PosterPDF Available

Relationship Between Cognitive Performance and Vagal Functioning

  • Alliant International University, San Diego, United States


The Neurovisceral Integration Model proposes that the reciprocity between the autonomic and central nervous systems facilitates an individual’s ability to respond appropriately to environmental demands by proper vagal withdrawal and recovery. Neuroimaging studies have shown the prefrontal cortex to be significantly associated with Heart Rate Variability (HRV) via the vagus nerve. Correspondingly, HRV has been shown to be associated with performance on tasks involving executive functions, such as attention, working memory and inhibition. The current study examines the relationship between cognitive performance and vagal tone, withdrawal, and recovery. Vagal tone, measured by the natural log of High Frequency (LnHF), was collected at rest for 10 min, during a cognitive stressor (Serial 7’s, while being pressed for time by the examiner), followed by a 5 min of recovery period. Vagal withdrawal was measured by the difference between LnHF at rest and during stress. Vagal recovery was measured as the difference between LnHF during recovery period and during stress. The Paced Auditory Serial Addition Test (PASAT) was used to assess auditory information processing and working memory in 15 healthy participants. A series of single digits were presented via an audio recording at the rate of one every 3 s (condition 1) and one every 2 s (condition 2) while the examinee was asked to add each number to the preceding number heard on the recording. Preliminary data (n = 15) show that PASAT performance during the 2 s condition, but not the 3 s condition demonstrated statistically significant association with vagal withdrawal and recovery (r = .739, p = .003 and r = .540, p = .046, respectively). Neither condition was associated with vagal tone at rest. Although cognitive performance was not related to resting vagal tone, it was significantly associated with vagal withdrawal and recovery. This indicates that an individual’s ability to appropriately respond to cognitive demands may be better assessed by dynamic vagal reactivity to stress. These findings support and extend the Neurovisceral Integration Model by specifying the vagal characteristics most related to cognitive performance. Further research should investigate the effects of biofeedback training on improving cognitive performance.
Abstracts of Papers Presented at the 46th Annual Meeting
of the Association for Applied Psychophysiology and Biofeedback
Published online: 8 May 2015
Springer Science+Business Media New York 2015
The 46th Annual Meeting of the Association for Applied
Psychophysiology and Biofeedback (AAPB) was held at
the Renaissance Austin Hotel in Austin, TX March 11–14,
2015. The theme of the meeting was ‘‘The Faces of
Biofeedback: Brain, Body, Performance Enhancement and
Marketing’’ The meeting included diverse program offer-
ings 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 Pro-
gram Committee to merit the special distinction as a ‘‘Ci-
tation’’ poster. The Program Committee members were Co-
Chairs Howard Hall and Dennis Romig, Richard Harvey,
Stuart Donaldson, Jay Gunkelman, Cynthia Kerson, Don-
een Moran, Jan Newman, Gabriel Sella, and Patrick Stef-
fen. The 47th Annual Meeting will be held March 9–13,
2016 at the Seattle Marriott Waterfront in Seattle, WA.
Poster Presentations
Building Resiliency in Family Practice Residents:
A Psychophysiological Approach
Angele McGrady, Ph.D., PCC, Julie Brennan, Ph.D.,
Denis Lynch, Ph.D., Kary Whearty, LSW, Caitlin Bolick,
Family Medicine residency is a high stress period of
training characterized by increasing responsibilities for
patient care. Schedules are busier and team work is a ne-
cessity compared to the last year of medical school. Dis-
tress resulting from maladaptive adjustments and overload
increases the probability for medical errors, burnout and
the emergence of mood and anxiety disorders. The goal of
the project was to utilize a wellness/resiliency intervention
to improve psychological well being and to prevent
burnout in family medicine residents. The study received
IRB approval. A needs assessment revealed that residents
wanted techniques to manage their cognitive, emotional
and physiological stress, more opportunities for physical
exercise, healthy eating and family social activities. Ele-
ven of twelve residents are participating: 6 men, 5 women
of average age 36 years. The resident interactive sessions
are: self-awareness, positive psychology, relaxation, im-
agery, mindfulness meditation. Residents set specific be-
havioral goals and identified a buddy for support. The
session on stress focused on identifying frequent stress
responses and characteristics of optimal performance.
Positive psychology focused on attitudes towards work,
gratefulness and simple pleasures. Relaxation was prac-
ticed at every session. The family session involved com-
pletion of a life map followed by an outdoor activity.
Reminders were sent via phone apps regarding practice of
relaxation skills. An elliptical was purchased for the on
call room and healthy snacks were provided for the out-
patient service residents. Three residents are at risk for
distress and burnout based on their scores on the Human
Services Survey and the Resiliency Scale. Residents have
incorporated the mindfulness skills into their daily routine.
Inpatient residents are meeting before rounds to mediate
for 5 min, using taped scripts. Physical activity has in-
creased and healthy snacks are being consumed in favor of
sugary items. The buddy system is providing support to
meet goals. Residents are reporting improvements in
ability to cope with the stressors of medical training and
using relaxation practice to manage physiological arousal.
Preliminary results shows that a psychophysiological
approach to wellness seems to benefit family practice
Appl Psychophysiol Biofeedback (2015) 40:117–138
DOI 10.1007/s10484-015-9282-0
residents by increasing physical activity, improving heal-
thy eating and decreasing stress reactions.
Angele McGrady, PhD, PCC
3000 Arlington Avenue, M.S. 1193
Toledo, OH 43614 USA
Family medicine
Wellness intervention
Heart Rate Variability Biofeedback Induces
Changes on Brain Electrical Activity in Healthy
Simona Carrubba, Ph.D.
Scientific evidence supporting the effectiveness of biofeed-
back (BF) training in modifying brain electrical activity is
still limited. Methodological issues—including the use of
objective measures, statistical analyses, and the inclusion of
control groups—needs to be addressed by researchers before
BF techniques will gain widespread acceptance and imple-
mentation in clinical settings. The goal of the present study
was to assess the acute effect of heart rate variability (HRV)
biofeedback on brain electrical activity of healthy subjects
by means of quantitative electroencephalography (QEEG).
