in euthymia reveal a pattern of responses across behavioral, electrocortical and

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autonomic measures that suggest an enhanced processing of task-irrelevant, mood-congruent and motivationally salient emotional stimuli with concurrent deficits in the processing of task-relevant emotionally neutral stimuli. The study used two types of behavioral tasks aimed to infer dysfunctions of emotion and cognition processes, analyzing overt responses, dense-array event-related potentials (ERP), and autonomic outcomes in 12 euthymic BD patients and 12 control subjects. In this experimental study we used two modifications of a three-category oddball task. In the first oddball test we presented verbal affective distracters without using them as targets; while in the second one, we used facial emotional expressions both as target and distracter stimuli. ERPs to targets, standards, and distracters, as well as difference waves (target-minus-standard; target-minus-distracter) were calculated at topographical regions-of-interest and compared across all conditions using ANOVA. Bipolar patients, compared with controls, demonstrated more interference effects expressed in delayed reaction time and lower accuracy, and prolonged latencies of endogenous ERP indices (P2a, N2b, P3a, P3b) when distracters were stimuli (words and facial expressions) related to negative emotional content, and demonstrated lower interference effects to emotionally neutral target and standard stimuli. Tonic autonomic measures (heart rate, HRV, SCL, respiration, etc.) also showed between group differences in conditions with emotional distracters. This study developed an innovative psychophysiological measurement approach by combining 128 channel EEG/ERP and autonomic activity recordings for more comprehensive assessment of the physiological manifestations of residual emotional disturbances in euthymic patients with BD. The proposed methodology has practical value and usefulness in the cognitive and emotional impairment assessment process in mood disorders. Dense-array ERPs and dipole source localization techniques make the recording of activity of the brain areas involved in cognitive and emotional processes possible. Affective states are under the control of a more primitive limbic system, which governs activity of the autonomic nervous system. Integration of both cortical and autonomic measures may have clinical significance in the study of mood disorders. Communications should be addressed to: Tato Sokhadze Ph.D. Department of Psychiatry University of Louisville 500 S. Preston Street, Building A, #210 Louisville, KY 40292, USA E-mail: [email protected] Keywords: Dense-array ERP, Autonomic activity, Bipolar disorder

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Findings from Four Studies Examining a Portable HRV Biofeedback Device Frederick Muench Helicor, New York, NY The presentation will highlight the underlying technology and study findings of an ambulatory RSA biofeedback device. The results of four studies including an integration study in a CBT clinic, a validation test with 76 users, an acute physiological study, and two occupational studies will be presented. Results suggest that the device increases feelings of calmness and relaxation, increases objective work performance, objectively increases cognitive focus, and is perceived as more helpful than other relaxation techniques. Other results indicate that the device can be easily integrated into practice, yields high compliance rates as compared to other relaxation techniques, and is an effective adjunctive and stand-alone stress reduction device. Barriers and limitations to integrating the device into private practice will also be discussed. Communications should be addressed to: Frederick Muench, Ph.D. Helicor 156 Fifth Avenue Suite 1218 New York, NY 10010, USA [email protected] Keywords: HRV biofeedback