Full Title: The Relative Efficacy of Connectivity Guided and Symptom Based EEG Biofeedback for Autistic Disorders

Autism is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and a limited range of interests with repetitive stereotypical behavior. Various abnormalities have been documented in the brains of individuals with autism, both anatomically and functionally. The connectivity theory of autism is a recently developed theory of the neurobiological cause of autisic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalogray (QEEG), which may be amenable to neurofeedback. In this study, we compared the results of two published controlled studies examining the efficacy of neurofeedback in the treatment of autism. Specifically, we examined whether a symptom based approach or an assessment/connectivity guided based approach was more effective. Although both methods demonstrated significant improvement in symptoms of autism, connectivity guided neurofeedback demonstrated greater reduction on various subscales of the Autism Treatment Evaluation Checklist (ATEC). Furthermore, when individuals were matched for severity of symptoms, the amount of change per session was significantly higher in the Coben and Padolsky (J Neurother 11:5-23, 2007) study for all five measures of the ATEC. Our findings suggest that an approach guided by QEEG based connectivity assessment may be more efficacious in the treatment of autism. This permits the targeting and amelioration of abnormal connectivity patterns in the brains of people who are autistic.

Appl Psychophysiol Biofeedback. 2009 Aug 1. Coben R, Myers TE. Neurorehabilitation & Neuropsychological Services, 1035 Park Blvd., Suite 2B, Massapequa Park, NY, 11762, USA, robcoben@optonline.net.

Full Title: Functional Neuroanatomy and the Rationale for Using EEG Biofeedback for Clients with Asperger's Syndrome

This paper reviews the symptoms of Asperger's Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (Hill and Frith in Phil Trans Royal Soc Lond, Bull 358:281-289, 2003), mirror neuron system (Ramachandran and Oberman in Sci Am 295(5):62-69, 2006), and Porges' (Ann N Y Acad Sci 1008:31-47, 2003, The neurobiology of autism, Johns Hopkins University Press, Baltimore, 2004) polyvagal theory. (A second paper, Outcomes using EEG Biofeedback Training in Clients with Asperger's Syndrome, summarizes clinical outcomes obtained with more than 150 clients.) Patterns seen with QEEG assessment are then presented. Single channel assessment at the vertex (CZ) reveals patterns similar to those found in Attention-Deficit/Hyperactivity Disorder. Using 19-channel data, significant differences (z-scores > 2) were found in the amplitude of both slow waves (excess theta and/or alpha) and fast waves (beta) at various locations. Differences from the norm were most often found in mirror neuron areas (frontal, temporal and temporal-parietal). There were also differences in coherence patterns, as compared to a normative database (Neuroguide). Low Resolution Electromagnetic Tomography Analysis (Pascual-Marqui et al. in Methods Find Exp Clin Pharmacol 24C:91-95, 2002) suggested the source of the abnormal activity was most often the anterior cingulate. Other areas involved included the amygdala, uncus, insula, hippocampal gyrus, parahippocampal gyrus, fusiform gyrus, and the orbito-frontal and/or ventromedial areas of the prefrontal cortex. Correspondence between symptoms and the functions of the areas found to have abnormalities is evident and those observations are used to develop a rationale for using EEG biofeedback, called neurofeedback (NFB), intervention. NFB training is targeted to improve symptoms that include difficulty reading and mirroring emotions, poor attention to the outside world, poor self-regulation skills, and anxiety. Porges' polyvagal theory is used to emphasize the need to integrate NFB with biofeedback (BFB), particularly heart rate variability training. We term this emerging understanding the Systems Theory of Neural Synergy. The name underscores the fact that NFB and BFB influence dynamic circuits and emphasizes that, no matter where we enter the nervous system with an intervention, it will seek its own new balance and equilibrium.

Appl Psychophysiol Biofeedback. 2009 Jul 1. Thompson L, Thompson M, Reid A. ADD Centre, 50 Village Centre Place, Mississauga, ON, L4Z 1V9, Canada, addcentre@gmail.com.

Interventions for improvement of cognitive problems in patients with traumatic brain injury (TBI) include electroencephalography biofeedback, also known as neurofeedback. Quantitative electroencephalography (QEEG) patterns are assessed in TBI patients and then compared to a database obtained from a normative population. Deviations in QEEG patterns from the normative group are the basis for an intervention plan. While QEEG patterns, obtained under an eyes closed, resting condition, provide information about deviations at rest, QEEG patterns obtained while the patient engages in cognitive tasks reflect specific deficiencies in brain functioning. This paper reviews and assesses QEEG patterns collected under both resting conditions as well as cognitive tasks. The article provides a theoretical and empirical base for QEEG interventions with TBI.