Twenty healthy participants were randomly assigned to ei-
ther a control group or a treatment group. Each subject’s
resting electroencephalogram (EEG) was recorded before
and after a single 15-min biofeedback session (treatment
group) or a sham session (control group). Power spectrum
analysis was used to extract the frequency content of
recorded signals of five frequency bands (delta, theta, alpha,
low beta and high beta). Statistical comparison of the rela-
tive power amplitude between pre- and post-treatment (or
pre- and post-sham) was performed within and between
groups. Group analysis did not reveal significant changes
between control and treatment group. However, statistical
analysis performed on an individual basis revealed changes
in brain activity between pre- and post-treatment session in
forty percent of the subjects in the treatment group
(p\0.01, adjusted for multiple comparisons). The effect
was manifested either as an increase or a decrease in the
relative spectral power, depending on the specific frequency
band and the subject. No significant changes were detected
in any of the subjects in the control group. The results of this
study showed that BF training produces acute effects on
brain electrical activity in healthy subjects.
Simona Carrubba, PhD, Biophysics Professor, Neuro-
science Researcher
4380 Main St
Amherst, NY 14226 USA
Heart rate variability biofeedback
Quantitative electroencephalography
Treatment efficacy
HRV Biofeedback Reduces PTSD in Combat
JP Ginsberg, Ph.D., Jane Arave, M.A., Paulette Muni,
Ph.D., Wendy Fogo, M.A., Madan Nagpal, Ph.D., Royce
Malphrus, Ph.D., Linda Leech, Ph.D., Leon Johnson,
Ph.D., Rebecca Rambharose, Kurt Gleichauf
Results of our completed 3 year Phase I randomized clinical
trial of the effects of Heart Rate Variability (HRV)
biofeedback on Posttraumatic stress disorder (PTSD) in
combat veterans are still being compiled, and some of the
basic results are reported here. Potential study participants
were recruited, screened for eligibility, and consented.
Combat veterans from Iraq and Afghanistan who were re-
cruited were assessed for PTSD (and other mental disor-
ders), HRV, and attention/immediate memory (the attention/
immediate memory results are not reported here). Based on
the PTSD score from the psychological assessment, par-
ticipants were classified into PTSD+ and PTSD-groups.
The PTSD+ veterans were then randomly assigned to either
an active or a sham HRV biofeedback training group.
PTSD-participants did not return for training or further
assessment, and were used as controls for baseline (Pre-
training) comparisons only. PTSD+ participants were pro-
vided with 6 weekly 45-min active or sham HRV biofeed-
back training sessions. Post-training, PTSD+ participants
were assessed using identical procedures as at baseline, and
assessed again at third, Follow-up assessment 8 weeks after
the end of training (i.e. about 16 weeks after baseline). 61
PTSD+ and 12 PTSD-combat veterans were enrolled;
among the PTSD+ veterans, 29 received active and 32 re-
ceived sham HRV biofeedback training. Results showed (1)
at baseline, the PTSD-group was statistically greater in
SDNN, RMSSD, and HF power, and these same HRV
variables were significantly correlated with measures of
PTSD; (2) using peak LF as an indicator of coherence, there
was no difference in HRV pre-training in the active vs sham
HRV biofeedback PTSD+ groups, but the groups did differ
significantly in peak LF (active [sham) after training; (3)
118 Appl Psychophysiol Biofeedback (2015) 40:117–138
active HRV biofeedback clinically and statistically de-
creased PTSD symptoms compared to sham training, and
improvements in HRV and PTSD were maintained for the
8 week follow-up period. Quality ratings of likelihood of
non-bias yielded a score of 4 out of 5, indicating that the
likelihood of non-bias in results is high. Details of the pro-
cedures and equipment used for physiological measurement,
active and sham HRV biofeedback training, and statistical
analysis will be presented in this poster.
JP Ginsberg, PhD, Licensed Clinical Psychologist
6439 Garners Ferry Road
Columbia, SC 29229 USA
Heart rate variability biofeedback
Posttraumatic stress disorder
Relationship Between Cognitive Performance
and Vagal Functioning
Mark J Stern, M.A., BCB, Leighton A Grampp, Carolyn J
Huntley, M.A., BCB; Jonathan Marquez, M.A., Kevin
Keeran, M.A., Tammy Wildgoose, B.S., William P Curci,
B.A., Joscelyn Rompogren, M.A., Scott C Wollman, M.S.,
Matthew G Hall, M.S., Omar M Alhassoon, Ph.D., Richard
Gevirtz, Ph.D.
The Neurovisceral Integration Model proposes that the re-
ciprocity between the autonomic and central nervous systems
facilitates an individual’s ability to respond appropriately to
environmental demands by proper vagal withdrawal and re-
covery. Neuroimaging studies have shown the prefrontal
cortex to be significantly associated with Heart Rate Vari-
ability (HRV) via the vagus nerve. Correspondingly, HRV
has been shown to be associated with performance on tasks
involving executive functions, such as attention, working
memory and inhibition. The current study examines the re-
lationship between cognitive performance and vagal tone,
withdrawal, and recovery. Vagal tone, measured by the nat-
ural log of High Frequency (LnHF), was collected at rest for
10 min, during a cognitive stressor (Serial 7’s, while being
pressed for time by the examiner), followed by a 5 min of
recovery period. Vagal withdrawal was measured by the
difference between LnHF at rest and during stress. Vagal
recovery was measured as the difference between LnHF
during recovery period and during stress. The Paced Auditory
Serial Addition Test (PASAT) was used to assess auditory
information processing and working memory in 15 healthy
participants. A series of single digits were presented via an
audio recording at the rate of one every 3 s (condition 1) and
one every 2 s (condition 2) while the examinee was asked to
add each number to the preceding number heard on the
recording. Preliminary data (n =15) show that PASAT
performance during the 2 s condition, but not the 3 s condi-
tion demonstrated statistically significant association with
vagal withdrawal and recovery (r =.739, p=.003 and
r=.540, p=.046, respectively). Neither condition was as-
sociated with vagal tone at rest. Although cognitive perfor-
mance was not related to resting vagal tone, it was
significantly associated with vagal withdrawal and recovery.
