ELECTROMUSCULAR and THERMAL BIOFEEDBACK

Introduction 

Michael Hale
Jean Hern
Desiree Morgan


Muscular activity in the forehead may only indicate the muscular activity in 
the head and neck, but there are indications that a person's conscious control 
over this muscular activity may generalize to their psychological stressors that 
affect the cardiovascular, neuroendocrine, and cellular immune response. In 
addition, EMG feedback has also been used to address stress-related 
complaints by increasing relaxation. Increased relaxation, in turn, has positive 
affects on muscle pain and depression.
 An extreme maladaptive state of stress is known as DMS-IV (TR) lists Post-
Traumatic-Stress Disorder, as an anxiety disorder that is caused by some 
traumatic event that happened to the person. The person expresses the anxiety 
as intense fear, helplessness, or horror. Acute symptoms of PTSD should 
appear at least one to three months after the trauma. If Post-Traumatic-Stress 
Disorder lasts longer than three months the symptoms are considered to be 
chronic. Also Fibromyalgia syndrome (FMS) is a condition of somatic and 
psychological distress without a determined root cause or cure. FMS is 
characterized by wide-spread pain, sleep disturbances, fatigue, and depression, 
among numerous additional adverse conditions. Because of the variety of 
complaints, EMG biofeedback has been used to address somatic complaints, 
such as specific muscle pain. Electromyographic (EMG) biofeedback is a 
beneficial tool that merits more investigation as part of a holistic 
Psychophysiology treatment plan for stress related ailments.






Biofeedback Peek Performance

					by Michael Hale


	Biofeedback is a verifiable means of getting results. 
Although somewhat categorized as alternative medicine, biofeedback 
is used on a regular bases for many things. One of those things is 
peak performance training, also known as peak achievement. Peak 
performance is the ability for a person to be able to controllably 
come to a higher level of performance. Peak performance has many 
areas of interest, from athletic performance to Attention Deficit 
Disorder (ADD). There are numerous goals of peak performance as 
well. Such goals as strengthening the ability to focus attention, 
strengthening the ability to intensify and control alertness and 
arousal, focusing attention on specific parts of the body that 
should be worked on, learn to relax body and take brief micro 
breaks, discover and enhance the performance of a sequence to a 
particular activity.

	As we can see, peak performance seems very useful to those 
who wish to be able to increase performance. The wide variety of 
applications for peak performance goes from athletics to work. 
Peak performance goals in athletics are: staying in "the zone", 
refining athletic skills and performance, sustaining concentration 
on the application even when fatigued, increase discipline, 
learning plays faster with better execution, reducing stressful 
situations, improving physical fitness and strength training, 
faster rehabilitation rate. The implication for academic 
situations are: paying better attention, increasing focus on 
particular subjects, reducing stress for better test taking, 
reducing impulsivity and hyperactivity that may distract, 
enhancing SAT and IQ test scores, increasing mental processing. 
Peak performance is applicable to work situations in that it: 
improves concentration, reduces stress at work, develops better 
work habits, the ability to master new tasks and material faster, 
staying focused on tasks and getting them done quicker, improve 
organizational skills, increasing accuracy and minimizing 
mistakes.

	There are many different modes of Biofeedback. The most 
popular are the Electromyography machine, Electroencephalographic 
machine, Electrodermal apparatus, and the temperature machine. 
Peak performance mainly deals with the Electromyography machine 
and the Electroencephalographic machine. This papers focus and 
research is on the Electromyography machine in the use of 
Biofeedback. The Electromyography machine measures the muscle 
activity of specific sites on the body. The goals of peak 
performance with the Electromyography machine are that of 
relaxation, arousal control, and muscle training. These goals may, 
or course, be achieved by regular training, but peak performance 
training seems to be faster, more efficient, and with greater 
results. 