Appl Psychophysiol Biofeedback. 2009 Mar;34(1):59-68. Epub 2009 Feb 6. Thornton KE, Carmody DP. Brain Foundation, 2 Ethel Road, Edison, NJ 08817, USA. ket@chp-neurotherapy.com

About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedges's g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was -0.233, SE = 0.057, z = -4.11, p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.

Clin EEG Neurosci. 2009 Jul;40(3):173-9. Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA. Michael E. DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, Texas, USA. tan.gabriel@va.gov

by David Siever, Edmonton, ALberta, Canada

As the majority of the North American population continues to age, cognitive decline in older adults is becoming an ever-growing concern. With the increase in age comes a decrease in cerebral blood flow, slowing of the brain's alpha rhythm and increased theta activity. These changes correlate with reduced cognition, spanning memory, problem solving ability, difficulty with language and speech, and locomotion. Chronic stress impairs hippocampal function leading to a host of disorders including Alzheimer's disease. The left hemisphere of the brain has a tendency to loose functionality before the right side, which may enhance spatial creativity and when coupled with fears and feelings of helplessness, may also bring forth depression. Preliminary studies of Audio-visual entrainment (AVE) have shown this technique to be promising in the treatment of age-related issues common with our senior citizens. AVE is proving to rehabilitate cognitive function in seniors and the best application of AVE may be that as a prophylactic against cognitive decline.

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For more information visit www.MindAlive.com

by David Siever, Edmonton, ALberta, Canada

Seasonal Affective Disorder (SAD) strikes all people from all nations, not just those near the poles of the earth as might be thought. The treatment of SAD has traditionally involved the use of anti-depressants, and more recently, light box therapy. Audio-Visual Entrainment (AVE) has also been shown to be beneficial in the treatment of this genetically based affective disorder and its related anxious/depressive/dietary conditions.

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For more information visit www.MindAlive.com

Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are unique attentional disorders which primarily involve slowed frontal brain wave activity and hypo-perfusion of cerebral blood flow in the frontal regions, particularly during tasks such as reading. A variety of disorders, such as anxiety, depression and Oppositional Defiant Disorder (ODD), are often co-morbid with ADD, thus creating a plethora of complications in treatment procedures. Audio-Visual Entrainment (AVE) lends itself well for the treatment of ADD/ADHD. AVE exerts a major wide spread influence over the cortex in terms of dominant frequency. AVE has also been shown to produce dramatic increases in cerebral blood flow. Several studies involving the use of AVE in the treatment of ADD/ADHD and its related disorders have been completed. AVE as a treatment modality for ADD/ADHD has produced wide-spread improvements including secondary improvements in IQ, behaviour, attention, impulsiveness, hyperactivity, anxiety, depression, ODD and reading level. In particular, AVE has proven itself to be an effective and affordable treatment of special-needs children within a school setting.

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Full Title: Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury.

Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.

Int J Clin Exp Hypn. 2009 Jul;57(3):239-68. Jensen MP, Barber J, Romano JM, Hanley MA, Raichle KA, Molton IR, Engel JM, Osborne TL, Stoelb BL, Cardenas DD, Patterson DR. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195-6490, USA.

by David Siever, Edmonton, ALberta, Canada

A great deal of temporo-mandibular joint dysfunction and myofascial pain dysfunction is activated in relation to anxiety and fear responses to challenging tasks, self-criticism and daily stresses. AVE, like passive meditation, appears to effectively alleviate these symptoms.

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For more information visit www.MindAlive.com

by David Siever, Edmonton, ALberta, Canada

Since the discovery of photic driving by Adrian and Matthews in 1934, much has been discovered about the benefits of brain-wave entrainment (BWE) or audio-visual entrainment (AVE) as it is commonly known today. Studies are now available on the effectiveness of AVE in promoting relaxation, hypnotic induction and restoring somatic homeostasis, plus improving cognition, and for treating ADD, PMS, SAD, migraine headache, chronic pain, anxiety, depression and hypertension.

Full Text.

For more information visit www.MindAlive.com

Clinical biofeedback procedures are highly effective ameliorating a variety of symptoms that range from urinary incontinence to hypertension as well as assess a person's somatic awareness by making the invisible visible. The paper reviews the biofeedback process and some psychosomatic applications. Psychosomatic patients often demand more skills than just attaching them to the equipment. Successful treatment includes a) assessing physiology as a diagnostic strategy, b) explaining the illness processes and healing strategies that are congruent with patients' perspective, c) reframing the patients' illness beliefs, and d) psychophysiological training with homework practices to generalize the skills. This process is illustrated through the description of a single session with a patient who experienced severe gastrointestinal distress and insomnia.