This indicates that an individual’s ability to appropriately
respond to cognitive demands may be better assessed by
dynamic vagal reactivity to stress. These findings support and
extend the Neurovisceral Integration Model by specifying the
vagal characteristics most related to cognitive performance.
Further research should investigate the effects of biofeedback
training on improving cognitive performance.
Mark J Stern, M.A., BCB
10455 Pomerado Road
San Diego, CA 92131 USA
Optimal performance
Vagal functioning
Executive functioning
Neurovisceral Integration Model
Clinical Report for the Use of HRV Biofeedback
with a Stroke Survivor
Jana Downum, M.A., L.P.C., B.C.B.
The following is a clinical report using Heart Rate Vari-
ability Biofeedback with a stroke survivor. The setting was
a post acute brain injury clinic. The patient received multi-
disciplinary services for return to functional living ac-
tivities, including her vocation. Due to her cerebral vas-
cular accident (CVA), she was experiencing word retrieval
difficulties and general stress. Her speech therapist rec-
ommended biofeedback services. Biofeedback offered the
survivor ways to manage stress, pain, and sleep. Twenty
sessions of biofeedback therapy were provided. Heart-
Math’s emWave and Thought Technology’s Biograph In-
finiti equipment were used. With daily practice of mindful
breathing and weekly biofeedback sessions, the patient
demonstrated consistently high mind body coherence. She
reported improved ability to manage stressors and was
going to use the skill set when she returned to work. Please
see the session data submitted in the poster.
Appl Psychophysiol Biofeedback (2015) 40:117–138 119
Jana Downum, M.A., L.P.C., B.C.B.
11430 Cherry Ridge Court
Dallas, TX 75229 USA
Heart rate variability biofeedback training
Stroke rehabilitation
Case study
*Combined Neuromodulation Therapy Integrating
rTMS and EEG Biofeedback for Treatment
of Children with Autism Spectrum Disorder
Tato Sokhadze, Ph.D., Ayman S. El-Baz, Ph.D., Allan
Tasman, M.D., Lonnie Sears, Ph.D., Yao Wang, M.S.,
Manuel F. Casanova, M.D.
Autism spectrum disorder (ASD) is a pervasive develop-
mental disorder characterized by deficits in social interac-
tion, language, stereotyped behaviors, and restricted range of
interests. In our previous studies repetitive transcranial
magnetic stimulation (rTMS) over dorso-lateral prefrontal
cortex (DLPFC) has been used, with positive behavioral and
electrophysiological results, for the experimental treatment
in children with ASD. Specifically we reported improve-
ments in behavioral and executive functioning using elec-
trocortical measures. In this study we combined 18 sessions
of low frequency rTMS over DLPFC with the prefrontal
EEG biofeedback (BFB) to prolong and reinforce TMS-in-
duced EEG changes using post-TMS EEG operant condi-
tioning paradigm. The pilot trial recruited 54 children with
ASD (mean age 14.2 yrs). Outcome measures included be-
havioral evaluations (Aberrant Behavior Checklist, repeti-
tive Behavior Scale, Social Responsiveness Scale) and
psychophysiological tests (e.g., visual oddball test with EEG
recording). For the main goal of the study, we used 18
sessions of rTMS-only (TMS, N =17), 18 sessions of
rTMS followed by prefrontal biofeedback combination
(TMS + BFB, N =18) and waitlist (WL, N =19, 3–6
moths between tests) groups to examine effects on EEG,
event-related potentials (ERP), and other functional and
behavioral clinical outcomes. The underlying hypotheses
were that: (1) the combination of rTMS with neurofeedback
will result in a synergetic outcome as compared to TMS-
alone, and (2) both TMS-only and TMS + BFB will im-
prove executive functions in autistic patients as compared to
the waitlist group. Behavioral, EEG and ERP outcomes were
collected in pre- and post-treatment tests in all 3 groups.
Results of the study partially supported our hypotheses by
demonstration of better expressed positive effects of
combined TMS + BFB neurotherapy as compared to TMS-
only, and both TMS groups showed significant improve-
ments in behavioral and functional outcomes as compared to
the children in wait-list group. Follow-up assessments of in
both treatment groups (6–9 months post-treatment) are un-
derway and data is collected for majority of patients enrolled
in the active treatment groups. Preliminary results of follow-
up tests are supportive of exploratory hypothesis that com-
bined rTMS and EEG biofeedback neuromodulation has
more long-lasting effects than rTMS alone.
Tato Sokhadze, PhD
401 E Chestnut Street, #600
Louisville, KY 40202 USA
(502) 852-0404
Transcranial magnetic stimulation
Autism spectrum disorder
Prefrontal EEG biofeedback
Dorso-lateral prefrontal cortex
Evidence-Based Ethics Related to Neurofeedback
Jason von Stietz, B.A.
Growth in the field of neurofeedback has led to a need for
practitioners to reexamine their ethical practices. Practi-
tioners navigate numerous ethical dilemmas related to pro-
fessional conduct on a daily basis. A practitioner committed
to serving the best interest of the client must go beyond the
mandatory ethics of one’s profession and strive to adhere to
the highest standard of professional conduct. Strife (2009)
outlined six key characteristics and skills that an ethical
neurofeedback practitioner upholds: confidence, compas-
sion, commitment, ethical competence, ethical resoluteness,
and ethical willingness. These six characteristics and skills
overlapped conceptually with the findings of a qualitative
study, which identified the shared ethical values of 10 psy-
chotherapists who were nominated, by their peers, as master
therapists: relational connection, beneficence, non-
maleficence, autonomy, competence, professional growth,
humility, self-awareness, and comfort with ambiguity and
complexity. Neurofeedback is a therapeutic technique uti-
lized by professionals of several healthcare disciplines, and
few empirical data have been collected on their ethical
practices and beliefs. A review of the literature found only
one empirical study of ethical issues related to neurofeed-
back. To this author’s knowledge, Percival and Striefel
(1994) published the only empirical study of ethical issues in
the clinical use of biofeedback. Therefore, empirical findings
from the field of neuropsychology are reviewed. Moreover,
120 Appl Psychophysiol Biofeedback (2015) 40:117–138
moral decision-making has been studied extensively in the
field of social psychology and recent findings may have
implications related to the ethical use of neurofeedback.
