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Thermal biofeedback as a psychological treatment in muscle relaxation

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Thermal biofeedback as a psychological treatment in muscle relaxation

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Content THERMAL BIOFEEDBACK AS A PSYCHOLOGICAL
TREATMENT IN MUSCLE RELAXATION
by
Bruce Michael Bongar
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education/Psychology)
June 1977
Copyright Bruce Michael Bongar
UMI Number: DP24184
All rights reserved
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a note will indicate the deletion.
Dissertation Pobi sNng
UMI DP24184
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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UNIVERSITY OF SOUTHERN CALIFORNIA
T H E G R A D U A T E S C H O O L
U N IV E R S IT Y P A R K
LO S A N G E L E S . C A L IF O R N IA 9 0 0 0 7
This dissertation, w ritten by
Bruce Michael Bongar
under the direction of h..%^.. Dissertation C o m
mittee, and approved by a ll its members, has
been presented to and accepted by The Graduate
School, in p a rtia l fu lfillm e n t of requirements of
the degree of
D O C T O R O F P H I L O S O P H Y
Dean
Date May,25,.J977
DISSERTATION COMMITTEE
Chairman
TABLE OF CONTENTS
LIST OF TABLES........................................ iv
LIST OF ILLUSTRATIONS.................................. v
i
Chapter ;
I. THE PROBLEM.................................... 1
Introduction ;
Purpose
Hypotheses :
Operational Definitions
Scope and Delimitations i
Overview
II. REVIEW OF LITERATURE......................... 11
Electromyographic Feedback-Assisted
Muscle Relaxation
Thermal (Skin Temperature) Biofeedback
Summary
III. METHODOLOGY.............................. 22'
Hypotheses
Design
Subjects
Instrumentation
Statistical Analysis
Limitations
Summary
IV. FINDINGS....................................... 3 o '
Discussion ■
V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS. . . 39i
I
Summary j
Î
iii
Conclusions I
Recommendations
REFERENCES 4 6
ni
LIST OF TABLES
1. Muscle Tension Difference--ANOVA.............. 32
2. Mean Differences in Pretreatment and Post-
treatment— Muscle Tension Measure ............. 32
[
3. Systolic Blood Pressure Difference--ANOVA .... 33
I
4. Mean Differences in Pretreatment and Post- i
treatment— Systolic Blood Pressure Measure. . . 33
5. Hand Temperature Difference— ANOVA............ 34
6. Mean Differences in Pretreatment and Post
treatment— Hand Temperature Measure ........... 34
I
7. Psychological Tension Difference (Anxiety
Differential)— ANOVA........................ 36
8. Mean Differences "in Pretreatment and Post
treatment— Anxiety Differential Measure .... 36
9. Psychological Tension Difference (State-
Trait Anxiety Inventory) — ANOVA.......... 37
10. Mean Differences in Pretreatment and Post
treatment— State-Trait Anxiety Inventory
Measure 3 7
IV
LIST OF ILLUSTRATIONS j
j
1. Sequence of Procedures for Participants ........ 26l
V
CHAPTER I
THE PROBLEM
Introduction
Biofeedback has been a recently developed psycho
logical biomedical technique that has shown promise in the
treatment of a variety of psychosomatic, psychogenic, and
physiological disorders. This technique has used visual,
I
auditory, and tactile devices to show the patient what is j
happening to normally unconscious bodily functions. Brown
(1974) pointed out that biofeedback was essentially the
feedback of biological information to the person whose body ■
it is. The expression feedback developed in the field of
engineering to denote control systems that functioned
through feedback mechanisms. Biofeedback devices have ;
allowed patients to sense signals of their own internal
somatic activities. The devices then translated these
:
internal somatic signals into visual, tactile, and/or audi- ;
tory readings. Through this visual, tactile, and/or audi- '
tory feedback, the patient could learn, with practice, to
control internal somatic activities. i
ll
One central area of research in the field of bio-: '
feedback and self-control has been that of electromyographic
feedback-assisted muscle relaxation. A number of studies
have attempted to ascertain the effectiveness of this elec- ,
tromyographic (EMG) muscle activity, feedback in the relaxa-j
tion of muscle tension (Budzynski, Stoyva, & Adler, 197 0;
Jacobs & Felton, 1969; Peper, 1973; Raskin, Johnson, &
Rondestuedt, 1973; Wickramasekera, 1974). However, Blanch- ■
i
ard and Young (1974), after an extensive review of the j
experimental and clinical literature, pointed out that *
although EMG biofeedback was the oldest and perhaps soundest
work in the biofeedback area, there was no clear-cut evi
dence to support the efficacy of EMG biofeedback's thera
peutic contribution to muscle relaxation. They further
stated that whether EMG biofeedback training was every nec
essary had not yet been determined.
A second major area of biofeedback research has
been that of utilizing skin temperature feedback as a treat
ment procedure (Mitch, McGrady, & lannone, 1975; Pearse,
Walters, Sargent, & Meers, 1974; Peper & Grossman, 1974 ;
Sargent, Walters, & Green, 1973; Wickramasekera, 1973) . The
majority of these experimental studies and clinical appli- !
I
cations of the skin temperature (thermal) biofeedback unit '
2 J
involved the learning of voluntary control of hand tempera-H
ture in the treatment of migraine headaches. Two of the
above studies, Mitch et al. (197 5) and Wickramasekera (1974),
also suggested that thermal biofeedback, while effective in |
the treatment of migraine headaches, was not related to, |
nor effective, in muscle tension reduction. In this area,
according to the above two studies, EMG biofeedback and/or |
counseling was necessary. However, Taylor (1976) presented |
anecdotal clinical evidence that auditory thermal biofeed- I
back (voluntarily increasing hand temperature), while effec- |
tive in migraine headache treatment, was also a significant
and efficient method of reducing muscle tension levels equal
to or superior to those produced by EMG biofeedback. '
The present study was directed to the need for
research into psychological methods for developing muscle
relaxation. It was hoped that the present study, in its