Peper, E., Harvey, R., & Takebayashi, N. (2009). Biofeedback an evidence based approach in clinical practice. Japanese Journal of Biofeedback Research, 36(1), 3-10.

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Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments. Tinnitus has been found to be associated with negative appraisal, dysfunctional attention shift, and heightened psychophysiological arousal, so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments. This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus.

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This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are the role of the biofeedback in pain management and Bier blocks for complex regional pain syndrome.

J Pain Palliat Care Pharmacother. 2008;22(1):61-3. Fishman SM. Division of Pain Medicine and Professor, Department of Anesthesiology and Pain Medicine, University of California at Davis, California, USA. smfishman@ucdavis.edu

Psychophysiological factors in maintaining tinnitus-related distress have been emphasized in current tinnitus models. Hyperreactivity in the autonomous nervous system is supposed to hinder habituation processes and might contribute to maladjustment to tinnitus symptoms in the long run.

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Biofeedback is a form of treatment that has no adverse effects and can be provided by physician extenders. The therapy relies on patients' ability to learn how to influence their bodily functions through dedicated machinery and teaching. This Review provides a comprehensive overview of all potential therapeutic applications of biofeedback for functional constipation, fecal incontinence, functional anorectal pain, IBS, functional dyspepsia, and aerophagia. Practical clinical applications of biofeedback therapy supported by randomized, controlled trials (RCTs) are limited to fecal incontinence and dyssynergic defecation. For fecal incontinence, RCTs suggest that biofeedback combining strength training and sensory discrimination training is effective in approximately 75% of patients and is more effective than placebo. However, verbal feedback provided by a therapist during extended digital examination may be equally effective, and children whose fecal incontinence is associated with constipation plus fecal impaction do no better with biofeedback than medical management. For dyssynergic defecation, RCTs show that biofeedback combining pelvic floor muscle relaxation training, practice in defecating a water-filled balloon, and instruction in effective straining is effective in approximately 70% of patients who have failed to respond to laxative treatment. For both incontinence and dyssynergic defecation, the benefits of biofeedback last at least 12 months.

Chiarioni G, Whitehead WE. Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA. Nat Clin Pract Gastroenterol Hepatol. 2008 Jul;5(7):371-82.

The aims of the present meta-analysis were to investigate the short- and long-term efficacy, multidimensional outcome, and treatment moderators of biofeedback as a behavioral treatment option for tension-type headache. A literature search identified 74 outcome studies, of which 53 were selected according to predefined inclusion criteria. Meta-analytic integration resulted in a significant medium-to-large effect size (d = 0.73; 95% confidence interval = 0.61, 0.84) that proved stable over an average follow-up phase of 15 months. Biofeedback was more effective than headache monitoring, placebo, and relaxation therapies. The strongest improvements resulted for frequency of headache episodes. Further significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication. Moderator analyses revealed biofeedback in combination with relaxation to be the most effective treatment modality; effects were particularly large in children and adolescents. In intention-to-treat and publication-bias analyses, the consistency of these findings was demonstrated. It is concluded that biofeedback constitutes an evidence-based treatment option for tension-type headache. (c) 2008 APA, all rights reserved

J Consult Clin Psychol. 2008 Jun;76(3) Nestoriuc Y, Rief W, Martin A. Section for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany. yvonne.nestoriuc@staff.uni-marburg.de

The onset of cognitive rehabilitation brought with it a hope for an effective treatment for the traumatic brain injured subject. This paper reviews the empirical reports of changes in cognitive functioning after treatment and compares the relative effectiveness of several treatments including computer interventions, cognitive strategies, EEG biofeedback, and medications. The cognitive functions that are reviewed include auditory memory, attention and problem solving. The significance of the change in cognitive function is assessed in two ways that include effect size and longevity of effect. These analyses complement the previously published meta-reviews by adding these two criteria and include reports of EEG biofeedback, which is shown to be an effective intervention for auditory memory.

Appl Psychophysiol Biofeedback. 2008 Jun;33(2) Thornton KE, Carmody DP. The Brain Foundation, Ste. 2a, 2509 Park Avenue, South Plainfield, NJ, 07080, USA, ket@chp-neurotherapy.com.