Further empirical studies of ethical issues faced by neuro-
feedback practitioners are needed, as the literature is limited
to one empirical study. Practicing neurofeedback ethically is
important; especially since unethical behavior can harm the
client, and tarnish one’s career as well as the public image of
one’s profession.
Jason von Stietz, B.A.
1311 Sartori Ave #7
Torrance, CA 90501 USA
949 836 6041
Evidence based ethics
Scope of practice
A Controlled Study of Prescribed Casual Video
Game Play as an Augmentation Intervention
for Anxiety
Matthew T. Fish, MS, LRT/CTRS, LPCA, BCB, Carmen
Russoniello, Ph.D., LRT/CTRS, LPC, BCB, BCN, Kevin
O’Brien, Ph.D.
Anxiety is an inherent reaction to stress that when exces-
sive can evolve into a clinical disorder. Traditional anxiety
treatments include the amalgamation of pharmaceuticals
and psychotherapy, which often are expensive and stig-
matizing. The purpose of this study was to test the effec-
tiveness of prescribed casual video games (CVG) play
added to participants’ current medication regimen in re-
ducing symptoms of anxiety. Casual video games are de-
fined as fun, uncomplicated, spontaneous, and
exceptionally popular. Data were obtained from a larger
study on the effectiveness of prescribed CVG play with
major depression and comorbid anxiety. Participants chose
to participate in the traditional (n =24) or alternative
(n =30) treatment group. All participants were prescribed
a selective serotonin reuptake inhibitor (SSRI) medication
and needed a second augmentative medication to alleviate
symptoms when beginning the study. The traditional
treatment group was prescribed a second medication to
alleviate symptoms. The alternative treatment group was
prescribed CVG play four times per week, for 30–45 min,
over a 1-month period to decrease anxiety symptoms. The
State Trait Anxiety Inventory (STAI) and heart rate vari-
ability (HRV) measures were used to test hypotheses and
explore if participants were able to engage in flow.
Repeated measures analysis of variance was utilized for
hypothesis testing and Cohen’s Delta for effect size chan-
ges. The results of this study demonstrated a significant
decrease in state anxiety scores after the 1-month pre-
scription and a medium to large effect. Trait anxiety scores
had a medium effect size and HRV measures demonstrated
small and small to medium effect sizes. Transitory analyses
of the alternative treatment group demonstrated significant
decreases in anxiety scores and HRV, which suggests that
CVG play may have facilitated flow and participants had
greater decreases in anxiety both from a subjective and
physiological perspective. In conclusion, prescribed CVG
play added to participants’ medication performed sig-
nificantly better than medication for state anxiety while
trait anxiety and HRV measures had meaningful effect
sizes. Clinicians should consider these non-stigmatizing
and low cost CVGs as a viable alternative intervention for
individuals who are in need of a second medication to
address symptoms associated with anxiety.
Matthew T. Fish, MS, LRT/CTRS, LPCA, BCB
Carol G. Belk Building, Room 2404
Greenville, NC 27858-4353 USA
Casual video games
Heart rate variability biofeedback
Alternative treatment
Stress and Tinnitus: Taming the Autonomic Nervous
Mickra Hamilton, Au.D., Andrea Meckley, M.S.
The importance of how tinnitus affects the body, mind and
spirit cannot be understated. Tinnitus has a significant effect
on the autonomic nervous system, which seems to be sym-
pathetically mediated (Vanneste and De Ridder, 2013). The
stress associated with tinnitus can range from mild heart rate
increase and annoyance to full blown physiologic panic at-
tacks and extreme anger. An individual’s stress response is
the most significant indicator of how bothersome their tin-
nitus will be perceived. Those who experience high levels of
mental, emotional and physiological stress, and perceive that
stress in a negative way, tend to have more significant re-
actions to tinnitus than those who are resilient, able to go
with the flow and ‘‘tune’’ it out (Carpenter-Thompson et al.,
2014) Heart Rate Variability (HRV) Biofeedback has been
shown to regulate the autonomic nervous system and
therefor we hypothesize that it will have a significant effect
Appl Psychophysiol Biofeedback (2015) 40:117–138 121
on perceived tinnitus distress as well as changes in HRV,
EEG and neurotransmitters. This pilot study will utilize
HRV Biofeedback with customized tinnitus frequency
breath pacing to evaluate the effects on subjective tinnitus,
HRV, EEG and neurotransmitters.
Mickra Hamilton, Au.D.
190 Broadway St. STE 101
Asheville, NC 28801 USA
Heart rate variability biofeedback
*Prefrontal rTMS Treatment Effects on Autonomic
Activity in Children with Autism
Yao Wang, M.S., Marie K Hensley, M.Eng., Manuel F.
Casanova, M.D., Estate (Tato) Sokhadze, Ph.D.