The ability to relax and control relaxation is probably one 
of the most important aspects and goals of Electromyography peak 
performance. Relaxation reduces stress and stress effects on the 
body. It keeps the muscles and body fresh for best results upon 
performance. Control of relaxation gives better awareness of 
muscle and body use. "Using Biofeedback to reduce left arm 
extensor EMG of string players during musical performances", 
Biofeedback and Self Regulation 1981 Dec. In this experiment 
Biofeedback sessions were used on an experimental group of 
musicians. The results show that EMG scores can be reduced during 
musical performance through Biofeedback. The relaxation of the 
extended arm increased (muscle stress decreased). This experiment 
only rated relaxation of the extensor arm and not the actual 
performance of the musicians. Musical performance quality is a 
complex and almost impossible variable to measure objectively. It 
was assumed that the musical quality would at least stay the same 
and at best improve vastly. Furthermore, the musicians themselves 
confirmed increased performance. Improvements in greater technical 
ability with the extensor hand and improved tone were identified.  

Another goal of Electromyography machine peak performance is 
arousal control. Arousal control is the ability to increase and 
decrease arousal levels, awareness levels, excitement levels, and 
energy levels. In doing so one may be able to give more to their 
performance or be able to respond better in their performance. 
"Psychological Skills for Enhancing performance: Arousal 
Regulation Strategies" Medicine and Science in Sports and 
Exercises, April 1995; identifies biofeedback as a valid way of 
arousal control. Biofeedback was noted as a technique than can be 
effective in influencing arousal and facilitating performance. 
Arousal has many different levels, from the physiological to the 
cognitive. Biofeedback was successful in accommodating many of 
these levels.

The last major area in of Electromyography machine peak 
performance is muscle training. Muscle training is teaching the 
muscle, or brain/mind as it were, for specific tasks or reactions. 
This teaching of the muscle involves the Autonomic Nervous System 
of the body as well as the subconscious and conscious. This will 
train voluntary muscles to react faster and automatically to 
certain situations. It also teaches control of involuntary muscle 
control such as heartbeat. "EMG biofeedback of the abductor 
pollicis bravis in piano performance" Biofeedback and Self 
Regulation, 1993 Jun, is a good example of this. In the experiment 
electrodes from the Electromyography machine connected with a 
muscle that is essential in "good" piano playing, the muscle near 
the base of the thumb. The experimental group received sessions of 
biofeedback to increase use of this muscle. The biofeedback group 
was able increase response on the Electromyography machine. This 
achievement is the same as a model that is characteristic of 
advanced pianists. This application of biofeedback is useful for 
the awareness of the movements of the fingers and muscles of the 
hand in the process of learning piano playing. The group learned 
advanced muscular pattern of playing piano through biofeedback and 
can be most noticed in a competitive area.


Bibliography

"EMG Biofeedback of the Abductor Pollicis Bravis in Piano 
Performance", Biofeedback and Self Regulation, 1993 June 18(2) ph 
67-77

"Effects of EMG biofeedback", Perceptual and Motor Skills, 1987 
December 65(3) pg 855-9

"Using Biofeedback to Reduce Left Arm Extensor EMG of String 
Players During Musical Performance", Biofeedback and Self 
Regulation, 1981 December 6(4) pg 565-72

"Psychological Skills for Enhancing Performance: Arousal 
Regulation Strategies" Medicine and Science in Sports and 
Exercise, 1994 April 26(4) pg 478-85

