Appl Psychophysiol Biofeedback (2010) 35:177–185 DOI 10.1007/s10484-010-9131-0

Abstracts of Select Papers Presented at the 40th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback

The 40th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback (AAPB) was held at the Hyatt Regency Albuquerque, Albuquerque, NM, April 2–4, 2009, with preconference workshops held April 1–2, 2009. The theme of the meeting was ‘‘Forty Years of Promoting Whole Person Health.’’ The meeting included diverse program offerings, consisting of platform and poster presentations, symposia, invited keynote and special addresses, a distinguished scientist presentation, a special tribute to Francine Butler, Ph.D., the presidential address, workshops, short courses, section and division programs, a meet the editors forum, plus a full array of exhibits. Abstracts for select platform and poster presentations follow. The Program Committee members were Chair Howard Hall, Frank Andrasik, Susan Antelis, John Arena, Steve Baskin, Timothy Culbert, Richard Gevirtz, Doil Montgomery, Donald Morgan, Carolyn Yucha, and AAPB President Aubrey Ewing.

Oral Presentations Citation Paper Novel Approach to Adolescent Physical Activity: Mood-Booster Acute Exercise Melita M. Nasca, PhD; Howard Hall, PhD, PsyD, BCIAC Despite well-known effects of physical activity on whole person health, lack of time and motivation are the top cited reasons for not exercising regularly. The objective of this work was to determine the effects of a single bout of acute, gradually increasing to peak intensity exercise on mood in healthy adolescents. The role of Body Mass Index (BMI), cardiorespiratory fitness and physical activity were examined. Twenty-eight apparently healthy, asymptomatic, 13–17 years old African American adolescents (16 females) participated. Health and lifestyle information, including habitual physical activity were obtained from questionnaires; anthropometry was laboratory-measured. Cardiorespiratory fitness was objectively measured with a computerized metabolic system during a single bout of cycle ergometry exercise of continuously incremental intensity (‘‘ramp’’ test) to peak pulmonary oxygen uptake (VO2 peak). Mood was assessed at baseline and after the exercise bout with a modified Profile of Mood States (POMS). Non-parametric paired tests (Wilcoxon signed rank), two-sample non-parametric tests (Wilcoxon rank sum), Spearman rank

order correlation and multiple regression models were used to analyze the data. Overall, following this single exercise bout of mean ± SD 11.0 ± 2.1 min, a significant decrease in negative mood was obtained (median -1.0, range -7 to 5, p = 0.001), regardless of BMI percentile, cardiorespiratory fitness (VO2 peak) or physical activity levels. Only baseline negative mood was related to significant change in negative mood (p \ 0.001). Moreover, adolescents reporting habitual heavy physical activity had a significant increase in positive mood (median 2.0, range -1 to 8, p = 0.02), while those reporting light physical activity had a significant decrease in positive mood (-2.0, range -15 to 4, p = 0.02). A single bout of acute (around 10 min, up to and including peak intensity) exercise can improve mood in healthy, asymptomatic adolescents regardless of weight or cardiorespiratory fitness level, but the more physically active, the better. Furthermore, given the accumulating evidence, from our work and of others, for the cardiometabolic benefits of high intensity interval training, it may emerge as a feasible, time-saving, enjoyable approach to regular exercise in contemporary healthy youth. Melita M. Nasca, PhD Case Western Reserve University 11100 Euclid Avenue, Mather House Rm. 203 Cleveland, OH 44106 Phone: (216) 464-8410 Email: [email protected] Keywords: -Adolescents -Acute exercise -Mood improvement

Wellness Programming for First Year Medical Students Angele McGrady, PhD, Med, LPCC; Kary Whearty, LSW; Julie Brennan The objective was to explore the effects of a structured wellness program on anxiety, depression, quality of life and acute illness in first year medical students. 184 students signed the consent form and were randomized to either intervention or wait list control; 98 men, 85 women of average age 23 years. Fifty-three students completed the intervention and 50 finished the control period. Variables consisted of the following: scores on the Beck Anxiety Inventory; Beck Depression Inventory; quality of life; SF-12; number of illnesses in the past 2 weeks; and Social Readjustment Scale (number of life events and

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178 weighted total). Seven sessions of deep breathing, progressive relaxation, passive relaxation, imagery, coping, survival thinking, and nutrition were provided. At baseline, mean (SD) values of BDI-II were 5.8 (5.4) and BAI were 6.5 (6.6). Women were significantly higher in both BAI and BDI-II (p = .01 and p = .002 respectively). Women had more acute illnesses than men (p = .000 l). Women reported lower quality of life (SF-12 mental and physical) (p = .0001 mental and p = .019 physical). Correlations were statistically significant between BDI-II and weighted life events (.39) and SF-12 mental (-.78 and SF-12 physical (-.26); and between BAI and weighted life events (.39), SF-12 mental -.61), and SF-12 physical (-.21). After 4 months of medical school, students endorsed more items on the BDI-II and BAI than before the start of classes, which is consistent with the literature. Students in the intervention group showed less of an increase in endorsed statements. Specifically, students who reported larger numbers of life events prior to the start of medical school benefited most from the intervention sessions. In conclusion, some students, more women than men, scored in the clinical range of depression and anxiety prior to medical school, while most endorsed fewer statements of sadness and anxiety. The number and type of life events influenced mood and the response to intervention. The first months of medical school are very stressful and require major adjustments; a wellness program can buffer some of the expected decrease in positive mood. Angele McGrady, PhD, Med, LPCC University of Toledo Health Science Campus 3120 Glendale Ave., Mail Stop 1193 Toledo, OH 43614 Phone: 419-383-5686 Email: [email protected] Keywords: -Medical Students -Wellness -Anxiety