comparison of the effect of thermal biofeedback with a con-'
trol procedure, would provide an indication of the method's
relative efficacy in experimental muscle relaxation.
The remainder of this chapter is subdivided into
six sections. The first, or the problem, identifies the
nature of the dissertation, while the discussion of the '
purpose relates the need and importance of this study. The i
3J
hypotheses are then conceptualized and provide the questions]
to be answered. Terms are operationally defined to facili- '
tate comprehension of the literature review and the method
ology subsequently presented. The scope and delineation j
provide focus for this study. The last section outlines thej
I
remainder of the study.
Purpose
I
The general purpose of this research was to deter- j
mine the effect of thermal biofeedback, in an experimental |
I
setting, on muscle relaxation. The study was also designed
to ascertain whether there were different experimental
I
effects for thermal biofeedback, as compared to a control
procedure, in systolic blood pressure and in psychological
tension levels.
Biofeedback has become an area of increasing pro
fessional and public interest. However, Blanchard and Young
(1974) stated that the evidence, while often interesting and
I
high provocative, was certainly far from conclusive. Fur
thermore, Hilgard and Hilgard (1975) pointed out that unfor
tunately biofeedback had been so exploited either commer- |
cially or by uncritical enthusiasts that it was difficult toj
gauge its successes and effectiveness.
Biofeedback should not be viewed as a therapeutic
panacea. It has exhibited potential as a therapeutic inter
vention if developed within the context of hard research and
responsible clinical findings and not sensationalized into a
global, nondiscriminative cure-all. ;
The determination of nonchemical methods useful in |
developing muscle relaxation would have broad applicability '
in the field of psychology, special education, and medicine.;
Rather than base treatment decisions, equipment expendi
tures, and professional training time on emotion, opinion, j
or unsubstantiated claims, experimental studies were sorely
needed as a solid foundation for evaluating differential
strategies in muscle relaxation. In accordance with the
above statement, the present study was designed to experi
mentally examine the effects of thermal biofeedback, as
compared to a control procedure, in the relaxation of a
selected muscle group, the frontalis (Budzynski et al., ’
(1970; Raskin et al., 1973; Schandler & Grings, 1975;
Wickramasekera, 19 72). The study was also designed to
examine the effects of thermal biofeedback on systolic blood
pressure and hand temperature. The study further sought to
ascertain the effects of thermal biofeedback, as compared
to a control procedure, on psychological tension levels as i
5J
measured by the anxiety differential (Huseck & Alexander, !
1963; Paul, 1966; Schandler & Grings, 1975) and as measured ;
by the state-trait anxiety inventory (Spielberger, Gorush,
& Lushene, 197 0). |
I
Hypotheses -
The general hypothesis was that participants who
I
received thermal biofeedback information would demonstrate i
lower levels of muscle tension than would participants who ^
received a control procedure, i.e., thermal biofeedback par
ticipants would evidence lower frontalis muscle tension
levels as compared to the muscle tension levels of partici-
I
I
pants in a control procedure. Participants in the control
procedure were instructed to relax and rest quietly using
their own methods (Paul, 1966; Schandler & Grings, 1975).
Specific hypotheses were that thermal biofeedback would sig
nificantly lower:
1. Levels of muscle tension
2. Levels of systolic blood pressure
3. Levels of psychological tension ,
A further specific hypothesis was that thermal bio- ;
/
feedback would significantly increase levels of hand ;
temperature.
The dependent variables were frontalis muscle ten
sion levels, systolic blood pressure, left hand temperature , i
scores achieved on the administrations of the anxiety dif
ferential, and scores achieved on the administrations of the
j
state-trait anxiety inventory. |
The treatment variable consisted of providing the
I
experimental group with auditory thermal biofeedback, and I
the control group with instructions to relax. ;
Operational Definitions I
Biofeedback.--The pick-up of internal bodily sig
nals by an instrument which converts these signals to sound !
or meter readings so that the individual is aware of the
specific internal state monitored. The individual can then,
with practice, learn to voluntarily control these specific
internal states.
Thermal biofeedback.--A biofeedback instrument mea-
------------------------' I
suring temperature, usually of the hand. The ordinary per-:
son, with the instrument as a guide, can usually learn to
warm his hands just by attending to the auditory (sound)
feedback and concentrating on increasing the tone and pitch.;
i
Electrode.— A cup or disk used to make electrical j
I
contact with the skin. !
Electromyograph (EMG).— A laboratory instrument
which converts muscle electrical impulses into sound and
i
into traces on a screen or a paper chart. Thus the shape
of the electrical waves can be seen and analyzed for mean- j
1 '
ing. It also provides for nerve electrical stimulation. j
Electromyometer (EMM).— A small instrument which |
converts the muscle electrical impulses into sound and into
a meter reading.
I
1
EMG (Electromyograph).— An abbreviation frequently |
used for various instruments measuring electrical signals '
from the muscles.
Progressive relaxation.— A technique developed by
Edmund Jacobson (1938) . It involves the tensing of a par
ticular group of muscles, as by pushing the shoulder forward
or bending the wrist upward, so that the patient is taught ,
to become aware of the other muscles involved in the move
ment and of the feeling when the muscles are tense. Then by
For the purposes of the present study, the terms
electromyometer (EMM) and electromyograph (EMG) will be
used interchangeably to denote generic biofeedback instru
mentation that involve the monitoring and feedback of
muscle activity through visual, tactile, and/or auditory
