Biofeedback and relaxation training in the treatment of psychophysiological disorders: or are the machines really necessary?

Caffeic acid and its derivatives as potential modulators of oncogenic molecular pathways: New hope in the fight against cancer

As a phenolic acid compound, caffeic acid (CA) can be isolated from different sources such as tea, wine and coffee. Caffeic acid phenethyl ester (CAPE) is naturally occurring derivative of CA isolated from propolis. This medicinal plant is well-known due to its significant therapeutic impact including its effectiveness as hepatoprotective, neuroprotective and anti-diabetic agent. Among them, anti-tumor activity of CA has attracted much attention, and this potential has been confirmed both in vitro and in vivo. CA can induce apoptosis in cancer cells via enhancing ROS levels and impairing mitochondrial function. Molecular pathways such as PI3K/Akt and AMPK with role in cancer progression, are affected by CA and its derivatives in cancer therapy. CA is advantageous in reducing aggressive behavior of tumors via suppressing metastasis by inhibiting epithelial-to-mesenchymal transition mechanism. Noteworthy, CA and CAPE can promote response of cancer cells to chemotherapy, and sensitize them to chemotherapy-mediated cell death. In order to improve capacity of CA and CAPE in cancer suppression, it has been co-administered with other anti-tumor compounds such as gallic acid and p-coumaric acid. Due to its poor bioavailability, nanocarriers have been developed for enhancing its ability in cancer suppression. These issues have been discussed in the present review with a focus on molecular pathways to pave the way for rapid translation of CA for clinical use.

2-Methoxy-6-Acetyl-7-Methyljuglone: A Bioactive Phytochemical with Potential Pharmacological Activities

Natural products have been the focus of biomedical and pharmaceutical research to develop new therapies in recent years. 2-methoxy-6-acetyl-7-methyljuglone (2-methoxystypandrone, MAM), a natural bioactive juglone derivative, is known to have various levels of pharmacotherapeutic efficacies as an anti-inflammatory, anticancer, antioxidant, antimicrobial, and anti-HIV activity. MAM fights cancer progression by inducing apoptosis, necroptosis, and deregulating signaling pathways through H2O2-induced JNK/iNOS/NO and MAPK, ERK1/2 pathways, JNK activation, and the RIP1/RIP3 complex. In this review, we summarize the pharmacological importance of MAM in the field of drug discovery. Furthermore, this review not only emphasizes the medicinal properties of MAM but also discusses its potential efficacy in future medicinal products.

Oleandrin: A bioactive phytochemical and potential cancer killer via multiple cellular signaling pathways

Nerium oleander, a member of family Apocynaceae, is commonly known as Kaner in various countries of Asia and Mediterranean region. This plant has been renowned to possess significant therapeutic potential due to its various bioactive compounds which have been isolated from this plant e.g., cardiac glycosides, oleandrin, α-tocopherol, digitoxingenin, urosolic acid, quercetin, odorosides, and adigoside. Oleandrin, a saponin glycoside is one of the most potent and pharmacologically active phytochemicals of N. oleander. Its remarkable pharmacotherapeutic potential have been interpreted as anticancer, anti-inflammatory, anti-HIV, neuroprotective, antimicrobial and antioxidant. This particular bioactive entity is known to target the multiple deregulated signaling cascades of cancer such as NF-κB, MAPK, and PI3K/Akt. The main focus of the current study is to comprehend the action mechanisms of oleandrin against various pathological conditions. The current review is a comprehensive summary to facilitate the researchers to understand the pharmacological position of the oleandrin in the arena of drug discovery, representing this compound as a new drug candidate for further researches. Moreover, in vivo and in silico based studies are required to explore the mechanistic approaches regarding the pharmacokinetics and biosafety profiling of this compound to completely track its candidature status in natural drug discovery.