Dimensions of Attention Questionnaire (DAQ): A Potential Pre-Screening Tool to Suggest Initial Use of Biofeedback or Hypnosis for Clients Joan H. Hageman, PhD Building upon previous research by Quall and Sheehan and mind-body research, the author utilized a repeated measures design to explore the relationship of absorption, dissociation, and practice level in attentional focus as measured by twelve dimensions of the Dimensions of Attention Questionnaire (DAQ) with 59 practitioners from a spiritual/ meditative practice attending an intensive 6-day training retreat. A total of four visualizations were used in which one was unstructured (eyes open, mind blank) and one structured (eyes closed, think about the retreat) for both before (pre-test) and after training (post-test). Results with ANOVAs and correlation statistics supported the hypotheses that absorption, measured by the Tellegen Absorption Scale (TAS), and dissociation, measured by the Dissociative Experiences Scale (DES), played significant roles in attentional focus for some DAQ dimensions, but practice level did not. TAS was significant on the pre-test unstructured visualization for DAQ dimensions Flexibility, Perspicacity, Absorption, and Simultaneity, accounting for 22%, 33%, 24%, and 26% of the variance respectively. TAS was also significant on the post-test unstructured and structured visualizations for Perspicacity, each accounting for 28% of the variance. DES was significant on dimensions Flexibility, Perspicacity, Locus, and Absorption in the pre-test unstructured visualization, accounting for 61%, 52%, 61% and 55% of the variance respectively. DES was

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Appl Psychophysiol Biofeedback (2010) 35:177–185 significant for Perspicacity in the post-test unstructured visualization accounting for over 50% of the variance. These findings are in line with previous research on the role of absorption and dissociation and are suggestive that absorption capabilities with meditative practices may enhance/inhibit attentional focus involving mystical experiences, flexibility of focus, absorption in tasks, and expansion/narrowing of awareness of sensations, thoughts, or feelings. Likewise, dissociative capabilities may also enhance/lessen perceived consciousness as localized within/external to the body. The findings raise the provocative consideration for the DAQ to be used as a screening tool to explore attentional focus, and thereby help to clarify a choice for the initial use of biofeedback or hypnosis dependent upon the client’s skill in attentional focus and history of meditative practice. Joan H. Hageman, PhD PSYmore Research Institute, Inc P. O. Box 340464 Tampa, FL 33694 Phone: 813-968-6876 Email: [email protected] Keywords: -Attentional Focus -Biofeedback -Hypnosis

Repetitive TMS Affects EEG Gamma and ERP During Perceptual Processing in Autism Estate Tato Sokhadze, PhD; Ayman El-Baz, PhD; Joshua Baruth, BS; Allan Tasman, MD; Grace Mathai, MA; Lonnie Sears, PhD; Manuel Casanova, MD Previous studies by our group suggest that the neuropathology of autism is characterized by a disturbance of cortical modularity. In this model a decrease in the peripheral neuropil space of affected minicolumns provides for an inhibitory deficit and a readjustment in their signal to noise bias. Given the geometric orientation of double bouquet cells within the peripheral neuropil space we proposed using low frequency transcranial magnetic stimulation (rTMS) as a way of selectively increasing the surround inhibition of minicolumns. Thirteen patients (DSM-IVTR, ADI-R) and equal number of age-matched controls participated in the study. Repetitive TMS was delivered at 0.5 Hz, 2 times per week, 3 weeks, with a total of 150 pulses per day. We used an oddball task with target and non-target Kanizsa illusory figures, and non-Kanizsa standard stimuli at pre-and post rTMS treatment stages. Outcome measures based on event related potentials (ERP), induced gamma band EEG activity and behavioral measures pre- and post-TMS showed significant improvement. As compared to controls, subjects in the autism group had higher amplitude and longer latencies of ERP components of interest to non-target rather than target stimuli during baseline ERP test. Similar response pattern of between group differences was typical for gamma oscillations. In particular, autistic patients showed higher power of gamma in response to non-target standards and non-target Kanizsa stimuli. In all autistic subjects difference of gamma density for target and non-target Kanizsa figures was negative. TMS resulted in a decrease of the amplitude in the frontal early and late ERP components to non-target Kanizsa and standard stimuli, but not to the target Kanizsa stimuli. Effects of rTMS on the posterior ERP were significant mostly for the latency pf P3b, which decrease to non-target Kanizsa, but not to targets. Repetitive TMS affected the power of gamma activity in response to non-target stimuli on the ipsilateral frontal and parietal sites. The power of gamma oscillations to non-target Kanizsa figures dramatically decreased, and difference between gamma responses target and non-target became less negative. The results

Appl Psychophysiol Biofeedback (2010) 35:177–185 suggest that the brains of autistic patients are often inappropriately activated and that rTMS offers a potential therapeutic intervention. Estate Tato Sokhadze, PhD University of Louisville 401 E. Chestnut street #610 Louisville, KY 40292 Phone: 502-852-0404 Email: [email protected] Keywords: -TMS -Autism -EEG and ERP

Efficacy of Connectivity Guided Neurofeedback on Language Functions and IQ in Autistic Children Robert Coben, PhD The objective was to analyze language, intelligence and EEG changes in a group of autistic children treated with connectivity guided EEG biofeedback. In a group of 15 autistic children with demonstrable language impairments and low to low average IQ, changes were analyzed following connectivity guided EEG biofeedback training. The variables of greatest interest in this study included language, IQ, parent rating scale measures and EEG findings. These individuals were compared to a similar group of children assigned to a wait-list control group. A repeated within and between groups (experimental and control) design was employed for language, IQ, and multiple EEG variables with corrections for multiple comparisons in the latter. Fifteen autistic children treated with connectivity guided EEG biofeedback served as the experimental group and were compared to 15 autistic children that served as a wait list control group. Neuropsychological measures included those related to language functions, IQ and parent ratings scales. The latter related to autistic symptoms, in general, and language impairments specifically. EEG power and coherence measurements were compared for changes from baseline to post-treatment recordings. Pre- and post-neurofeedback (20 sessions) neuropsychological, IQ, parent rating scales, and EEG data were gathered for the experimental group. Similar data were also acquired for 15 autistic children that composed the wait list control group. ANOVA’s were performed for language, IQ and rating scale data for pre and post measurements comparing the experimental and control groups. Student’s t-test for correlated (within groups comparisons) data with corrections for multiple comparisons were used to analyze changes in the EEG data. The findings included significant changes in language functions, IQ and autistic symptoms. There were also significant changes in regions of interest in brain functioning as revealed by EEG source localized power changes and neural connectivity. Connectivity guided neurofeedback targeted to enhance language functions in autistic children appears efficacious. There are associated changes in IQ, autistic symptoms and brain functions as measured by the EEG.