readings.
8 I
relaxing the hand or shoulder, the patient can learn to be
aware of the feeling of lack of tension. Jacobson was able ,
to show that muscles, not ordinarily considered to be under
i
voluntary control, could be relaxed by this method. !
Digital integrator.— A laboratory instrument that
provides the average value of a physiological variable for
1
a selected time period. This information is extracted from i
the biofeedback instruments, i.e., EMM and thermal biofeed-'
I
back units, and is displayed in a digitial format. ;
Temperature probe (temperature sensor).— A sensitive
surface probe (thermistor) that is placed on the body part I
from which the temperature is to be monitored, i.e., base
of the left index finger. The probe is then connected to
the thermal biofeedback unit so that the temperature of the .
body part may be monitored.
Scope and Delimitations
This study was limited to students in the Los Ange- |
les Community College District who were enrolled in intro
ductory psychology classes. The generalizability was also j
restricted by the reliability and validity of the instru- ,
ments selected for use in the study, by the degree of coop-;
eration and attitudes toward the experimental session by the!
9
participants, and by the reactive effects from the experi
mental setting and the data collection procedures.
Overview
' I
The remainder of the dissertation consists of Chap-
!
ter II, review of literature, which provides a background i
I
as well as a review of the pertinent literature for thermal i
i
i
biofeedback and electromyographic feedback-assisted muscle I
relaxation.
Chapter III is devoted to explication of research
design, research hypotheses, selection of the subjects, pro4
I
cedures of data collection, and statistical methods used for
evaluation. Chapter IV is addressed to the analysis and
evaluation of the data collected. Also included in this
chapter is the interpretation of these findings in relation
ship to the hypotheses proposed. The final chapter includes
a summary of the findings, and conclusions drawn. Addi
tional research is suggested as well. i
10
CHAPTER II
REVIEW OF LITERATURE
This chapter provides a brief overview of the gen
eral basic research dealing with biofeedback, as well as a
discussion of some of the research pertaining specifically i
to the area of concern of this study. i
Dicara (1971) stated that if visceral and glandular ,
responses can only be modified by classical conditioning,
they can only be reinforced by the unconditioned stimuli
that elicit responses similar to those learned; but if vis
ceral and glandular responses are subject to instrumental
learning, they are subject to reinforcement by any reward.
Instrumental learning of visceral and glandular responses |
would then allow more flexible possibilities for the learn
ing and maintenance of particular physiological states.
A number of early experimental studies showed that
both heart rate (Engel & Chism, 1967; Engel & Hansen, 1966; i
Frazier, 1966 ; Miller & DiCara, 1967 ; Weiss, 1971), blood
pressure (Benson, Herd, Morse, & Kelleher, 1969 ; DiCara &
Miller, 1968; Plumlee, 1969), and a wide range of other
111
.visceral and glandular responses (Miller, 1969) could be
modified by instrumental conditioning procedures. These ;
findings had significance for learning theory and were fur
thermore of special importance in the initial development of
biofeedback techniques. Shapiro and Schwartz (1972) com- i
piled a list of variables so far shown to be modified by
operant-feedback methods in man, the list included electro- '
dermal activity; heart speeding, slowing, and stabilization;;
systolic and diastolic blood pressure; gross muscle poten- j
I
I
tials; single motor unit activity; alpha, beta, and theta :
rhythms of the EEG; evoked cortical responses; skin tempera
ture; peripheral vasomotor activity; and salivation.
The present review of literature was limited to an
examination of the research in the area of thermal, or skin
temperature, feedback and its relationship to the relaxation
of a selected muscle group. This review was therefore lim
ited to the research related to the biofeedback modalities
of electromyographic feedback-induced muscle relaxation, and
thermal biofeedback as an experimental treatment procedure
in the relaxation of a selected muscle group.
Electromyographic Feedback-Assisted
Muscle Relaxation
I
Electromyographic (EMG) feedback-assisted relaxation
1 2 J
has been one of the central research areas in the field of
I
' [
biofeedback and self-control, Raskin et al. (1973) examined
the effect of EMG feedback-assisted relaxation on ten pa
tients with chronic anxiety. The results were mixed, with :
all patients demonstrating experimental session reduction I
in their level of muscle tension. The results did not con- j
clusively support the efficacy of this procedure for the '
primary symptom of chronic anxiety, but did reveal some
interesting findings as to the relationship of this proce
dure and the symptoms of insomnia and tension headache.
Garrett and Silver (197 2) combined EMG feedback and alpha
brain wave feedback as a treatment for test anxiety. The
study did not reveal significant results in any of the
important dependent behaviors. Peper (197 3) utilized EMG
feedback with a patient with insomnia. Although the study
reported success in the treatment of this symptom with EMG
feedback-assisted muscle relaxation, the anecdotal case
study nature of the report and its n (n = 1), precluded any
scientific generalizations. Jacobs and Felton (1969) com- '
pared the effects of EMG feedback with patients with neck
I
injuries and normal subjects. This study showed that while j
I
EMG feedback-assisted relaxation had a significant effect on
acute muscle spasm, no long-term clinical differences were
13
found. Wickramasekera (197 2) combined EMG feedback- I
assisted muscle relaxation and systematic desensitization '
I
in the treatment of a patient with test anxiety. Again, as i
with the previous case study conducted by Peper (1973), the I
patient was successful in reducing the level of the pre- ;
senting symptom. Budzynski et al. (1973) showed success in '
the treatment of tension headache patients with a combina