Autism spectrum disorder (ASD) is a developmental disor-
der marked by difficulty in social interactions and commu-
nication. Children with ASD also often present symptoms of
autonomic nervous system (ANS) functioning abnormalities,
featured by predominantly sympathetic over-activation and
low parasympathetic tone. In prior studies of our group we
reported positive behavioral outcomes of neuromodulation
based on low frequency repetitive transcranial magnetic
stimulation (rTMS) in autism using various length of treat-
ment course and site of prefrontal stimulation. The objective
of this study was to determine the effect of 12 sessions of
weekly rTMS treatments on autonomic function in 30
children with autism (mean age around 14.2 years) by
recording electrocardiogram (EKG) and electrodermal ac-
tivity during each rTMS session using C-2J&J Engineering
Inc. monitor. Heart rate variability (HRV) measures such as
R–R intervals, standard deviation of cardiac intervals,
pNN50, power of high frequency (HF) and low frequency
(LF) components of HRV spectrum, LF/HF ratio, were then
derived from the recorded EKG and analyzed off-line using
Kubios software. We expected that the course of 12 weekly
inhibitory low-frequency rTMS applied to the dorsolateral
prefrontal cortex (DLPFC, 6 sessions at the left, 6 at the
right DLPFC) would improve autonomic balance probably
through improved frontal inhibition of limbic activity, and
will be manifested in decreased overall heart rate, increased
HRV in a form of increased HF power, decreased LF power,
resulting in decreased LF/HF ratio and decreased SCL. In
addition we analyzed changes of heart rate and SCL on
minute-by-minute basis in each rTMS session to evaluate
ANS activity changes during procedure. Our post-12 TMS
results show significant increases in cardiac intervals vari-
ability measures and decrease of tonic SCL indicative of
increased cardiac vagal control and reduced sympathetic
arousal. HR slowing and SCL decreases were also sig-
nificant during rTMS. We could not find any significant
differences between autonomic effects depending on the
stimulated hemisphere as both left and right DLPFC rTMS
showed similar autonomic outcomes and main changes were
driven by the number of rTMS treatments. Behavioral
evaluations completed by parent showed decreased irri-
tability, hyperactivity, stereotype behavior and compulsive
behavior ratings.
Yao Wang, MS, PhD student
401 E Chestnut Street, #600
Louisville, KY 40202 USA
Autism spectrum disorder
Transcranial magnetic stimulation
Autonomic activity
Heart rate variability
Psychophysiological Markers of Trauma:
Investigating the Absence of Vagal Brake
in Veterans with a History of Interpersonal Trauma
Robert Guiles, M.A., Richard Gevirtz, Ph.D., Carolyn
Allard, Ph.D., Constance, Dalenberg, Haig Pilavjian, B.A.,
Kelley Nguyen, B.A., Yen K Mai, B.A.
No research in the field of psychophysiology has examined
the relationship between interpersonal trauma (IPT) and
vagal tone in a veteran population. The measurement of
heart-rate variability (HRV) provides an opportunity to
monitor changes in the vagal regulation of the heart during
recovery from exercise. In a 2009 study, individuals with
depressed cardiac vagal tone were unsuccessful in their
ability to recruit and successfully reinstate the vagal brake
following the transitory physiological disruption due to a
mild exercise modality (Dale et. al., 2009). A calm re-
covery following exercise requires the reinstatement of the
vagus nerve (Porges, 2011). We propose to examine both
male and female veterans with history of IPT and compare
their findings to a normative non-traumatized HRV data-
base to more accurately determine whether the absence in
vagal brake is consistent in the clinical sample. The pur-
pose of this study is to provide a closer examination into
122 Appl Psychophysiol Biofeedback (2015) 40:117–138
the psychophysiological mechanisms involved in IPT with
the objective of measuring the vagal regulation in a sample
of men and female veterans. A total of 20 veterans vol-
unteered to participate in the study. Each participant was
hooked up to non-invasive biofeedback modalities intend-
ed to measure and give feedback about the participant’s
autonomic activity. The specific physiological character-
istics that were examined included heart-rate, skin con-
ductance, respiration, and temperature. Physiological data
was collected while the participant sat quietly for 5 min
prior to and for 5 min following riding a stationary bike for
10 min or approximate ridden distance of 1 mile. Physio-
logical data has been collected on 20 veteran participants.
Results are currently being analyzed for pre/post differ-
ences in HRV values. Preliminary results suggest that a
history of IPT is associated with a decreased ability to
rapidly re-engage and modulate vagal regulation following
mild exercise to support a relaxed state, compared to nor-
mative non-traumatized HRV samples. Additionally, early
results indicate that male and female veterans with IPT
histories have lower HRV values suggesting a lower
threshold to express sympathetically mediated behaviors in
response to stress.
Robert Guiles, MA
10455 Pomerado Road
San Diego, CA 92131 USA
Interpersonal trauma
Heart rate variability
Vagal regulation
The Influence of EEG Biofeedback on Amateur
Sport Players’ Confidence and Performance: A Pilot
Robert C. Nicks, B.A., Katie Melton, B.S., Gavin Sanders,
B.S., Brittany McCreary, B.A., Conner Wyckoff, Luis
Aguerrevere, Ph.D.
The purpose of this pilot study was to determine how dif-
ferent neurofeedback training protocols might influence the
self-efficacy and sport performance of amateur basketball
players. There are numerous studies that test the effect of
neurofeedback on performance and anxiety in athletes;
however, data on performance is inconsistent. Despite this,
recent research has been able to demonstrate a consistent
effect of neurofeedback on improving confidence and
anxiety (Faridinia, Shojaei, and Rahimi, 2012; Pop-
Jordanova and Demerdzieva, 2010; Vernon, 2005). This
study expands on that body of research by exploring how
neurofeedback treatment regimens might be used to increase
sports performance. The participants were five males en-
rolled in college at a Southwestern university. Each par-
ticipant played basketball at the amateur level in an
intramural sports clubs and volunteered for the study to try
to improve their performance. Participants completed
questionnaires for attention and executive functioning
namely, the Elite Athlete Self Description Questionnaire
(EASDQ), and the Sport Motivation Scale. Baseline
EASDQ and performance data was collected for two games,
then neurofeedback training conditions were implemented.
Participants were randomly assigned to either Z-score
training (training based on normative sample for F3, C3, Fz,
referencing P4), or sham conditions (random feedback).
Results for efficacy were taken from EASDQ once per
session. Performance was measured by comparing multiple
play variables for each game during the season, including
several offense and defense playing statistics, such as shots
made and turnovers. Results indicated improved self-effi-
cacy for both neurofeedback protocols, compared to the
baseline and sham conditions. These results suggest that
these protocols may be effective for increasing amateur
sports players’ confidence in their performance. Perfor-
mance data proved insufficient to make significant claims.
Implications and future directions are discussed.
Robert C. Nicks, BA
P.O. Box 13019
Nacogdoches, TX 75962 USA
Z-score training
Infra-slow training
Eliminating Chronic Migraines
with Electromyography, Autogenic Training,
Posture and Cognitive Control: A Successful Case
Brandy J. Miceli, Erik Peper, Ph.D., BCB, Richard
Harvey, Ph.D.