179 Citation Paper A Randomized Controlled Trial of a Yoga Treatment for Chronic Insomnia Sat Bir Singh Khalsa, PhD The purpose of this study was to evaluate the efficacy of a yoga treatment for chronic primary insomnia in a randomized controlled trial. Subjects were recruited and screened for the presence of chronic insomnia (minimum 6 month history) and sleep onset insomnia (minimum 30-min average sleep onset latency) and excluded for any current psychopathology, psychoactive medications, other sleep disorders and any secondary conditions that could account for the insomnia (secondary insomnia). Data were analyzed from 40 adults who completed participation in the trial. Subjects randomized to the active treatment (N = 20) underwent an 8-week daily yoga behavioral treatment whereas those assigned to the control treatment (N = 20) underwent a sleep hygiene treatment. All participants maintained daily sleep diaries during a two-week baseline evaluation, and during the subsequent treatment phase. Comparative analysis (ttest) of baseline 2-week averages and the last 2 weeks of treatment showed statistically significant improvement in average sleep onset latency in the yoga group over time (46.8 min to 29.5 min, p \ 0.001) whereas the improvement in the sleep hygiene group showed a trend for significance (48.1 min to 34.7 min, p = 0.05). There was no difference between the groups in the average baseline to end-treatment difference scores in sleep onset latency (yoga = 17.3 min vs. hygiene = 12.5 min, p = 0.47). The yoga group also showed significant improvements over time (all p \ 0.05) in average sleep efficiency, wake time after sleep onset, total wake time and total sleep time. In contrast, the hygiene group had significant improvements only in wake time after sleep onset and total sleep time. In measures of clinical significance (the percentage of subjects at baseline with clinically accepted criteria for a particular sleep variable who ended the treatment with normative criteria) for sleep onset, sleep efficiency, wake time after sleep onset and total wake time, the yoga group showed greater percentages of subjects achieving normative criteria at end-treatment than did the hygiene control subjects. These data suggest that the yoga treatment applied in this study is clinically effective and may be a valuable adjunct to existing behavioral treatments for insomnia. Sat Bir Singh Khalsa, PhD Harvard Medical School Sleep Disorders Research Program, BWH, 221 Longwood Avenue Boston, MA 02115 Phone: (617) 732-7994 Email: [email protected] Keywords: -Yoga -Insomnia -Meditation

Robert Coben, PhD Private Practice 1035 Park Blvd, Suite 2B Massapequa Park, NY 11762 Phone: 516-799-8599 Email: [email protected]

Poster Presentations

Keywords: -EEG biofeedback -Autism -Language

The objective of this study was to assess the effects of resonance breathing training on heart variability (HRV) in healthy college age individuals. Participants in this study were 4 healthy adults (2 males, 2 females) ages 21–23 with a body mass index ranging from 23.9 to

Resonance Breathing Training and Heart Rate Variability: A Pilot Study Jacalyn McComb, PhD; Laurel Littlefield, MS

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27.4. Each participant received 8 sessions of heart rate variability biofeedback (HRV BFB) training for 2 months, one session per week. Each session included 20 min of baseline breathing followed by 20 min of HRV BFB. The J & J Engineering I-330 C2 ? System was used to collect electrocardiogram and respiration data, to provide HRV biofeedback training, and to present a respiratory pacing stimulus. During the 20 min of HRV BFB training, participants were asked to breath at a pace that produced a peak in the spectral display between the range of 0.08 and 0.11 Hz while trying to maximize HRV amplitude. An on-line display of beat-to-beat heart rate curve, a respiratory curve, and a moving Fourier analysis of heart rate was used to provide feedback. Participants were also required to practice slow diaphragmatic breathing at home for 20 min for a total of 5 breathing training sessions per week. Software for advanced HRV analysis from the University of Kuopio, Finland was used to analyze data. Two measures of HRV were analyzed, a time-domain parameter, the number of consecutive RR intervals that differ more than 50 ms (NN50) and a frequency domain parameter, the fast Fourier transform (FFT) based ratio of low frequency and high frequency band powers in ms2 (LF/HF). Given the small sample size, a nonparametric statistic, the Friedman One-Way ANOVA for related samples was used to analyze differences in HRV data from baseline in session 1, HRV BFB training session 1, baseline session 8, and HRV BFB training session 8. No significant differences were found in the time domain parameter NN50 (x2 = .6, df = 3, p = .896), however, there were significant differences in the frequency domain series LF/HF ratio (x2 = 9.90, df = 3, p = .018). Post hoc tests showed that the differences in the LF/HF ratio occurred from baseline to the HRV BFB training session. It was concluded that HRV BFB training had an effect on the frequency bands associated with baroreceptor regulation.

tasks: (1) pre-baseline, (2) eyes open at rest, (3) eyes closed at rest, (4) sensory attentiveness (listening to an audio book clip), and (5) cognitive effort (a higher level cognitive flexibility task). EEG and SCR were recorded, using the Procomp Infiniti. Poor sleepers demonstrated higher theta across all conditions, although this finding was not significant. A significant Group X Task interaction, F (3, 16) = 4.81, p = .01 was attained on the theta data. Specifically, for poor sleepers, theta increased from the ‘‘eyes open at rest’’ to the ‘‘sensory attentiveness’’ tasks, while good sleepers showed the opposite pattern. Theta decreased from the ‘‘eyes open at rest’’ to the ‘‘sensory attentiveness’’ tasks. This pattern of theta suppression was found in 70% of the good sleepers and only 20% of the poor sleepers. No between group differences were noted in the SCR data, suggesting a brain disregulation model, rather than a general psychophysiological stress model. Future research and treatment implications will be discussed.