Peakachievement.com  


EMG a Valuable Piece
 Of Wellness Training
 By Roslyn McCoy



	Stress is necessary part of life, but excessive autonomic activation can 
impair the individuals psychologically and physiological functioning. Research 
has shown individuals successful use of (EMG) biofeedback training to control 
forehead muscular activity and reducing the muscular indication of stress.  
Other research didn't support the claim that frontal EMG activity was an 
accurate indication of the individual's overall stress level and that it is only a 
placebo effect that was responsible for the changes in the participant's 
autonomic activation. Claims varied widely for the therapeutic uses of 
biofeedback in the late 1960s that were not supported with scientific evidence, 
so biofeedback lost its credibility in America.  This resulted in the loss of 
funding and interest of many researchers to conduct, and have their names 
connected with biofeedback research.  Because of the lack of funding the size 
of many of these studies are small and inclusive. 
	Nieis Birbaumer, and Herta Flora in "Applied Psychophysiology and 
Learned Physiological Regulation" presented a brief history of biofeedback and 
the Society of America (BSA), founded 1969.  At that time this group did not 
provide well-designed and replicated research to support its claims of 
psychosomatic, behavioral, and medical disorders, such as "anxiety, attention 
deficit disorders, depression, autoimmunological disease (such as lupus), skin 
diseases, psychiatric conditions, stress-related diseases, asthma, gastric ulcers, 
nonmuscular pain syndromes, sleep disorders (some limited studies with few 
subjects indicate some efficacy for idiopathic insomnia), and even marriage and 
partner problems",  which damaged the efficacy of biofeedback for disorders. 
Because of the loss of credibility of publications such as Biofeedback and Self-
Regulation or Applied Psychophysiology and Biofeedback pioneering 
experimental studies would only publish in prestigious journals such as Nature 
and Science.  These scientists would use terms such as "self-regulation," 
"operant training," "physiological self-regulation," instead of the word 
"biofeedback," to protect their credibility. 
	There is a benefit of autonomic activation up to a point, but there are 
hidden costs to excessive autonomic activation such as, Somatization 
(headaches, pain, physical discomfort, etc.), severe cognitive interference, 
irritable bowel, and professional burnout. John T. Cacioppo published a 
comprehensive research called "Autonomic, Neuroendocrine, and Immune 
Responses to Psychological Stress" a correlation of stress and impaired immune 
system. This research showed the effects of psychological stressors on 
cardiovascular, neuroendocrine, and cellular immune response. John 
hypothesized "that persons who show relatively high physiological stress 
responses to the threats and irritations of everyday life (high stress reactivity) 
may be at greater risk for disease susceptibility, even though their perceptions 
of coping and stress are comparable to persons who show relatively low 
physiological stress responses (low stress reactivity)." Through John's research 
we can see the importance of stress on individuals health. Stress-reduction 
training can promote health and long lives because an individual can stabilize 
their autonomic activation, cardiovascular, neuroendocrine, and cellular 
immune response. Autonomic and neuroendocrine activation that exceed 
metabolic requirements in responding to stressors that trigger the mobilization 
of the metabolic resources that once was needed in the fight or flight behaviors 
of our ancestors, but uncontrolled it is now negatively impacted many people's 
health (Charles). 
	There have been numerous studies documenting excess stress in 
graduate students who are engaged in professional training programs.  These 
inexperienced counselors can display the same response as someone who has 
experienced an actual threat of personal or physical harm.  In 1995 suggestions 
were made that counselor education programs address the counseling students 
stress and stress coping methods as part of the course curriculum. Chandler 
and colleagues present research "Enhancing Personal Wellness and Counseling 
Trainees Using Biofeedback: an Exploratory Study" that supports the 
hypothesis that biofeedback assisted relaxation training will reduce the stress 
in students who are learning and practicing counseling techniques, and will 
result in the reduction in their physical and psychological complaints. This 
study consisted of 33 original participants because of attrition a total of 19 
participants completed the study.  All the participants completed the SCL-90-
R assessment, a well-researched instrument that has demonstrated a reliable, 
validity, and utility indicator of stress at the beginning and end of the 
semester. This study was extremely small, but the results indicated that the 
students receiving the biofeedback assisted relaxation therapy significantly 
reduced their negative symptomology whereas the control group had no 
significant changes. 
	Charles Graham with the Midwest research Institute tested the 
hypothesis: "the frontales to be 'key muscles' uniquely indicating the degree 
attention presented in the general musculature." The muscles in the forehead 
were not a good indication of the overall level of stress in individuals, but 
frontal EMG biofeedback techniques could improve stress-related disorders 
involving head and neck muscular tension. Individuals using 
Electromyographic (EMG) biofeedback reported an increase in the conscious 
control over the neck and head muscles reducing symptoms. Joyce Segretol 
wanted to see if EMG Biofeedback Learning could improve the abilities of 
individuals to control the muscular activity in their forehead.  To answer this 
question using the EMG machine Joyce assessed 72 undergraduate students.  
They were asked to produce a target response from 1.0 to 5.0 RV every 15 
seconds for 16 trials.  This group was divided into one of three groups: no 
feedback, accurate feedback, or inaccurate feedback (noncontingent feedback); 
this group were not informed about the false feedback they were receiving from 
the visual and audio feedback device.  The groups were trained for 64 trials to 
produce a target EMG reading and the group receiving accurate biofeedback 
information was the only group that improved from initial EMG awareness 
level.  This indicates that accurate feedback training enabled individuals to be 
less deviant from target muscle activation than the practice or the 
noncontingent groups (Segretol).  Being able to control muscular activation in 
our forehead doesn't explain why biofeedback training helps certain individuals 
control their maladaptive stress levels. 
	Lan Wickramasekera, Ph.D.published an article called "Does 
Biofeedback Reduce Clinical Symptoms and Do Memories and Beliefs Have 
Biological Consequences?" Toward a Model of Mind-Body Healing" 
hypothesized that biofeedback reduce clinical symptoms by temporarily 
increasing trait hypnotic ability of the participants. Lan found risk factors for 
stress (threat) related diseases and clinical symptoms to be correlated with the 
individual's low hypnotic ability.  Increase in hypnotic ability or perceptual 
flexibility using biofeedback training can elicit a response condition known as 
"mind-body therapeutic placebo response." Biomedical instruments used in 
biofeedback training can trigger memories of prior healings stimulating feelings 
of hope and reducing anxiety, also patients who believe that their condition is 
strictly organic and is unable to actively participate in a psychosocial therapy 
may respond to the use of Biomedical instruments. 
	There is a lot of documentation that shows that stress over time is 
detrimental to most individuals.  There isn't enough research to conclusively 
indicate the best stress therapy, but a holistic approach to this maladaptive 
state will usually provide the best results.  Biofeedback can be very useful tool 
for the practitioner and patient, but there isn't evidence that the isolated use 
of biofeedback will provide lasting results.  More funding for scientific 
research is needed to identify the best combination of therapeutic practices 
to address this significant problem. Biofeedback can be a part of 
comprehensive intervention programs and that is why Nieis Birbaumer and 
Herta Flora suggested a modification of Mark Schwartz's definition of 
Applied Psychophysiology:
 "Applied Psychophysiology is a scientific discipline that uses noninvasive 
psycho physiological measurements for clinical and other applied 
purposes. As the applied section of psychophysiology it shares with its 
mother discipline the scope of understanding and modification of the 
relationship between behavior and physiological functions by using 
noninvasive physiological recordings. Noninvasive physiological 
recordings encompass all the classical psycho physiological variables 
such as EEG, MEG (magneto encephalography), EMG, skin 
conductance, skin temperature, blood pressure, heart rate, gastro-
intestinal motility, blood flow and vasomotor variables, endocrinological 
and biochemical measures in blood, urine, feces and saliva but also 
modem imaging techniques such as optical recording and functional 
magnetic resonance imaging (fMRI) and transcranial magnetic 
stimulation (TMS). Psychophysiology and applied psychophysiology 
never use these measures in isolation but always simultaneously with 
psychological/behavioral measurement techniques."


