FULL TITLE: Heart rate biofeedback fails to enhance children's ability to identify time spent in moderate to vigorous physical activity.

Physical activity recommendations for children in several countries advise that all young people should accumulate at least 60min of moderate to vigorous physical activity every day. Perceiving physical activity intensity, however, can be a difficult task for children and it is not clear whether children can identify their levels of moderate to vigorous physical activity in accordance with the recommended guidelines. This study aimed to (1) explore whether children can identify time spent in moderate to vigorous physical activity; and (2) investigate whether heart rate biofeedback would improve children's ability to estimate time spent in moderate to vigorous physical activity. Thirty seven children (15 boys and 22 girls, mean age 12.6 years) wore data recording Polar E600 heart rate monitors during eight physical education lessons. At the end of each lesson children's estimated time in zone was compared to their actual time in zone. During a six lesson Intervention phase, one class was assigned to a biofeedback group whilst the other class acted as the control group and received no heart rate biofeedback. Post-Intervention, students in the biofeedback group were no better than the control group at estimating time spent in zone (mean relative error of estimation biofeedback group: Pre-Intervention 41±32% to Post-Intervention 28±26%; control group: Pre-Intervention 40±39% to Post-Intervention 31±37%). Thus it seems that identifying time spent in moderate to vigorous physical activity remains a complex task for children aged 11-13 even with the help of heart rate biofeedback.

J Sci Med Sport. 2010 Nov 17. Conley MM, Gastin PB, Brown H, Shaw C. Deakin University, School of Exercise and Nutrition Sciences, Australia.

Classical studies of mammalian movement control define a prominent role for the primary motor cortex. Investigating the mouse whisker system, we found an additional and equally direct pathway for cortical motor control driven by the primary somatosensory cortex. Whereas activity in primary motor cortex directly evokes exploratory whisker protraction, primary somatosensory cortex directly drives whisker retraction, providing a rapid negative feedback signal for sensorimotor integration. Motor control by sensory cortex suggests the need to reevaluate the functional organization of cortical maps.

Science. 2010 Nov 26;330(6008):1240-3. Matyas F, Sreenivasan V, Marbach F, Wacongne C, Barsy B, Mateo C, Aronoff R, Petersen CC. Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland.

OBJECTIVE: The authors investigated the potential effectiveness of biofeedback as a complementary treatment for PTSD. DESIGN: This exploratory study used heart variability biofeedback and determined its efficacy in treating PTSD through the use of two rating instruments, The Post-traumatic Stress Disorder Checklist (PCL)-Military version and the Zung Self-Rating Depression Scale. Active duty service members deployed to Iraq or Afghanistan were alternatively assigned to a treatment as usual control group and treatment as usual with the addition of biofeedback. The authors administered the two instruments before treatment and at the conclusion of three weeks of biofeedback therapy. RESULTS: Biofeedback did not produce a measurable improvement. A one way repeated measures analysis of variance (ANOVA) was used to examine change in PCL scores over time. There was a main effect for time, F(1, 36)=11.98, p<.001, indicating a decrease in PCL scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 36)=.1.79, p=ns, and a nonsignificant group by time interaction, F(1, 36)=.2.59, p=ns. Similarly, for depression, results showed a significant main effect for time, F(1, 33)=10.26, p<.003, indicating a decrease in Zung scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 33)=.385, p=ns, and a nonsignificant group by time interaction, F(1, 33)=3.52, p=ns. CONCLUSION: The addition of biofeedback did not produce a measurable improvement in PTSD or depression scores in this exploratory study.

Complement Ther Med. 2010 Dec;18(6):256-9. Lande RG, Williams LB, Francis JL, Gragnani C, Morin ML. Psychiatric Continuity Service, Department of Psychiatry, Walter Reed Army Medical Center, Washington, DC, United States. rglande@act85.com

Full Title: Biofeedback for training balance and mobility tasks in older populations: a systematic review.

ABSTRACT: Context: An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity. Objectives: To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults. Data Sources: PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists. Study Selection: For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task. Data Extraction: Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated. RESULTS AND CONCLUSIONS: Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery. IMPLICATIONS: Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.

J Neuroeng Rehabil. 2010 Dec 9;7(1):58. Zijlstra A, Mancini M, Chiari L, Zijlstra W.

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.

J Sex Res. 2010 Dec 22:1-7. Lofrisco BM. Psychological and Social Foundations, University of South Florida.

Full Title: Breaking the cycle: Cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome.

The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.

Psychol Health Med. 2010 Dec;15(6):625-31. Slutsker B, Konichezky A, Gothelf D. Psychosomatic Unit, Department of Child Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa.

Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level.