Jacalyn McComb, PhD Texas Tech University 8501 Miami Lubbock, Texas 79423 Phone: (806)742-3371 Email: [email protected]

Event-Related Potential Study of Frontal Executive Deficits in Psychogenic and Neurodegenerative Movement Disorders

Keywords: -Heart Rate Variability -Breathing Training -Biofeedback

Awake EEG Disregulation: Good vs Poor Sleepers Susan Buckelew, PhD; Douglas DeGood, PhD; Kristyn Roberts; Jessica Butkovic, BS; Scott Crittendon, BA Sleep deprivation is a common problem among college students. To date, biofeedback treatment is often based on a ‘‘psychophysiological insomnia’’ model, characterized by high levels of autonomic arousal. The goal is to teach relaxation. Alternatively, a disregulation model has been proposed, which suggests that people with sleep onset difficulties may experience trouble matching EEG patterns to the demand characteristics of the situation. Our goal in the present study was to test a disregulation model of sleep deprivation in college students by assessing the ability of poor sleepers compared to good sleepers to shift daytime EEG patterning to changing environmental demands. Ten poor sleepers and ten good sleepers were identified from a sample of 110 college students who completed the Pittsburgh Sleep Quality Inventory (PSQI). Poor sleepers reported chronic trouble falling asleep, specifically taking 30 min or longer to fall asleep for at least 6 months, and obtained a score of five or greater on the PSQI. Good sleepers obtained a score of four or less on the PSQI and reported no major sleep problems. Each of the 20 participants attended a psychophysiological session, which included the following

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Susan Buckelew, PhD University of TN at Martin 325 Humanities Building Departent of Psychology, UTM Martin, TN 38238 Phone: 731-881-7544 Email: [email protected] Keywords: -EEG -Sleep -Disregulation

Estate Sokhadze, PhD; Ben Schoenbachler, MD; Irene Litvan, MD; Allan Tasman, MD In a speeded reaction time experiment with motor response demands we used dense-array event-related potentials (ERP) to test the hypothesis that frontal ‘‘top-down’’ motor control is differentially impaired in psychogenic and neurodegenerative movement disorders. The goal of this chronopsychophysiological methodological approach was to determine if higher order motor control deficits in patients with conversion disorders of the motor type are mediated by a dysfunctional interaction of executive prefrontal cortical networks with medial frontal and premotor structures, and if in Parkinson’s disease (PD) motor impairments are the result of an abnormal connectivity of the prefrontal and motor cortices with subcortical structures (e.g., basal ganglia) accompanied by a diminished cortical control over movements. The study was aimed at investigating the functional chronometry of event-related brain activity associated with movement preparatory processes by examining externally-cued motor activity in a flanker task with NoGo elements in patients with motor conversion disorder, patients with PD, and matched control subjects. We analyzed the differences in ERP indices of visual signal processing, motor conflict detection, response choice, and action monitoring in a forced choice Eriksens’ flanker task in 7 patients with motor conversion, 6 patients with Parkinson’s disease and 10 healthy controls. In the experiment we used the fronto-central N200 and N450 components of stimulus-locked ERPs and the fronto-central responselocked error-related negativity (ERN) and correct-response negativity (CRN) as measures of response conflict and action monitoring in this speeded reaction time (RT) task with interferences. We used the midline fronto-central No-Go-N2 and NoGo-P3 difference waves as indices of cortical inhibition in NoGo trials of the task. Results are discussed in a framework of model of movement preparation process in which prefrontal, medial frontal, parietal and primary motor areas

Appl Psychophysiol Biofeedback (2010) 35:177–185 are differentially impaired in externally triggered movements in motor conversion disorder and Parkinson disease. Estate Sokhadze, PhD University of Louisville 500 S. Preston street, Bldg A, #210 Louisville, KY 40292 Phone: 502-852-0404 Email: [email protected] Keywords: -Conversion Disorder -Parkinson Disease -Event-related Potentials

EEG Biofeedback and Reactivity to Pictorial and Verbal Drug- and Stress-Related Cues in Cocaine Addiction Comorbid with PTSD Estate Sokhadze, PhD; Christopher Stewart, MD; Guela Sokhadze; Michael Hollifield, MD; Allan Tasman, MD EEG biofeedback training is one of the probably efficacious treatment options for substance use disorders (SUD), posttraumatic stress disorder (PTSD), and dual diagnosis when SUD is co-occurring with PTSD. Our study was aimed at investigating the EEG biofeedback effects in cocaine addiction and cocaine addiction comorbidity with PTSD. In our conceptual review (Sokhadze et al., J. Neurotherapy, 2007, 11:13–44) we proposed that cocaine users and addicts with PTSD comorbidity may benefit from a biofeedback protocol aimed on increasing SMR (sensory-motor rhythm, 12–15 Hz) activity at frontocentral sites. We proposed as well that a combined application of SMR biofeedback and other Cognitive-Behavioral Therapies (CBT), for example Motivational Interviewing (MI) techniques, may result in an effective behavioral intervention for SUD-PTSD comorbidity. Cognitive, behavioral, and emotional deficits and their persistence in cocaine users undergoing behavioral treatment based on SMR biofeedback and MI were explored on 14 cocaine dependent outpatient subjects. Seven of these patients had a diagnosis of PTSD and formed a dual diagnosis group, while the remaining subjects formed a SUDonly group. Event-related potentials (ERP) were assessed prior and following behavioral intervention using 2 cognitive tasks containing drug-related and generic stressful cues. The study examined cue reactivity to both stress- and drug-related stimuli in a three-stimuli oddball task with pictorial and verbal stimuli with concurrent ERP recording before and after 4-week long behavioral treatments. Each subject participated in 12 SMR biofeedback training sessions (30 min, twice a week) and 3 sessions of MI. Most of the subjects successfully learned to increase SMR rhythm. Subjects with a SUD after combined SMR biofeedback and MI intervention showed decreased reactivity indexed by frontal and parietal P300 ERP components in response to drug-related pictorial and verbal cues, whereas subjects with a dual diagnosis showed decreased reactivity to both drug- and stress-related cues. Among the clinical outcome measures the most significant were decreases of depression scores (BDI-II) and PTSD symptom scores (PSS-SR scale). The results of this study support the suggestion that a combination of motivational interviewing with biofeedback might be a promising bio-behavioral intervention for addictive disorders, and specifically for treatment of cocaine addiction co-occurring with PTSD. Estate Sokhadze, PhD Department of Psychiatry, University of Louisville 401 E. Chestnut street #610 Louisville, KY 40292 Phone: 502-852-0404 Email: [email protected]