Systematic Review of Biofeedback Interventions for Addressing Anxiety and Depression in Children and Adolescents with Long-Term Physical Conditions

Children and adolescents with long-term physical conditions are at increased risk of psychological problems, particularly anxiety and depression, and they have limited access to evidence-based treatment for these issues. Biofeedback interventions may be useful for treating symptoms of both psychological and physical conditions. A systematic review of studies of biofeedback interventions that addressed anxiety or depression in this population was undertaken via MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases. Primary outcomes included changes in anxiety and depression symptoms and 'caseness'. Secondary outcomes included changes in symptoms of the associated physical condition and acceptability of the biofeedback intervention. Of 1876 identified citations, 9 studies (4 RCTs, 5 non-RCTs; of which all measured changes in anxiety and 3 of which measured changes in depression) were included in the final analysis and involved participants aged 8-25 years with a range of long-term physical conditions. Due to the heterogeneity of study design and reporting, risk of bias was judged as unclear for all studies and meta-analysis of findings was not undertaken. Within the identified sample, multiple modalities of biofeedback including heart rate variability (HRV), biofeedback assisted relaxation therapy and electroencephalography were found to be effective in reducing symptoms of anxiety. HRV was also found to be effective in reducing symptoms of depression in two studies. A range of modalities was effective in improving symptoms of long-term physical conditions. Two studies that assessed acceptability provided generally positive feedback. There is currently limited evidence to support the use of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions. Although promising, further research using more stringent methodology and reporting is required before biofeedback interventions can be recommended for clinical use instead or in addition to existing evidence-based modalities of treatment.

Relaxation Training Techniques — A Review Part Two: How Effective is Relaxation Training?

This article is part two of a literature review of relaxation training techniques. Part one presented descriptions of the major relaxation training techniques, and part two deals with their evaluation. Firstly, the general limitations and difficulties affecting research studies on the effectiveness of relaxation training methods are discussed. Secondly, brief critical appraisals of some examples of outcome studies on different relaxation training techniques are given, together with comments on their clinical application.

Behavioral Treatment of Psychophysical Disorders

The behavioral treatment of psychophysiological disorders is reviewed with an emphasis on group outcome research and controlled, comparative group outcome studies. These behavioral treatments tend to fall into three categories: (I) biofeed-back training; (2) relaxation training; and (3) other behavioral techniques including assertiveness training and systematic desensitization.

Guided by two inclusion criteria-seriousness as defined in terms of prevalence and mortality and the existence of a large body of research-this review discusses the following disorders: essential hypertensions, migraine headaches, muscle contraction headaches, asthma, ulcers, and colitis.

Applied Relaxation in the Management of Chronic Pain

Seventeen chronic pain patients at a rehabilitation center participated in an investigation of the effects of applied relaxation on chronic pain. The experimental group received regular rehabilitation treatment plus intensive training in applied relaxation. One control group received the regular rehabilitation treatment only, while another control group consisted of patients waiting for treatment. Results indicated that the applied relaxation group did significantly better than the control group(s) on measures of subjective pain, medication intake, activity, and overall evaluation of the treatments. This suggests that applied relaxation can be a valuable addition to chronic pain treatment programs.

Assessment and psychological management of recurrent headache disorders

This article updates earlier reviews of recurrent headache disorders published in 1982 and 1992, selectively reviewing research published since 1990. Current issues in assessment (headache diagnosis, psychophysiology, comorbid psychopathology, quality-of-life assessment, and new assessment technologies) and psychological treatment (efficacy, therapeutic mechanisms, treatment delivery, and integration with drug therapy) are addressed. The author emphasizes the need to adapt psychological treatments to the severity of the headache disorder and to developments in drug therapy. Opportunities for the integration of biological, medical, and psychological science are highlighted.

Biofeedback treatments of essential hypertension

Fifteen years of research in the self-regulatory treatment of hypertension by the author is summarized. A model relating expectations, task performance, home practice, and biochemical variables to the thermal biofeedback treatment of hypertension is presented.

Behavioral medicine in the general hospital

The application of behavioral procedures to the treatment of medical disorder has greatly expanded the techniques available to the psychiatrist practicing in the general hospital. While there are diverse behavioral strategies that have proven quite useful, the bases for these are limited and readily implemented in the hospital setting. In this paper, the behavioral methods of assessment and various strategies of treatment of medical, psychophysiological, and "psychosomatic" disorders are overviewed.

Steps toward a cognitive-behavioral model of relaxation

The prevailing model of relaxation posits a generalized state of reduced arousal, a position inconsistent with much relaxation research and clinical practice. This paper proposes an alternative model based on cognitive-behavioral principles. It hypothesizes that relaxation training has three effects: (a) reduced arousal, (b) development of cognitive skills of focusing, passivity, and receptivity, and (c) acquisition of increasingly abstract and differentiated cognitive structures supportive of relaxation. According to this perspective, different approaches to relaxation are not interchangeable but have quite different effects. Clinical implications are discussed.

Stress management techniques in childhood and adolescence. Relaxation training, meditation, hypnosis, and biofeedback: appropriate clinical applications

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.

Cost effectiveness of biofeedback and behavioral medicine treatments: a review of the literature

This paper reviews multicomponent behavioral medicine studies that contain cost-effectiveness and or cost-benefit data relevant to the field of biofeedback and relaxation training, primarily when assisted by biofeedback, with or without stress management, in the treatment of psychosomatic illness and pain. A model for evaluating biofeedback treatment is presented. Cost-effectiveness data concerning reduction in physician visits and/or medication use, decrease in medical care costs to patients, reduction in hospital stays and rehospitalization, reduction of mortality, and enhanced quality of life are reviewed. Evidence suggests that multicomponent behavioral medicine treatments are cost-effective on all dimensions reviewed. Cost/benefit ratios range between 1:2 and 1:5, with a median of 1:4. Evidence that could increase the cost effectiveness of biofeedback is reviewed.

EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain

24 patients with chronic low back pain were randomly assigned to three treatment conditions: EMG biofeedback, relaxation training, and a placebo condition. Patients were seen for eight sessions and were evaluated before Session 1 and after Session 8. Eight analyses of covariance which were adjusted for age and pretest scores were computed on the final scores to find which variables could detect significant difference between treatments. Age was included as a covariate because the differences in age between conditions were significant. Four variables with significant and nearly significant differences were chosen for analysis. The second set of analyses identified the nature of the differences among the three conditions. These included a priori planned comparisons among conditions, and paired t tests. Relaxation-trained subjects were significantly superior to subjects in the placebo condition, in decreasing pain during the function test, increasing relaxation, and decreasing Upper Trapezius EMG. They were superior to EMG Biofeedback training in increasing reported activity. Both Relaxation and EMG trained subjects were able to reduce Upper Trapezius EMG by Session 8. Relaxation-trained subjects showed significant change on eight of the 14 possible comparisons for each treatment condition. EMG biofeedback training showed significant favorable results in only one condition; the placebo condition showed no significant results. Relaxation training gave better results in reducing EMG and pain, and in increasing relaxation and activity than either EMG biofeedback alone or a placebo condition.

Personalized versus usual care of previously uncontrolled hypertensive patients: an exploratory analysis

This study was conducted to explore whether the quality of provider care may contribute to blood pressure reduction and whether other factors related to the treatment of hypertension may explain decline in blood pressure. In the study, 46 uncontrolled (greater than or equal to 140/90 mm Hg), medically treated hypertensive patients who received more personalized care differed significantly in the magnitude of blood pressure reduction from 36 usual-care patients (10/7 vs 2/2 mm Hg means for systolic and diastolic blood pressure reduction, respectively). About twice as many experimental patients as controls were reclassified as having "controlled" blood pressure, and this difference reached statistical significance. A multiple regression analysis for personalized-care subjects showed that no dynamic variables were related to blood pressure changes. It was postulated that more personalized care may have accounted for the significant difference between groups in blood pressure reduction. Similar personalized monitoring services might be important additions to usual medical care in order to control blood pressure more fully in high-risk hypertensive patients.

A review and clinical perspective on the use of EMG and thermal biofeedback for chronic headaches

A comprehensive survey of EMG and thermal biofeedback for chronic muscle contraction and migraine headaches is presented. The studies done to date suggest a high degree of short-term efficacy of biofeedback, which has been maintained on long-term follow-ups. While comparisons of biofeedback with relaxation generally have shown approximately equivalent effectiveness, the two forms of therapy may be differentially effective with different subjects. Attempts to correlate EMG and/or thermal parameters with headache parameters generally have failed to produce significant results, particularly in more recent and better-controlled studies; however, numerous technical and procedural difficulties have obscured meaningful interpretation of physiological data. Results with pseudofeedback do suggest a likely specific contribution of frontalis EMG to muscle contraction headaches, at least for some subjects. Comparable evidence for a specific contribution of thermal parameters to migraines is almost totally lacking. Clinical outcome research suggests that biofeedback in general may be more effective in younger anxious subjects who show no chronic habituation to drugs, and that there is little apparent benefit from repeating biofeedback for more than about 12 sessions maximum. Three broad areas for subsequent research are suggested: longitudinal study of EMG and thermal parameters in a naturalistic setting, specification of processes critically involved in biofeedback, and clinically relevant comparative outcome research with biofeedback and alternative therapies.

Relaxation for the treatment of headache. Controlled evaluation of two group programs

The effectiveness of two group relaxation programs for the treatment of headache were evaluated in comparison to a waiting-list control group. A group of 48 subjects diagnosed as either classic migraine, common migraine, muscle-contraction headache, or mixed headache were randomly assigned to one of three treatment conditions: self-help relaxation therapist-assisted relaxation, or waiting-list control group. Results indicated that both treatment conditions were superior to the waiting-list control group at one-month follow-up. Analysis of changes in headache within each treatment condition, diagnosis, and physiological changes during relaxation were significant predictors of treatment outcome. These findings were discussed in terms of the literature pertaining to the psychological treatment of headache.

The use of a new relaxation method in a case of tension headache

A tension headache sufferer was treated with a newly developed procedure called behavioral relaxation training that assumes relaxed postures. The client was a 21 yr old female who had a 15-yr chronicity of headaches. During treatment, headache activity was reduced to a near zero level. After the first week of behavioral relaxation training, a second week of that training was administered combined with EMG biofeedback, followed by one more week of behavioral relaxation training alone. The combination phase was employed to determine if the addition of biofeedback would produce a more relaxed state. There were no significant differences in terms of EMG levels of muscular activity. Results are discussed regarding alternative explanations of the results and future research proposals.

EMG levels in the occipitofrontalis muscles under an experimental stress condition

In view of the importance attached to the frontalis muscles by researchers into the etiology of head pain and its treatment by biofeedback techniques, it is surprising that no data have yet been reported on the functioning of the occipitalis muscles, which have a close physiological relationship to the frontales. This study explores the response of the frontalis and occipitalis muscles under a condition of experimental stress. Migraine and tension-headache sufferers were separately compared with a headache-free control group under four conditions: baseline, while listening to instructions, while carrying out an auditory vigilance task, and for a further resting period equivalent to baseline. Results showed that tension levels in the frontalis muscles were not elevated at rest in any of the experimental groups, nor were they significantly responsive to the experimental task. The occipitales however proved to have significantly higher levels in both the tension-headache and migraine groups during the task and recovery periods. The results for the tension group reached significance because of a drop in control group values. These results may have significance in determining the best site for electrode placement in biofeedback.

Sequence effects of relaxation training, EMG, and temperature biofeedback on anxiety, symptom report, and self-concept

Assessed the effects of particular treatment combinations of relaxation training, temperature, and EMG biofeedback on state-trait anxiety, symptom report, and self-concept. The four groups received one of the following sequences: (a) relaxation training, temperature, and EMG biofeedback; (b) temperature, EMG biofeedback, and relaxation; (c) temperature followed by EMG biofeedback; (d) EMG biofeedback followed by temperature. A sample of 37 volunteers participated in 16 20-minute training sessions over an 11-week period, which totaled 800 appointments. Training was found equally effective for decreasing frontalis EMG and increasing finger skin temperature, regardless of sequence. Most substantial improvement occurred after 8 sessions, whereas little improvement was found after 16 sessions. Each group became increasingly homogeneous over time on all measures.

Effectiveness of biofeedback for treating migraine and tension headaches: a review of the evidence

A review of the research reveals no evidence that finger temperature biofeedback training or temporal artery pulse biofeedback training is effective for treating migraine headaches. On the other hand, there is evidence that EMG biofeedback training is effective for treating tension headaches, but the EMG biofeedback training is not more effective than less complex and less expensive relaxation training. Reasons for the ineffectiveness of biofeedback training are discussed. The results of the controlled investigations are in sharp contrast to the prevailing beliefs and the results have a variety of implications.

Self-control procedures in biofeedback: a review of temperature biofeedback in the treatment of migraine

It is argued that in order to optimize the achievement of self-control and to evaluate the clinical effects of biofeedback three skills should be included in training and assessment, namely: (1) the ability of voluntary control with external feedback, (2) the ability of voluntary control without external feedback, and (3) the ability to apply the self-control skill in critical situations in everyday life. A review of the literature concerning temperature-biofeedback in the treatment of migraine headaches shows that the research from this point of view is in a rather poor state of affairs and that no definite conclusion can in fact be drawn about the degree of self-control which has been achieved and hence of the ultimate clinical value of biofeedback.

Controlled group designs in biofeedback research: ask, "What does the control group control for?"

The extant literature on the specific role of biofeedback in promoting skeletal muscular relaxation is reviewed and found deficient with respect to the use of properly controlled group outcome research. The review emphasizes the failure of commonly used control procedures to adequately control a number of potentially confounding variables. Strengths and weaknesses of three types of controlled group design (attention placebo, pseudofeedback, and altered contingency) are discussed with respect to their relative usefulness in controlling certain nonspecific or placebo effects in biofeedback research. Many published biofeedback studies failed to measure the credibility of control procedures or the subject's ability to discriminate different feedback contingencies. The studies reviewed suggest that the various control procedures used are not inert and are not equivalent with respect to their effects on control group behavior. The suggestion is made that the controlled group outcome design be accepted as the minimum requirement for testing the specific effects of biofeedback, and possible methods for improving control procedures are discussed.

Cognitive and cognitive-behavioral methods for pain control: a selective review

The literature on cognitive and cognitive-behavioral methods for pain control is selectively reviewed, with particular focus on controlled studies. Such methods include the provision of preparatory information, cognitive coping skills or strategies, the provision of preparatory information plus some form of coping skills instructions or training, prepared childbirth techniques, multifaceted cognitive-behavioral treatment regimens, and stress-inoculation training. Overall, the scientific evidence for the efficacy of cognitive and cognitive-behavioral methods for clinical pain attenuation is somewhat meager, although some encouraging but still tentative results have been obtained. There has been much work on the psychological elements involved in such strategies in the laboratory but there is still little sound information on their use for clinical pain. Several issues emerging from the literature review are discussed, with the need for further controlled evaluations being obvious.

The comparative effectiveness of heart rate biofeedback, speech skills training, and a combination of both in treating public-speaking anxiety

Forty-two speech-anxious undergraduate students (21 female, 21 male) were administered either heart rate biofeedback training, speech skills training, or a combination of both to aid in the alleviation of speech anxiety. Physiological (heart rate, tonic skin conductance level, systolic blood pressure, and diastolic blood pressure), overt motor, and self-report measures of anxiety were assessed during a pretreatment speech and two posttreatment speeches. Results indicated that all treatments were effective in lowering overt motor and self-report components of anxiety. However, only the biofeedback and combined group subjects demonstrated significantly less heart rate increase while speaking before an audience during the posttreatment assessment. Two individual difference variables examined in this study--cognitive/autonomic focus of anxiety and subjective confidence in treatment--were not found to significantly influence treatment effectiveness. Finally, factor analyses of the physiological data suggested that heart rate changes play a large role in the physiological component of anxiety.