J Korean Med Sci. 2009 Oct;24(5):936-40. Kang EH, Park JE, Chung CS, Yu BH. Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Full Title: Biofeedback effectiveness to reduce upper limb muscle activity during computer work is muscle specific and time pressure dependent

Continuous electromyographic (EMG) activity level is considered a risk factor in developing muscle disorders. EMG biofeedback is known to be useful in reducing EMG activity in working muscles during computer work. The purpose was to test the following hypotheses: (1) unilateral biofeedback from trapezius (TRA) can reduce bilateral TRA activity but not extensor digitorum communis (EDC) activity; (2) biofeedback from EDC can reduce activity in EDC but not in TRA; (3) biofeedback is more effective in no time constraint than in the time constraint working condition. Eleven healthy women performed computer work during two different working conditions (time constraint/no time constraint) while receiving biofeedback. Biofeedback was given from right TRA or EDC through two modes (visual/auditory) by the use of EMG or mechanomyography as biofeedback source. During control sessions (no biofeedback), EMG activity was (mean+/-SD): 2.4+/-1.1, 2.5+/-2.1, and 9.1+/-3.1%max-EMGrms for right and left TRA and EDC, respectively. During biofeedback from TRA, activity was reduced in right TRA (1.7+/-1.6%max-EMGrms) and left TRA (1.2+/-2.0%max-EMGrms) compared to control. During biofeedback from EDC, activity in EDC was reduced (8.3+/-3.3%max-EMGrms) compared with control. During time constraint, activity was reduced in right TRA (1.9+/-1.3%max-EMGrms), left TRA (1.5+/-1.5%max-EMGrms), and EDC (8.4+/-3.2%max-EMGrms), during biofeedback compared to control. Conclusion: biofeedback reduced muscle activity in TRA by approximately 30-50% and in EDC by approximately 10% when given from the homologous or bilateral muscle but not from the remote muscle, and was significant in the time constraint condition; while feedback source and presentation mode showed only minor differences in the effect on reducing homologous muscle activity. This implies that biofeedback should be given from the most affected muscle in the occupational setting for targeting relief and prevention of muscle pain most effectively. Copyright © 2010. Published by Elsevier Ltd.

J Electromyogr Kinesiol. 2010 Jul 9. Vedsted P, Søgaard K, Blangsted AK, Madeleine P, Sjøgaard G. Alectia A/S, Sofiendalsvej 9, 9200 Alborg, Denmark.

Full Title: Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls

AIM: Long-term results of biofeedback for faecal incontinence are controversial. Moreover, its value compared with standard care has been recently questioned. The study aimed to analyse the long-term efficacy of biofeedback therapy for faecal incontinence to formed stool and to compare it with no treatment. METHOD: Seventy-nine patients with faecal incontinence to solid stool were evaluated at baseline and 1, 6, 36 and 60 months after treatment. To compare the long-term results with no treatment, 40 patients initially evaluated but not referred for therapy were used as controls. RESULTS: More than 80% of patients recovered continence or had a reduction in the number of episodes of incontinence greater than 75% at 1, 6, 36 and 60 months, indicating that the success rate of biofeedback was maintained over time. At 60 months, 86% of patients treated with biofeedback were fully continent or had a > 75% reduction in the number of incontinent episodes compared to 26% of the untreated patients (P < 0.001). CONCLUSION: Biofeedback therapy is effective in patients with faecal incontinence to formed stool compared with no treatment. Overall, clinical improvement is maintained in the long term..

Colorectal Dis. 2010 Aug;12(8):742-9. Epub 2009 Apr 10. Lacima G, Pera M, Amador A, Escaramís G, Piqué JM. Digestive Motility Unit, Digestive Diseases Institut, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain. glacima@clinic.ub.es

Full Title: First non-contingent respiratory biofeedback placebo versus contingent biofeedback in patients with chronic low back pain: a randomized, controlled, double-blind trial

Previous studies reported that respiratory feedback (RFB) aids in alleviating chronic pain. However, to date, this adjunct treatment has not been rigorously tested against non-contingent (placebo) feedback. Forty-two patients with chronic low back pain were randomized to either RFB or non-contingent RFB. Both groups performed a daily 30-min home training for 15 consecutive days. A respiratory associated relaxation index (RI) was measured. Pain levels and a somatosensory profile were assessed before and after intervention. Additionally, pain levels were assessed 3 months after the end of intervention. Secondary outcome parameters included daily functioning, psychopathology, and suggestibility. T-tests showed higher and significant pain reductions for RFB, compared to non-contingent RFB. Between-group comparisons reached no significance. However, changes were more pronounced in the RFB condition, which was also true for the course of the RI and the psychopathological scores. This is the first study using a non-contingent respiratory placebo feedback in a randomized, controlled design. Within this design previous positive findings of symptom reductions in patients treated with RFB could partially replicated. Nonetheless, tendencies suggest that contingent feedback patients compared to placebo patients profit more from RFB in the long run regarding reduction of chronic pain and psychological distress.