181 Keywords: -EEG biofeedback -PTSD -Substance use disorders

Inhalation-to-Exhalation Ratio Affects HRV Training Success Jonathon Grant; Igor Korenfeld; Christopher Wally; Aaron Truitt While there is strong empirical support in HRV biofeedback for teaching patients to slow their respiration rate to between 5 and 7 breaths-per-minute, there has been no definitive study of the best inhalation-to-exhalation ratio. In theory, a 1:2 ratio should increase global measures of HRV (SDRR, pNN50, HR Max-HR Min) more than a 1:1 ratio, because extended exhalation should prolong parasympathetic slowing of the heart. The present crossover study addressed this question. Ten male undergraduates, ages 18–22, were randomly assigned to one of two orders of HRV training: 1:1 ratio training followed by 1:2 ratio training, or 1:2 ratio training followed by 1:1 ratio training. A Thought Technology ProComp Infiniti data acquisition system using Infiniti 4.0 software measured HRV using a photoplethysmographic (PPG) sensor placed on the thumb of the nondominant hand and a respiration sensor placed over the navel. Participants received four consecutive weekly training sessions using their initial inhalation-to-exhalation ratio. Then, they received four additional training sessions using the second inhalation-to-exhalation ratio. During each session, they were instructed to follow a pacing display to guide their inhalation and exhalation, and watch analog feedback displays for heart rate, the very low frequency (VLF), low frequency (LF), and high frequency (HF) amplitude components of HRV, and strain gauge movement. Participants were encouraged to breathe abdominally from 5 to 7 breaths per minute and increase LF amplitude. Each session consisted of a 5-min stabilization period, 3-min eyes-open prebaseline, six 3-min training segments, and a 3-min eyes-open postbaseline. No feedback was provided during baseline measurements. A GLM Repeated Measures analysis found that only the 1:2 ratio training increased SDRR, F(1, 9) = 16.91, p = .003, eta squared = 0.65, and pNN50, F(1, 9) = 5.91, p = .038, eta squared = 0.40. Neither training method increased HR Max-HR Min, which is a third global measure of HRV. These findings should be replicated with a significantly larger, gender-balanced clinical sample to confirm their generality. Jonathon Grant Truman State University McClain 229, c/o Dr. Fred Shaffer Truman State University, 100 E. Normal Kirksville, Missouri 63501 Phone: 660-785-4643 Email: [email protected] Keywords: -HRV -Respiration -Inhalation-to-Exhalation Ratio

The Physiological Effects of Kargryya Throat-Singing: Paradoxical Arousal Michael Urlakis Kargryya throat-singing is an Eastern vocal technique that allows an individual to sing more than one note or pitch at the same time. Preliminary data showed that this meditative technique increased the percentage of power in the very low frequency (VLF) band of the heart rate variability spectrum. Since VLF activity may be associated

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182 with sympathetic arousal, it was hypothesized that Kargryya throatsinging would increase heart rate (HR) and skin conductance level (SCL), and decrease temperature. Three male undergraduates, ages 21–23, participated in this study. A Thought Technology Ltd. ProComp Infiniti physiological data acquisition system with BioGraph 4.0 software monitored alpha and theta amplitude with a gold cup electrode at the vertex of the scalp and a linked-ear reference on the left and right ears, heart rate and SDRR using a photoplethysmographic (PPG) sensor on the middle finger of the nondominant hand, respiration rate using an abdominal strain gauge placed over the navel, skin conductance level using electrodes on the second phalanx of the 2nd and 4th fingers of the dominant hand, and temperature using a thermistor on the web dorsum of the dominant hand. In this small-N design, after three 50-min training sessions, the participants were monitored with eyes open and without receiving feedback. They sat upright during nine 5-min periods, which included a prebaseline, listening to prerecorded Kargryya throat-singing, a baseline, performing throat-singing, a baseline, listening to prerecorded throatsinging, a baseline, performing throat-singing, and a postbaseline. All three subjects showed sharply increased heart rate and skin conductance levels, and decreased temperature that coincided with both periods of performing Kargryya throat-singing. Subjects 2 and 3, whose respiration rates slowed to 6 breaths-per-minute during singing, displayed large-scale increases in SDRR and HR Max-HR Min that also coincided with the two periods of performing throat-singing. Subjects 1 and 2 showed increased alpha and theta amplitudes while singing. These findings suggest that meditative procedures may produce complex and paradoxical patterns of physiological activity, such as increased sympathetic arousal and HRV. These findings should be replicated using a large-N design with gender balance and greater control for order effects. Michael Urlakis Truman State University McClain 229, c/o Dr. Fred Shaffer Truman State University, 100 E. Normal Kirksville, MO 63501 Phone: 660-785-4643 Email: [email protected] Keywords: -Kargryya throat-singing -Heart rate variability -Meditation

Citation Poster Alexithymia, Worldview and Blood Pressure in an African American Community Sample Denise Hatter-Fisher, PhD This correlational investigation was designed to examine the relationships among alexithymia, worldview and blood pressure in a community sample of African Americans. Data was collected at community events from 300 African Americans residing in a metropolitan area in the Midwest over a 1 year period. Afrocentric worldview was assessed using the Belief Systems Analysis Scale (BSAS) developed by Myers, Montgomery, Fine & Reese(1996); alexithymia as measured by the Toronto Alexithymia Scale (TAS-20) developed by Bagby, Parker &Taylor (1994); and an assessment of blood pressure comprised the protocol given to each participant, in addition to a brief demographic questionnaire. Preliminary data analyses were completed using a subset (n = 104) of the African American participants (N = 300). Seventy-nine were women and 25