tion of EMG feedback training and home training in relaxa
tion .
I
Haynes, Griffin, Mooney, and Parise (1975) found |
that both EMG feedback and progressive relaxation were '
superior to a no-treatment control group in decreasing ten
sion headaches, but they did not differ from each other.
Coursey (1975) compared EMG feedback as a relaxation tech
nique to two control treatments. After seven 21-minute
treatments over a two-week period, the results showed the
feedback group with significantly lower EMG scores than the
control groups.
A study by Schandler and Grings (1975) examined the •
relationship between the effects produced by EMG biofeed
back and those produced by other available tension reduction
i
I
procedures, especially those procedures with a similar
!
emphasis on the control of overall tension through manipu- !
I
14'
lation of tonic muscle levels within the body. Of the lat- '
ter procedures, progressive relaxation was the most widely
used and most effective procedure for producing reduction of
muscle tension levels, and was thus selected for the com
parison. This study, although presenting some interesting j
information concerning new modes of electromyographic ,
feedback, did not yield significant results toward an exami
nation of traditional feedback and its relationship to
other modes of tension reduction, here represented by pro
gressive relaxation.
Steffen (1975) utilized EMG feedback-assisted relax
ation training in the experimental treatment of chronic
alcoholics. While this study indicated that EMG-induced
muscle relaxation resulted in significantly lower muscle
tension levels, the small sample size and inconsistent find-
1
ings, in regard to the alcohol consumption variable, made
the results concerning the efficacy of this procedure dif
ficult to interpret.
Jessup and Neufeld (1977) examined the effects of
EMG feedback-assisted relaxation and autogenic phrases in
inducing relaxation in a group of psyciatric patients. The;
results did not support the efficacy of either procedure in
inducing relaxation in the sample of psychiatric patients, i
I
I
15
Blanchard and Young (1974), after an extensive
review of the experimental and clinical literature, pointed
out that although EMG biofeedback was the oldest and per
haps soundest work in the biofeedback field, there was no I
clear-cut evidence to support the efficacy of EMG biofeed- !
back's therapeutic contribution to muscle relaxation. They^
further stated that whether EMG biofeedback training was |
I
ever necessary had not yet been determined. |
Finally, Franks and Wilson (976), after reviewing
!
the relevant literature in the area of biofeedback and ,
relaxation training, concluded that, overall, EMG biofeed
back training had not been demonstrated to be more effec- |
tive than the simpler progressive relaxation procedure,
which had the added advantage of not requiring specialized
and often expensive technology.
Thermal (Skin Temperature) Biofeedback
i
A second major area of biofeedback research involved
the patients': learning voluntary control of their own skin •
temperature, when provided with immediate feedback concern
ing variations in localized skin temperature. j
The majority of experimental studies and clinical i
applications of the skin temperature unit involved the
learning of voluntary control of hand temperature in the
1
16 I
treatment of migraine headaches. Sargent et al. (1973) '
stated that considerable research must be conducted before !
we are certain of the neural mechanisms involved in volun
tary control, but it seemed quite clear that the limbic- I
hypothalmic axis was an essential part. Furthermore, they j
stated that learning to control hand temperature was a good
indicator of learning to control central processes that are
associated with vascular dysfunction.
Shapiro and Schwartz (1972) pointed out that no
i
I
clear-cut relationship had been demonstrated between operant:
!
autonomic control and cognitive or thought processes. They
conjectured that the thinking involved in controlling inter
nal responses is relatively undeliberate or unconscious, a
kind of passive volition, or indirect process of cognitive
control. A number of studies were conducted to explore the •
effectiveness of this passive volition and other variables
in conjunction with the feedback of skin temperature.
Sargent et al. (197 3) conducted an important study =
using autogenic (Schultz & Luthe, 1969) temperature feed- j
back training to control blood flow dysfunction in migraine
headaches. The study consisted of 75 adult migraine pa
tients. Significant improvement was obtained with 81 per- i
cent of the sample. The study also found that younger I
17
persons seemed to respond more quickly to training than '
older individuals. They offered as a possible explanation
the concept that a person's life values increase in rigidity
i
with increasing age and that consequently an older person i
may then adjust less rapidly to new situations. The study |
i
stated that the patients had developed psychosomatic self- '
regulation of migraine headaches by voluntarily relaxing .the
sympathetic section of the autonomic nervous system in the j
hand, therefore increasing the blood flow to that area.
, I
Pearse et al. (1974) conducted a study of 23 head- |
1
ache patients ranging in age from 14 to 71 years. The
study utilized a combination of autogenic training and bio-;
feedback with the skin temperature unit. The study obtained
significant results in the alleviation of headache symptomsi
and also suggested the possibility of significant results
with an intensive five-day autogenic temperature feedback
training program. The study closely replicated and sup
ported the findings of Sargent et al. (1973).
Peper and Grossman (1974) successfully utilized ;
autogenic temperature feedback training with two young
girls, aged 9 and 13. The study, which according to the ;
authors was the first to use autogenic temperature feedback[
(
training with children, suggested that the process may be \
I
18
facilitated if it is presented as a play task involving
i
self-exploration and self-responsibility. !
I
Wickramasekera (1974) described the treatment of
two adult migraine patients who were initially treated with j