A 20-year-old female has had chronic migraines for
6 years occurring up to 7 days a week. The prescribed
medications (Imitrex (used to treat migraines) and
Appl Psychophysiol Biofeedback (2015) 40:117–138 123
Topamax, (used to prevent seizures and migraine head-
aches)) were ineffective in treating her migraines. The only
medication that reduced her migraines to three times per
week was Nortriptyline (a tricyclic antidepressant). She
took Excedrin Migraine to manage her pain. The educa-
tional self-training intervention embedded within a class
structure included (1) electromyography feedback to
identify the dysponesis in her neck and shoulders, (2)
minimum and maximum tension awareness training in both
shoulders and relaxing the shoulders at rest, (3) daily au-
togenic training practice and integrating autogenic phrase
‘My neck and shoulders are heavy’’ throughout the day to
relax the neck and shoulders, (4) shifting thoracic to di-
aphragmatic breathing, (5) observing slouching of body
posture which was associated with feeling self-critical and
powerless and then shifting posture to an empowering erect
posture, and (6) transforming negative thoughts and self-
judgments to empowering thought. The subject has been
migraine free since implementing this educational ap-
proach for more than 2 months, she feels empowered,
mentally clear, healthy, and her skin has cleared up. Dis-
cussed are the implications of integrating biofeedback,
autogenic training, somatic awareness, posture and cogni-
tive changes within an integrative biofeedback for reducing
symptoms within and education setting.
Brandy J. Miceli
451 Faxon Ave
San Francisco, CA 94112 USA
Self-training intervention
Autogenic training
Case study
Relaxation Training of SMR Activity: Implications
of Meditative Therapy on Attention Deficit Disorder
Cherifer Cruz, Mitchell Davis, Elizabeth Bigham, Ph.D.
Attention Deficit Disorder (ADD) has been a hot topic debate
among teachers, parents and casual observers. Since ADD
was added to the DSM in 1980, its diagnosis and treatment has
mushroomed into one of the most common mental health
disorders occurring in children. The most prevalent treat-
ments for this disorder are powerful drugs and/or increased
parent and teacher involvement in the child’s education. The
purpose of this pilot study was to look into the effects of
meditation on attentional performance as measured by
neurofeedback. We created two groups, an ADD group and
without ADD group. We created these groups through the
commonly used Jaspers/Goldberg screening. Participants
played Zukor’s Grind, a skateboarding game that is controlled
by the player’s brain activity for two separate 5-min rounds.
Zukor’s Grind scores points for increased sensory motor
rhythm, which is an indicationof coherence of brain and body
functions. In between each round participants followed the
instructions for a guided meditation. While analysis failed to
reveal a significant change, a trend was revealed that was
contrary to the hypothesis—the ADD group’s SMR was re-
duced after the meditation. This may suggest that meditation
is not appropriate for persons with ADD as relaxation tech-
niques may only further make it difficult for them to maintain
their engagement. In summary, although meditation may help
with many stressors and anxieties, its relaxing effects may not
be effective in supporting focus in those suffering from
attention disorders.
Cherifer Cruz
4869 Terracina Street
Oceanside, CA 92056 USA
Attention Deficit Disorder
Guided meditation
The Power of Breathing: A Case Report on HRV
Biofeedback and Pre-hypertension
Bridget Asplund, B.A.
Resonance frequency breathing may be useful for
strengthening the baroreflex, subsequently improving blood
pressure. This case report was conducted to determine the
effectiveness of heart rate variability (HRV) biofeedback in
lowering blood pressure in a single subject with pre-hy-
pertension. Subject was a 27-year old Hispanic male with a
family history of hypertension. He reported having been
diagnosed with pre-hypertension at age 23 by a primary
care physician. Subject practiced resonance breathing at six
breaths per minute for 10 min a day over the course of
6 weeks. Diastolic and systolic measures of blood pressure
were recorded immediately after waking every day for the
length of the study, with the exception of 4 days. HRV data
was collected approximately once a week. Measures of
vagal tone (determined by the natural log of the power of
the high frequency during baseline) and heart rate vari-
ability (determined by the route mean square successive
124 Appl Psychophysiol Biofeedback (2015) 40:117–138
differences (RMSSD) during baseline) were recorded.
Results showed a decrease in the average blood pressure
post-treatment (M =132/82) compared to pre-treatment
(M =134/84). Most notably, the lowest blood pressure
achieved before treatment was 130/84, whereas in the last
2 weeks of treatment, the lowest blood pressure was
126/80. Furthermore, comparing measurements taken on
the first day of treatment to the last, there was an increase
in the RMSSD from 29.6 ms to 40.3 ms and an increase in
vagal tone from 5.6 to 6.0. The results of the current case
report supported the hypothesis that HRV biofeedback
would be effective in lowering blood pressure. This being a
single case report over the course of only 6 weeks leaves
room for further investigation on the topic. Results of such
research could have implications for including HRV
biofeedback in the treatment plan for pre-hypertension.
Bridget Asplund, B.A.
2033 Englewood Drive
Lemon Grove, CA 91945 USA
(813) 300-6176
Resonance frequency breathing
Heart rate variability biofeedback
Blood pressure
Case study
Indigenous and Contemporary Practices in Pain
Elizabeth Bigham, Ph.D.
The circularity of the pain response has been examined for
decades. Psychological, cultural, biological factors impact
one’s perception of pain which in turn impacts one’s
physiological response which in turn impacts one’s experi-
ence of pain, etc. Cultural beliefs must be understood in order
for psychophysiological treatment strategies to be effective.
This project examined the indigenous and contemporary be-
liefs and practices of pain management in the Panajachel area
of Guatemala, a region with rich Mayan history and customs
as well as modern-day influence from the West. We explored
available pain management methods to be better able to de-
sign and deliver culturally sensitive treatment strategies that
accommodate and/or incorporate historical beliefs and prac-
tices. We discovered, however, that the indigenous and con-
temporary beliefs and practices seemed to co-exist in parallel
planes. The broader implication for delivery of psy-
chophysiological treatment strategies is discussed.