Biofeedback is a form of treatment that has no adverse effects and can be provided by physician extenders. The therapy relies on patients' ability to learn how to influence their bodily functions through dedicated machinery and teaching. This Review provides a comprehensive overview of all potential therapeutic applications of biofeedback for functional constipation, fecal incontinence, functional anorectal pain, IBS, functional dyspepsia, and aerophagia. Practical clinical applications of biofeedback therapy supported by randomized, controlled trials (RCTs) are limited to fecal incontinence and dyssynergic defecation. For fecal incontinence, RCTs suggest that biofeedback combining strength training and sensory discrimination training is effective in approximately 75% of patients and is more effective than placebo. However, verbal feedback provided by a therapist during extended digital examination may be equally effective, and children whose fecal incontinence is associated with constipation plus fecal impaction do no better with biofeedback than medical management. For dyssynergic defecation, RCTs show that biofeedback combining pelvic floor muscle relaxation training, practice in defecating a water-filled balloon, and instruction in effective straining is effective in approximately 70% of patients who have failed to respond to laxative treatment. For both incontinence and dyssynergic defecation, the benefits of biofeedback last at least 12 months.

Nat Clin Pract Gastroenterol Hepatol. 2008 Jun 3. Chiarioni G, Whitehead WE. G Chiarioni is Deputy Chief of the Division of Gastrointestinal Rehabilitation of the University of Verona, Valeggio sul Mincio, Italy.

PURPOSE: Biofeedback is known to effect symptomatic and objective cure in children with dysfunctional voiding. While some authors advocate animation assisted biofeedback to achieve success, we previously demonstrated similar success without animation. We recently used animated biofeedback aimed at simplifying muscle isolation and encouraging patient interest. We compared the efficacy of biofeedback with and without animation in treating dysfunctional voiding, and its concomitant urinary symptoms. MATERIALS AND METHODS: We compared our experience with the last 60 cases of biofeedback using electromyography tracing alone (nonanimated) with our first 60 cases using the Urostym Pediflow program (animated). All 120 girls presented with urinary complaints and exhibited dysfunctional voiding on electromyography uroflow. Post-void residual measurements were made by ultrasound. We compared the 2 groups with respect to time to resolution of symptoms and dysfunctional voiding, and improvement in post-void residual volume after treatment. RESULTS: The nonanimated and animated groups were comprised of girls of similar ages (7.3 years vs 6.9 years). There was no significant difference between the 2 groups regarding symptom relief at a mean of 5.4 months after therapy, including daytime incontinence, nocturnal enuresis, urgency, frequency and hoarding. Three patients in each group experienced urinary tract infection following treatment, compared to 42 and 41 before treatment in the nonanimated and animated groups, respectively. Dysfunctional voiding resolved in 95% of patients in both groups. Post-void residual reduction was similar, namely from 35% to 9% of pre-void volume in the nonanimated group, and from 28% to 8% in the animated group. Children in the animated biofeedback group achieved success in significantly fewer sessions (3.6) than those undergoing nonanimated biofeedback (7.6, t test p <0.05). CONCLUSIONS: Despite our proved experience with nonanimated biofeedback systems and our inexperience with an animated system, animated biofeedback systems yielded similar results in a significantly shorter time. Animated and nonanimated biofeedback is efficacious in the treatment of dysfunctional voiding and its symptoms.

J Urol. 2008 Jul;180(1) Kaye JD, Palmer LS. Division of Pediatric Urology, Schneider Children's Hospital of North Shore-Long Island Jewish Health System, Long Island, New York, USA.

Hypnosis and biofeedback are cyberphysiologic strategies that enable subjects to develop voluntary control of certain physiologic processes for the purpose of improving health. Self-hypnosis has been used with and without biofeedback for a wide range of therapeutic applications, and both laboratory studies and clinical trials have shown it to be effective in improving symptoms and outcomes in various disorders. More formal Cochrane reviews of hypnotherapeutic interventions are currently under way. Thorough patient assessment should precede training in self-hypnosis in order to properly tailor training strategies to patient preferences and characteristics, especially for children. Workshops offered by various clinical societies are available to train health professionals in self-hypnosis.

Cleve Clin J Med. 2008 Mar;75 Suppl 2:S39-43. Olness K. Case Western Reserve University, Cleveland, OH 44106, USA. karen.olness@case.edu

StressEraser((R)) is a commercially marketed biofeedback device designed to enhance heart rate variability. StressEraser((R)) makes its internal calculations on beat-to-beat measures of finger pulse intervals. However, the accuracy and precision of StressEraser((R)) in quantifying interbeat intervals using finger pulse intervals has not been evaluated against standard laboratory equipment using R-R intervals. Accuracy was assessed by simultaneously recording interbeat intervals using StressEraser((R)) and a standard laboratory ECG system. The interbeat intervals were highly correlated between the systems. The average deviation in interbeat interval recordings between the systems was approximately 6 ms. Moreover, correlations approached unity between the systems on estimates of heart period, heart rate, and heart rate variability. Feedback from StressEraser((R)) is based on an interbeat time series that provides sufficient information to provide an excellent estimate of the dynamic changes in heart rate and heart rate variability. The slight variations between StressEraser((R)) and the laboratory equipment in quantifying heart rate and heart rate variability are due to features related to monitoring heart rate with finger pulse: (1) a lack in precision in the peak of the finger pulse relative to the clearly defined inflection point in the R-wave, and (2) contribution of variations in pulse transit time.