EMG feedback training without positive response and later )
successfully treated with temperature feedback. However, i
I
in this study the use of autogenic phrases was omitted. '
i
Mitch et al. (1975) successfully utilized autogenic tempera-'
ture feedback training with 2 0 adult migraine patients.
I
This study and the previous study by Wickramasekera (1974) |
suggested that temperature feedback was an effective tech
nique with migraine patients, but that EMG feedback train- j
ing (Budzynski et al., 1969, 1973) and/or counseling might ;
also be necessary in effecting muscle tension reduction.
A number of other studies were also conducted using
temperature feedback. Roberts, Kewman, and MacDonald (197 3)
demonstrated that a select group of six hypnotically tal- ;
i
ented subjects produced a difference in skin temperature in |
one hand relative to the other in a direction specified by
the experimenter. The study utilized hypnosis and auditory ,
temperature feedback to achieve control over the autonomic j
functions in the hand. Interestingly, all the subjects j
reported that hypnosis helped, but only one of the subjects j
I
19
felt that it was necessary. Steptoe, Mathews, and Johnston '
j
(197 4) conducted a temperature feedback study with eight [
i
university students to attempt the development of precise I
control of peripheral blood flow. The subjects learned to '
produce small differential temperature differences between |
their earlobes. The study utilized visual and auditory
feedback, but involved no autogenic training. Peper (197 3) |
reported a case of Raynaud disease treated unsuccessfully |
by hand temperature biofeedback. !
i
I
In a recent study, Taylor (1976) presented substan-'
tial, although anecdotal, clinical evidence that auditory
thermal biofeedback, voluntarily increasing hand tempera- |
ture, while effective in migraine headache treatment, was
also a significant and effficient method of reducing muscle
tension levels equal to or superior to those produced by
EMG biofeedback.
I
Summary j
In summary, the data presented indicate that the i
effectiveness of electromyographic biofeedback's contribu
tion to muscle relaxation has not yet been established. i
i
The data also suggest that while there was evidence as to j
the efficacy of thermal biofeedback training in the treat- I
I
ment of migraine headache patients, there appears to bè some!
20 ,
conflicting data relevant to its effectiveness in the reduc
tion of muscle tension. In the light of these findings,
the present study proposed to experimentally test the :
effectiveness of thermal biofeedback on muscle relaxation. !
21
CHAPTER III
METHODOLOGY
This chapter outlines the proposed method of the
study, including the statistical measures that were used to
analyze the data. This study was experimental in nature,
comprised of an experimental treatment group and a control
group. Participants were randomly assigned to the treatment
or control group.
Hypotheses
The general hypothesis of this study was that par
ticipants who received a thermal biofeedback procedure would
demonstrate lower levels of muscle tension than would par
ticipants who received a control procedure. In addition,
it was hypothesized that participants who received a thermal
biofeedback procedure would evidence lower levels of sys
tolic blood pressure and psychological tension, as well as
i
increased levels of hand temperature. To test these hypoth
eses, five directional hypotheses were developed. Statis- i
i
tically stated in null form, these hypotheses were : '
22!
1. The mean reduction in levels of muscle tension
for the treatment group will not significantly exceed the
mean reduction in levels of muscle tension for the control
I
group.
I
2. The mean reduction in levels of systolic blood
pressure for the treatment group will not significantly
(
exceed the mean reduction in levels of systolic blood pres- ^
sure for the control group. ;
3. The mean increase in levels of hand temperature
for the treatment group will not significantly exceed the :
I
mean increase of levels of hand temperature for the control !
group. !
4. The mean reduction in levels of psychological
tension (as measured by the anxiety differential) for the
treatment group will not significantly exceed the mean
reduction in levels of psychological tension for the control
group. !
I
5. The mean reduction in levels of psychological
tension (as measured by the state-trait anxiety inventory)
for the treatment group will not significantly exceed the ,
mean reduction in levels of psychological tension for the
control group.
231
Design !
A total of 2 7 female and 3 male volunteers from
introductory psychology classes in the Los Angeles Com
munity College District served as participants. The par- |
I
ticipants were randomly assigned to either a treatment group!
which received auditory thermal biofeedback of left hand
temperature or a control procedure consisting of the in
struction to relax and rest quietly using their own methods !
I
(Paul, 1966; Schandler & Grings, 1975). Auditory thermal |
biofeedback involved the use of auditory tone changes to j
correspond to each .1° Fahrenheit increase or decrease in '
left hand temperature. The participant was instructed !
merely to listen to the tone and to concentrate on elevating
the sound in tone and pitch. Control participants were
instructed to relax and rest quietly using their own
I
methods. ^
I
Upon entering the experimental room for the first ;
time, the participant was placed in a seated position in a
comfortable armchair. The participant then completed the
I
anxiety differential and the state-trait anxiety inventory. |
I
Electrodes were then attached to the frontalis muscle and i
the temperature probe was attached to the base of the left
index finger. The participant was assured that neither
I
24
shock nor other unpleasantries were involved. The partiel- I
I
pant's blood pressure was taken and recorded. ;
!
The experimental session was divided into three
periods. An initial period of 6 minutes was used to obtain j
f
I
pretreatment measures. During this period all participants |
were instructed to relax and rest quietly using their own
methods. The treatment period followed and had a duration