Appl Psychophysiol Biofeedback. 2010 Sep;35(3):207-17. Kapitza KP, Passie T, Bernateck M, Karst M. Department of Anesthesiology, Pain Clinic, Hannover Medical School, 30625, Hannover, Germany.

Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence.

Appl Psychophysiol Biofeedback. 2010 Sep;35(3):229-42. Wheat AL, Larkin KT. Psychology Department, West Virginia University, 53 Campus Drive, 1124 Life Sciences Building, Morgantown, WV 26506-6040, USA. Amanda.wheat@mail.wvu.edu

Full Title: Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded: a clinical case series of behavioral problems

According to the DSM-IV, Mental Retardation is significantly sub-average general intellectual functioning accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety. In pilot work, we have seen positive clinical effects of Neurofeedback (NF) applied to children with Trisomy 21 (Down Syndrome) and other forms of mental retardation. Given that many clinicians use NF in Attention Deficit Hyperactivity Disorder and Generalized Learning Disability cases, we studied the outcomes of a clinical case series using Quantitative EEG (QEEG) guided NF in the treatment of mental retardation. All 23 subjects received NF training. The QEEG data for most subjects had increased theta, alpha, and coherence abnormalities. A few showed increased delta over the cortex. Some of the subjects were very poor in reading and some had illegible handwriting, and most subjects had academic failures, impulsive behavior, and very poor attention, concentration, memory problems, and social skills. This case series shows the impact of QEEG-guided NF training on these clients' clinical outcomes. Fourteen out of 23 subjects formerly took medications without any improvement. Twenty-three subjects ranging from 7-16 years old attending private learning centers were previously diagnosed with mental retardation (severity of degree: from moderate to mild) at various university hospitals. Evaluation measures included QEEG analysis, WISC-R (Wechsler Intelligence Scale for Children-Revised) IQ test, TOVA (Test of Variables of Attention) test, and DPC-P (Developmental Behaviour Checklist) were filled out by the parents. NF trainings were performed by Lexicor Biolex software. NX-Link was the commercial software reference database used to target the treatment protocols, along with the clinical judgment of the first author. QEEG signals were sampled at 128 samples per second per channel and electrodes were placed according to the International 10-20 system. Between 80 and 160 NF training sessions were completed, depending on the case. None of the subjects received any special education during NF treatment. Two subjects with the etiology of epilepsy were taking medication, and the other 21 subjects were medication-free at the baseline. Twenty-two out of 23 patients who received NF training showed clinical improvement according to the DPC-P with QEEG reports. Nineteen out of 23 patients showed significant improvement on the WISC-R, and the TOVA. For the WISC-R test, 2 showed decline on total IQ due to the decline on some of the subtests, 2 showed no improvement on total IQ although improvement was seen on some of the subtests, however even these cases showed improvement on QEEG and DPC-P. This study provides the first evidence for positive effects of NF treatment in mental retardation. The results of this study encourage further research.

Clin EEG Neurosci. 2010 Jan;41(1):32-41. Surmeli T, Ertem A. Living Mental Healthy Center for Research and Education, Istanbul, Turkey. neuropsychiatry@yahoo.com

Full Title: Effectiveness of respiratory-sinus-arrhythmia biofeedback on state-anxiety in patients undergoing coronary angiography

AIM: This study is a report of a study conducted to evaluate the value of psychological assistance including respiratory-sinus-arrhythmia biofeedback training in its ability to reduce the level of anxiety in patients undergoing coronary angiography. BACKGROUND: Coronary angiography has been reported to cause anxiety and emotional stress. METHODS: Between March 2004 and January 2005, 212 patients undergoing routine elective coronary angiography for the evaluation of stable coronary artery disease were randomized into two groups. In the psychological support group (n = 106) a structured psychological conversation and respiratory-sinus-arrhythmia biofeedback training were offered prior to coronary angiography. In the control group (n = 106) standard care and information was provided without psychological support. State-anxiety was measured (scale 20-80) 1 day prior to and after coronary angiography, along with blood pressure and heart rate. FINDINGS: Prior to coronary angiography, state-anxiety was 54.8 +/- 11.5 (mean +/- SD) in the control group and 54.8 +/- 12.6 in the psychological support group. After coronary angiography, state-anxiety was 47.9 +/- 18.5 in the control group but 28.3 +/- 12.5 in the psychological support group (Wilcoxon rank sum test W = 7272, P < 0.001). Blood pressure was statistically significantly lower in the psychological support group prior to the intervention and the day after coronary angiography. CONCLUSION: Psychological support including respiratory-sinus-arrhythmia biofeedback is an effective and simple tool that could be used by nurses to reduce state-anxiety and emotional stress in patients undergoing coronary angiography.