Appl Psychophysiol Biofeedback. 2008 Apr 1 Heilman KJ, Handelman M, Lewis G, Porges SW. Department of Psychiatry, Brain-Body Center, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL, 60612, USA, kheilman@psych.uic.edu.

The present study examines a new alertness training strategy (Self-Alert Training, SAT) designed to explore the relationship between the top-down control processes governing arousal and sustained attention. In order to maximally target frontal control systems SAT combines a previously validated behavioural self-alerting technique [Robertson, I. H., Tegner, R., Tham, K., Lo, A., & Nimmo-Smith, I. (1995). Sustained attention training for unilateral neglect: Theoretical and rehabilitation implications. Journal of Clinical and Experimental Neuropsychology, 17, 416-430] with an autonomic arousal biofeedback protocol in which participants learn to modulate their own arousal levels. The SAT protocol was first validated with a group of 23 neurologically healthy participants and then independently tested in a group of 18 adults with ADHD to determine its clinical utility. Half of the participants in each group were assigned to a placebo condition to control for non-specific effects. All participants performed the sustained attention to response task (SART) during pre- and post-training testing sessions to assess training effects on sustained attention. By the end of SAT all participants were able to modulate their own arousal levels without external prompting. Comparison of pre- and post-training baseline data indicated that, as predicted, SAT was associated with increased levels of autonomic arousal accompanied by improved accuracy on the SART. In contrast, participants in the placebo condition exhibited a gradual reduction in arousal over time and increased reaction time variability indicative of a vigilance decrement. These data demonstrate that the recruitment of top-down control processes during volitional modulation of arousal leads to improved sustained attention. These findings have important implications for the rehabilitation of attention deficits arising from frontal dysfunction.

Neuropsychologia. 2007 Dec 27 O'Connell RG, Bellgrove MA, Dockree PM, Lau A, Fitzgerald M, Robertson IH. School of Psychology and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training-either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.

Appl Psychophysiol Biofeedback. 2008 Mar;33(1):1-28. Sokhadze TM, Cannon RL, Trudeau DL. Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA, tato.sokhadze@louisville.edu.

This research is based on previous studies which identified a specific respiratory pattern and inhalation-exhalation ratio, with which we were able to obtain significantly greater reductions in psychophysiological activation than with other respiratory patterns. The present study aimed to check the effectiveness of this respiratory pattern in learning based on biofeedback from the electrical conductance of the skin. The results obtained demonstrated that biofeedback combined with this respiratory pattern produced a significant reduction in psychophysiological activation and improved learning through biofeedback techniques.

Appl Psychophysiol Biofeedback. 2008 Mar;33(1):49-54. Conde Pastor M, Javier Menéndez F, Sanz MT, Vila Abad E. Department of Basic Psychology II, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal, 10, 28040, Madrid, Spain, mconde@psi.uned.es.

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training-either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.

Appl Psychophysiol Biofeedback. 2008 Jan 24 Sokhadze TM, Cannon RL, Trudeau DL. Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA, tato.sokhadze@louisville.edu.

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

Diabetes Educ. 2007 May-Jun;33(3):442, 444-5, 447-8, 454.

Rice BI.

University of Minnesota, School of Public Health, Epidemiology Clinical Research Center, 1100 Washington Avenue S Suite 201, Minneapolis, MN 55415, USA. ricex016@umn.edu

Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal. In large-scale clinical trials, the efficacy of EEG biofeedback for AD/HD is comparable to that of stimulant medications. Many different EEG biofeedback protocols for AD/HD are available. Single-channel protocols developed by Lubar and interhemispheric protocols developed by the Othmers are widely practiced and supported by large-scale clinical studies.

Altern Med Rev. 2007 Jun;12(2):146-151.

Friel PN.

Forensic toxicologist; EEG biofeedback training, EEG Institute, Woodland Hills, CA. Correspondence address: Washington State Toxicology Laboratory, Forensic Laboratory Services Bureau Suit 360, 2203 Airport Way South, Seattle, WA 98134. Email: Pat.Friel@wsp.wa.gov.