Elizabeth Bigham, PhD Health Psychology
333 S Twin Oaks Valley Rd
San Marcos, CA 92096 USA
760 750 7356
Pain management
Cultural implications
Cultural sensitivity
Psychophysiological treatment provision
Resonant Frequency Breathing for Stress
Management and Increased Heart Rate Variability
for University Students
Barbara Morrell, Ph.D., BCB, Patrick Steffen, Ph.D., BCB,
Maureen Rice, Ph.D.; Louise Fidalgo, Katie Steck, Yoko
Caldwell, Tracy Brown
This study builds on the research on resonant frequency (RF)
breathing of Yvgeny Vaschillo, Paul Lehrer, Richard Ge-
virtz and others. They used heart rate variability (HRV)
biofeedback to determine the rate of breathing between 4.5
and 7.0 Breaths-per-Minute (BPM) at which an individual
achieves autonomic balance. Autonomic balance is associ-
ated with calmness, mental clarity, and peak performance as
well as improved heart health. Research has shown that in-
dividuals can increase their HRV through biofeedback
training and paced breathing. A sample of 25 university
students were given the Trier Social Stress Test (TSST). To
assess physiological reactivity and recovery their blood
pressure and heart rate were measured. Their RF BPM was
estimated using both the PPG and ECG method. They were
instructed to practice breathing at their RFBPM 20 min a
day for 4 weeks. Preliminary findings show that (1) Thirty-
nine percent of the sample accurately guessed their RF BPM
and 71 % guessed within .5 BPM. (2) Determining the RF
BPM in one biofeedback session is accurate (R =.82,
p\.001). (3) The PPG measure of RF BPM correlated
.85 % with the ECG measure (p\.001). (4) With practice
students were able to breathe at their RF BPM without a
pacer (R =.80, p\.001). (5) Most individuals demon-
strated increased HRV at follow-up. (6) Students reported
that RF breathing was helpful in managing stress. At the
4 week follow-up retest of the TSST (1) systolic blood
pressure decreased (p=.05), (2) females on average had
decreased heart rate and males on average had an increase.
Most research on RF BPM has been done with adults with
medical issues. This research indicates that RF breathing is a
promising technique for use with normal young adults to
manage stress and protect heart health.
Barbara Morrell, PhD, BCB
1500 WSC Brigham Young University
Appl Psychophysiol Biofeedback (2015) 40:117–138 125
Provo, UT 84602 USA
Stress management
Heart rate variability biofeedback
Resonant frequency breathing
Autonomic balance
Biofeedback Training Leads to Improved Gait
and Muscular Activity in Hemiparetics Patients
Leonardo Gomes, Msc., Erik Peper, Ph.D., BcB, Richard
Harvey, Ph.D., Joaquim Miguel Maia Ph.D., Humberto
Remigio Gamba Ph.D., Tiago P. L. Neto, M.D.
For hemiparetic patients, heel pressure biofeedback in-
creases awareness of body balance and enhances gait re-
lated movement. This pilot study compared normal healthy
controls with hemiparetic patients with foot deformity who
trained using heel pressure biofeedback for 10 min each in
asymmetric and symmetric feet positions. Ultrasonography
and electromyography were used to measure changes in
muscle activity and videography was used to measure gait
patterns. The results showed greater SEMG activity in the
Tibialis anterior muscle compared to the lateral Gastroc-
nemius lateral muscle when heel pressure increases in the
asymmetric position. Biofeedback training also resulted in
increasing body balance and gait patterns, without a change
in hip symmetry and head position.
Leonardo Gomes, Msc.
Rua Padre julio Saavedra 139 sb 18
Curitiba, Parana
´81570180 Brazil
Feel pressure biofeedback
Gait pattern
Pilot study
Designing Weight Bearing and Pressure Sensing
Biofeedback Equipment for Balance Training
in Hemiparetic Patients
Leonardo Gomes, Msc., Erik Peper, Ph.D., Richard
Harvey, Ph.D.
This report presents biofeedback equipment designed for
improving balance in patients with hemiparetic foot
paralysis due to brain injury or, cerebral palsy, respec-
tively. Hemiparesis and motor disabilities often limit social
interactions and other activities of daily living. Biofeed-
back training using weight bearing and pressure sensing
equipment can ameliorate and improve hemiparesis and
other motor disability symptoms and neurological dys-
functions. Biofeedback techniques to restore body balance
particularly among patients with paralyzed lower can be
used to help patients improve control of body balance and
maintain body weight under the flat of the foot.
Leonardo Gomes, Msc.
Rua padre julio Saavedra 139 sb 18
Curitiba, Parana
´81570180 Brazil
Weight bearing biofeedback equipment
Biofeedback training
Psychophysiological Changes During Prescribed
Casual Video Game Play
Carmen V. Russoniello, Ph.D., LPC, LRT, BCB, BCN,
Matthew Fish, Ph.D., LPC, LRT, BCB, Kevin O’Brien,
Ph.D., Brenton Laing, M.S., Christina Brown-Bochicchio,
M.S., CTRS, Laura Gremore, B.S.
Video games are often used to facilitate biofeedback training.
Yet, little is known about psychophysiological changes oc-
curring during game play that add or subtract from the
biofeedback training effect. Depression is a debilitating ill-
ness that is estimated to affect more than 300 million people
worldwide. Although there has been some success in treat-
ment of this illness with pharmaceuticals and behavioral
techniques like cognitive behavioral therapy, these are often
costly and have stigma associated with them. The purpose of
this study was to test whether a prescribed regimen of casual
videogame (CVG) play could reduce symptoms associated
with depression. Participants were screened for depression
using the Patient Health Questionnaire-9 (PHQ-9). They were
then randomized into the control (n =29) or experimental
(n =30) groups. Data collection included psychological self-
reports, EEG and HRV. Experimental participants were pre-
scribed to play CVGs three times per week (with 24 h be-
tween each session), for 30 min, over a 1-month period.
Control participants surfed the National Institute of Mental
Health’s Web page on depression. Repeated-measures sta-
tistical analyses revealed there was a significant interaction of
group and time, supporting the hypothesis that the groups
126 Appl Psychophysiol Biofeedback (2015) 40:117–138
would be different after the intervention using the PHQ.