J Adv Nurs. 2010 May;66(5):1101-10. Mikosch P, Hadrawa T, Laubreiter K, Brandl J, Pilz J, Stettner H, Grimm G. Department of Internal Medicine 2, General Hospital Klagenfurt, Austria. peter.mikosch@tele2.at

Full Title: Correcting abnormal flexion-relaxation in chronic lumbar pain: responsiveness to a new biofeedback training protocol

OBJECTIVES: Lumbar flexion-relaxation is a well-known phenomenon that can reliably be seen in normal participants, but not in most chronic low back pain (CLBP) participants. No earlier studies have investigated any specific clinical intervention designed to correct abnormal flexion-relaxation. The objective of this study was to evaluate the contribution of a surface EMG-assisted stretching (SEMGAS) biofeedback training protocol, within a functional restoration treatment program, on flexion range of motion (ROM) and erector spinae surface EMG (SEMG) during maximum voluntary flexion (MVF). METHODS: Lumbar flexion ROM and MVF SEMG were assessed in 2 groups of CLBP patients at the beginning and end of rehabilitation. One group participated in functional restoration only, whereas the other group participated in functional restoration plus SEMGAS biofeedback training. Both treatment groups were compared with a separate control group of normal, pain-free participants. RESULTS: Pretreatment ROM and MVF SEMG measures were similar in both treatment groups, but were very different than the control group. At posttreatment, the functional restoration only group remained statistically different than the control group on MVF SEMG and some ROM measures, but the SEMGAS group was statistically equivalent to the control participants on all posttreatment measures, including the ability to show flexion-relaxation. DISCUSSION: Interdisciplinary functional restoration rehabilitation of CLBP participants is effective for increasing ROM and other functional measures, but the addition of a SEMGAS biofeedback training protocol can result in normalization of the flexion-relaxation phenomenon, so that these participants are comparable with a pain-free control group.

Clin J Pain. 2010 Jun;26(5):403-9. Neblett R, Mayer TG, Brede E, Gatchel RJ. PRIDE Research Foundation, Dallas, TX, USA.

Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780-789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8-12 years, completed either 36 sessions of NF training (n = 59) or a computerised AST (n = 35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n = 38) at follow-up were superior to those of the control group (n = 23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD.

Eur Child Adolesc Psychiatry. 2010 May 25. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H. Child and Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, 37075, Göttingen, Germany.

Full Title: Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial

OBJECTIVES: Although biofeedback therapy is effective in the short-term management of dyssynergic defecation, its long-term efficacy is unknown. Our aim was to compare the 1-year outcome of biofeedback (manometric-assisted pelvic relaxation and simulated defecation training) with standard therapy (diet, exercise, laxatives) in patients who completed 3 months of either therapy. METHODS: Stool diaries, visual analog scales (VASs), colonic transit, anorectal manometry, and balloon expulsion time were assessed at baseline, and at 1 year after each treatment. All subjects were seen at 3-month intervals and received reinforcement. Primary outcome measure (intention-to-treat analysis) was a change in the number of complete spontaneous bowel movements (CSBMs) per week. Secondary outcome measures included bowel symptoms, changes in dyssynergia, and anorectal function. RESULTS: Of 44 eligible patients with dyssynergic defecation, 26 agreed to participate in the long-term study. All 13 subjects who received biofeedback, and 7 of 13 who received standard therapy, completed 1 year; 6 failed standard therapy. The number of CSBMs per week increased significantly (P<0.001) in the biofeedback group but not in the standard group. Dyssynergia pattern normalized (P<0.001), balloon expulsion time improved (P=0.0009), defecation index increased (P<0.001), and colonic transit time normalized (P=0.01) only in the biofeedback group. CONCLUSIONS: Biofeedback therapy provided sustained improvement of bowel symptoms and anorectal function in constipated subjects with dyssynergic defecation, whereas standard therapy was largely ineffective.

Am J Gastroenterol. 2010 Apr;105(4):890-6. Epub 2010 Feb 23. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Department of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1009, USA. satish-rao@uiowa.edu

Full Title: Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome

BACKGROUND & AIMS: Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiologic mechanisms for treatment. METHODS: Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as "highly likely" to have LAS if they reported tenderness with traction on the levator muscles or as "possible" LAS if they did not. All 157 patients received 9 sessions including psychologic counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months. RESULTS: Among patients with "highly likely" LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0-10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a "possible" diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon and by reducing the urge and pain thresholds. CONCLUSIONS: Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation. 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Gastroenterology. 2010 Apr;138(4):1321-9. Epub 2010 Jan 4 Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Division of Gastroenterology, University of Verona at Verona, Italy. chiarioni@tin.it

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.

Full Text.

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.

Full Text.

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.

Full Text.

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.

Full Text.

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.

Full Text

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.

[More]

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.

[More]

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.