of 21 minutes. Finally, a 9-minute posttreatment period,
identical procedurally to the pretreatment period, was used.
I
The final 6 minutes of the posttreatment period were used to
obtain muscle tension and temperature data. At the conclu
sion of the posttreatment period, blood pressure was again
taken and recorded. The electrodes and temperature probe
were then removed and the participants once again completed
the anxiety differential and the state-trait anxiety in
ventory. i
I
Frontalis muscle tension was measured in microvolts. :
The microvolt readings were integrated over a 3-minute
period to obtain an average muscle tension level. The skin
temperature was measured in degrees Fahrenheit and inte
grated over the same time period as the muscle tension. j
Figure 1 depicts the sequence of events that indi- !
viduals in each group experienced. I
j
25
PERIOD PRETREATMENT TREATMENT POSTTREATMENT
Treatment
group
Instructions
to relax
Auditory
thermal
biofeedback
Instructions
to relax
i
Control
group
Instructions
to relax
Instructions
to relax
Instructions !
to relax
Minutes 1-6 7-27 30-36
Figure 1. Sequence of Procedures
for Participants
26
Subjects
The participants for this study were 30 male and :
female volunteers from introductory psychology classes in
the Los Angeles Community College District. The sample
included 27 female students and 3 male students. Partiel- !
pants were randomly assigned to either the treatment or con-|
trol procedures. All participants were at least 18 years of
i
age. j
t
Instrumentation |
Muscle tension data were obtained using a model 502a
Toomim electromyometer connected to a model 507 Toomim digi
tal integrator; skin temperature was obtained through the
use of a model 5 06 Toomim digital thermometer connected to a
model 507 Toomim digital integrator. Blood pressure was
measured using a Taylor manual sphygmomanometer. Psycholog
ical tension levels were assessed from administrations of
the anxiety differential (Huseck & Alexander, 1963; Paul,
1966) and the state-trait anxiety inventory (Spielberger et
al., 1970).
I
i
Statistical Analysis I
I
A one-way ANOVA (fixed constants model) was used.
The treatment either thermal biofeedback or a control pro-
I
I
27
cedure) constituted the independent variable. ANOVA was *
used to statistically test the null hypotheses that the mean
reductions (from pretreatment to posttreatment) in levels of
muscle tension, blood pressure, and psychological tension I
for the treatment group did not significantly exceed those
of the control group.
A one-way ANOVA (fixed constants model) was also
used to statistically test the null hypothesis that the mean
increase (from pretreatment to posttreatment) in levels of
hand temperature for the treatment group did not signifi-^
cantly exceed those of the control group. The level of sig-^
nificance was set at p < .05. I
Limitations
The major limitation of this study was that the
sample was limited to college student volunteers. There
was also the possibility of sex bias due to the relatively ^
1
small number of male participants. The generalizability was
restricted by the reliability and validity of the instru
ments selected for use in the study, by the degree of coop- !
(
eration and attitudes toward the experimental session by the
I
participants, and by the reactive effects from the experi- j
mental setting and the data collection procedures.
I
28
Summary
This chapter describes the participants of the
study, the design, and the statistical procedures used to
analyze the data collected. The general hypothesis was
stated with concomitant specific hypotheses operationally
stated in null form. The limitations were noted relative
to the sample and procedures used.
CHAPTER IV
FINDINGS
The purpose of this chapter is to discuss and evalu
ate the data. The findings are presented by hypothesis and
the chapter concludes with a summary statement. The general-
I
hypothesis was that participants who received a thermal bio-j
feedback procedure would demonstrate lower levels of muscle I
tension than would participants who received a control pro
cedure. In addition it was hypothesized that participants
who received a thermal biofeedback procedure would evidence
lower levels of systolic blood pressure and psychological
tension. It was further hypothesized that participants who
were provided with thermal biofeedback would demonstrate
increased levels of hand temperature, as compared to partic
ipants who received a control procedure. ;
The following is a brief discussion of the results !
I
of each of the five directional hypotheses. A one-way ANOVA
(fixed constants model) was used to provide information I
regarding differences between groups. The level of signifi
cance was set at p < .05.
30
1. The hypothesis that the mean reduction in levels
of muscle tension for the treatment group will significantly
exceed the mean reduction in levels of muscle tension for
the control group was evaluated to provide information ;
regarding differences between the two groups. The differ- I
I
ence was significant (F = 4.64, = 1, 28, p < .05), allow-!
ing rejection of the null hypothesis (see Tables 1 and 2). |
(
2. The hypothesis that the mean reduction in levels
of systolic blood presssure for the treatment group will >
i
significantly exceed the mean reduction in levels of sys- ;
I
tolic blood pressure for the control group was evaluated to •
provide information regarding differences between the two
groups. The difference was significant (F = 27.36, dÆ = 1, '
28, p < .05), allowing rejection of the null hypothesis
(see Tables 3 and 4).
3. The hypothesis that the mean increase in levels
of hand temperature for the treatment group will signifi
cantly exceed the mean increase in levels of hand tempera
ture for the control group was evaluated to provide infor- !
mation regarding differences between the two groups. The
difference was significant (F = 17.81, df = 1, 28, p < .05),*
allowing rejection of the null hypothesis (see Tables 5
and 6).
i
311
Table 1
Muscle Tension Difference— ANOVA
Source of
Variance
Sum of
Squares â Æ
Mean
Squares F
Significance
of F j
Between
Groups 16 . 73 1 16.73 4.64
1
0.038 i
Within
Groups 101.00 28 3.61
Total 117.73 29