References
Birbaumer, Nieis & Herta Flora.(1999) Applied Psychophysiology and Learned 
Physiological Regulation, Applied Psychophysiology and Biofeedback, Vol. 24, 
No. l, 

Cacioppo, John. T. & Gary G. Berntson.(1998) "Autonomic 
Neuroendocrine, and Immune Responses to Psychological Stress: The 
Reactivity Hypothesis" Annals of the New York Academy of Sciences 840: 
664-673 

Chandler, Cynthia.(2001)" Enhancing Personal Wellness in Counselor 
Trainees Using Biofeedback: A Exploratory Study." 
Applied Psychophysiology and Biofeedback, Vol. 64, No. 1, 

Graham,Charles and Mary R.(1986) Cook,Effects of Variation in Physical 
Effort on Frontalis EMG Activity. Biofeedback and Self-Regulation, Vol. 
11, No. 2, 

 Segretol, Joyce. (1995) "The Role of EMG Awareness in EMG Biofeedback 
Learning."  
Biofeedback and Self-Regulation, Vol. 20, No. 2, 

Wickramasekera, Ph.D. Lan. (1999) "How Does Biofeedback Reduce 
Clinical Symptoms and Do Memories and Beliefs Have Biological 
Consequences? Toward a Model of Mind-Body Healing" 
Applied Psychophysiology and Biofeedback, Vol. 24, No. 2, 




Treatment of Post-Traumatic Stress Disorder with EMG Biofeedback and the 
Treatment of
Post-Traumatic-Stress Headache with EMG and Thermal Biofeedback.





Jean E. Horn


Humboldt State University


			 
    According to DiMatto (1991) Biofeedback, which measures muscle tension, is 
called EMG (electromyographic) feedback.  The EMG (electromyograph) measures 
the amount of electrical charge in the muscle (contractions), which the individual 
realizes as muscle tension.  Biofeedback, which measures temperature and blood flow, 
is called Thermal Biofeedback.  Thermal biofeedback measures the body temperature 
in Fahrenheit degrees, which is an indirect measure of peripheral vasoconstrictions of 
the blood vessels (Schwartz, 1995).  The therapist may use EMG biofeedback and 
Thermal biofeedback in the same session.  EMG biofeedback for clients who suffer 
from muscle tension, and Thermal biofeedback if the client suffers from tension 
headaches.
    EMG (electromyographic) biofeedback is used in the treatment of Post-Traumatic-
Stress Disorder (PTSD). Clients who suffer from Post-Traumatic-Stress Disorder may 
also suffer from Post-Traumatic Headache (PT-HA), which is treated with Thermal 
biofeedback.
     The DSM-IV (TR) lists Post-Traumatic Stress Disorder as an anxiety disorder that 
is caused by some trauma to the person.  The person expresses the anxiety as intense 
fear, helplessness, or horror.  Acute symptoms of PTSD should appear at least one to 
three months after the trauma.  If Post-Traumatic-Stress Disorder lasts longer than 
three months the symptoms are considered chronic.  The DSM-IV (TR) states that 
trauma may be the result of physical or sexual child abuse, rape, natural disasters 
(earthquakes, floods, or tornadoes), robberies, terrorist attacks, vehicle accidents, and 
trauma experienced during combat in war.
    The study conducted by Peniston (1986) included 16 Viet Nam Veterans (10 
inpatients and 6 outpatients) with a seven-year history of chronic Post-Traumatic-
Stress Disorder.  The participant's ages ranged from 29 to 49 years.  Participants were 
randomly assigned to the EMG biofeedback induced desensitization procedure 
(EMG-D) or the NO Treatment control (NT) procedure.  Participants in the (EMG-
D) procedure were seen for three pre-training sessions comprised of 
visualization/imagery and progressive relaxation training (Peniston, 1986).  The NO 
Treatment control (NT) was given pre-and post-EMG measures (Peniston, 1986).  
Stress was recorded for both groups through the measurement of the participant's 
forehead muscle tension.  Peniston (1986) found that participants in the (EMG-D) 
procedure had significantly reduced their muscle tension and showed continued 
improved functioning over a twenty-four month follow up period.  The no Treatment 
control (NT) did not see a reduction of EMG forehead tension. 
	The twenty-four month follow-up was conducted through telephone contacts 
with the 8 participants in the (EMG-D) and NT groups.  Peniston (1986) found that 
the (EMG-D) group Vietnam combat veterans self-reported less anxiety.  Fewer 
flashbacks and nightmares were reported by the (EMG-D) group during this 24 
month period.  Peniston (1986) reports of several instances where the veterans 
reported the occurrence of 2 to 4 flashbacks, but in each instance the (EMG-D) group 
reported that they were able to cope with the anxious feelings.  
	The NT group reported greater anxiety with more frequent re-occurrences of 
nightmares and flashbacks.  Peniston (1986) reports that the NT group had more 
hospital readmissions than the (EMG-D) group (5 out of 8) during the twenty-four 
month follow-up period.
    This study shows the effectiveness of EMG biofeedback and imagery relaxation as 
a useful method in the reduction of client's muscle tension.
    Hickling, Sison, and Vanderploeg (1986) study included six participants who were 
referred for treatment in a biofeedback clinic in a Veterans Administration medical 
center.  The participant's ages ranged from 33 to 66 years.  Hickling (1986) stated 
that the treatment goal for all of the participants included the reduction of physical 
arousal and subjective tension/stress as well as increasing the participant's ability to 
deal effectively with stress.  Two participant's treatment goals included the reduction 
of tension headache intensity and frequency.
    The biofeedback equipment (Hickling, 1986) used was a Cyborg Processor 
Integrator.  For the Thermal biofeedback the researchers used a Cyborg 142 
temperature unit.
    The researchers stated that all of the treatment sessions were conducted by a 
female psychology aide, certified in biofeedback therapy.  Hickling (1986) stated the 
initial two or three sessions consisted of audiotaped progressive muscle relaxation 
(PMR) training, based largely on procedures outlined by Bernstein and Borkovec 
(1978).  The researchers used Electromyographic biofeedback (EMG), simultaneously 
with both auditory and visual feedback from a frontalis muscle electrode placement.  
Participants received between 7 and 14 relaxation/EMG training sessions over a 
period of 8 to 16 weeks, as well as group therapy and individual therapy.  Sessions 
following the PMR Training involved the use of autogenic phrases as used by 
(Schultz & Luthe, 1969).  The researchers encouraged the participants to practice 
relaxation on a daily bases.  Two of the participants were given additional training in 
Thermal biofeedback following the relaxation/EMG training in an effort to relieve 
complaints of vascular headaches (Hickling, 1986).  The researchers had the 
participant's rate their subjective feelings of tension at the beginning and end of each 
session (0= no tension, 10 = worst imaginable tension).  Each of the participants 
were asked to rate their progress, a seven point Likert scale was used (-3 = markedly 
worse, -2 = moderately worse, -1 = slightly worse, 0 = no change, + 1 = slight 
improvement, +2 = moderate improvement, +3 = markedly improved).  
    As a group, the researchers found that all of the participants reported lower tension 
ratings from the beginning to the end of the sessions.  The participants reported 
significantly less tension as treatment progressed, and all learned to lower their 
frontalis (muscle) readings.  The researchers believed that relaxation training and 
biofeedback might be particularly useful in the treatment of PTSD.  
    This study is an example of how biofeedback may be used along with other 
treatments to help clients relieve their muscle tension and tension headaches.
    Sadigh (1999) quotes Noriss (1992) as suggesting that traffic accidents were the 
most common cause of the experience of post-traumatic symptoms in the United 
States. 
    In a study conducted by (Hickling, Blanchard, Schwartz, and Silverman, 1992) 
twelve participants (11 females and 1 male, with a mean age of 31.1 years) were 
observed.  All of the participants were seeking treatment for Post-Traumatic 
Headache (PT-HA), following a motor vehicle accident, and were referred to Hickling 
(1992).  Ten participants were referred by neurologists form outpatient practices, a 
hospital-based psychiatrist referred one patient, and an attorney referred one.  
According to the researchers none of the participants had a significant headache 
history before their motor vehicle accident.  Hickling (1992) reports that nine of the 
participants had suffered diagnosable head trauma, three had lost consciousness; nine 
were taking more than one medication each day for their headaches.  According to 
Hickling (1992) six of the twelve participants had tried physical therapy and one 
participant had seen a chiropractor before seeking psychological treatment for their 
headaches.
    Hickling (1992) states the participant's headaches were diagnosed using the 
guidelines put forth by the Headache Classification Committee of the International 
Headache Society (Olsen, 1988, 1990).  The researchers had the twelve participants 
evaluated by (DJS) a Board Certified Neurologist; evaluations were by personal 
examination, or by reviewing the participant's neurological/medical records.
    Following the Blanchard and Andrasik (1985) headache scale, the researchers had 
each of the participant's record their headaches into a daily headache diary.  
Headaches were recorded by the participants for one week before treatment and for 
one week after the treatment.  Headaches were rated on a scale from "0" (no 
headache) to "5" (intense, incapacitating headache).
     Hickling (1992) stated treatment was individually tailored to address the needs of 
each participant.  All of the participants received cognitive/ behavioral therapy and 
relaxation training.  The researchers used biofeedback treatment when it was 
clinically determined that relaxation training and cognitive/ behavioral therapy failed 
to provide sufficient relief.  Of the twelve participants, seven participants received 
either Thermal or EMG biofeedback.  The researchers stated that the mean number 
of treatment sessions was 20 (range 8 to 50). 
    Hickling (1992) found that eight of the twelve participants (67%) met the 
generally accepted criteria (Blanchard and Schwartz, 1988) of clinically significant 
improvement.  The researchers found that headache daily diaries of more then one 
week might be a better estimate of headache activity.
    Eight of the participants in the Hickling (1992) study met the DSM-III-R criteria 
for PTSD.  Those participants who met the criteria for PTSD required significantly 
more treatment sessions (a mean of 24.6 sessions) than the non-PTSD group (10.8 
sessions).  The researchers found from their data that patients with PTSD required 
almost 2.5 times as much treatment as those who did not meet the criteria for PTSD.  
The researchers say that the presence of PTSD complicates the treatment of 
headaches, and that the PTSD disorder must also be treated as well. 
    The study conducted by Hickling (1992) shows how cognitive/behavioral therapy, 
relaxation training, and EMG and Thermal biofeedback can be combined into one 
treatment program.
    Schwartz (1995) agrees with the Hickling (1986) study, he states that clients who 
are diagnosed with post-traumatic headache often experience the most time with pain 
each year.   Those clients who suffer from tension-type headaches and "mixed 
headaches" often experience less time     with pain than do those with Post-Traumatic 
headaches (Schwartz, 1995).  Schwartz (1995) also stated that clients with Post-
Traumatic headache experience more time with pain than most patients with 
migraines.  
    I believe that EMG biofeedback is a useful therapy, which allows clients to take an 
active role in their own medical care.  EMG or Thermal biofeedback is cost efficient, 
relaxation or other biofeedback techniques may be learned in a very short period of 
time.  Through the training of relaxation techniques the client is able to have some 
control over their physiological processes.  That is the client with the aid from a 
biofeedback therapist learns to do relaxation techniques without the aid of an EMG 
or Thermal biofeedback machine.  Eventually the client is able to do the relaxation 
techniques without the aid from the biofeedback therapist.  The client may do their 
relaxation techniques they have learned, at home or at work, and without others 
knowing that they are doing relaxation techniques.  Helping the client to relieve 
muscle tension or tension headaches at anytime that they (the client) are in pain. 
    It is not known exactly how EMG or Thermal biofeedback works, some critics say 
that biofeedback has a placebo effect.  Never the less, if a client receives relief from 
their symptoms of muscle tension or tension headache then EMG and Thermal 
biofeedback are useful therapies.
    Post-Traumatic –Stress Disorder (PTSD) and Post-Traumatic Headache (PT-HA) 
are the most difficult illnesses to treat, with EMG or Thermal biofeedback therapy 
alone.  As Hickling (1992) suggests the Post-Traumatic-Stress Disorder should be 
treated along with biofeedback therapy.  Treating Post-Traumatic-Stress Disorder 
with a combination of different therapies is more realistic, such therapies would 
include, cognitive/behavioral therapy, drug therapy, and biofeedback therapy. A 
holistic treatment plan would take the individual's physical and mental condition 
into consideration.