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Appl Psychophysiol Biofeedback (2010) 35:177–185 were men, aged 21–65. Their educational attainment ranged from high school diploma/GED (17.3%) to post graduate (14.4%) degrees (n = 15). Twenty-five percent (n = 27) of the participants reported an annual income of less than $20,000. And less than 25% of the subset reported being hypertensive. Bivariate Pearson correlation coefficients between alexithymia and worldview as well as between each variable and blood pressure were computed. Preliminary analysis of the participant subset (n = 104) indicate a significant positive correlation between total TAS-20 scores and level of Afrocentricity (r = .38, p \= .001) as well as Afrocentricity and the difficulty describing feelings (r = .32, p \= .001) and difficulty identifying feelings (r = .41, p \= .001) TAS-20 sub scales. Note, higher scores on the BSAS indicate a more afrocentric worldview while higher scores on the TAS-20 indicate the absence of alexithymia. Neither concept correlated with blood pressure. These preliminary analyses indicated the more afrocentric the participant the less the tendency to endorse indicators of alexithymia. Hence, development of an afrocentric worldview may buffer against emotional disconnection for African Americans. This finding conceivably has implications for hypertension risk reduction interventions for African Americans. Still, similar to previous findings (e.g., Peters & Lumley, 2007) alexithymia was not directly related to blood pressure. Additional conclusions will be drawn from this correlational investigation once the complete data set has been analyzed. Denise Hatter-Fisher, PhD 8496 Morgan Street NW Pickerington, OH 43147 Phone: 614-823-1987 Email: [email protected] Keywords: -Alexithymia -Worldview -African Americans

Citation Poster Psychophysiological Responses and Sense of Coherence Jennifer Kretzschmar, BBA; Sharon Lewis, RN, PhD, FAAN; Peter Bonner, MS; Paula Blackwell, BA, MS; Allen Novian, PhD; Monica Escamilla, BS, MS Sense of coherence (SOC) is believed to be a powerful mediator of stress and illness. The purpose of this study was to assess the relationship of SOC with physiological responses in caregivers of patients with Alzheimer’s disease. Caregivers (n = 123) of patients with Alzheimer’s disease participated in the study. Instruments used to collect data included Sense of Coherence (measures how an individual sees the world and one’s life in it) questionnaires. Biograph software and Thought Technology hardware were used to collect the physiological data while four acute laboratory stressors (Stroop, serial seven math problems, thinking about a stressful event, and talking about a stressful event) were performed. The caregiver’s amplitude of recovery from stress (the difference between the mean score during an acute laboratory stressor minus a two minute rest immediately following the stressor) was assessed. SOC scores were used to divide the overall sample into low (SOC B 123), medium, and high (SOC C 150) SOC groups. The amplitude of recovery for electromyography readings, skin conductance, skin temperature, blood volume pulse, and heart rate was lowest for the SOC group with weak scores. Caregivers with a strong SOC were able to recover faster from acute laboratory stressors. Individuals with a high SOC have an ability to see life as manageable and meaningful which may

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mediate the effect of stress on their body. On the other hand, individuals with a weak SOC are more likely to interpret stressors as threatening.

Brainwaves and Heartwaves: Psychophysiological Studies of Healers, Mystics and Shamans

Jennifer Kretzschmar, BBA University of Texas Health Science Center at San A 10511 Wind Walker Helotes, TX 78023 Phone: 210-949-3697 Email: [email protected]

The objective was to explore the psychophysiology of the energetic transaction between healers and clients using QEEG and HRV analysis. For QEEG, Lexicor NRS-24 and Mitsar 201 equipment with standard Electrocap 19 channel 10–20 hookup, referential linked ears montage, bandwidth, 0–40 Hz. (up to 60 Hz) were employed. Data analysis was performed with the following software: Neurolex, NREP, WinEEG and Neuroguide. Statistical analysis consisted of correlated samples paired t-tests. An initial 10 min. resting baseline with eyes closed was recorded from the healer, followed by a 15– 20 min. healing session. In some cases, the client receiving the healing was recorded. For HRV analysis, a 5–10 min baseline was recorded from the client, followed by a 10–20 min. healing session, during which HRV was continuously monitored. A session consisted of the healer doing Energy work directed at the client without any body or hand contact; healer-client separation ranged 0.5–10 ft. In some cases, HRV analysis of the healers was also included in the session. Healers and clients voluntarily participated in this study. Healing modalities included: Vedic, Reiki, Pranic, Heart-spiritual, Falun-gong, Shamanic. Preliminary results have been previously reported in JACM, 2004,Vol. 10, no. 4, p. 728. For QEEG, the most consistent finding was a robust increase in EEG Alpha power (range: 50–150 %) for the healer during the healing session. The client’s Alpha power was also significantly increased (50–100%, when monitored in some experiments). Power in the other EEG bands (Delta, Theta and Beta) was also shifted during healing reflecting the diverse sample of healers’ baseline profiles. Changes in Assymetry, Phase and Coherence were also observed. For HRV study, all healing sessions (N = 12) produced significant shifts in baseline HRV values. Two types of responses were recorded, increased SDNN (Ave. 48%, N = 4); and decreased SDNN (29%, N = 8). LF/HF ratios also increased (Ave. 155%, N = 6) and decreased (186%, N = 6). Powerfrequency spectral peaks often shifted to VLF region (incr. sympathetic drive) in healers and clients without a significant rise in mean heartrate. Robust EEG and HRV changes are associated with the ‘‘healing state’’.