Table 2
1
1
i
1
1
i
1
Mean Differences in Pretreatment and Posttreatment--
Muscle Tension Measure |
Group n Mean
Standard
Deviation
Control 15 -1.24 1.93
Thermal
Biofeedback 15 -2.74 1.87 ;
Total 30 -1.99 2.01 j
_ . 3 2 J
Table 3
Systolic Blood Pressure Difference— ANOVA
Source of
Variance
Sum of
Squares df
Mean
Squares F
Siqnificance:
of F I
Between
Groups 388.80 1 388.80 27.36 0.001
1
Within
Groups 397.87 28 14.21
!
Total 786.57 29
Table 4
!
Mean Differences in Pretreatment and Posttreatment—
Systolic Blood Pressure Measure
Group n Mean
Standard
Deviation
Control 15 -4. 73 2.69 1
1
Thermal
Biofeedback 15 -11.93
1
4.61
Total 30 -8.33 5.21 -
33
Table 5
Hand Temperature Difference--ANOVA
Source of
Variance
Sum of
Squares df
i Mean
Squares F
Significance j
of F
Between
Groups 123.02 1 123.02 17.81 0.001 '
Within
Groups 193.37 28
Total 316.38 29
'
Table 6
i
Mean Differences in Pretreatment and Posttreatment--
Hand Temperature Measure
Group n Mean
standard
Deviation
Control 15 0.81 1.12 '
Thermal
Biofeedback 15 4.86 3.54
Total 30 2.84 3.30
34
4. The hypothesis that the mean reduction in levels
of psychological tension (as measured by the anxiety differ
ential) for the treatment group will significantly exceed
the mean reduction in levels of psychological tension for i
the control group was evaluated to provide information re- i
garding differences between the two groups. The difference
was not significant (F = 0.74, dJE = 1, 28, p > .05). The re
fore the null hypothesis was accepted (see Tables 7 and 8). ;
I
5. The hypothesis that the mean reduction in levels
I
of psychological tension (as measured by the state-trait i
anxiety inventory) for the treatment group will signifi^
cantly exceed the mean reduction in levels of psychological ;
tension for the control group was evaluated to provide in
formation regarding differences between the two groups. [
The difference was not significant (F = 2.34, d^ = 1, 28,
I
p > .05). Therefore, the null hypothesis was accepted (see j
Tables 9 and 10). !
I
Discussion
The general hypothesis, that participants who
received a thermal biofeedback procedure would demonstrate
lower levels of muscle tension than would participants who
received a control procedure, was significant (p < .05).
The hypothesis that participants who received a thermal !
- __
Table 7
Psychological Tension Difference
(Anxiety Differential)— ANOVA
Source of
Variance
Sum of
Squares
Mean
Squares F
Significance■
of F
Between
Groups 270.00 1 270.00 0.74 0.403 ;
Within
Groups 10267.21 28 366.69
1
Total 10537.20 29
!
Table 8
Mean Differences in
Anxiety
Pretreatment and Posttreatment--
Differential Measure
i
Group n Mean
Standard
Deviation
Control 15 -12.40* 21.13 :
Thermal
Biofeedback 15 -18.40 16.94 •
Total 30 -15.40
!
19.06 ;
*Negative change equals a decrease in anxiety
36
Table 9
Psychological Tension Difference
(State-Trait Anxiety Inventory)— ANOVA
Source of
Variance
Sum of
Squares
Mean
Squares F
Significance
of F
Between
Groups 202.80 1 202.80 2.34 0.134
Within
Groups 2423.07 28 86.54
■
Total 2625.87 29
Table 10
1
Mean Differences in Pretreatment and Posttreatment—
State-Trait Anxiety Inventory Measure
Group n Mean
Standard
Deviation
Control 15 -8.33* 8.45
Thermal
Biofeedback 15 -13.53 10.06
Total 30 -10.93 9.52 1
^Negative change equals a decrease in anxiety
37
biofeedback procedure would demonstrate lower levels of
systolic blood pressure was also significant (p < .05). The
hypothesis that the group that received a thermal biofeed
back procedure would evidence increased levels of hand tem
perature was also significant (p < .05). Thus the differ- |
i
ences in all of the physiological dependent variables were |
significant. |
I
The hypothesis that participants who received a |
!
thermal biofeedback procedure would demonstrate lower levels
i
of psychological tension was not significant. The level of |
significance was set at p s .0,5. Neither the differences :
on the anxiety differential (p = .403) nor the differences ;
on the state-trait anxiety inventory (p = .134) were sig
nificant. While Schandler and Grings (197 5) did find some
significant effect for a biofeedback procedure on psycho
logical tension levels, more recent studies investigating
the effect of a biofeedback training procedure on a variety '
i
of self-report measures of anxiety and relaxation (Bear,
1977; Coursey, 1975; Jessup & Neufeld, 1977) failed in gen
eral to find a significant effect. The evaluation of the ,
present data would appear to be somewhat congruent with the '
I
latter more recent literature. !
38
CHAPTER V
SUMf/IARY, CONCLUSIONS, AND RECOmENDATIONS
Summary ;
I
Over the past few years a number of reports (Morris,,
i
1972; Pines, 1970) and even books (Karlins & Andrews, 1972; =
I
Lawrence, 1972) have appeared in the lay press about the |
i
I
miracles and wonders of a new kind of treatment for a vari
ety of ills. This treatment, biofeedback training, has been
hailed as a panacea for most psychosomatic disorders, with
diseases as diverse as hypertension, migraine headaches,
cardia arrhythmias, and epilepsy yielding to this mighty '
new tool (Blanchard & Young, 1974). =
Melzack (1975) pointed out that with high technology
and high hopes combined, there had appeared the new glorious
panacea: no pills, no side effects, just train the mind
(with the aid of elegant electronic equipment), and it will
prevail over bodily functions. Melzack also stated that it ;
was time to stop the exhilarating speculations and to carry
out well-controlled research instead. '
1
I
The impetus of the present study was the need for '
I
experimental studies into alternative nonchemical methods |
useful in developing muscle relaxation. These methods '
would have broad applicability in the fields of psychology, 1
medicine, and special education. j
The literature concerned with this study, research
into electromyographic (musele-activity) assisted muscle
relaxation and research with thermal (skin temperature)
feedback, revealed that the effectiveness of electormyo-
. graphic biofeedback's contribution to muscle relaxation had
:
not yet been established. The literature also suggested
that while there was evidence as to the efficacy of thermal |
biofeedback training in the treatment of migraine headache j