      






Reference

    DiMatteo, M.R. (1991).  The Psychology of Health, Illness, and Medical Care . . . 
An Individual Perspective.   Pacific Grove, California: Brooks/Cole Publishing 
Company.  173.

    Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, TR 
(2000).  Washington, DC: APA.  463, 464, and 465.

    Hickling, E.J., Sison, Jr., G.F., Vanderploeg, R.D. (1986).  Treatment of 
Posttraumatic Stress Disorder with Relaxation and Biofeedback Training.  
Biofeedback and Self-Regulation.  11, (2).  125-134.

    Hickling, E.J., Blanchard, E.B., Schwartz, S.P., and Silverman, D.J. (1992).  
Headaches and Motor Vehicle Accidents: Results of the Psychological treatment of 
Post-Traumatic Headache.  Headache Quarterly, Current Treatment and Research.  
3, (3).  285-289.


    Morgan, J. (2003).  Psychology 476 Class Lectures.  Spring 2003.

    Peniston, E. (1986).  EMG Biofeedback-Assisted Desensitization Treatment for 
Vietnam Combat Veterans Post-Traumatic – Stress Disorder.  Clinical Biofeedback 
and Health.  9, (1).  35-41.

    Sadigh, M.R. (1999).  The Treatment of Recalcitrant Posttraumatic Nightmares 
with Autogenic Training and Autogenic Abreaction: A Case Study.  Applied 
Psychophysiology and Biofeedback.  24, (3).  203-210.

    Schwartz, M.S. (1995).  Biofeedback A Practitioner's Guide, Second Edition.  New 
York, New York: The Guildford Press.  340. 

Copyright © 2003, Dr. John M. Morgan, All rights reserved - This page last edited April 23, 2003
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