Keywords: -Sense of coherence -Alzheimer’s Disease Caregivers -Stress

The Clinical Utility of Tracking Hand Skin Temperature Before and After Daily Relaxation Practice in Individuals with Chronic Sympathetic Activation Martyn Thomas Dysfunction in the autonomic nervous system has long been considered a significant etiological and/or maintenance factor in many physiological and anxiety disorders. It was hypothesized that individuals presenting with Chronic Sympathetic Activation (CSA), irrespective of problem type, would benefit from intervention focused on reducing sympathetic arousal and restoring autonomic balance. It was also hypothesized that hand skin temperature (HST) recorded before and after daily relaxation practice at home would: (1) be an easy and inexpensive method of tracking reductions in sympathetic arousal, (2) be a source of motivation to continue daily practice over lengthy timeframes, and (3) inform the process by showing progress over time. Seven case studies (5 females, 2 males) were examined using a repeated measures, multiple baseline type design. Presenting problems included chronic headache, pain and stress subsequent to a catastrophic motor vehicle accident, anxiety and life stress. Mean age was 44.7 yrs. (SD = 21.9) with a range of 15–74 years. Subjects were identified as having CSA based on an average weekly HST of 85°F or less for 3 consecutive weeks. Treatment included daily home practice with a relaxation CD with HST recording pre and post practice. Treatment also included office sessions during which subjects were exposed to HST and respiration biofeedback, support, and cognitive behavioural therapy as needed. The results showed a gradual increase in pre-practice HST at home of 10.2°F from 78.6°F (SD = 6.1) to 88.8 (SD = 7.95) (p \ .002). This increase occurred over a range of 12–45 weeks (mean = 22 wks, SD = 12.8). There was a positive relationship between this increase in pre-practice HST and ability to achieve the relaxed range (95°F) within home practice sessions. Irrespective of gender, age, number of sessions, or mix of treatment, significant improvement in symptoms occurred when subjects’ average weekly pre-practice HST approached the normal range (90°F). HST recording was easy and was a significant maintaining factor in keeping up daily home practice over many weeks. Martyn Thomas Biofeedback Treatment Centre—Whitby & Toronto 54 Teresa Drive Whitby, Ontario L1 N 6J2 Canada Phone: 289-200-1704 Email: [email protected] Keywords: -Hand temperature monitoring -Chronic sympathetic activation -Home record keeping

Juan Acosta-Urquidi, PhD

Juan Acosta-Urquidi, PhD Iglesia 2 C-603 Mexico City, DF 01090 Mexico Phone: 206 360-1820 Email: [email protected] Keywords: -QEEG -HRV -Healers

An Evaluation of a Cardiorespiratory Biofeedback Approach for the Treatment of Pregnancy-Induced Hypertension Sandy W. Cullins, MS; Richard Gevirtz, PhD; Larry Cousins, MD; Raoul Edward Harpin, PhD; Debra Poeltler, RN, MPH, CCRC; Marna Morimoto Pregnancy-induced hypertension is the most common medical disorder in pregnancy (Walling, 2004). The purpose of this study was to determine the efficacy of a cardiorespiratory biofeedback intervention compared to bed rest in the treatment of 47 women diagnosed with pregnancy-induced hypertension. The intervention applied a portable biofeedback device known as the StressEraser (SE). Subjects were recruited from the San Diego Perinatal Center and Sharp Mary Birch

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184 Hospital for Women in San Diego, California. Inclusion in the investigation were met by the following criteria: 1. A diastolic blood pressure of 90 mm Hg or higher and/or a systolic blood pressure of 140 mm Hg or higher, 2. Gestational age between 24 and 36 weeks, 3. A structured bed rest regimen anticipated, and 4. Delivery at SMBHW. Exclusion in the study criteria were deemed by the following criteria: 1. Evidence of another medical disorder which could account for the high blood pressure, 2. Severe preeclampsia, or 3. Triplets. The investigation consisted of a historical control group and an experimental group. The historical control group contained 31 subjects on bed rest. The experimental group contained 16 subjects that received a prescription of restricted physical activity and instruction in using a StressEraser device. These subjects were instructed each day to utilize the device for 20 min and to attain a score of 100 points until delivery. Results indicated that the systolic, diastolic, and mean arterial blood pressure levels were unchanged for either group. Findings of associated hypotheses revealed that infants in the Stresseraser group were 35% heavier than those in historical control group. The gestational age at delivery was 10% greater in the Stresseraser group than in the historical control group. Exploratory analysis found a significant relationship between SE Total and the 1-min infant Apgar score. Therefore, higher SE Totals were correlated with better birth outcomes. During a follow-up interview, eighty-one percent of the subjects stated that the device was relaxing. Fifty percent of the subjects believed that device helped them fall asleep. The results of this investigation suggest that the StressEraser may be effective in reducing stress during pregnancy and improving perinatal outcomes. Sandy W. Cullins, MS Email: [email protected] Keywords: -Pregnancy-Induced Hypertension -StressEraser

Chronic Pain Biofeedback Program for Active Duty Service Members Stacey Ketchman, PsyD; Keisha O’Garo, PsyD Due to recent advancements in protective military gear, the survival rate surpasses that of previous wars. However, with this comes an increase in soldiers with injuries that can often lead to chronic pain. In order to better equip the military with treatment approaches appropriate for this relatively new influx of patients, the Chronic Pain Biofeedback Program was incepted at Womack Army Medical Center via the Department of Behavioral Health. Patients undergo a screening process that includes an initial informational briefing, clinical interview, as well as psychological assessment. Service Members are screened for injury type and location, past compliance to medical treatments, significant psychiatric history and motivation for maximum participation in the program. The program is an intensive 5-week out-patient service that is comprised of two individual biofeedback sessions as well as two educational group sessions per week. The biofeedback sessions focus on teaching the patient to recognize and control the physiological changes that can exacerbate pain. Standard initial readings include sEMG, temperature, and EDR. The educational groups are centered on reducing the emotional distress and negative thought processes that are typically associated with patients suffering with chronic pain. Patients are encouraged to increase appropriate physical activity as well as to monitor their sleep and pain patterns. With the more recent trend toward alternative treatments modalities, this program offers Service Members a noninvasive and medication free option to manage chronic pain.

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Appl Psychophysiol Biofeedback (2010) 35:177–185 Stacey Ketchman, PsyD Womack Army Medical Center Email: [email protected] Keywords: -Chronic Pain -Military -Biofeedback