patients, there appeared to be some conflicting data rele
vant to its effectiveness in the reduction of muscle ten
sion. In light of these findings, this study proposed to
test the effectiveness of thermal biofeedback on muscle
relaxation experimentally.
A number of hypotheses were proposed to test the
effect of a thermal biofeedback treatment procedure as com-.
pared to a control procedure. An experimental design was j
devised with which to test these hypotheses, involving the ’
measurement of levels of muscle tension, systolic blood ■
401
pressure, and hand temperature, as well as scores on two
self-report measures of psychological tension.
A one-way ANOVA (fixed constants model) was used to
statistically test the null hypotheses that the mean reduc
tions (from pre treatment to posttreatment) in levels of ^
musle tension, blood pressure, and psychological tension for
the treatment group did not significantly exceed those of ^
the control group. ANOVA was also used to statistically !
test the null hypothesis that the mean increase (from pre- |
treatment to posttreatment) in levels of hand temperature !
f
for the treatment group did not significantly exceed those '
of the control group. -
Conclusions
Evaluation of the above findings led to the follow
ing conclusions:
1. Participants who received a thermal biofeedback
treatment procedure demonstrated significantly lower levels
of muscle tension (p < .05) than participants who received
a control procedure.
2. Participants who received a thermal biofeedback
treatment procedure demonstrated significantly lower levels
of systolic blood pressure (p < .05) than participants who
received a control procedure.
41
3. Participants who received a thermal biofeedback
treatment procedure demonstrated significantly increased ;
levels of hand temperature (p < .05) over participants who
I
received the control procedure. I
4. Participants who received a thermal biofeedback
treatment did not evidence significantly lower levels of !
i
psychological tension. Neither the differences on the '
!
anxiety differential (p = .403) nor the differences on the \
state-trait anxiety inventory (p = .134) were significant. }
I
These data indicate that there was a significant 1
difference between the participants who received a thermal •
I
I
biofeedback treatment and those receiving a control procedure
in all of the physiological dependent variables. The treat
ment group showed lower levels of muscle tension and sys
tolic blood pressure, along with increased hand temperature.
The results did not show significantly lower levels
of psychological tension for participants who received the '
thermal biofeedback treatment. This finding appears to be !
somewhat congruent with the more recent literature (Bear,
1977; Coursey, 1975; Jessup & Neufeld, 1977) that has
attempted to examine the effects of biofeedback training on j
I
a variety of self-report measures of anxiety and relaxationJ
!
While the differences between the thermal biofeedback group '
i
42l
and the control group were nonsignificant, both groups did ■
exhibit decreased scores on the two psychological self-
report measures (indicating lower levels of psychological
tension). A possible factor in this lack of significance ■
may lie in some interesting anecdotal data that arose at
the conclusion of the experimental session. Virtually every
participant at the conclusion of the experimental session, '
without any prompting whatsoever, verbally reported how ,
calm and relaxed they felt. This anecdotal evidence is in ;
accord with the statement by Wickramasekera (1974) that bio-j
I
I
feedback may lead to a technology for creating more powerful-
and reliable placebos. i
In summary, the data from this study suggest that
there appear to be significant experimental differences in
muscle tension, systolic blood pressure, and hand tempera
ture between participants who received a thermal biofeedback
treatment and participants in a control procedure.
Recommendations
While these data suggest significant differences in
the effects of thermal biofeedback on certain physiological |
variables, it is recommended that additional research be
conducted to answer questions that have arisen as a result
of this study:
43'
1. Would similar results have been found with an ^
all-male sample?
2. What would the effect of this procedure be on a
psychiatric patient population? Jessup and Neufeld (1977) i
j
noted that psychophysiological differences between psychiat-j
I
ric patients and other subject groups suggest that a train- ;
ing procedure found to be effective for reducing arousal in
normals must be assessed for its effect on patients before '
it can be recommended as a clinical treatment. i
I
I
3. Would similar results be found in the evaluation
!
of this treatment procedure with other age groups (i.e., ;
children and the elderly)? '
4. What are the relative merits of thermal biofeed
back as a relaxation technique over other methods such as
transcendental meditation, autogenic training, or Jacobson's
progressive relaxation procedure?
While the results of this study are significant,
they only provide impetus for further research in evaluating
the effectiveness of thermal biofeedback training as a tech
nique in muscle relaxation. Miller (1972) pointed out that
when it comes to accurate visceral perception, we are all i
novices, but with the help of modern instrumentation perhaps
we can be trained to be experts. |
!
44!
REFERENCES
45
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51

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Asset Metadata

Creator Bongar, Bruce Michael (author)

Core Title Thermal biofeedback as a psychological treatment in muscle relaxation

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Philosophy

Degree Program Education (Counseling Psychology)

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,psychology, physiological

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-452496

Unique identifier UC11247755

Identifier usctheses-c26-452496 (legacy record id)

Legacy Identifier DP24184.pdf

Dmrecord 452496

Document Type Dissertation

Rights Bongar, Bruce Michael

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA