PosterPDF Available

Vagal Recovery in Healthy Adults: A Normative Data Study



The sympathetic and parasympathetic nervous systems control the physiological expression of stress in mammals. These branches work in conjunction to regulate heart rate pattern. Porges (1995) has hypothesized that the vagus nerve evolved within the parasympathetic nervous system as a cardiac brake that creates a rhythmic acceleration and deceleration of heart rate associated with respiration, known as Respiratory Sinus Arrhythmia (RSA). Chronic stress can lead to parasympathetic withdrawal and a decrease in vagal influence on heart rhythm. Parasympathetic activity can be used as a measure of stress, and can be assessed by quantifying vagal tone from heart rate variability (HRV). Exercise can be utilized to mimic the natural stress response and recovery. The aim of the present study is to provide normative data on average vagal tone and vagal recovery in healthy adults. Participants (n = 30) were male and female, aged 18–65, with no co-morbid health or psychological issues. Participant HRV data was recorded using J + J Engineering’s I-330-C2+ and windows software. Each participant was recorded for a total of 13–15 min. Each recording included a 5-minute resting baseline, followed by 3–5 min of exercise on a stationary bike, and a 5-minute recovery period. Vagal tone was calculated for the baseline and recovery periods using the High-Frequency (HF) power (ms2) derived from recordings using Kubios HRV software. This study concluded that average baseline vagal tone in healthy adults was 6.67, while the mean change in vagal tone pre to post exercise was not significantly different (delta = -0.4, p = .179). Findings from this study will have widespread clinical and research applicability in the growing field of HRV biofeedback as a standard for healthy individuals and basis of comparison for future studies with diverse populations.
Abstracts of Papers Presented at the 45th Annual Meeting
of the Association for Applied Psychophysiology and Biofeedback
Springer Science+Business Media New York 2014
The 45th Annual Meeting of the Association for Applied Psycho-
physiology and Biofeedback (AAPB) was held at the Savannah
Hyatt Regency in Savannah, GA, March 19–22, 2014. The theme of
the meeting was ‘‘Applied Psychophysiology Comes of Age.’’ The
meeting included diverse program offerings and a full array of
exhibits, as well as preconference workshops. Abstracts for the oral
and poster presentations follow, using an * to recognize those judged
by the Program Committee to merit the special distinction as a
‘Citation’’ poster. The Program Committee members were Chair
Ron Rosenthal, Aubrey Ewing, Dick Gevirtz, Ben Greenberg,
Howard Hall, Robert E. Longo, Jan Newman, Barbara Peavey,
Patrick R. Steffen, and Richard Sherman. The 46th Annual Meeting
will be held March 11–14, 2015 at the Renaissance Austin Hotel in
Austin, Texas.
Oral Presentations
A Sufi Self-piercing Analyzed with EEG and sLORETA
Thomas F. Collura, PhD, MSMHC, BCN; Howard Hall, PhD,
BCB; Erik Peper, PhD, BCB
This oral presentation will include a video summary of the reported
work, as well as graphic data showing results in an unusual experi-
ment. An experienced Sufi practitioner was observed during the 2012
AAPB meeting in Portland, during which time he pierced himself
with skewers and did not experience significant pain or bleeding. As a
scientific experiment, his EEG was recorded with 19 channels and a
continuous sLORETA reconstruction of his brain activity was per-
formed. Using a normative database (John et al.), it was possible to
create images of unusual brain activation and deactivation in specific
locations related to pain perception. The results show that this
individual effectively self-regulated his brain activity in specific
locations, leading to the ability to endure an otherwise painful
experience, while remaining evidently comfortable and healthy.
Thomas F. Collura, PhD, MSMHC, BCN
195 Willis Street
Bedford, OH 44146
USA440 232-6000 x205
Sufi self-piercing
QEEG-Neurometric Analysis Guided Neurofeedback
Treatment in Dementia: 20 Cases. How Neurometric
Analysis is Important
Tanju Surmeli, MD, BCN, Associate Fellow
Dementia is characterized by a loss of cognitive function. Dementia
patients may have comorbid mood problems, sleep problems, or
agitation. They may need additional psychotropic drugs to address
these problems. Therefore, an effective non-drug alternative would be
very useful in this population that not only treats the cognitive
symptoms but the comorbid symptoms associated with this disorder.
In this study, we wanted to show the outcomes of a clinical case series
using QEEG in the assessment and NF in the treatment of dementia.
We studied 20 patients (9 male and 11 female). Before coming to our
center, almost half of the subjects were on or had taken an
antidementia drug. Some of the subjects were on more than one
psychotropic medication, with the most common being the concurrent
use of an antipsychotic and an antidepressant. Evaluation measures
included drug free QEEG analysis with the FDA approved Nx-LINK
data base, the Mini Mental State Exam (MMSE), Clinical Global
Impressions scale (CGI), Neuropsychological tests, and interviews
with the patient‘s family. Our hypothesis was that neurofeedback
treatment targeted towards normalizing the deviations from norms
seen in the QEEG would be the most beneficial treatment. All the
subjects showed improvement based on the CGI, Mini Mental State
Exam, and in interviews with the patients’ families. This study pro-
vides the first clinical evidence that NF treatment can produce
improvements in patients with Alzheimer’s Disease and Vascular
Dementia. It is recommended that further controlled studies with
additional outcome measures to be conducted.
Tanju Surmeli, MD
Kore Sehitleri caddesi No:49 Zincirlikuyu
Appl Psychophysiol Biofeedback (2014) 39:293–316
DOI 10.1007/s10484-014-9254-9
Istanbul, NY 34397
9 05335159470
The Effect of NeuroField on Parkinson’s Disorder:
A Case
Nicholas Dogris, PhD
The purpose of this case study was to investigate the effect of slow
frequency pulsed electromagnetic field (pEMF) stimulation on Parkinson
Disease symptoms. Initial research in this area conducted by Dr. Dogris in
2012 suggested that Parkinson symptoms could be reduced for a period of
time by stimulating the sensory motor cortex with 1–100 Hz low intensity
pEMF. During the initial research QEEG analysis showed a trend in
which delta absolute power was greater than three standard deviations
below the mean. It was then theorized that the thalamus, being a delta
generator, was not generating enough delta to inhibit the excitatory
function of the reticular activating system (RAS), thereby giving rise to
exponential neuronal firing of sensory motor neurons. This hypothesis
was put to the test in the following case study. A male diagnosed with
severe Parkinson’s Disease was given 1–4 Hz pEMF stimulation for
45 min per day, twice a day, for six weeks. The NeuroField low intensity
pEMF system was used to deliver the treatment by placing four individual
coils over the entire sensory motor strip. Four QEEG acquisitions were
conducted pretreatment during treatment, post treatment, and six week
follow-up. Statistical analysis of the QEEG data showed significant dif-
ferences between each QEEG acquisition. The most salient finding was
that the six week follow up QEEG showed continued improvement in the
delta absolute power z-score. Patient ratings of Parkinson symptoms
showed a significant decrease in tremor, rigidity, insomnia and cognitive
difficulties. pEMF appears to have clinical value in reducing the symp-
toms of Parkinson’s Disease. Further research is warranted in this area that
should test large group samples with a randomized control group design.
Nicholas Dogris, PhD
PO Box 506
Bishop, CA 93515
Parkinson disease
Pulsed Electromagnetic Field Stimulation
Infraslow EEG and Gamma: Cross-Spectral Coupling
and Consciousness
Jay Gunkelman, QEEG-Diplomate
Modern Neurofeedback methods use techniques oriented to the infra-
slow EEG below 0.5 Hz and also to gamma, allowing a wide spectrum of
activity to be used as feedback. A system explaining the interaction
across the spectrum of the infraslow and faster EEG rhythms, fromTheta
and alpha to beta and gamma. Concepts such as the bispectrum or ‘‘cross
spectral coupling’’ and ‘‘nesting’’ are used in modern neuroscience, and
this phenomenon can be seen in the clinical work done with modern tools
such as wavelet analysis and the JTFA displays in ADHD. A model of
consciousness holding within it the fundamentals of cross spectral cou-
pling and the infraslow and gamma bands will be presented.
Jay Gunkelman
4637 Chabot Drive, Suite 102
Pleasanton, CA 94588
Cross spectral coupling
Infraslow and gamma bands
The Dynamics of Joy: Towards a Neuroscience-Based
Model of Cognitive-Emotional Regulation
Thomas Collura, PhD, MSMHC, BCN
This talk will describe the author’s integration of recent research that
provides an updated brain-based view of cognitive and emotional
processing. Based on findings related to brain activation during dif-
ferent emotional states, it is possible to identify different roles of the left
and right hemispheres in producing and regulating emotional respon-
ses. Whereas rapid, parallel processing leads to judgments related to
whether situations are ‘‘bad’’ or ‘‘dangerous,’’ more time-consuming
sequential processing is required in order to arrive at judgments of
‘good’’ or ‘‘safe.’’ As a result, the relative time and effort required to
achieve and maintain positive versus negative affect can be analyzed in
a dynamic model. It is shown that emotional states can be understood in
terms of being either reactions to stimuli, or as the results of sustained
intrinsic mechanisms. Implications for interventions such as counsel-
ing, medication, and bio/neurofeedback, are discussed.
Thomas F. Collura, PhD, MSMHC, BCN
195 Willis Street
Bedford, OH 44146
USA440 232-6000 x205
Cognitive and emotional processing
Cognitive Enhancement with LORETA Z-Score
Lucas Koberda, MD, PhD; Andrew Moses, Student; Paula
Koberda; Jessica Winslow
Our group has already previously reported evidence of successful
cognitive enhancement (Koberda, 2012; Koberda, Moses, Koberda, &
294 Appl Psychophysiol Biofeedback (2014) 39:293–316
Koberda, 2012) with Low Resolution Electromagnetic Tomography
Analysis (LORETA) Z-score Neurofeedback (NFB). One case report
included an individual with Asperger’s Syndrome (Koberda, 2012)
associated with speech expressive dysfunction; another one described a
student with low information processing speed and decreased memory
(Koberda et al., 2012). This presentation contains a larger case series
report where 35 consecutive patients complaining of cognitive dys-
function were subjected to LORETA Z-score NFB therapy. Before
NFB initiation these patients were evaluated with computerized cog-
nitive testing in order to document and confirm any cognitive
dysfunction reported in chief complaint. Many patients underwent
brain imaging and laboratory testing to rule out any treatable condition
that could have contributed to the patient’s symptoms. Electrical
imaging with QEEG/LORETA localization was also completed in
order to visualize any area of cortical electrical dysregulation which
could have been potentially responsible for the patient’s symptoms
(with specific Brodmann’s Areas). The NFB protocol was based either
on the patient’s symptoms, the area of cortical dysregulation, or both.
After 10 sessions of surface/LORETA Z-score NFB the computerized
cognitive testing and QEEG were repeated in order to see if any
increase in cognitive score and/or reduction in QEEG abnormalities
were achieved. In addition, the subjective patient’s response was
recorded as to whether or not they felt that the therapy was beneficial.
25 patients (71 %) were identified as having an objective improvement
(on average 10 points) through cognitive testing. In addition the sub-
jective cognitive improvement and an objective reduction of QEEG
abnormalities with NFB were also achieved in most of the patients.
These results are very promising and indicate good effectiveness of
LORETA Z-score NFB in cognitive enhancement.
Lucas Koberda, MD
4838 Kerry Forest Parkway
Tallahassee, FL 32309
Cognitive dysfunction
Introduction to Pulsed Electro-Magnetic Field
Stimulation with BrainMaster’s MIcrotesla
John N. Demos, MA, LCMHC, BCIA-EEG
This talk will describe the author’s recent research into pulsed Electro-
Magnetic Field stimulation (pEMF). It will include the history of pEMF
for the treatment of physiological disorders as well as recent develop-
ments in the application of pEMF for brain disorders.Participants will be
introduced to the fundamentals of both pulsing electro-magnetic fields as
wells as pulsing photic stimulation. Case studies will demonstrate the
efficacy of these therapeutic interventions, especially when they are
combined with neurofeedback training. Users will learn the advantage of
using z-score statistics to guide protocol selection and more specifically
frequency output. Participants with MicroTesla equipment installed on
BrainMaster as well as Dz-Caps to hold pEMF coils will be able to add
this new modality to their practice after the workshop.
John N. Demos, MA
PO Box 5
Westminster, VT 5158
Pulsed electromagnetic field stimulation
Pulsing photic stimulation
Psychophysiological Applications in Sport Shooting
Emily Ortega, PhD Candidate
In recent years, sport psychologists have increasingly used biofeed-
back training as an objective means to help elite athletes perform
better in competitions. The main goal of biofeedback training for
athletes is to enable them to enhance their functioning to perform
better than their previous levels (Moss & Tattenbaum, 2011).
Research on sport shooters has shown that biofeedback training is an
effective means of improving shot accuracy while enhancing self-
awareness and psychophysiological control (Couture et al., 1999). In
sport shooting, the ability to regulate arousal levels is even more
critical as compared to other sports because the shooter needs to stay
focused over a series of forty to sixty shots to shoot consistently good
shots. The shooter is required to stay disciplined to his or her shot
cycle routine to ensure accuracy and consistency. Slight changes in
the shooter’s routine and arousal level can cause a poor shot (less than
10). Currently, with perfect scores commonly achieved at interna-
tional competitions, one miss may be enough to cause a shooter to
lose out on a medal. This presentation showcases biofeedback training
programmes that have been done with elite developmental shooters
and army shooters to enhance their psychophysiological awareness to
get into the optimal state for each shot. Shooters were profiled and
taught various psychophysiological strategies based on their profiles
to help enhance their shooting performance. Heart rate variability
training was introduced and both heart rate and respiration rate were
monitored during live shooting to monitor each shooter’s optimal shot
cycle. The biofeedback training programmes were well-received by
both the shooters and the coaches alike as it provided them with an
objective means to ‘‘look inside the shooter’’ and help them to fine-
tune their shooting for optimal performance during competitions.
Emily Ortega
93 Lorong N Telok Kurau
425244 Singapore
Sport shooting
Heart rate variability
Resperation rate
To Observe the Effect of Spiritual Interventions
on Physiology of Persons
Gajanan Kelkar, M. Tech (ITT Mumbai)
At Manashakti Centre Lonavla (MCL), India, it was planned to study
the effects of spiritual interventions on the human mind and body.
Appl Psychophysiol Biofeedback (2014) 39:293–316 295
The spiritual intervention included daily meditation; prayer; deep,
slow and abdomnial breathing and selfless work. Twenty-five seekers
(disciples who practiced mediation over the years-14 ladies and 11
gents-over the ages 35 to 72) volunteered for the study. They stayed in
the center for one month, from 1st Feb 2013 to 28th Feb 2013, and
participated in the study while being monitored. For one month they
were given the above mentioned spiritual intervention. On the 4th,
15th and 28th of Feb each of them were subjected to a mind stress
test, incorporating the Stroop Color test, a Math stress test, and a Talk
test to recall an unhappy incident. Prior to and during the test, five
readings of physiology were taken, e.g. (1) skin conductance (SC), (2)
heart rate (HR), (3) EMG, (4) body temperature (TEMP) and (5)
respiration (RES) on a Nexus machine. It is known through the lit-
erature that commonly used normal specifications are as follows: for
Temp [91 F, Resp \12 bpm, EMG\3 mv, HR 60–80 bpm, and SC
\5 micosiemens. In our study we generated 15 records for each
individual, but we could analyze only records on 16 individuals for
further study (due to artifacts). Marginal analysis of these indicated
that HR was normally distributed and the mean and variance of 15th
Feb was smaller than that of measurements on 4th Feb. It turned out
that the rest of the four measurements followed a Weibull distribution
and the shape parameter also changed after 15 days at the MCL. The
shift in the shape parameter caused a change in variation, also. Further
the 5th and 95th percentiles of these distributions indicated that the
limits for the class of the chosen group of ‘‘seekers’’ may be different
than the specifications known in literature. Because this study is based
on a small sample size, the estimated parameters should be treated as
tentative and in need of further study. Based upon current data, we
offer the following preliminary conclusions. 1. There is improvement
in readings of temperature. 2. For HR there seemed to be improve-
ment from the 4th to 15th Feb. 3. For EMG there was no significant
difference in readings. 4. There was little improvement in SC between
the 4th and 15th Feb, but the values were improved between the 15th
and 28th Feb. 5. For respiration, there was improvement during the
15th and 28th Feb. Thus our spiritual intervention gave an indication
of positive improvement in some of the physiological parameters
improving general wel-being of the persons.
Gajanan Kelkar
76, Mumbai Pune Rd
Maharashtra 410401 India
Spiritual interventions
Stress testing
Using Biofeedack and Health Coaching for Chronic
Disease Self Management at the Veterans
Krystin Buckley, Health Coach, MHA; Lindsay Weinstein, MPH
The battleground for Veterans returning from deployment is the risk
for chronic disease and poor self management skills. In primary care
settings, almost 50 % of Veterans seen in primary care will have
hypertension, 80 % of Veterans will be overweight or obese, and over
20 % will have diabetes. Biofeedback can assist Veterans in taking
charge of their health, as preliminary evidence reveals. Biofeedback-
assisted therapies can improve chronic diseases like hypertension,
diabetes mellitus, and coronary artery disease, and emotional disor-
ders such as anxiety or PTSD. Biofeedback is used to promote health
behaviors while also helping Veterans to improve self management
skills. Patients undergoing Biofeedback therapy have also reported
improvements in quality of life. At the Veterans Administration,
Biofeedback is used in individual and in group treatment. Our 6-week
classes include interventions in self-regulation. Patients learn to use
biofeedback to promote health and to prevent disease. This is coupled
with Motivational Interviewing techniques and health coaching, as it
is equally important for patients to set goals for biofeedback practice
and to integrate self regulation skills into everyday life. This pre-
sentation discusses the importance of Biofeedback and Health
Coaching in promoting health at the Veterans Administration.
Krystin Buckley
11301 Wilshire Blvd
Los Angeles, CA 90073
Health coaching
The Cause is Not the Location of the Pain: SEMG
and Pandiculations to Reduce Chronic Shoulder
and Head Pain
Erik Peper, PhD, BCB
Surface electromyography (SEMG) is a useful diagnostic tool to
identify covert dysfunctional muscle bracing patterns. Using a bilat-
eral upper trapezius SEMG protocol adapted from Sella (tighten a
muscle for 10 s, relax for 10 s, repeat five times), dysfunctional
muscles are often observed on the opposite side of the body from the
reported location of pain. The dysfunctions include ongoing muscle
activity after contraction during the relaxation period (the subject
thinks the muscle has relaxed) and significant amplitude differences
between the right and left muscles while performing the similar tasks.
Although SEMG feedback can be successful in teaching clients to
relax the muscle, in some cases somatic pandiculation strategies are
more effective to normalize muscle activity, within a few minutes.
The integration of SEMG assessment and training with somatic
practices is illustrated by clinical case examples such as the successful
intervention with a 40+ year old female who had suffered 30 years of
headaches and 20 years of severe left shoulder pain.
Erik Peper, PhD
1600 Holloway Ave
San Francisco, CA 94132
Somatic pandiculation
296 Appl Psychophysiol Biofeedback (2014) 39:293–316
What the Sella Protocol Can Tell Us About Muscle
Annette Booiman, MSCT, BCB
Discomfort and pain are often the reason for a less energetic and joyful
life. The performance of the muscles is very essential for that wellbeing
of a person. The Sella protocol is a quick and very useful assessment
protocol for the clinician to obtain an idea of particular muscle function.
The protocolcan show if the muscles staytense after performinga task or
if they relax. The protocol can also provide information about left–right
differences or recruitment of the muscles. In this paper the implications
of what the Sella protocol tells us will be explained and shown by several
case examples. Clinicians will obtain an idea about how they can use this
protocol as it allows the invisible differences in muscle tension to
become visible and helps the therapist to develop a tailor made treatment
with the Sella protocol as a useful teaching approach.
Annette Booiman
Roerdompstraat 35
1531 XE Wormer
The Netherlands
Sella protocol
Treating PNS Dysfunction: Vagal Nerve Stimulation
Versus Biofeedback
Christine S. Moravec, PhD
This presentation will focus on reversing cardiovascular disease and the
accompanying autonomic imbalance. The anatomy and physiology of the
autonomic nervous system, and its role in chronic diseases such as heart
failure will be reviewed. The talk will focus mainly on the parasympathetic
nervous system, the anatomy of the vagus nerve, afferent vs efferent
signaling, the possibilities inherent in vagal nerve stimulation, anti-
inflammatory aspects of parasympathetic function, and a comparison, both
theoretical and empirical, of the effects of vagus nerve stimulation vs
biofeedback in the regulation of the parasympathetic nervous system.
Christine S. Moravec, PhD
9500 Euclid Ave, NE61
Cleveland, OH 44195
Parasympathetic nervous system
Vagal nerve stimulation
Effects of EEG Biofeedback on Experimental Cold
Perception and Tolerance
Luis Aguerrever, PhD
There is indication that EEG biofeedback training can help with the
pain experience. However, it is still unclear how exactly EEG
biofeedback influences pain perception or pain related behavior. The
purpose of the current project is to determine the strength of one EEG
biofeedback session using different protocols to decrease pain per-
ception and increase pain tolerance on healthy subjects. Data was
collected from 129 college students from a Southwestern university
located in the United States. Subjects were randomly assigned into five
training groups: Frontal location Beta frequency (N =23), Frontal
location Alpha/Theta frequency (N =23), Middle location Beta fre-
quency (N =25), Middle location Alpha/Theta frequency (N =18),
and simulation/sham (N =21). Participants experienced cold pressor-
induced pain after the EEG biofeedback training. To complete the cold-
pressor task participants placed their hand into a bucket of ice water at
approximately 40 degrees Fahrenheit and were asked to keep it in place
for as long as they could tolerate the discomfort or until completion of
3 min. A between subjects ANOVA was conducted on type of fre-
quency of neurofeedback training while measuring pain report and
tolerance. For pain report, results demonstrated no significant group
differences between participants trained at Middle Alpha frequency
(M =4.8, sd =2.5) and Simulation (M =6.4, sd =2.0). For pain
tolerance, significant results were obtained between those that trained
at Frontal Beta frequency (M =109.7, sd =70.3) and those trained at
Middle Beta frequencies (M =68.4, sd =63.1). Results demonstrated
that different EEG biofeedback protocols can have advantageous or
detrimental effects on pain perception and tolerance on the cold-press
task. These results are somewhat consistent with previous reports that
employed one- or two-channel electrode EEG biofeedback systems that
were frequently aimed at reducing excessive cortical beta activity.
However, location of the beta wave could also be beneficial for toler-
ance when this is found on the frontal cortex.
Luis E. Aguerrevere, PhD
2100 N Raguet, HSTC Bldg 105D
Nacogdoches, TX 75962
Cold pressor
EEG biofeedback
Optimizing Performance in Sport: Reaction Time
Training Combined with Biofeedback
and Neurofeedback with 200 Meter Canoe and Kayak
Sommer Christie, PhD Candidate
The difference between success and failure in 200-meter canoe and
kayak events is measured in milliseconds. Thus, the ability to focus
effectively and manage arousal is crucial to the ability to react quickly
off the start (e.g., Crews, Lochbaum, & Karoly, 2001). Mediated by
the ability to self-regulate physiologically and neurologically, bio-
feedback (BFB) and neurofeedback (NFB) training have been shown
to reduce anxiety, improve attention, and enhance performance (e.g.,
Bar-Eli, Dreshman, Blumenstein, & Weinstein, 2002; Galloway,
2011). This presentation will cover: (1) psychological skills necessary
for optimal performance in sport, (2) current review of the literature
in BFB/NFB training interventions in sport, (3) presentation of
research completed with flat water canoe and kayak athletes, and (4)
key takeaways for implementing optimal performance training into
Appl Psychophysiol Biofeedback (2014) 39:293–316 297
Sommer Christie
207-881 Sage Valley Blvd. NW
Calgary Alberta T3R 0R1
Sports performance
Case Study in Applied Psychophysiology: Using
Biofeedback and Neurofeedback with an Olympic
Penny Werthner, PhD
A number of key mental skills are associated with success at the
Olympic level (Gould & Maynard, 2009). Successful performance in
the highly stressful environment of the Olympic Games depends
greatly on an athlete’s ability to self-regulate his or her arousal levels
and to focus effectively (Gould, Dieffenbach, & Moffett, 2002). The
purpose of this case study was to explore the effectiveness of a bio-
feedback (BFB) and neurofeedback (NFB) intervention with an
athlete preparing for the winter 2010 Olympic Games in Vancouver,
BC. A 16-session BFB/NFB intervention case study will be discussed
in order to provide directions on effective work with high perfor-
mance athletes. This presentation will cover: (1) the three key
psychological skills required for optimal performance in Olympic
level sport, (2) the presentation of a case study with one Olympic
athlete, and (3) a discussion of the key findings in relationship to best
practices with high performance athletes.
Penny Werthner, PhD
2500 University Drive NW
Calgary Alberta T3R 0R1
Sports performance
Passive Training with Bedtime Stories
Elizabeth Bigham, PhD
The symptoms of chronic pain with a vascular component (i.e.,
migraines, irritable bowel syndrome, recurrent abdominal pain) respond
to psychophysiological interventions (i.e., cognitive therapy with bio-
feedback), vary with changes in diet (i.e., increased fiber, increased
water, etc.), and activity level (i.e., increased physical activity, decreased
strain behaviors) and, for some, seem to spontaneously remit with no
identifiable cause. The common thread in each of these, except the
spontaneous remission theory, is that they all may impact autonomic
regulation. The most consistent results for chronic pain have come from
programs that use a combination of approaches, which include cognitive
therapy and using self-regulation techniques that strengthen autonomic
nervous system regulation, such as breathing techniques and guided
relaxation techniques. Working a new routine, such as this training, into
busy family lives can be a challenge yet it may be possible to incorporate
the training into bedtimes stories. The present study compared the
psychophysiological effects of two children’s bedtime stories designed
to passively guide the audience through two different autonomic regu-
lation conditioning strategies.
Elizabeth Bigham, PhD
333 S. Twin Oaks Valley Rd., UNIV306
San Marcos, CA 92096
Bedtime stories
Autonomic regulation
Does Sitting Position Matter in Heart Rate Variability
Teresa Vodopest, BCIA Certificate of Completion in HRV
Biofeedback; Alexander Kane, BCIA Certificate of Completion
in HRV Biofeedback; Jabri Allen, BCIA Certificate
of Completion in HRV Biofeedback, Christopher Williams, Evan
Fluty, Joseph Gregory, David Schultz, Monica DeBold, Grace
Robinson, Ram Golan, Joe Hannan, Marissa Fabbri, Sandi
Bowers, Alec Cangelosi and Fred Shaffer, PhD, BCB (Faculty
This randomized controlled study examined whether sitting position
affects HRV frequency domain and time domain measures. Forty-one
undergraduates (20 male and 21 female), 19–24 years of age, par-
ticipated in this study. A Thought Technology ProComp
system monitored abdominal SEMG, ECG, HRV, and respiration.
The SEMG active electrodes were placed 1–1/2 inches below the
navel and 2 inches to either side. The reference electrode was equi-
distant from each active. ECG active electrodes were placed about 2
inches above the navel and 4 inches to the left and right of the midline
and the reference electrode was centered over the angle of the ster-
num. A respirometer was positioned over the navel to measure
abdominal excursion and respiration rate. Subjects were stabilized for
5 min and then were observed with eyes open and no feedback in
each of the three sitting positions for 5 min with a 2-minute buffer
period between conditions. These positions were leaning forward
(45), sitting upright (90), and leaning backward (120). Data were
analyzed using a GLM analysis with familywise correction. Sitting
position did not affect abdominal SEMG, abdominal excursion (the
difference between maximum expansion and contraction), or respi-
ration rate. However, an upright sitting position produced greater low
frequency power (LF n.u.) than leaning forward, F(1, 22) =15.56,
p=.001, g
=0.41, and leaning backward, F(1, 22) =7.94,
p=.01, g
=0.27. Consistent with this finding, an upright position
produced lower high frequency power (HF n.u.) than leaning forward,
F(1, 22) =15.56, p=.001, g
=0.41, and leaning backward, F(1,
298 Appl Psychophysiol Biofeedback (2014) 39:293–316
22) =7.94, p=.01, g
=0.27. These outcomes were not mediated
by respiration rate, which did not vary across sitting positions. Sitting
position did not affect any of the major time domain measures of heart
rate variability (HR Max–HR Min, NN50, pNN50, RMSSD, SDNN).
Since increasing LF power is a major goal of HRV biofeedback, we
recommend training in an upright sitting position for subjects who
resemble our undergraduates. Future researchers should replicate
these findings with clinical populations.
Teresa Vodopest
1601 S Florence St, Campbell Apartments Rm 114
Kirksville, MO 63501
Heart rate variability biofeedback
Sitting position
HRV Biofeedback Training Raises Temperature
and Lowers Skin Conductance
Teresa Vodopest, BCIA Certificate of Completion in HRV
Biofeedback; Alexander Kane, BCIA Certificate of Completion
in HRV Biofeedback; Jabri Allen, BCIA Certificate
of Completion in HRV Biofeedback, Christopher Williams, Evan
Fluty, Joseph Gregory, David Schultz, Monica DeBold, Grace
Robinson, Ram Golan, Joe Hannan, Marissa Fabbri, Sandi
Bowers, Alec Cangelosi and Fred Shaffer, PhD, BCB (Faculty
This randomized controlled study explored whether HRV biofeed-
back training can indirectly raise hand temperature and lower skin
conductance level (SCL). Twenty-one undergraduates (7 male and 14
female), 18–22 years of age, participated in this study. A Thought
Technology ProComp
Infiniti system monitored ECG, HRV, res-
piration, SCL, and temperature. In this mixed-design study, subjects
were pre-assessed on the State-Trait Anxiety Inventory, matched on
State Anxiety scores, and then randomly assigned to four sessions of
either HRV or temperature biofeedback. Each weekly training session
consisted of stabilization (5 min), pre-baseline (5 min), biofeedback
training (30 min), and post-baseline (5 min) conditions. The HRV
biofeedback group (HRV) was instructed to sit upright, breathe six
times per minute, and increase peak-to-trough heart rate differences.
They received visual analog respirometer and heart rate feedback, and
practiced breathing six times per minute for 15 min a day. The
temperature biofeedback group (TEMP) was instructed to sit upright
and increase index finger temperature. They received visual analog
temperature feedback and practiced hand-warming for 15 min a day.
Compliance was confirmed by weekly logs. Data were analyzed using
a GLM analysis with familywise correction. Both biofeedback groups
were successful. The HRV group, alone, increased the SDNN (stan-
dard deviation of all NN intervals) from session 1 (69.3 ms) to session
4 (93.8 ms), F(1,11) =12.81, p=.004, g
=0.54. The TEMP
group increased hand temperature from session 1 (88.8 degrees F) to
session 4 (92.2 degrees F), F(1,10) =6.54, p=.028, g
Despite no temperature biofeedback or practice, the HRV group
increased hand temperature from session 1 (90.2 degrees F) to session
4 (94.3 degrees F), F(1,11) =19.21, p=.001, g
=0.64, and
achieved greater session 4 post-baseline hand temperatures (93.9
degrees F) than the TEMP group (92.2 degrees F), F(2,20) =6.87,
p=0.005, g
=0.41, even with correction for pre-baseline differ-
ences. Finally, despite no SCL feedback or practice, the HRV group
also reduced SCL from session 1 (5.8 uS) to session 4 (2.3 uS),
F(1,11) =15.5, p=.002, g
Teresa Vodopest
1601 S Florence St, Campbell Apartments Rm 114
Kirksville, MO 63501
Heart rate variability biofeedback
Temperature biofeedback
Biofeedback in Grandmothers: Correlations
of Subjective and Objective Measures
Jaclene A. Zauszniewski PhD, RN-BC, FAAN
As the number of grandmothers raising grandchildren continues to
grow, research shows that 20 % of them are at high risk for experi-
encing stress and depression. To date, interventions for grandmothers
raising grandchildren have been limited to psycho-education programs,
parenting skills training, and support groups. More recently, a study of
heart rate variability (HRV) biofeedback showed that grandmothers
reported lower stress and fewer negative emotions and depressive
cognitions over time. However, it is unknown whether self-report
measures truly reflect physiological changes detectable through an
objective indicator, i.e., coherence score, obtained from a biofeedback
device. This secondary analysis of data from 20 grandmothers raising
grandchildren examined correlations between subjective measures of
stress, negative emotions, and depressive cognitions and the average
coherence score achieved during four weeks of biofeedback training. A
longitudinal, correlational design was used in a convenience sample of
grandmothers raising grandchildren to examine associations between
average coherence scores and subjective measures of stress, negative
emotions, and depressive cognitions over time. Subjective data were
collected during face-to-face interviews before and at 2, 8, and
14 weeks after biofeedback; objective data were recorded daily within
the biofeedback device for four weeks and averaged as a mean
coherence score. The findings showed that higher mean coherence
scores correlated significantly (p\.03) over time with the self-report
measures of stress (r’s ranged from -.48 to -.94), negative emotions
(r’s ranged from -.48 to -.89), and depressive cognitions (r’s ranged
from -.49 to -.77); the mean coherence score also correlated signif-
icantly with the average time spent per biofeedback session (r =.50;
p=.02). In addition to showing the effectiveness of HRV biofeedback
for reducing stress, negative emotions, and depressive cognitions in the
grandmothers, the findings demonstrate consistency between the self-
report measures of stress, negative emotions, and depressive cognitions
and an objective measure of coherence, reflecting optimal heart rate
variability over time. The findings provide support for the validity of
subjective measures of stress, emotions, and cognitions using the
coherence score as an objective indicator. Further research to examine
effects of HRV biofeedback on stress biomarkers in relation to self-
report measures is needed.
Jaclene A. Zauszniewski, PhD
2120 Cornell Road
Cleveland, OH 44106
Appl Psychophysiol Biofeedback (2014) 39:293–316 299
Heart rate variability biofeedback
Negative affect
Depressive cognitions
Alcanzando Ninos en las Fronteras A.C., Tapalpa
Village, State of Jalisco, Mexico: A Prevention Program
for 600 Disadvantaged Children
Scheherazade Shamsavari, PhD, ATR
Since 2007, the death toll in the Mexican cities along the U.S./Mexico
border due to drug violence and criminal activity has reached 16,500
(Johnston, 2011). Seventy percent of these victims were women and
children. In remarks to the Central American Security Conference at a
Regional Security Conference in Guatemala, Hillary Clinton, then U.S.
Secretary of State, said that the governments need to work together to
combat the criminal organizations feeding the violence while also
addressing economic and educational needs in the region (U.S.
Departmentof State, 2011). To break this cycle of criminality andviolent
behavior, the government ofMexico is putting preventative programs in
place to give children and their families an alternative path. Alcanzando
˜os en la Frontera (Reaching Children at the U.S./Mexico Border) is
one of the first of these programs and will use noninstrumental bio-
feedback to teach self-regulation to children and their families, as well as
bring about fundamental social change. The concentration of Mexican
and Central American immigrants on the northern border of Mexico has
been a difficult problem with authorities of each border state. These
individuals and families lack financial support and education, so they
often engage in criminal activities such as drug trafficking, human
trafficking, and sexual abuse. Many are joining drug cartels that are
recruiting young children who lack self-esteem. The low socioeconomic
status of these children leaves them susceptible to adult criminals who
may involve them against their will in violent activities, according to the
findings of the Mexican Commission on Human Rights on poverty, child
labor, and prostitution (Comisi ´on de Derechos Humanos, 2012).
Advanced students graduating in the Biofeedback track that need a paid
internship can work in the Ministry of Health in Mexico in the states
listed: Baja California, Chiapas, Quintana Roo, Sonora, Coahuila,
Tamaulipas, Chihuahua, Jalisco, Colima. Housing will be organized by
the Rotary clubs of each states.
Scheherazade Shamsavari, PhD
107 Algaza Ave. Dr. Baez
Guadalajara, C.P. 44660 Mexico
Mexican border children
Heart Rate Variability Norms for Healthy
Teresa Vodopest, BCIA Certificate of Completion in HRV
Biofeedback; Alexander Kane, BCIA Certificate of Completion
in HRV Biofeedback; Jabri Allen, BCIA Certificate
of Completion in HRV Biofeedback, Christopher Williams, Evan
Fluty, Joseph Gregory, David Schultz, Monica DeBold, Grace
Robinson, Ram Golan, Joe Hannan, Marissa Fabbri, Sandi
Bowers, Alec Cangelosi and Fred Shaffer, PhD, BCB (Faculty
The present study calculated heart rate variability (HRV), respiration,
and accessory surface EMG norms for 29 variables in healthy
undergraduates to aid clinicians and researchers. The calculation of
norms for 9 nonlinear HRV measurements for this age group
addresses an important deficiency in the literature. Fifty undergrad-
uates (25 male and 25 female), 19–24 years of age, participated in this
study. A Thought Technology ProComp
Infiniti system was used to
monitor ECG, respiration, and accessory SEMG. Active ECG elec-
trodes were placed about 2 inches above the navel and 4 inches to the
left and right of the midline and the reference electrode was centered
over the angle of the sternum. A respirometer was positioned over the
navel to measure abdominal excursion and respiration rate. SEMG
active electrodes were placed over the belly of the right trapezius and
scalene muscles, with the reference electrode over the spine. Subjects
were stabilized for 5 min and then monitored for 7 min sitting
upright, with eyes open, no feedback, and instructions to breathe
normally. The first 2 min of data were discarded to control for
adjustment to the laboratory and the remaining 5 min were artifacted
within CardioPro and then detrended in Kubios 2.1 using a smooth-
ness priors procedure. Frequency domain analysis utilized a Fast
Fourier Transformation (FFT)-based on Welch’s periodogram pro-
cedure. Means and standard deviations were calculated for HRV time
domain measures (heart rate, HR Max–HR Min, HRV triangular
index, NN50, pNN50, RMSSD, SDNN, and TINN), frequency
domain measures (VLF, LF, and HF peak frequencies, absolute VLF,
LF, and HF power, normalized LF and HF power, and LF/HF ratio),
and nonlinear measures (SD1, SD2, ApEn, SampEn, D2, detrended
fluctuation analysis (DFA) indices a1 and b1, and recurrence plot
analysis (RPA) indices DET and ShanEn), respiration measures
(respiration amplitude and rate), and accessory SEMG. Future
researchers should replicate these findings with clinical populations.
Teresa Vodopest
1601 S Florence St, Campbell Apartments Rm 114
Kirksville, MO 63501
Heart rate variability
Surface EMG
Normative data
College students
HRV Biofeedback Training Decreases Beck Depression
Inventory Scores in Healthy Students
Teresa Vodopest, BCIA Certificate of Completion in HRV
Biofeedback; Alexander Kane, BCIA Certificate of Completion
in HRV Biofeedback; Jabri Allen, BCIA Certificate
of Completion in HRV Biofeedback, Christopher Williams, Evan
Fluty, Joseph Gregory, David Schultz, Monica DeBold, Grace
Robinson, Ram Golan, Joe Hannan, Marissa Fabbri, Sandi
Bowers, Alec Cangelosi and Fred Shaffer, PhD, BCB (Faculty
300 Appl Psychophysiol Biofeedback (2014) 39:293–316
This randomized controlled study explored whether HRV biofeed-
back training can decrease the Beck Depression Inventory (BDI)
scores of students with low self-reported levels of depression.
Twenty-one undergraduates (7 male and 14 female), 18–22 years of
age, participated in this study. A Thought Technology ProComp
Infiniti system was used to monitor ECG, HRV, respiration, SCL, and
temperature. In this mixed-design study, subjects were pre-assessed
on both the Beck Depression Inventory (BDI) and State-Trait Anxiety
Inventory, matched on State Anxiety scores, randomly assigned to
four sessions of either HRV or temperature biofeedback, and then
post-assessed on both inventories. Each weekly training session
consisted of stabilization (5 min), pre-baseline (5 min), biofeedback
training (30 min), and post-baseline (5 min) conditions. The HRV
biofeedback group (HRV) was instructed to sit upright, breathe six
times per minute, and increase peak-to-trough heart rate differences.
They received visual analog respirometer and heart rate feedback, and
practiced breathing six times per minute for 15 min a day. The
temperature biofeedback group (TEMP) was instructed to sit upright
and increase index finger temperature. They received visual analog
temperature feedback and practiced hand-warming for 15 min a day.
Compliance was confirmed by weekly logs. Data were analyzed using
a GLM analysis with familywise correction. Both biofeedback groups
succeeded in learning self-regulation of their modality. The HRV
group increased the SDNN (standard deviation of all NN intervals)
from session 1 (69.3 ms) to session 4 (93.8 ms), F(1,11) =12.81,
p=.004, g
=0.54. The TEMP group increased hand temperature
from session 1 (88.8 degrees F) to session 4 (92.2 degrees F),
F(1,10) =6.54, p=.028, g
=0.40. The HRV group reduced BDI
scores from pre-assessment to post-assessment over a 6-week period,
F(1,10) =6.37, p=.03, g
=0.39, while TEMP group’s BDI
scores did not change. Moreover, the HRV group achieved lower
post-assessment BDI scores than the TEMP group, F(2,23) =11.80,
p=0.000, g
=0.51. Future replications should study a gender-
balanced sample of students diagnosed with depression.
Teresa Vodopest
1601 S Florence St, Campbell Apartments Rm 114
Kirksville, MO 63501
Heart rate variability biofeedback
Temperature biofeedback
Beck depression inventory
State-trait anxiety
Poster Presentations
Wireless Podalic Monitor Biofeedback-Weightbearing
Training with Adults and Elderly People
Leonardo Gomes, PhD Student; Reginato Domingos,
Scremimtechnician; Humberto R. Gambaprofessor, Supervisor;
Gustavo Benvenutti Borba; Guilherme Resende
The interaction between biomedical engineering and the biofeedback
methods can decrease the time spent with motor rehabilitation, and
the autonomy and self-esteem in individuals who are neurologically
compromised. The development of modern and more accurate devi-
ces, grounded in biofeedback, will help improve volitional movement
and mobility. This research is educationally focussed and aimed to
help individual acquire better body balance control, using a co-con-
traction for ankle muscles during biofeedback when weight bearing,
which is very important to the independence in the daily activities.
Twenty volunteers were invited to participate: 10 healthy and 10 with
hemiparetic deformity. The volunteers have been oriented to receive
motor training with a wireless podalic monitor, for weight-bearing
control. The results showed an increase of the body balance control
over a lower limb during a contralateral lower limb swing.
Leonardo Gomes
R. Padre Julio Savedra 123 sb 18
Curitiba Parana
Weight bearing
Hemiparetic deformity
Podalic monitoring
Repetitive TMS Course Improves Measures
of Information Processing and Behavioral Performance
in Autism
Estate M. Sokhadze, PhD; Lonnie Sears, MD; Ayman S. El-Baz,
PhD; Yao Wang BS, MS; Marie K Hensley, BS, Manuel F.
Casanova, MD
Our group has developed a neuropathology model of autism that
emphasizes minicolumnar pathology and lateral inhibition deficits.
We proposed that neuromodulation based on repetitive Transcranial
Magnetic Stimulation (rTMS) will enhance lateral inhibition through
activation of inhibitory double bouquet interneurons and will be
accompanied by improvements in the executive functions. In addition
we proposed that rTMS effects will be manifested in electrocortical
responses, such as event-related potentials (ERP) and evoked and
induced EEG gamma oscillations during cognitive tests (visual odd-
ball task with illusory Kanizsa figures). We compared clinical,
behavioral and electrocortical (ERP, single trial EEG) outcomes in 2
groups of children with autism (TMS, wait-list group). We used 18
sessions of 1 Hz rTMS applied bilaterally over the dorso-lateral
prefrontal cortex in 20 individuals with ASD (11–21 years old). The
wait-list group was comprised of 20 age-matched subjects with autism
tested twice. Both TMS, and wait-list (WTL) groups were assessed at
(1) the initial baseline using clinical behavioral questionnaires (i.e.,
Aberrant Behavior Checklist [ABC], and Repetitive Behavior Scale-
Revised [RBS-R]) and during performance on visual oddball task, and
(2) post completion of 18 sessions of TMS/wait-period. Post-TMS
evaluations showed decreased irritability and hyperactivity on the
ABC, and decreased stereotypic behaviors on the RBS-R. Following
rTMS we found decreased magnitude of the frontal N100 ERP and
evoked gamma power to non-targets, and shorter latency and ampli-
tude of the fronto-central P3a ERPs and reduced induced gamma
oscillations to non-targets in TMS group as compared to the wait-list
group. These ERP changes along with increased centro-parietal P300
(P3b) and enhanced induced gamma oscillations (increased hemi-
spheric and anterior-posterior phase coherence) to targets are
indicative of more efficient processing of information post-treatment.
Enhanced processing was also reflected in reaction time (RT) and
error rate. Furthermore, we found that active treatment was
Appl Psychophysiol Biofeedback (2014) 39:293–316 301
accompanied by post-error RT slowing and higher accuracy of
responses in the TMS group. Collected data support our concept that
rTMS improves executive functioning as evidenced by normalization
of ERP and EEG responses and behavioral reactions (response time,
accuracy) during executive function test, and also by improvements in
clinical behavioral evaluations.
Estate M. Sokhadze, PhD
401 E Chestnut Street
Louisville, KY 40202
United States
Transcranial magnetic stimulation
Executive function
Event-related potentials
The Effects of Auditory Integration Training (AIT)
on Mismatch Negativity in Children with Autism
Estate M. Sokhadze, PhD; Kirk A. Akaydin, BS; Stephen M.
Edelson, PhD; Sally Brockett, MS; Lynzee Alworth, PhD; Jeffrey
Weihing, PhD; Marie K. Hensley, BS; Pranathi Mruthyunjaya,
MD; Manuel F. Casanova, MD
Children with autism are featured by sensory over-sensitivity
including excessive reactivity to sounds. Reactivity to sound can be
measured using auditory evoked potentials recorded during presen-
tation of the sounds of different frequency and recording EEG
responses. Mismatch Negativity (MMN) is one of the early auditory
potentials reflecting differences of evoked potentials between rare
(20 %) and frequent (80 %) sounds. MMN is typically recorded at the
fronto-central EEG sites and represents a difference wave (rare-
minus-frequent tone) occurring within 130–190 ms post-stimulus.
The aim of the study was to apply Berard’s Auditory Integration
Training (AIT) techniques in children in autism and assess AIT
course outcomes using MMN, frontal P2a and P3a evoked potentials,
and behavioral questionnaires (ABC,CPI). EEG data were acquired
with Electrical Geodesics EEG system. AIT was administered
through the Earducator. Children listened to modulated music during
30 min long sessions, twice a day for 10 days. We investigated
evoked potentials before and after AIT in children between the ages
of 5 and 21 (N =11 in AIT, mean age 13.6 years, SD =4.1). Eleven
control subjects were used for evoked potential (MMN, P2a, P3a)
measurements in MMN test (mean age 14.8, SD =3.2). Berard’s AIT
resulted in significant decreases for Irritability, Hyperactivity and
Lethargy scores on the Aberrant Behavior Checklist (ABC), and
improved Emotion, Behavior and Receptive Language Scores on the
Comprehensive Performance Index (CPI) scales. Auditory evoked
potential tests conducted at baseline and after AIT showed lower
MMN (F =5.29, p=0.035), and significant decrease of the frontal
P2a component (F =4.71, p=0.041 and longer latency of P2a
(F =5.53, p=0.028), while the frontal and fronto-central P3a
component showed amplitude decrease (F =9.22, p=0.006) with-
out any latency changes. Comparison of auditory MMN test results
between typical children and autism groups showed significant dif-
ferences in MMN amplitude (higher in autism, F =4.75, p=0.043),
P2a amplitude (higher in autism, F =5.65, p=0.03), P2a latency
(shorter in autism, F =4.98, p=0.039), and amplitude and latency
of P3a (smaller and prolonged in autism, F =5.31, p=0.033). Our
study supports suggestions that Berard’s AIT positively affects
auditory stimulus processing reflected both in early (MMN) and late
(P2,P3a) evoked potentials.
Estate M. Sokhadze, PhD
401 E Chestnut Street
Louisville, KY 40202
Auditory integration training
Mismatch negativity
Aberrant behavior checklist
Comprehensive Performance Index
Testing the Association between Client Stress
and Financial Help-Seeking Behavior
Wookjae Heo, MA; Abed Rabbani, MS; John E. Grable, PhD,
Previous research shows that the financial planning data gathering
process generates stress responses in prospective clients. It is gener-
ally assumed that high stress levels negatively impact future financial
help-seeking behavior; however, there are those who argue that
financial stressors introduced into the client-planner relationship lead
clients to take action (i.e., stressors cause a type of planning eustress).
The literature is silent on this issue. This exploratory study was
designed to evaluate the strength of association between stress levels
and future financial help-seeking behavior. This exploratory experi-
mental was designed to place prospective financial planning clients
under dual emotional pressure and cognitive load. Participants (age
20–63) were randomly assigned to a control and treatment group.
Those in the control group were asked a series of common financial
planning assessment questions by a financial planner. Questions
included items designed to assess financial knowledge, risk tolerance,
and goal planning outcomes. Those in the treatment group were asked
the same questions, as well as measures intended to promote a stress
reaction. These questions included assessments of past financial
behavior and perceived controllability of behavior. The outcome
variable was the likelihood of meeting with a financial planner in the
future. This item was assessed by asking each participant to rate on a
scale, with 10 being absolutely certain and 1 being very unlikely, their
future help-seeking tendency. Physiological stress was evaluated via
skin conductance (SC) using a ProComp Infiniti
(Thought Tech-
nology, Montreal, Canada) system. In total, 20 individuals
participated in the study. Session changes in SC were used as the test
variable in a series of non-parametric and ANCOVA tests. Results
provide baseline evidence that stress can be reshaped positively and
does play a role in shaping financial help-seeking behavior, which
opens the door to future research into biofeedback and other psy-
chophysiological interventions that may lead individuals to seek
financial help. Results suggest the following: (1) data gathering, at the
initial stages of the financial planning process, induces physiological
stress; (2) the more anxiety provoking and higher cognitive loading
that occurs (i.e., treatment), the less help-seeking behavior exhibited;
(3) rather than leading to a reduced likelihood of help-seeking,
financial stress leads to an increased willingness to seek help in the
future, when controlling for the level of treatment. One possible
302 Appl Psychophysiol Biofeedback (2014) 39:293–316
explanation is that financial planners, as agents of change, turn dis-
tress into a form of help-seeking eustress.
Wookjae Heo, MA
172 Cabin Creek Road
Athens, GA 30605
Financial planning
Biofeedback Use in Treating Substance Use and Co-
occurring Disorders: The Current Evidence
and Proposed Brief Protocol for Inpatient Settings
Gage Stermensky II, MA, LADC, CRADC; Rae Mazzei, MA;
Erin Conway, BCB
Biofeedback evidence for treating various disorders (both physical
and psychological) is growing rapidly. However, little evidence has
been found to address individuals diagnosed with co-occurring dis-
orders in a short-term, residential, substance-abuse treatment setting.
The prevalence of anxiety disorders (including panic, generalized
anxiety, post-traumatic stress disorders, among others) for individuals
suffering from substance dependence compared to the general pop-
ulation is nearly double. With a paradigm shift towards population
based health and shorter terms of stay in residential substance abuse
treatment, being able to introduce clients to psychophysiological
interventions, such as respiration and heart rate variability biofeed-
back, can assist in meeting the needs of these clients. The authors
propose a brief protocol to meet the needs of individuals with co-
occurring substance dependency and anxiety disorders in a short-
term, residential treatment facility. The protocol begins by educating
and orienting clients to biofeedback. Education is followed by pro-
viding clients with the rationale behind the treatment. Clients are then
shown the difference between desired diaphragmatic breathing rates
and their day-to-day breathing rate. In addition, heart rate variability
and respiration coherence is assessed and the results are provided to
the client to assist them in practicing for future sessions. The fol-
lowing session provides examples of different types and rates of
breathing, as well as their bodily response and in session success.
Later sessions assist clients in developing generalizability of treat-
ment gains and the ability to call on relaxation through diaphragmatic
breathing on demand. This is achieved through practicing coherence,
and reinforced using various ‘‘games’’ through biofeedback software
programs. Future sessions (if possible) increase the difficulty of the
biofeedback session tasks and work towards mastery in anticipation of
the client’s discharge from the program. The authors believe if such a
protocol is efficacious, generalizability into other brief settings
(behavioral health, medical homes, primary care medical settings) is
possible. The authors hope to empirically evaluate the protocol
with clients in a short-term, residential substance abuse treatment
Gage Stermensky II, MA
42421 N.Woodbine Ave
Antioch, IL 60002
Substance abuse
Impact of Biofeedback Training on Physiological
Yoko H.W. Tsui; Brigham Breton; Laura M. Van Duker; Patrick
Steffen, PhD
Actual physical or perceived stress influence one’s body functioning
(Chandler et al., 2001). Biofeedback interventions have been shown
to reduce one’s stress level (Palomba, 2011) and improve tasks per-
formance (Paul & Garg, 2012). The current study attempted to
examine the impact of biofeedback heart-rate variability training on
physiological responses to stressful situations in a laboratory setting.
It was hypothesized that after receiving biofeedback heart-rate vari-
ability training there will be decreased physiologic responses in
participants’ systolic blood pressure (SBP) and heart rate (HR) to a
stress test. Seventy-two undergraduate students at Brigham Young
University were recruited to participate in this study. The majority of
the participants were predominantly Caucasian. Males and females
were similarly distributed in the sample. All participants were sub-
jected to the Trier Social Stress Test (TSST). TSST is an affective test
for eliciting stress responses. It has high internal reliability (Cron-
bach’s Alpha =.93). During the stress test, participants were asked to
prepare for and carry out a public speech, and perform a mathematical
task mentally in the presence of a confederate. Their physiological
responses, such as blood pressure, respiration, heart rate, and heart
rate variability, to stressful situations were recorded. A one-way
ANOVA repeated measure and post hoc tukey test were performed.
Findings from current study showed that TSST successfully evoked
stressful responses and that biofeedback relaxation techniques help to
reduce resting SBP (p\.05) and HR reactivity (p\.05) to stressful
Yoko H.W. Tsui
659 N 700E Apt 7
Provo, UT 84606
Heart rate variability biofeedback
Blood pressure
Trier Social Stress Test
EEG-Biofeedback Training: Protocols and Their
Effects on the Stroop Task after a Single Session
Kathy Williams, MA; Luis E Aguerrevere, PhD; Robert Nicks
BA; Becky Recio Pre-bachelor student; Harris, H; Swift, T.J.,
McCreary, B & Limeta, F
A number of studies have suggested that EEG-biofeedback improves
attention in individuals with ADHD. However, there is no consensus
on the optimal number of sessions, brain frequency, course, electrode
Appl Psychophysiol Biofeedback (2014) 39:293–316 303
placement, or length of lasting effects. This study investigated the
efficacy of one session EEG-biofeedback in modifying brain patterns
and improving attention on the Stroop Color Word Test in non-
clinical young adults and its effects over 24 h. In specific, this study
aimed to determine if six randomized treatment groups led to dif-
ferences in Stroop performance completed right after and a day after
training. Five treatment conditions were trained using referential
montage EEG biofeedback protocols, and one comparison group
involved playing computerized attention games for the same training
time. A repeated measures ANOVA was conducted to evaluate the
effect of training conditions and time on the Stroop task. Significant
differences were found for Stroop word and interference. Main effects
were significant for Time as well as the interaction between Training
Condition X Time. For stroop word, results showed mean differences
between the groups, in that central Beta scored significantly higher
than Frontal Alpha/Theta and games, 24 h after training. Although
not significant, the Frontal Beta also scored higher than games in
Stroop word. These results suggest that over time participants trained
at a Beta frequency score higher than those trained in Alpha/Theta
and those trained using attentional games on a processing speed task.
For Stroop Interference, results show that training Frontal Beta,
Frontal Alpha/Theta and Games scored significantly higher than
Sensorimotor Beta, 24 h after training. These results suggest that over
time participants trained at a Beta frequency at the sensorimotor area
are not as distracted as those trained at the frontal lobe at either alpha/
theta or beta frequencies or those trained using attention games. Thus,
this study showed differences in attention tasks after only one training
session of EEG-biofeedback, favoring Sensorimotor Beta training
over other referential training sites and frequencies. This shows that
EEG-biofeedback has the possibility of changing observable behavior
even after one session.
Kathy Williams, MA
2100 N. Raguet St. HSTC Bld, Rooom 105. PO Box 13019
Nacogdoches, TX 75962
EEG biofeedback
Stroop color word test
Indices of Heart Rate Variability and Compassion
in Healthcare Professionals Following Stress Resilience
Molly J. Lahn, DPT; Elizabeth Bigham, PhD; Donald Moss, PhD;
Mary Kay Chess, PhD, MSW; Sari Abelson; James Riley
The growing demands on the American healthcare system and its care
providers, coupled with the increasing demand for patient-centered
care, are associated with compassion fatigue and burnout among
healthcare professionals. There is an increasingly urgent need for the
promotion of self-care and stress resilience in the healthcare work-
place. The polyvagal theory asserts that creating calm states and
exercising the neural regulation of the heart may foster prosocial
emotion such as compassion, thus promoting both prosocial behavior
and physical health (Porges, 2001). The implication for medicine is
twofold: Interventions that increase self- and other-compassion may
benefit healthcare professionals by strengthening relationships with
patients, reducing chances of empathetic distress and burnout, and
enhancing well-being. In addition, compassionate care may optimize
regulation of the patient’s physiological state and thus promote
healing. The purpose of this randomized controlled trial was to
examine the relationship between physiological self-regulation and
the outcomes of compassion and heart rate variability (HRV) in
rehabilitation professionals (N =18). The 4-week training protocol
compared the two control conditions of mental focus on the breath
(control n =7) and mental focus plus heartfelt emotion (n =4), to
the condition of mental focus plus paced breathing (n =7), a tech-
nique designed to optimize vagal modulation of the heart. The
combination of both mental focus and optimization of respiratory
sinus arrhythmia in the paced breathing group was hypothesized to
foster the physiological substrate for the prosocial emotion of com-
passion. Compassion satisfaction, self-compassion, and short term
resting-condition SDNN, RMSSD, pNN50, HFnu, LFnu, and peak
power were measured before and after the training. Results of
between and within-group ANOVAs partially supported hypotheses.
Both compassion indices increased significantly, and HRV measures
demonstrated a modest but non-significant trend in the hypothesized
direction across groups. Participants reported elements of enhanced
patient care in addition to increases in their own self-awareness, self-
care, and emotional regulation. This study extended neurocardiology
theory to address a practical need in healthcare, suggesting promising
directions for future research in both fields.
Molly J. Lahn, DPT
10916 Bush Lake Road
Bloomington, MN 55438
Polyvagal theory
Heart rate variability
Spirituality and Cardiovascular Outcomes During
the Midlife Transition
Tracy Brown, Doctoral Student; Malvina Salash, MS; Patrick
Steffen, PhD
The menopausal transition can be a physically and emotionally
challenging stage of life that may be compounded by psychosocial
changes. Some studies have found that postmenopausal women (PW)
have higher blood pressure and are more reactive to laboratory
stressors than pre-menopausal women of the same age, possibly
related to increased sympathetic nervous system activity (Farag et al.,
2003; Mathews et al., 2001). Previous studies have found an associ-
ation between religiosity/spirituality and lower blood pressure (BP),
although one study did not find that daily spiritual experiences were
protective for SBP in midlife women (Fitchett & Powell, 2009).
Tartaro et al. (2005) reported that greater religiosity/spirituality in
women was associated with elevated BP. This study extended current
research on linking spirituality to health. We hypothesizd that women
in the midlife transition who are higher in spirituality would have
lower BP reactivity and a shorter recovery time from laboratory
stressors. Participants included 75 women ages 40–60. The Trier
Social Stress Test (TSST) and the Functional Assessment of Chronic
Illness Therapy—Spiritual well-being (FACIT-Sp) were used to test
our hypothesis. Subjects were asked to respond on the FACIT-Sp
through an online survey, after which a laboratory visit was conducted
where the TSST was administered to each subject. Blood pressure of
304 Appl Psychophysiol Biofeedback (2014) 39:293–316
participants was measured during an initial resting period, the TSST
administration, and a 20-minute recovery period. Because of the
nature of our repeated measures factors, we used Proc Mixed (SAS
Institute) to analyze the data. Women who reported higher levels of
spirituality had lower BP during the baseline, r (76) =-0.26,
p=0.02, less reactivity to TSST (speech), r (76) =-0.29, p=0.01,
and lower BP at recovery, r (76) =-0.31, p=0.01. Women in the
midlife transition who are higher in spirituality had lower BP and a
shorter recovery period, than their counterparts. Both spirituality and
biofeedback breathing training can play an important role in handling
daily stress in an effective and healthy way.
Tracy Brown
4464 Winter Circle
Cedar Hills UT 84062
Blood pressure
Functional assessment of chronic illness therapy-spiritual
Trier Social Stress Test
Clinical Outcomes and Patient Characteristics:
Children and Adolescents Treated with HRV
Biofeedback for Functional Gastrointestinal Disorders:
A Case Series
Jaime Spray, MA; Richard Gevirtz, PhD; Robert Guiles, MA
Approximately 10 % of school-aged children are affected by recur-
rent abdominal pain, with most cases considered ‘‘functional
abdominal pain’’ due to no organic explanations of the pain (Chitkara
et al., 2005; Rasquin et al., 2006). These children/adolescents may
miss school more than usual, participate in fewer social and other
extracurricular activities, and experience significant sleep problems,
anxiety, and depression (Campo 2007; Huntley et al., 2007). Patients
presenting with IBS symptoms are generally dissatisfied with the
overall efficacy and tolerability of current treatments, and more
treatments need to be studied (Hulisz, 2004). Parasympathetic activity
promotes digestion and motility in the gut, while autonomic nervous
system dysfunction is implicated in patients with IBS symptoms
(Adeyemi et al., 1999; Sheehan, 1943). Autonomic dysregulation has
been shown to be present in patients with functional abdominal pain,
though HRV biofeedback has been shown to improve vagal tone and
reduce symptoms of functional abdominal pain (Sowder, Gevirtz,
Shapiro, & Ebert, 2010). Twenty-four patients (18 females, 6 males)
ages 8–17 were treated on an outpatient basis with heart-rate vari-
ability biofeedback and acceptance and commitment therapy (ACT)
for an average of 6 sessions. Approximately 18 of these patients
presented with functional abdominal pain (FAP), 5 with irritable
bowel syndrome (IBS), and 1 with chronic vomiting syndrome. This
case series will present patient characteristics such as ethnic, age, and
gender differences, and patient-reported experiences such as sleep
problems and school attendance before and during treatment. The
specific techniques of the HRV biofeedback and ACT treatment will
be presented. Additionally, length of HRV biofeedback and ACT
treatment, adherence to the slow diaphragmatic paced-breathing
practice, and clinical outcomes will be analyzed and reported. Of the
24 cases, 50 % had complete symptom improvement, 42 % had some
symptom improvement, and 8 % experienced no change in symptoms
over the treatment period. Lastly, implications for future research and
treatment of functional gastrointestinal disorders will be discussed.
Jaime Spray, MA
4004 Crystal Dawn Lane #103
San Diego, CA 92122
Functional gastrointestinal disorders
Heart rate variability biofeedback
Acceptance and commitment therapy
*Neurotherapy and Sleep Onset Insomnia: A Pilot
Susan P. Buckelew, PhD; Douglas E. DeGood, PhD; Micah
D’Archangel, BA; Jerika Taylor, BS
Sleep onset insomnia is a common problem of college students.
Buckelew, DeGood, et al. (2009, 2013) found evidence for an EEG
disregulation (or impaired neuroflexibility) model for poor sleepers
with persistent delayed sleep onset. Students who were good sleepers
demonstrated better alpha activation/deactivation control compared
with poor sleepers. The current pilot study was designed to assess if
poor sleepers could improve voluntary EEG activation/deactivation
control, utilizing alpha feedback (both enhance and suppress) during
neurofeedback conditions. Poor sleepers were identified as students
who attained a score above a 5 on the Pittsburgh Sleep Quality
Inventory (PSQI) and reported chronic trouble sleeping (taking 30 min
or longer to go to sleep for at least one year). Eight students (3 male, 5
female) participated in a six-week sleep enhancement program
including basic insomnia education, sleep hygiene, relaxation, and
stimulus control training. Additionally, these students also participated
in six sessions of two trials of alpha enhancement and suppression with
auditory and visual feedback. EEG was recorded from a Cz placement.
The PSQI was completed before and at the end of training. A com-
parison group of 7 other poor sleepers also completed the PSQI at
6-week intervals, but did not participate in any treatment. There was a
significant between group across time interaction on Sleep Quality
scores, F (1, 13) =7. 186, p=. 02, with students who participated in
the training program reporting improved sleep and the comparison
students reporting poorer sleep across time. For the treatment group a
repeated measures ANOVA with alpha control as the dependent vari-
able, revealed that alpha control significantly improved across training
from Session 1 (time 1) until after training (Session 6, time 2). Thus, the
poor sleepers in the treatment group reported both improved sleep and
demonstrated better alpha control (enhanced neuroflexibility) at the
end of training. This preliminary study provides support for neuro-
feedback as an adjunct to a comprehensive sleep-training program.
Seemingly, neuroflexibility impairments, which we believe are asso-
ciated with poor sleep regulation, can respond to neurofeedback
treatment. Future studies should include a larger sample size and ran-
dom assignment to an experimental and a placebo controlled condition.
Susan P. Buckelew, PhD
Department of Behavioral Science
Martin, TN 38238
Appl Psychophysiol Biofeedback (2014) 39:293–316 305
Sleep onset insomnia
Sleep hygiene
EEG biofeedback
Effects of Ambient Prism Lenses and Visual-Motor
Training on Heart Rate Variability in Autism
Marie Hensley BS; Melvin Kaplan, OD; Barbara Kotsamanidis,
Autism Spectrum Disorder (ASD) is a developmental disorder
marked by difficulty in social interaction, lack of communication, and
repetitive behavior. Characteristics of ASD include impaired ambient
vision and autonomic nervous system (ANS) dysfunction. Deficits in
ambient vision affect spatial orientation, peripheral vision, attention,
hand-eye coordination, and balance. These deficiencies in ambient
vision prompt adaptive responses consistent with behavioral symp-
toms observed in autism. Autonomic dysfunction in autism is an
imbalance between the two branches of the ANS, generally increased
sympathetic and decreased parasympathetic nervous system activity.
Because heart rate (HR) is monitored by these two branches, heart
rate variability (HRV) is an appropriate indicator of autonomic
function. The objective of this study was to determine the effect of
prism lenses on HRV and autonomic balance. Patients with ASD were
recruited, evaluated, and each prescribed corrective ambient prism
lenses. A six-month daily vision therapy protocol was implemented in
an attempt to ameliorate ambient vision deficiencies and abate autistic
behaviors. Daily vision therapy procedures included exercises that
required the patients to wear disruptive prism lenses and occasionally
red/green lenses. The combination of the lenses and tasks were used
to address problems involved in balance, visual organization, and
depth perception. HR was recorded while the subject watched scenes
from the classic Disney film, ‘‘The Lion King,’’ to evoke emotional
responses. Kubios HRV software was used to analyze HR and cal-
culate HRV measurements. Expected outcomes were a decrease in
HR, increase in high frequency (HF) power and decrease in low
frequency (LF) power, indicative of enhanced parasympathetic ner-
vous system activity and/or decreased sympathetic activity. We
observed a significant decrease in average heart rate among the par-
ticipants from the baseline 94.6 beats/min to post-sessions 89.6 beats/
min. There was a decrease in LF power from 60.2 to 48.6 nu and an
increase in the percentage of HF power from 24.8 to 37.6 %. Lastly,
the ratio of LF to HF power decreased from 1.71 to 1.60. These results
support the hypotheses that ambient prism lenses in combination with
therapy vision exercises had the desired effect on HRV and improved
autonomic balance in children with ASD.
Marie Hensley, BS
3313 Brownsboro Vista Dr.
Louisville, KY 40242
Autism spectrum disorder
Heart rate variability
Ambient prism lenses
Casual Video Games: A Review of Recent Historical
Research and Implications for Future Research
Matthew T. Fish MS, BCB, LRT, CTRS; Carmen Russoniello,
PhD, BCB, BCN, LPC, LRT, CTRS; Kevin O’Brien, PhD
Recent research exploring the use of alternative interventions, specifi-
cally, casual video games (CVGs) has demonstrated their applications
for improving individuals’ physical and mental health. Stress, depres-
sion, and anxiety are the most prevalent mental-health issues in
America. Interventions that can ameliorate and prevent the development
of such disorders are needed. CVGs are fun, easy to play, spontaneous,
and extremely popular. This poster reviews recent research examining
the effects of CVGs on mood, stress, depression, and anxiety. Ongoing
research that examines the psychophysiological effects of a prescribed
regimen of CVG play added to antidepressant medication can help
further reduce symptoms of depression and co-morbid anxiety. Changes
in symptoms will be indicated by physiological measures such as
electroencephalography (EEG), heart rate variability (HRV), and bio-
chemical assays, as well as, psychological metrics such as the patient
health questionnaire (PHQ), profile of mood states (POMS), and state-
trait anxiety inventory (STAI). Current and previous studies being
reviewed will include methodology and results that demonstrate the
effects of CVGs on participants’ symptom severity. These research
studies and their findings have important implications for practitioners
who are interested in exploring alternative techniques. Non-pharma-
ceutical interventions that have significant physiological impacts in
persons with stress related dysfunction seem specifically indicated.
Based on existing findings, further research of the effects of CVGs is
justified in conjunction with psychophysiology training.
Matthew T. Fish, MS
2100-B East 3rd Street
Greenville, NC 27858
Casual video games
Psychophysiological measures
A Pilot Study: Vagal Response to Mild Exercise:
Establishing HRV Norms among Adult Women
Robert Guiles, MA; Mark Stern, MA; Lauren Gunneson, MA;
Allan Gary; Richard Gevirtz, PhD
Vagal tone has become a prominent index of stress vulnerability and
reactivity in many studies of populations with affective disorders.
Recent research has shown that trauma significantly influences respi-
ratory-sinus arrhythmia (RSA) recovery from mild exercise. Women
with no traumatic history showed that RSA returned to baseline levels,
while traumatic history continued to decline after cessation of exercise.
These results are promising for future psychophysiological concomi-
tants of PTSD; however, prior to clinical comparison it is vital to collect
an appropriate normative database for time and spectral domains of
heart-rate variability (HRV) at pre and post sympathetic innervation.
Thus, the purpose of our study is to examine the physiological impact of
the vagal brake on women and establish HRV normative database in
response to a pre and post mild exercise. Forty adult females will
randomly participate through convenience sampling of flyers around a
local university. HRV data will be collected while the participants sit
306 Appl Psychophysiol Biofeedback (2014) 39:293–316
quietly for 5 min prior to and for 5 min following riding a stationary
bike for 1-mile. Physiological data in response to mild exercise has
been collected on 22 woman. Thus far, results are consistent with our
hypothesis that women without a history of trauma are showing HRV
recovery close to baseline levels. Further analysis will be conducted on
the remaining female participants. This pilot investigation justifies the
creation of a large database for HRV stress and recovery norms among
women without a history of trauma. Given the promising homogeneity
of these results this may prove useful for clinical comparisons.
Robert Guiles, MA
10455 Pomerado Rd
San Diego CA 92131
Heart rate variability
Mild exercise
Normative data
Perfectionism, Religiosity, and Cardiovascular
Malvina Salash, MS; Tracy Brown, PhD Candidate; Patrick
Steffen, PhD
Recent studies have found evidence that stress is a major indicator of
hypertension and Cardiovascular Disease in women. The menopausal
transition can be a physically and emotionally challenging stage of life
that may be compounded by psychosocial changes. For example, per-
fectionism has been shown to be related to increased systolic blood
pressure and increased heart rate. Several studies have found intrinsic
religiosity to be associated with more positive health outcomes. One
study found that intrinsic religiosity was associated with adaptive
perfectionism. We hypothesized that intrinsically religious women will
manifest adaptive perfectionism, while extrinsically religious women
will manifest maladaptive perfectionism. In addition, we hypothesized
that intrinsically religious women with adaptive perfectionism will
have lower blood pressure and a shorter recovery time from laboratory
stressors than their counterparts. Participants included 76 women ages
40–60. The Trier Social Stress Test (TSST), the Intrinsic-Extrinsic
Religiosity Scale (IER), and the Almost Perfect Scale-Revised (APS-
R) were used to test our hypotheses. Subjects were asked to respond on
the IER and APS-R scales through an online survey, after which a
laboratory visit was conducted where the TSST was administered to
each subject. Blood pressure of participants was measured during an
initial resting period, the TSST administration, and a 20-minute
recovery period. Because of the nature of our repeated measures fac-
tors, we used Proc Mixed (SAS Institute) to analyze the data. Intrinsic
religiosity was significantly correlated with maladaptive perfectionism
(discrepancy), r (76) =-0.26, p\0.05. Also, intrinsically religious
women had lower BP during recovery period r (76) =-0.24,
p=0.04. Intrinsic religiosity was found to be negatively correlated
with maladaptive perfectionism. Although, there was no difference in
BP during the TSST, intrinsically religious women had lower BP and a
shorter recovery period from laboratory stressors than extrinsically
religious women. Perhaps the results of this study can inspire more
focus on intrinsically religious people, who can then learn to handle
daily stress in a more effective and healthy way. Such effective tech-
nique may include biofeedback breathing training.
Malvina Salash, MS
710 Wymount Terrace
Provo, UT 84604
Blood pressure
Trier Social Stress Test
Intrinsic-Extrinsic Religiosity Scale
Almost Perfect Scale-Revised
Establishing a Resonance Frequency Breathing Rate:
A Comparison of MyCalmBeat to HRV Biofeedback
Lauren A. Gunneson, MS; Rachael S. Davenport, MA; Richard
N. Gevirtz, PhD
According to Lehrer and Gevirtz (2003), each individual has a reso-
nance frequency breathing rate (RF). The RF is the optimal breathing
rate, at which the vagus nerve is stimulated to achieve balance or
homeostasis in the autonomic nervous system. Although the gold
standard for determining RF has been HRV biofeedback—the use of
heart rate, respiration, temperature, and skin conductance—other
programs have been developed to determine it from heart period
signals alone. It is important to assess the accuracy and reliability of
these newer programs. Thus, the current research aims to compare
one such program, MyCalmBeat, to a full physiological assessment to
discern whether or not this program provides an accurate and reliable
RF rate. Twelve graduate students from Alliant International Uni-
versity, who had no preexisting heart conditions, were recruited for
this study. Each participant underwent the protocol with both meth-
ods. The participants were simultaneously hooked up to a J&J C2+
monitor and the MyCalmBeat ear lobe electrode. Participants were
then asked to breathe at different rates for two minutes at a time.
MyCalmBeat recorded the heart rate and calculated an RF rate, while
the researcher assigned an RF rate based on the feedback from the
earlobe sensor and an algorithm measuring amplitude of the low
frequency (LF) band, smoothness, and other mathematical parame-
ters. The discrepancies between the two programs will be reported,
and the results will be presented at the conference.
Lauren A. Gunneson, MS
10455 Pomerado Road
San Diego, CA 92131
(973) 886-7068
Resonance frequency breathing rate
Heart rate variability biofeedback
Psychophysiological assessment
Maltreated Children: EEG Abnormalities
and Psychotropic Medication
Andrea Meckley, MA, BCN, QEEGT
Early abuse and neglect can have a profound impact on brain
development and this impact can be readily seen in brainwave
activity. As early as 1937 it was recognized that abnormalities existed
Appl Psychophysiol Biofeedback (2014) 39:293–316 307
in the EEGs of children with behavioral disorders and more recently it
has been reported that children with a history of abuse are three times
more likely to exhibit EEG abnormalities than other children (Ito
et al., 1993; Solomon et al., 1937). Our experience with neglected and
abused children confirms these estimates. The EEG recordings from
100 children with histories of abuse and/or neglect between the ages 6
and 17 were evaluated. Fifty percent presented with EEG abnormal-
ities that were visually identified by a neurologist. These
abnormalities included paroxysms, localized slowing, diffuse slow-
ing, a dominant frequency that was considered to be slower than
typical for the child’s age and epileptiform activity, which accounted
for 36 % of the abnormalities. The use of psychotropic medications is
also quite high among this population and a relationship between the
use of medications and EEG abnormalities was questioned.
Andrea Meckley, MA
31 College Place
Asheville, NC 28801
Child abuse and neglect
Investigation of Vagal Afferent Functioning Using
the Heartbeat Event-Related Potential
Christina Huang, PhD; Richard Gevirtz, PhD; Julie Onton PhD;
Jose Criado, PhD
Although there has been much empirical support for HRV Biofeedback
as an effective intervention for various disorders, there is a lack of
comprehension of the underlying mechanism of HRV Biofeedback.
The predominant theories of increased vagal efferents and baroreflex
gain are insufficient in explaining the frequent observations that HRV
Biofeedback affects changes in constructs that extend beyond solely
ANS mediation, including emotion and affect regulation, attentional
control, and self-regulatory reserve. Therefore it is likely that some
greater degree of integrated systems apart from the immediate effects of
consciously manipulating the ANS is responsible. It has been suspected
that the vagal afferents may be the underlying mechanism of HRV
Biofeedback, but very little research to date has explored this. However,
researchers developed the ‘‘Heartbeat Evoked Potential (HEP)’’ to
measure possible cortical influences on the heart, or an indication of
vagal afferent functioning (Schandry, Sparrer, & Weitkunat, 1986).
Twenty-five participants were randomly stratified to HRV Biofeedback
or relaxation control conditions for four sessions. Repeated measures
ANOVAs were calculated to analyze the data. Despite the limitation of
small sample size, results yielded statistically significant differences in
that the HRV Biofeedback group exhibited steadily increasing baseline
HEPs while the control group did not. The groups did not statistically
differ in reported quality of sleep, anxiety, or mood after the study. The
results of this study provide initial support to the central premise that
HRV Biofeedback stimulates changes in the vagal afferent pathway that
are longer lasting than simply the short term effects of breathing.
Christina Huang, PhD
17336 Eagle Canyon Way
San Diego, CA 92127
Heartbeat evoked potential
Heart rate variability biofeedback
Relaxation training
*Dual-Probe ERP Protocol in Assessment of Memory
Deficit and Malingering: Comparing ERP Responses
to Pictorial and Verbal Stimuli
Elena Labkovsky, PhD; J. Peter Rosenfeld, PhD
It has been previously shown that event-related potential (ERP) meth-
odology can be effectively used for assessing memory deficit/intactness
and malingering/deception(Rosenfeld et al., 1995, 1998, 1999, 2008). In
the present study we test a novel Dual-Probe Complex Trial Protocol
(DPCTP). In our previous studies we were using a ‘‘single-probe’
Complex Trial Protocol (CTP), which probed for only one known to the
subject detail (Probe) per block. DPCTP allows probing two familiar
details to thesubject per block. In the currentstudy subjects were asked to
take an item from a mailbox and memorize what the item was. This item
was one probe (P1)and a name of the envelope, from which subject was
taking the item, was the second probe (P2). In DPCTP each trial contains
two probes. The first part contains P1 and a few ‘‘Irrelevants’’ (Iall1). In
the second part—P2, another set of Irrelevants (Iall2), and Target. ‘‘Ir-
relevants’ were items and names (other than the name on the envelope)
not familiar to the subject (8 images and 8 names), and the ‘‘Target’’ was
the only stimulus that required a distinct behavioral response. We ran 3
groups: an ‘‘Experimental’’ (EG), N =15 ‘‘Control’’(CG), N =14 and
‘Counter-Measure’’(CMG), N =14. Hit rates were 100 % (EG) and
93 % (CMG) with either P1 or P2 detected. There was 1 false positive
(with only 1 probe) in CG. Mixed ANOVA (3 groups 95 stimulustype)
revealed marginal group difference, F(2,40) =3.025, p=0.060.
Without ‘‘Target’’ F(2,40) =3.989, p=0.026.There was stimulus type
effect, F(3,38) =22.691, p\0.001, and interaction effect,
F(6,76) =3.294; p=0.005. T-tests revealed significant differences
between P1 and Iall1 amplitudes, t(14) =7.016, p\.01(SG),
t(13) =4.29, p\.01—(CMG). No difference in CG for P1 vs. Iall1,
t(13) =0.47, p=0.47. Significant differences also occurred between
P2 and Iall2: t(14) =7.45, p\.01—(EG), and t(13) =2.21, p\.05—
(CMG). No difference was found between P2 and Iall2 in CG,
t(12) =2.66, p=0.02.The results also indicate that pictorial stimuli
evoke a greater probe-irrelevant difference than the verbal stimuli, as
demonstrated by ANOVA, when comparing (EG and CMG) averaged
across both trial parts, the interaction of PART x ORDER was close to
significant at F (1,25) =3.68, p=.067. The study helps to better
understand neural mechanisms underlying cognitive processes related to
memory and recognition through the use of the ERP method. The study
shows practical applicability of the ERP-based investigations for evalu-
ation of memory deficit and/or malingering and demonstrates superiority
of pictorial vs. verbal stimuli in ERP responses.
Elena Labkovsky, PhD
1610 Washington St
Evanston, IL 60202
Dual-probe complex trial protocol
Counter measures
308 Appl Psychophysiol Biofeedback (2014) 39:293–316
Event-related potentials
Pictorial and verbal stimuli
Biofeedback Apps for Clinical and Personal Use
Jasmine Mitose; Richard Harvey, PhD; Erik Peper, PhD; Emily
Rogers; San Liu
For more than a decade, researchers (Bianchi et al., 2003) have been
working on designing hardware and software biofeedback applications
(‘apps’) for use on smartphones and other portable computing devices.
Some of the impetus for developing apps is motivated out of necessity,
such as the need for low cost devices, continuous monitoring and the
use in remote military settings. For example, according to Luxton et al.
(2011) ‘‘The National Center for Telehealth and Technology (T2) is
one organization that is leading usability research on these smartphone
functions for use among military Service Members and health care
providers.’’ The purpose of the study was to compile and evaluate
biofeedback applications currently available for the Apple and Android
platforms that can be used for clinical and personal use on smartphones
and tablets. We searched for available apps through the buying mar-
ketplaces for each platform using keywords including ‘‘biofeedback,’
‘self-regulation,’’ ‘‘observational data,’’ and ‘‘behavioral change’’ and
interviewed biofeedback vendors. Eighty apps were organized into 3
groups, ‘‘logging/reminders/pacing,’’ ‘‘physiological monitoring (via
the phone/tablet),’’ and apps requiring ‘‘adjunctive biofeedback sen-
sors.’’ Twenty-four apps gave feedback without the use of adjunctive
sensors and utilized the camera or movement detector, 46 apps were
used for behavioral and monitoring that required input from the user,
and 10 apps used adjunctive biofeedback sensors. The top 15 apps are
listed and assessed in utility for clinicians to use in their practice and
clients for personal use. Apps requiring adjunctive sensors were more
focused on clinical biofeedback methods, while behavioral monitoring
apps were general ‘‘wellness’’ types that included themes like weight
loss and stress reduction. Using readily available technology enables
both clinical and non-clinical biofeedback users to access equipment
and forms of feedback previously only available in biofeedback labo-
ratories or by other types of specialized equipment. This systematic
review of biofeedback apps for the Android and Apple platform
smartphones and tablets serves as a baseline measure for what will
surely emerge as a growing field of biofeedback technology. We invite
clinicians and educators to contribute by submitting descriptions and
links of apps so that the database will be more complete.
Jasmine Mitose
297 Westridge Avenue
Daly City CA 94015
415 531 2252
Smartphone Apps
Plantar Fasciitis and Biofeedback Training
Taylor Williams, BA; Richard Harvey, PhD; Erik Peper, PhD
This study reports a biofeedback approach for addressing Plantar Fas-
ciitis (PF). Painful inflammationof the plantar fascia on the bottom of the
foot (plantar fasciitis) occursfor 10 % of Americans at one point in their
lives, resulting in difficulty walking. Plantar fasciitis can also cause a
bone spur to form on their heel leading to persistent discomfort,with pain
most often reported upon waking, as well as exacerbated by physical
exercise. Typical approaches that reduce or eliminate plantar fascia
inflammation include: specific stretching exercises; wearing special
splints, footware and/or orthotic devices; ice/heat treatments; anti-
inflammatory and steroid medications; and specific needling of the fas-
cia. Approaches for addressing associated bone spurs include shockwave
therapy and surgery. This study hypothesized that muscle measurements
may be used to identify planter fasciitis that occurs when different
muscles of foot fail to relax after tensing. A second hypothesis was that
biofeedback training for increasing awareness of unintended muscle
tension could provide relief from typical PF symptoms. Eight partici-
pants, five with and three withoutPF, were trainedto increase awareness
of unintended low-back muscle and foot muscle tension as the partici-
pants systematically moved through anterior, neutral and posterior
pelvis/hip positions. Participants had SEMG sensors (Thought Tech-
nology, MyoScan-Pro) placed on the low-back (latissimus dorsi) and
foot muscle extensors and flexors (adductor halluscis and extensor hal-
luces longus, respectively). In repeated measurements, participants
systematically tightened and released foot muscles for five rounds of
10-second intervals, with pelvis/hips in anterior, neutral and, posterior
positions, respectively. Biofeedback training included relaxing, then
slightly tightening by 1–2 microvolts, then again relaxing each muscle
group. A one-way repeated measures analysis of variance (ANOVA)
was conducted for two groups (Plantar Fasciitis/PF and non-PF) to assess
the mean differences in biofeedback training on muscle tension in the
right and left foot as well as right and left back region during four
conditions—clench toes, relax toes, clench toesand relax toes. There was
a significant difference between groups (PF and non-PF) for the right-
foot measurements. Neither left-foot, right-back nor left-back muscle
measurements showed a significant group difference. Curiously, there
was no significant effect for time. It was hypothesized that measuring
foot and back muscles could help differentiate between PF and non-PF
patients. There is some support for the hypothesis in that right-foot
measurements showed a group difference. It was also believed that a
combined program of SEMG feedback and teaching to correct pelvis/hip
tile position could lead to quicker healing from Plantar Fasciitis, or
possibly help prevent it. For example, PF participants could learn to
slightly clench their toes by 1–2 microvolts and relax them immediately
so that their muscle clenching pattern would be similar to non-PF par-
ticipants. Evidence in support of the secondhypothesis was not apparent.
A limitation of the study is the small number of participants. This sug-
gests that tracking a larger number of subjects over time to see how long
the biofeedback training conveys benefit to Plantar Fasciitis participants
may still be needed to provide support for the second hypothesis.
Taylor Williams, BA
1600 Holloway Avenue, HSS 326
San Francisco, CA 94132
Plantar fasciitis
EMG biofeedback
Pre-start Psychophysiological Profile of a 200-meter
Canoe Athlete: A Comparison of Best and Worst
Reaction Times
Sommer Christie, BSc, MHK, PhD Candidate; Penny Werthner,
The difference between success and failure in 200-meter canoe and
kayak events is measured in milliseconds. The difference between not
Appl Psychophysiol Biofeedback (2014) 39:293–316 309
reaching the podium and winning a bronze medal was merely 31 ms in
the 200-meter kayak event at the summer 2012 Olympic Games (Men’s
Kayak Single (K1) 200 m Results, 2012). In addition to physical fit-
ness, strength and technique, the ability to focus effectively and
manage arousal is crucial to the ability to react quickly off the start
(Crews, Lochbaum, & Karoly, 2001). Moreover, the inability to
manage arousal and focus has been shown to reduce reaction time (RT)
(Williams & Andersen, 1997). The objective of this single case analysis
was to investigate the idiosyncratic psychophysiological patterns
associated with best and worst RTs in one male national team
200-meter canoe athlete. The athlete completed 10 h of BFB/NFB
training, and a total of 300 RT trials each (10 sets of 30 individual trials)
over the span of six weeks. RT trials were conducted in the laboratory
on a paddle ergometer to simulate as much as possible real life race
starts. Psychophysiological data (muscle tension (EMG), respiration
patterns, electrodermal activity (EDA), peripheral body temperature,
and brainwave activity) were recorded simultaneously with RT using a
synchronizing device. From the RT trial results five of the best (i.e.,
quickest) and five of the worst (i.e., slowest) RTs were selected for
analysis. Results indicated that there was a significant difference
between the mean RT of the athlete’s five best and five worst RT trials
(p\0.05), with best starts occurring later in the training (session 6 and
10) and worst starts early in the training (sessions 1 and 2). In best RTs
respiration (p\0.005), EMG (p\0.05), and temperature (p\0.001)
was higher and EDA was lower (p\0.001) than in worst RTs. Fur-
thermore, in best starts theta (p\0.05) and low alpha (p\0.005) were
lower, and high alpha (p\0.001), SMR (p\0.001), beta1
(p\0.001), low beta (p\0.001), high beta (p\0.001), and busy
brain (p\0.001) were higher than in worst RTs. The results in the case
study analysis will be used to pilot further research on psychophysio-
logical profiles for optimal sport performance.
Sommer Christie, BSc
207-881 Sage Valley NW
Calgary, AB
Sports performance
Reaction time
Psychophysiology measurement
*Biofeedback Assisted Stress Management for Multiple
Ben Greenberg, PhD; Christine Moravec, PhD; Michael McKee,
PhD; Elizabeth Grossman, Alison Reynard, Gregory Bolwell,
Dana Schneeberger, Francois Bethoux
Participants (n =19) were adults aged 18–90 diagnosed with multi-
ple sclerosis (MS). They were randomized to receive either Usual
Care (UC; n =9) or Biofeedback Assisted Stress Management
(BFSM; n =10). A variety of subjective and objective outcome
measures were evaluated including: blood plasma markers of stress
and immunological functioning (Norepinephrine, Epinephrine,
Dopamine, C-Reactive Protein, and Tumor Necrosing Factor—
alpha); self-reported mood and functioning (SF-36, PHQ-8, GAD-7,
LET, and 0–10 stress and pain scales); and MS-specific measures of
functioning (Paced Auditory Serial Addition Test, 9-Hole Peg Test,
25 foot walk test, Multiple Sclerosis Functional Composite composed
of these three measures, and the Modified Fatigue Impact Scale).
Additionally, all participants completed a psychophysiological stress
assessment which evaluated peripheral temperature, skin conduc-
tance, right trapezius EMG, respiration rate, heart rate, and multiple
measures of heart rate variability. A series of analyses was conducted
including paired t-tests, ANCOVA, and effect size measures. From
these results, it appeared that while participants who received BFSM
experienced significant change in biomarkers of stress and immun-
logical functioning, they experienced meaningful and significant
gains in 4/7 measures of mood. These results support the utility of
BFSM as a potential intervention for patients with MS.
Ben Greenberg, PhD
823 Overlook Ridge Drive
Cleveland, OH 44109
Multiple sclerosis
Biofeedback assisted stress management
Psychophysiological stress assessment
Biofeedback in Interdisciplinary Care at the National
Intrepid Center of Excellence
Frances Stewart, MD; Tara Staver PsyD; Celene Moorer, MS,
ATP; Andrea Lucie, RYT, PhD student Mind–Body Medicine
The National Intrepid Center of Excellence at the Walter Reed
National Military Medical Center provides comprehensive interdis-
ciplinary evaluation and treatment for active duty service members
who have suffered one or more traumatic brain injuries. Most of them
have multiple problems such as post-traumatic stress disorder,
depression, sleep problems, headaches, and musculoskeletal pain
problems. They are evaluated and treated by a interdisciplinary team
including a primary care physician, neurologist, psychiatrist, phys-
iatrist, integrative medicine physician, neuropsychologist, physical
therapist, occupational therapist, speech and language pathologist,
audiologist, recreation therapist, family therapist, art therapist, neu-
rologic music therapist, clinical pharmacist, nutritionist, optometrist,
assistive technologist, chaplain and nurse. Autonomic problems are
commonly seen in patients with post-traumatic stress disorder and
traumatic brain injuries. Biofeedback is very useful in treating these
complex patients. It is an integral part of the NICoE program. Each
patient has a psychophysiologic stress profile and screening for
hyperventilation done in the first week. A handheld heart rate vari-
ability feedback device is used to introduce biofeedback and heart rate
variability. It also provides the opportunity for patients to use bio-
feedback as a tool in multiple settings including community
reintegration outings and in virtual reality. Additional biofeedback
treatment is based on the results of the initial evaluation as well as
input from the interdisciplinary team and the patient. Biofeedback is
used by staff in psychiatry, psychology, physical therapy, recreation
therapy, music therapy, speech and language pathology, animal-
assisted therapy, nursing and the Fire Arms Training Simulator as part
of their work with patients. Three cases are presented that illustrate
some of the common problems that are seen and how biofeedback is
used as part of the interdisciplinary treatment plan.
310 Appl Psychophysiol Biofeedback (2014) 39:293–316
Frances Stewart, MD
8901 Wisconsin Ave.
Bethesda, MD
National Intrepid Center of Excellence
Traumatic brain injury
The Effects of Oxytocin and 3D Nature Soundscapes
on Decreasing Stress Biomarkers: A Pilot Project
and Proposal for PTSD Treatment
Mickra Hamilton, AuD; Jack Ginsberg, PhD; Daniel L. Stickler,
MD; Andrea Meckley, MA
In this pilot project, we will explore the effects of Oxytocin and 3D
Nature Soundscapes on stress biomarkers. The outcome is intended to
assist in the development of a non-invasive, evidence-based treatment
for use with individuals with Post Traumatic Stress Disorder (PTSD).
There are 2 main objectives: 1. To determine the effect size of 3D
nature soundscapes as an intervention on reduction of abnormal stress
responding and dysphoric effect in a stressed group, to be used as a
control group to a sample of the population of interest, PTSD. 2. To
compare the effect of the intervention on stress biomarkers when
combining sub-lingual oxytocin administration with nature sound-
scapes to that of nature soundscapes alone. This is a double-blind,
placebo-controlled study of twenty (N =20) subjects with normal
hearing, and no history of head injury or psychiatric diagnosis. Study
subjects will be evaluated on coherent and incoherent HRV during a
stress challenge/performance task. Based on results, they will be
divided into two cohorts of ten (10): Cohort A will be comprised of ten
‘non-stressed’’ subjects and Cohort B will be 10 ‘‘stressed’’ subjects.
Oxytocin will be administered to five (5) randomly assigned subjects
from each cohort and the other five (5) cohort subjects will receive
placebo. Length of the intervention is eight, twenty-minute sessions.
Oxytocin or placebo administration will occur prior to each 3D inter-
vention session. The auditory stimuli will be a nature soundscape
introduced in a 3D Anechoic Chamber. Outcome measures will be
obtained before treatment, during each twenty-minute session and at
the completion of the eight sessions. Outcome measures include: heart
rate variability, temperature, galvanic skin response, Electroencepha-
lography (EEG) Functional Connectivity (FC). Each participant will be
assessed with a Quantitative EEG, and three psychological subjective
scales, both prior to and at the end of the study. Results of this study will
reveal the effects of nature soundscapes and oxytocin on the physio-
logical and emotional state of patients with high stress response serving
as a control for the target population of future studies with PTSD.
Mickra Hamilton, AuD
190 Broadway St. STE 101
Asheville, NC 28801
3D nature soundscapes
HRV Biofeedback Effects on PTSD and Cognition
in Combat Veterans
JP Ginsberg, PhD Licensed Clinical Psychologist/
Neuropsychologist; Paulette Muni, PhDLicensed Clinical
Psychologist; Jane Areve, MA, Licensed Professional Counsellor
and Biofeedback Profession; Wendy Fogo, MA Graduate
Assistant; Rebecca Rambharose, Research Coordinator; Madan
Nagpal, PhD; Dawn Morales, PhD
Data are continuing to emerge from a relatively large-scale study of
the effects of HRV Biofeedback on affect and cognition in combat
veterans with PTSD. This study is in progress at the Dorn VA
Medical Center in Columbia, SC. A thorough evaluation of symp-
toms (e.g., CAPS, PCL-M, BDI), HRV, and cognition was
completed on recently returned combat Veterans less than age 45.
Combat veterans without PTSD were control subjects and seen only
for baseline evaluation. Veterans diagnosed with PTSD were ran-
domized into active or sham HRV biofeedback training (HRVB+
and HRVB-, respectively). HRVB+ participants met with an HRVB
professional weekly for 6 weeks and received visual feedback in
HRV patterns while receiving training in resonance frequency
breathing and positive emotion induction. HRVB-participants met
with the HRVB professional the same number of times in the same
setting and viewed a static relaxing image on the computer screen
(mountain, flowers) while receiving passive instructions to relax.
Assessment was repeated immediately upon completion of training,
and then again 8 weeks after completion of training. To date, 68
Veterans have been included in the study: 12 Controls, 27 HRVB+,
29 HRVB-. Thirty-two of the randomized PTSD veterans have
completed training (another 12 are still in training), and 25 remained
in the study through follow-up. Primary outcome variables are
PTSD, log10 of peak LF power, and commission errors on a go–go
no test. Interaction of group with training, and the main effect of
training, were significant for HRV power, indicating that HRVB+
increased HRV power significantly more than just meeting with the
biofeedback professional. Paired t-tests of pre-post PTSD and go-no
go commission errors in each group separately revealed that PTSD
significantly decreased and commissions significantly decreased in
HRVB+ but not HRVB-; however, significance was not achieved in
mixed-model analysis. All randomized subjects have not completed
the training, so sample size and therefore study power will increase
in coming weeks. Data are still being analyzed. Nonetheless, at this
point in time, HRVB has produced robust increases in HRV power
and modest improvements in affect and cognition in PTSD combat
JP Ginsberg, PhD
6439 Garners Ferry Road
Columbia, SC 29209
Combat veterans
Heart rate variability biofeedback
Appl Psychophysiol Biofeedback (2014) 39:293–316 311
The Effectiveness of Mobile TeleHealth Biofeedback
in Improving Symptoms of PTSD in Marines
and Corpsmen Exposed to Combat
Dominiquie M. Clemmons-James MS, LPCA, NCC; Carmen V.
Russoniello, PhD, LRT, LPC, BCB, BCN; Brenda-Bart Knauer,
The purpose of this controlled efficacy study is to determine whether
Telehealth biofeedback is efficacious in reducing symptoms associ-
ated with Post Traumatic Stress Disorder (PTSD) in 60 active duty
Marines and Corpsmen exposed to combat and currently experiencing
symptoms. In this study a specific type of biofeedback, heart rate
variability (HRV), is utilized to improve the autonomic nervous
system (ANS) and subsequently improve symptoms associated with
PTSD. HRV biofeedback involves measuring cardiovascular status
through the use of a non-invasive sensor and software that analyzes
the results of the data similar to an electrocardiograph (ECG). The
cardiovascular data are recorded, analyzed, and fed back to the par-
ticipant on a computer screen in a form that is understandable and
entertaining; i.e., a graph, animation or a game. A biofeedback spe-
cialist teaches the participant a specific breathing technique shown to
be effective in producing respiratory sinus arrhythmia (RSA). This
breathing technique ‘‘exercises’’ the ANS, increasing its power and
control. PTSD has been associated with hyperarousal of the ANS and,
if left unmitigated, can cause depression, anxiety, insomnia, anger and
a number of somatic issues. Using HRV analysis of the ANS, real-
time information is fed back to the participant who learns how to
dynamically train the system. Participants will be taught by a spe-
cialist how to perform HRV training and be given a sensor and
application to perform training from a remote location on the Mobile
Teleheath System developed for the Department of Defense. We
hypothesize that HRV training will decrease hyperarousal and
increase ANS power and control. Simultaneously, we believe par-
ticipants will experience a reduction of PTSD symptoms.
Dominiquie M. Clemmons-James, MS
300 Curry Court Suite 2501
Greenville, NC 27834
Heart rate variability biofeedback
The Influence of Music Therapy on Heart Rate
Variability at the National Intrepid Center
of Excellence
Julie Garrison MA, MT-BC (Music Therapist, Board Certified);
Frances Stewart, MD
The universality, accessibility and neurologic effects of music make
music therapyan excellent way to address the psychophysiological needs
of patients. Music therapy is the evidence-based use of music interven-
tions to accomplish non-musical goals within a therapeutic relationship
with a music therapist. Music therapy protocols are effectively and
efficiently incorporated into the management of psychological health,
rehabilitation, and preventive services through active and supportive
music making. Extemporaneous music-making within music therapy is
designed to ‘‘tap into’’ human’s proclivity to create and respond to
sounds expressively and aesthetically. This is believed to facilitate
emotional regulation, which is reflected in improved heart rate vari-
ability. Music therapy at the National Intrepid Center of Excellence
provides insights into cognitive functioning, thought processes, and
emotional regulation through music-making interventions with active
duty service members (SMs). These SMs have suffered traumatic brain
injuries and typically have additional problems such as post-traumatic
stress disorder, depression, sleep problems, headaches, and musculo-
skeletal pain. All SMs receive one group music therapy session
consisting of structured and semi-structured music improvisations that
facilitate emotional regulation and flexible thinking in a three-step pro-
tocol. They complete visual analogue scales of pain, anxiety, and mood
before and after the session. SMs are invited to use a handheld heart rate
variability biofeedback device throughout the session. A range of
musical instruments are introduced. SMs are invited to choose a drum
and maintaina 4-count rhythmic sequence. This task evokes a behavioral
response through group rhythmic entrainment within an unpredictable
auditory environment. Next SMs are invited to create a ‘‘Warrior
Cadence’’ through sounding a variety of instruments within a group
context. Lastly, SMs are invited to listen to a guided music meditation
consisting of live piano improvisation or ascending and descending
arpeggiatedmajor chords with added 6th or 4th in the bass, set at a tempo
of 60 beats per minute. Musical content within sessions are audio
recorded to correlate musical behaviors with psychophysiologic
responses. Three cases will be presented that illustrate how a music
therapy protocol with three evaluation points influences HRV within
Julie Garrison, MA
8900 Wisconsin Ave.
Bethesda, MD 20889
National intrepid center of excellence
Music therapy
Active duty service members
Heart rate variability biofeedback
Increase Productivity, Decrease Procrastination
and Increase Energy
Erik Peper, PhD; Richard Harvey, PhD; I-Mei Lin, PhD
‘All of a sudden I no longer procrastinated.’’ Students procrastinate
and have reduced productivity, while some clients forget to complete
their home practices. This study investigates how a cognitive strategy
of changing internal language may affect participants’ procrastina-
tion, productivity, and energy. Two groups of college students
completed questionnaires for the study. Seventy-one participants (22
males and 49 females, mean age 23.2 years) were sampled from a
Holistic Health class in which they practiced the self-care/stress
management techniques of transforming failure into success. Another
71 respondents (19 males and 52 females, mean age 22.8 years) were
sampled from comparable Health Education classes in which they did
not practice this skill. After practice, the impact was assessed by an
anonymous questionnaire using a 11-point Likert-type scale, from -5
to +5 with sample items asking how often they did their practice, as
well as how their procrastination, productivity and energy level had
312 Appl Psychophysiol Biofeedback (2014) 39:293–316
changed. The Holistic Health exposure group reported practicing the
cognitive exercise almost daily (M =6.7 times per week, SD =2.2).
There were no differences between the groups based on age or sex.
The exposure group as compared to the comparison group reported a
significant decrease in procrastination (p\0.01), and significant
increases in productivity (p\0.01) and in energy (p\0.01) as
analyzed by t-tests. There was no significant correlation between age,
gender and frequency of practice with procrastination, productivity
and energy. There were significant correlations between energy and
productivity (r =0.70, p\0.05), energy and procrastination
(r =0.40, p\0.05), and productivity and procrastination (r =0.40,
p\0.05). For the Holistic Health exposure group, the questionnaire
responses were cross-validated with written logs. Nearly all of these
students reported that their productivity and energy had increased
while their procrastination had decreased. The cognitive practice of
transforming failure into success steers away from negative self-talk
and self-blame and focuses on developing new strategies for
achieving positive movement in pursuit of goals. We recommend that
therapists integrate this practice into their work with their clients to
reduce procrastination and increased homework compliance.
Erik Peper, PhD
1600 Holloway Avenue
San Francisco, CA 94705
Holistic health education
Development of a Mobile Naturalistic Cognitive
John Evans LCDR, PhD; Carmen Russoniello, PhD; Vadim
Pougatchev, MD; Brenda Bart-Knauer, MD; Nick Murray, PhD;
Matt Fish, MS; Brenton Laing, BS; Dominiquie Clemmons-
James, MS
It is estimated that 20 % of all combat troops will experience a con-
cussion while deployed. There has been a dramatic rise in the
development of new psychometric instruments to identify and classify
mild traumatic brain injuries. A mobile application with specialized
software that can capture, measure, and interpret cognitive data in remote
locations is needed. This poster reviews the development of a mobile
Naturalistic Cognitive Assessment (mNCA) that is designed to measure a
variety of factors relatedto attention and response time. By incorporating
game-play as an integral piece of the assessment process, the experi-
menter may be able to avoid experimental effects of testing and improve
motivational compliance in users. The mNCA data are protected by using
strong passwords, content encryption, and data transmission with 256-bit
SSL encryption/decryption and data integrity check. An upcomingstudy
with military service members at Camp Lejeune will aim to establish the
concurrent validity of the mNCA against other current psychometric
instruments. The study will also evaluate the criterion validity with
regards to differentiating between clinical diagnoses of Post Traumatic
Stress Disorder, varying levels of Traumatic Brain Injury, or no diag-
nosis. Eventually, health care practitioners whoare using the mNCA will
be able to make judgments about a soldier’s cognitive fitness level and
make more guided recommendations for treatment.
John Evans, PhD
300 Curry Court Mail Stop 540
Greenville, NC 28758
Mobile naturalistic cognitive assessment
Mild traumatic brain injury
Skin Conductance Correlates of EEG Control in Good
vs. Poor Sleepers
Douglas E. DeGood PhD, BCB; Susan P. Buckelew, Ph.D
The purpose of this investigation was to compare the skin conduc-
tance levels (SCLs) of good and poor sleepers during a daytime effort
to regulate EEG with alpha biofeedback. In two prior studies
(Buckelew et al., 2009, 2013) it was found that the capacity to adjust
CNS activation levels (i.e., what we call ‘‘neuroflexibility’’) to the
immediate stimulus demands of the daytime environment can be
related to the quality of night time sleep. Likewise, we have previ-
ously noted (e.g., DeGood & Mohr, 1984) that there appears to be an
optimum level of autonomic nervous system (ANS) activation that
can reflect a similar adjustment to the situational demands of the
environment. For example, SCLs during any environmentally
imposed task demand should correspond to the cognitive/emotional
demands of that particular situation. Atypically low SCLs may reflect
low motivation, over sedation, or inattention to situational demands,
while excessively high SCLs may reflect anxiety or general distress
in meeting the CNS-ANS requirements of the situation. In a previ-
ously reported study (Buckelew, et al., 20 13) we found that college
students, who were good nighttime sleepers, demonstrated better
daytime alpha control when confronted with an EEG biofeedback
task than did poor sleepers. SCL was also recorded but has not been
previously reported. SCLs of the good sleepers were significantly
higher (p[.01) than those of the poor sleepers and this group dif-
ference was consistent across efforts to both enhance and suppress
alpha with both eyes open as well as closed. This group difference
was true during baseline, EEG feedback, and post baseline segments
of the session and was most pronounced during the actual feedback
task itself. This same SCL sleep group difference was repeated in a
second similar session. There were no medication use differences
between the groups. The SCLs of the good sleepers were not
excessively elevated (4 umho range), but rather showed the expected
response of subjects reacting to a new situational task demand. By
contrast the poor sleepers were characterized by unusually low SCL
levels (2 umho range). This SCL difference appears to reflect an ANS
correlate of superior regulated attention by the good sleepers to a
specific task demand. The observed association amongst sleep qual-
ity, EEG control and SCL suggest that the adjustment of physiologic
activation of good and poor sleepers to the specific awake task
demands of a daytime EEG biofeedback self-regulation task involves
capacity to fine tune regulation of both CNS and ANS activation.
Douglas E. DeGood, PhD
P.O. Box 800223
Charlottesville, Virginia
Appl Psychophysiol Biofeedback (2014) 39:293–316 313
Skin conductance
EEG biofeedback
The Effects of Heart Rate Variability Training
on Marksmanship
Brenton Laing BS/BA; Carmen Russoniello, PhD, BCB; Brenda
The purpose of this quantitative study is to evaluate the effects of a
heart rate variability (HRV) training program on marksmanship per-
formance. Rifle shooting is a complex behavior that has been linked
to replicable characteristic autonomic patterns. HRV is a measurable
function of cardiac parasympathetic activity. A standardized HRV
training program designed to improve autonomic regulation by
inducing cardiopulmonary resonance may have beneficial effects on
marksmanship. This study tests the efficacy of a HRV biofeedback
training program on a segment of the ROTC students from East
Carolina University (ECU). Marksmanship testing is completed at the
ECU Virtual Shooting Range using an EST-3000. This study utilizes
a two-group design. The treatment group is comprised of participants
who receive HRV biofeedback training. The comparison group is
comprised of participants who receive supplemental reading that
would not predictably impact shooting performance in any way.
Marksmanship testing, autonomic balance testing, and the CSAI-II
are the dependent variables used to evaluate the effect of training. The
scores of each individual on the marksmanship test are used as a
measure of performance. The aim of this study is to determine if
participants who receive HRV training improve their marksmanship
performance and their psychophysiology. If it is determined that HRV
training improves both marksmanship and psychophysiology, then
further investment in biofeedback training programs aimed at
improving performance is justified.
Brenton Laing, BS/BA
935 Spring Forest Road Apt 13
Greenville, NC 27834
Heart rate variability biofeedback
The Effect of Restorative Environments on Attention
and Physiological Arousal
Brittany Neilson, Graduate Student; Curtis Craig MA; Martina
Klein, PhD
Research on mental restoration has suggested that exposure to nat-
ural environments can reduce stress and mental fatigue (Kaplan,
2001). Specifically, natural environments are thought to capture
bottom-up attention and thus allow top-down, directed attentional
resources to replenish; this process is known as attention restoration
theory (ART; Kaplan, 1995, 2001). However, the available research
on the physiological reaction to restorative environments is pre-
liminary and needs further investigation. The purpose of this study
is to understand the usefulness of physiological measures as an
indicator of mental restoration produced by exposure to natural
environments. Participants in this study will perform one of two
sustained attention tasks based on random assignment: (1) Sustained
Attention to Response Task (SART; Berto, 2005), which assesses
the ability to inhibit frequent responses, and (2) a traditional vigi-
lance task, which assesses the ability to make responses to rare
critical signals. Next, participants view a screen that displays either
nature, urban, or blank (control) scenes. They then perform the same
sustained attention task as they did previously. Physiological mea-
sures (ECG, EEG, facial EMG) are recorded continuously
throughout the session using the BioPac MP150 data acquisition
system. An EEG engagement index (Pope et al., 1995) will be
calculated as a brain-based criterion of participant engagement. We
hypothesize that exposure to nature scenes will improve perfor-
mance on both sustained attention tasks and decrease physiological
arousal, as indicated by ECG, facial EMG, and the EEG engagement
index, compared to exposure to urban and control scenes. We do not
expect to find differences between the two sustained attention tasks
but we are interested in generalizing the restorative effect found in
Berto’s (2005) study using the SART to a traditional vigilance task.
The results of this study may be useful in understanding if exposure
to nature stimuli would be useful during biofeedback training to
reduce stress and improve mental fatigue. Preliminary results will be
presented, and implications for future use of restorative environ-
ments will be discussed.
Brittany Neilson
4110 17th Street, Apt. 606
Lubbock, TX 79416
Attention restoration theory
Exposure to natural environments
Psychophysiological measurement
Smartphone and Tablet Use Survey Among Students
Esther Lin BA; Sandy Lau, BA; Jasmine Mitose, BA; Emily
Rogers, BA; Rick Harvey, PhD; Erik Peper, PhD
A survey was designed to assess self-reports of ergonomic factors
associated with Smartphone and computer Tablet use among students.
Prior research has examined factors such as body strain (e.g. muscle-
strain, eye-strain) related to computer keyboard and screen use with
less written about time and location of use related to students. For
example, the amount of time spent using a Smartphone or Tablet
during class or before sleeping has not been explored. What is
known? Smartphones are primarily used for communicating (e.g.,
talking or texting), however smartphones and tablets are also used for
game playing, internet searching, social networking and music lis-
tening. The current survey explores the growing use of Smartphones
and Tablets by students augmenting health behaviors, such as
increasing exercise activities or managing time (e.g., using sleep and
wake alarms). Over the past few years, there has been a rise in daily
‘screen time,’ with electronic devices such as televisions, computers,
smartphone and tablets accounting for approximately 53 h per week
314 Appl Psychophysiol Biofeedback (2014) 39:293–316
by a typical 18 year old (Kaiser Family Foundation, 2010). Currently,
screen time on Smartphones has reached about 75 min per day
(Soikkeli & Karikoski, 2011), so the propensity for unintentional
muscle strain, possibly leading to injury is ever increasing. Due to
portable electronic devices becoming omnipresent in daily life, this
study also considers exposure to ‘electronic smog’ leading to various
health effects (e.g., anxiety, depression, reduced energy levels) in
addition to ergonomic effects such as body-strain. The survey was
administered to students at San Francisco State University, a large
public university in San Francisco, CA. The students represented a
cross-section of age, and sex as part of general education courses. The
surveys were made available online as part of a class exercise. The
sample was represented by 34 men and 88 women, with a mean age of
21.3 years (SD =2.3 years). Of these, there were 114 right-handed
and 8 left-handed individuals. There were no significant differences in
Smartphone minutes of usage based on age, sex or handedness. The
Median hours of Smartphone usage among the students was 80.7 min
per day (SD =39.6 min). The Median hours of Tablet usage among
the students was 95.5 min per day (SD =45.8 min). Using the
Smartphone to text while waiting in line or while walking, as well as
for taking notes, were ranked as the top two uses for the Smartphone.
Using a Tablet for taking notes was also ranked among the top uses
for students. In contrast to Smartphones, Tablets were used by almost
half (59/122) of the students during class to check social media
websites such as Facebook. Students reported eye-strain as the most
common complaint of Smartphone use, with 22 individuals reporting
a discomfort level of 9.3 on a scale of 0–10, with 10 being most
uncomfortable. Neck and shoulder discomfort were also reported,
however with a lower level of discomfort, 4.9 and 4.2, respectively,
on a scale of 0–10, with 10 being most uncomfortable. Students
reported eye-strain as the most common complaint of Tablet use,
however median discomfort levels were 4.3 on a scale of 0–10, with
10 being most uncomfortable. Neck and shoulder discomfort were
also reported, however discomfort, 3.5 on a scale of 0–10, with 10
being most uncomfortable. Students by and large used both Smart-
phones and Tablets with both hands (117/122), and the majority of
students used Smartphones and Tablets before sleep while lying down
(81/122). Students reported low levels of anxiety, depression during
Smartphone and Tablet use. Thus, students reported using Smart-
phones and Tablets about 10–20 more minutes per day than the
national average of usage, possibly because they use the devices for
taking notes in class. Students tend to strain their eyes while using
Smartphones in class, suggesting that instructors should discourage
Smartphone use in class, as well as make sure that lighting is adequate
in classrooms. Students reported low levels of negative affect during
Smartphone and Tablet usage, suggesting a link between mood and
device use, possibly where Smartphone and Tablet use elevates mood.
Students reported a low level of chronic neck pain, which may lead to
later discomfort. We recommend using 7-inch or larger screens (e.g.,
Nexus 7, iPad-mini) to reduce eyestrain and to prop up the device to
reduce neck and shoulder muscle tension. More research is needed to
explore the ecology of Smartphone and Tablet use among students.
Esther Lin, BA
1600 Holloway Avenue, HSS 326
San Francisco CA
Smartphone use
Tablet use
College student survey
Pain Disorder and Injured Workers: Efficacy of 20-
Session Biofeedback Treatment
Julie M. Carlson, Bachelor of Art in Psychology; Emily L. Shultz,
Upper level Bachelor of Arts in Psychology student; Merritt S.
Oleski, Doctor of Philosophy in Psychology
Although previous research has demonstrated that biofeedback relaxa-
tion enables individuals with chronic pain to decrease muscular tension
and subjectivelevel of pain, as well as facilitate vasodilation,the scope of
such research has been limited (Corrado, Gottlieb, & Abdelhamid,
2003). A comprehensive literature review conducted by Morone and
Grego (2007) indicated that research in the area has been restricted by
methodological problems,including small sample size.Furthermore, it is
often unclear if the participants suffered from chronic pain only asso-
ciated with a medical condition, or were diagnosed with the
psychological aspects associated with pain disorder. The current study
aims to examine the efficacy of biofeedback relaxation trainingin injured
workers (N =38) within the context of a 20-session interdisciplinary
chronic pain management program specifically designed to treat pain
disorder associated with both psychological factors and a general med-
ical condition (307.89). Repeated measures ANOVAs will be conducted
to determine: 1) if psychophysiological measurements (frontalis muscle
tension, peripheral skin temperature, and subjective level of stress)
change significantly within each session, 2) how many training sessions
are needed before there ceases to be significant between-session
improvements (indicative of the number of sessions necessary to achieve
optimal benefits from relaxation training) 3) which technique (progres-
sive muscle, autogenic, imagery, or a combination) is the most effective
in this specific population, and 4) pre-post treatment differences in pain
beliefs (catastrophizing, fear of reinjury, expectation for cure, blaming
self, entitlement, future despair, social disbelief, lack of medical com-
prehensiveness) utilizing the Behavioral Assessment of Pain-2 (BAP-2).
Additionally, correlational analyses will be employed to determine the
relationship between scores on the MMPI-2 and the maximum
improvement in psychophysiological responses. By determining the
number of sessions needed for an optimal relaxation response that is
consistent, the most effective technique, potential predictors at the time
of evaluation, and the effect of interdisciplinary intervention on pain
beliefs, this study could provide insight into designing the most effica-
cious interventions for injured workers with pain disorder.
Julie M. Carlson, BA
1325 E. Kemper Rd., Suite 100
Springdale, OH 45246
Injured workers
Pain management
Pain beliefs
Behavioral assessment of pain-2
Physiological Stress Reactivity at the Beginning and End
of Psychotherapy: Stress Response and Outcome
Louise G. Fidalgo, BS; Doctoral Student; Brigham Breton, BS;
Dominic Schmuck, BS Candidate; Patrick Steffen, PhD
Physiological stress reactivity is related to psychotherapy outcomes.
Research has shown that PTSD patients who respond positively to
Appl Psychophysiol Biofeedback (2014) 39:293–316 315
cognitive behavior therapy show decreased heart rate reactivity in
response to trauma cues (Blanchard et al., 2002). Psychiatric patients
who showed less physiological stress reactivity before therapy had
significantly better treatment outcomes at the end of therapy (Eh-
renthal et al., 2010), suggesting that psychotherapy outcomes are
negatively impacted by high stress reactivity. It is not known, how-
ever, how physiological stress reactivity is related to outcome in
general psychotherapy patients. The purpose of the present study was
to examine if physiological stress reactivity at the beginning of
therapy can predict psychotherapy outcome at the end of therapy. We
hypothesized that patients reporting higher levels of distress would
have higher levels of physiological stress reactivity compared to less
distressed psychotherapy patients, which would contribute to their
lack of success in therapy. To test this hypothesis, we measured the
physiological stress reactivity (respiration, heart rate variability,
blood pressure and cortisol levels) of patients beginning psycho-
therapy using the Trier Social Stress Test (TSST). Our results show
that on the Outcome Questionnaire (OQ-45), red responders (patients
whose distress scores significantly go up after baseline) showed
slower systolic blood pressure (SBP) recovery on the TSST
(F =3.101, p=.018). Our results also show that patients scoring
high on the OQ-45 (above 63) have higher levels of heart rate and
SBP (F =3.804, p=.006) and take more time to reduce their stress
levels during the recovery period compared to less distressed psy-
chotherapy patients. In conclusion, we propose that stress-reducing
techniques such as biofeedback will provide a useful adjunct to
psychotherapy and will help improve the psychotherapeutic experi-
ence and the outcome of these patients.
Louise G. Fidalgo, BS
273 N 800 E
Provo, UT 84606
Physiological stress reactivity
Trier social stress test
Vagal Recovery in Healthy Adults: A Normative Data
Jonathan Marquez, MA; Derek Ray, BS; Taryn Lilliston
Gammon, BS; Karina Gutman, Tammy Wildgoose; Bethany
Dawson, BA; William Curci, Jonathon Vose, BA: Mark Stern,
MA; Richard Gevirtz, PhD
The sympathetic and parasympathetic nervous systems control the
physiological expression of stress in mammals. These branches work
in conjunction to regulate heart rate pattern. Porges (1995) has
hypothesized that the vagus nerve evolved within the parasympathetic
nervous system as a cardiac brake that creates a rhythmic acceleration
and deceleration of heart rate associated with respiration, known as
Respiratory Sinus Arrhythmia (RSA). Chronic stress can lead to
parasympathetic withdrawal and a decrease in vagal influence on
heart rhythm. Parasympathetic activity can be used as a measure of
stress, and can be assessed by quantifying vagal tone from heart rate
variability (HRV). Exercise can be utilized to mimic the natural stress
response and recovery. The aim of the present study is to provide
normative data on average vagal tone and vagal recovery in healthy
adults. Participants (n =30) were male and female, aged 18–65, with
no co-morbid health or psychological issues. Participant HRV data
was recorded using J + J Engineering’s I-330-C2+ and windows
software. Each participant was recorded for a total of 13–15 min.
Each recording included a 5-minute resting baseline, followed by
3–5 min of exercise on a stationary bike, and a 5-minute recovery
period. Vagal tone was calculated for the baseline and recovery
periods using the High-Frequency (HF) power (ms
) derived from
recordings using Kubios HRV software. This study concluded that
average baseline vagal tone in healthy adults was 6.67, while the
mean change in vagal tone pre to post exercise was not significantly
different (delta =-0.4, p=.179). Findings from this study will
have widespread clinical and research applicability in the growing
field of HRV biofeedback as a standard for healthy individuals and
basis of comparison for future studies with diverse populations.
Richard Gevirtz, PhD, BCB
Distinguished Professor
Department of Psychology
CSPP@Alliant International University
108 Daley Hall
10455 Pomerado Rd.
San Diego, CA 92131
Vagal tone
Vagal recovery
Heart rate variability
Parasympathetic nervous system
Normative data
316 Appl Psychophysiol Biofeedback (2014) 39:293–316
ResearchGate has not been able to resolve any citations for this publication.
Bachelor of Art in Psychology Upper level Bachelor of Arts in Psychology student
  • Julie M Carlson Emily
  • L Shultz
Julie M. Carlson, Bachelor of Art in Psychology; Emily L. Shultz, Upper level Bachelor of Arts in Psychology student; Merritt S.