Vagal Tone and Information Processing in Recently Returned Combat Veterans: HRV Biofeedback Improves HRV and Attention/Memory Performance Melanie Berry, MS; J.P. Ginsberg, PhD; D.A. Powell, PhD The unique contribution that reduced heart rate variability (HRV) makes to attention and immediate memory (ATTN/IM) deficits in PTSD ? combat veterans has not been well-studied. As a Pilot Study, we tested this association by assessing the effect that improving heart rate variability coherence through HRV biofeedback (HRVB) training has on objective performance measures of ATTN/IM in five PTSDand five PTSD ? combat veterans. Our results re-confirm the hypothesis that vagal tone indexes the ability to attend and appropriately respond to information in the environment. Inspection of individual power spectrum density confirmed that the veterans were in coherence after training. Across the PTSD ? subgroup, HRVB training shifted the spectrum from monotonically decreasing band power to a spectrum with a peak in the target low frequency (LF) range; the PTSD- subgroup began with a small LF peak, and PostTraining had a similarly shaped spectrum but with a statistically significant increase in LF power. The shape of the Post-Training HRV spectrum of the PTSD ? subgroup was similar to the Pre-Training spectrum of the PTSD- subgroup. Total power for all subjects (n = 10) across all bands increased from 977.7 to 1753.7 ms2/Hz. The Post-training peak of all subjects shifted into the LF range, appeared to be normally distributed with a mean of 0.11 Hz (SD = 0.02, SE = 0.01), and did not significantly differ from 0.1 Hz. Statistically significant improvements in ATTN/IM were also found. A significant interaction between PTSD and HRVB training was seen in total number of words on List learning, with the PTSD ? subgroup increasing from 54.4 to 59.0 words learned after HRVB training. A significant main effect of HRVB training was seen for Commissions T score and Digits Backward, with Commissions T score decreasing (i.e., improving) from 47.5 to 43.2 and Digits Backward trials improving from 6.8 to 8.1. Within the PTSD ? subgroup only, the improvement in Commissions was related to the CAPS Avoidance cluster and % change in LF power, and CAPS-A and % change in LF power were related to each other. Semi-partial correlation controlling for the effect of %LF power change on CAPS-A showed that when the variance in % LF was removed from CAPS-A, the zero-order correlation between CAPS-A and Commissions decreased from .92 to .41 (increase in 1-tailed p value from .01 to .30), suggesting that the % change in LF power, not CAPS-A, is predictive of reduction in Commissions. Melanie Berry, MS Dorn VA Medical Center, Columbia Phone: 803-776-4000 Email: [email protected] Keywords: -Post Traumatic Stress Disorder -Heart Rate Variability Biofeedback -Attention -Memory

Appl Psychophysiol Biofeedback (2010) 35:177–185 The Effect of Biofeedback on Function in Patients with Heart Failure Kimberly Swanson, PhD; Richard Gevirtz, PhD; Milton Brown, PhD; James Spira, PhD; Ermina Guarneri, MD; Liset Stoletniy, MD Attenuated heart rate variability (HRV) has been consistently associated with increased cardiac mortality and morbidity in HF patients. The aim of this study was to determine if a 6-week course of HRV biofeedback and breathing retraining could increase exercise tolerance, HRV, and quality of life in patients with New York Heart Association Class I–III heart failure (HF). Participants (N = 29) were randomly assigned to either the treatment group consisting of 6 sessions of breathing retraining, HRV biofeedback and daily practice, or the comparison group consisting of 6 sessions of quasi-false alphatheta biofeedback and daily practice. Exercise tolerance, measured by the 6-min walk test (6MWT), HRV, measured by the standard deviation of normal of normal beats (SDNN), and quality of life, measured by the Minnesota Living with Congestive Heart Failure Questionnaire (LHFQ), were measured at baseline (week 0), post (week 6), and follow-up (week 18). Cardiorespiratory biofeedback significantly increased exercise tolerance (p = .05) for the treatment group in the high ([31%) left ventricular ejection fraction (LVEF) category between baseline and follow-up. Neither a significant difference in SDNN (p = .09) nor quality of life (p = .08), was found between baseline and follow-up. A combination of HRV biofeedback and breathing retraining may improve exercise tolerance in patients with HF with an LVEF of 31% or higher. Because exercise tolerance is considered a strong prognostic indicator, cardiorespiratory biofeedback has the potential to improve cardiac mortality and morbidity in HF patients. Kimberly Swanson, PhD Email: [email protected] Keywords: -Heart Failure -Heart Rate Variability Biofeedback

Comparison of Relaxation Techniques for Group Cognitive Behavioral Therapy for Generalized Anxiety Disorder Jennifer Webb-Murphy, PhD; James Spira, PhD, MPH; Richard Gevirtz, PhD; Stefan Hofmann, PhD; Stefan Schulz, PhD; Fred Muench, PhD

185 heart rate variability (HRV) and cardiac vagal tone. Cognitive behavioral therapy (CBT) is established as an effective method for treating GAD. However, there is a need for greater treatment effectiveness, especially given the high prevalence and disability rates for GAD. An HRV biofeedback intervention could enhance CBT for GAD by targeting the specific physiological dysfunction underlying GAD. This study investigated if CBT plus HRV biofeedback resulted in a greater reduction of GAD symptoms, improved autonomic reactivity, and an increase in cardiac vagal tone and HRV compared with CBT plus progressive muscle relaxation (PMR). Seventy-nine participants with GAD were randomized to use the StressEraser, a portable respiratory sinus arrhythmia (RSA; a measure of HRV) biofeedback device, or PMR, as part of an eight session CBT group. All patients completed psychological and physiological measures before, during and after treatment, and at 1 and 3 months follow-up. Statistical analyses showed no differential improvement in GAD symptoms for the StressEraser group compared to the PMR group at the end of treatment. However, significant within-group differences were found on measures of GAD, anxiety and depression from pre to post-treatment and throughout the 3 month follow-up assessment. This indicates that in combination with a CBT group use of the StressEraser is as effective as PMR; although, both could be equally ineffective since there was no control group to evaluate if the CBT group alone produced the symptom reductions. Despite significant changes on self-report measures and ample relaxation practice, neither group showed a clear pattern of improved autonomic reactivity, increase in cardiac vagal tone or HRV. Furthermore, the amount of StressEraser use was not significantly related to changes in GAD symptoms. These results suggest that changes in autonomic functioning do not need to occur in order to benefit from CBT and that the StressEraser might not have been an adequate HRV intervention. Based on these findings, further research should examine if other HRV interventions could increase HRV in GAD patients and if so, if increases in HRV augment CBT. Jennifer Ann Webb Murphy, PhD Naval Center for Combat & Operational Stress Control (NCCOSC) Phone: 619-532-8889 Email: [email protected] Keywords: -Generalized Anxiety Disorder -Cognitive Behavior Therapy -Heart Rate Variability Biofeedback -Relaxation

Research has shown that individuals with generalized anxiety disorder (GAD) have rigid autonomic nervous systems, evidenced by low

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