Moreover, when data were compared using tests of within-
subjects contrasts between baseline (Time 1) and the end of
the 1-month study (Time 3), we found significant decreases in
depression symptoms in the experimental group. When this
was compared with the control group changes, the results
were still significant. We found that a prescribed regimen of
playing CVGs significantly reduced symptoms of clinical
depression as measured by the PHQ-9. Clinicians should
consider these low-cost CVGs as a possible intervention to
address psychological and somatic symptoms associated with
depression. EEG and HRV findings and their relationship to
biofeedback training will be reported and discussed.
Carmen V. Russoniello, PhD, LPC, LRT, BCB, BCN
300 Curry Court, Suite 2501
Greenville, NC 27858 USA
Heart rate variability
Casual video game play
Association Between Trait Anxiety and Vagal Tone,
Withdrawal, and Recovery
Carolyn J Huntley, M.A., BCB, Mark J Stern, M.A., BCA,
Leighton A Grampp, Jonathan Marquez, M.A., Kevin
Keeran, M.A., William P Curci, B.A., Tammy Wildgoose,
B.S., Omar M Alhassoon, Ph.D., Richard Gevirtz, Ph.D.
High levels of trait anxiety (TA) as measured by the State-
Trait Anxiety Inventory (STAI) have consistently been
shown to be associated with low cardiac vagal control.
While the current literature illustrates that TA is associated
with reduced autonomic regulation; dynamic measures of
vagal activity as assessed by vagal withdrawal and recovery
in response to a stressor. In healthy individuals, vagal re-
sponse to stressors may have a higher association with TA
than resting vagal tone. Results of the present study are
expected to show that TA is negatively associated with vagal
tone at rest, vagal withdrawal, and vagal recovery. TA was
measured by using the STAI. Baseline vagal tone was op-
erationalized as the natural log of High Frequency (LnHF)
component of HRV, vagal withdrawal as the difference in
LnHF between baseline and stressor, and vagal recovery as
the difference in LnHF between recovery and stressor. Inter-
beat interval data were collected continuously during a
10-min resting baseline condition, a 4 min mental stress
task, and a 5 min recovery period. Standardized percentile
scores of TA based on STAI normative data were utilized for
correlational analysis. Preliminary data (n =15) show va-
gal withdrawal (r =-.60, p=.025) and vagal recovery
(r =-.61, p=.021) to be significantly associated with TA
standardized percentiles. Unlike previous studies, however,
vagal tone at rest was not significantly related to TA (r =-
.15, p=0.58). Results indicate that greater withdrawal and
greater recovery are associated with lower levels of trait
anxiety. These results suggest that vagal withdrawal and
recovery stress profiles support emerging findings as po-
tentially stronger markers of parasympathetic health than
resting vagal tone. Further research should explore the dif-
ferential role of vagal withdrawal and recovery compared to
resting vagal tone in both healthy and clinical populations.
Carolyn J Huntley, MA, BCB
10455 Pomerado Rd, DH 213
San Diego, CA 92131 USA
Trait anxiety
Vagal activity
Heart rate variability
Parasympathetic health
Abdominal SEMG Feedback for Diaphragmatic
Breathing: A Methodological Note
Erik Peper, Ph.D., Annette Booiman, MSCT, BCB, Imei
Lin, Ph.D., BCB, Richard Harvey, Ph.D., Jasmine Mitose
Many psychophysiological disorders are associated with
breathing dysregulation such as shallow, rapid or irregular
breathing, predominantly in the chest, increased sighing or,
breath-holding patterns triggered as a defensive reaction to
an actual or perceived stressor. This defensive, anxious
breathing reaction usually includes a concomitant tightening
of the lower abdomen and the pelvic floor. When respiratory
strain gauges alone are used to measure breathing without
also measuring lower abdominal muscles related to breath-
ing, many clients may appear to breathe diaphragmatically,
yet they may still not expand or relax muscles of the lower
abdominal wall and/or, the pelvic floor. For example, lower
abdominal muscles that affect breathing may remain con-
tracted because of a previous abdominal injury (e.g., hernia
repair, cesarean or appendectomy) or pelvic floor discomfort
(e.g., vaginal infections or difficulty during childbirth). As
compared to measuring respiration with a strain gauge and/
or with trapezius/scalene SEMG sensor, this paper describes
a methodology for recording muscle activity from the
transverse abdominis SEMG as a non-invasive technique to
Appl Psychophysiol Biofeedback (2015) 40:117–138 127
monitor the lower abdominal wall during respiration. During
inhalation as the abdominal wall expands and relaxes, the
transverse abdominal SEMG decreases, particularly at the
end of the exhalation when the abdominal wall contracts and
the abdominal circumference decreases and the SEMG
slightly increases. For patients with pelvic floor pain, this
methodology may be used as a surrogate marker for pelvic
floor tension. SEMG can be recorded either from the right or
left transverse abdominis or, with wide placement of elec-
trodes from the right and left transverse abdominis muscles.
Discussed is a methodology of electrode placement over the
transverse abdominis muscle. For example, the electrodes
should be placed midway between the crest of the iliac (iliac
crest) and acetabulum. The participant is asked to loosen
material around the waist (e.g. beltline), fold the clothing
down on the side where the electrode is placed. Even in
adipose individuals, the transverse abdominis SEMG ac-
tivity can usually be recorded when placed on a boney
prominence. In addition, the SEMG signal from the con-
traction of the diaphragm can be observed as an artifact
because the electrode locations (e.g. iliac crest vs. di-
aphragm) are far enough apart. If the wide electrode place-
ment is used, an EKG artifact may be observed, however the
EKG artifact can usually be filtered out with the narrow band
filter setting (100–200 Hz). Lower abdominal SEMG feed-
back can be used as a strategy for teaching participants about
breathing patterns related to biological fear reactions and,
possibly in the treatment of pelvic floor pain.
Erik Peper, PhD
1600 Holloway Avenue, HSS326
San Francisco, CA 94132 USA
Surface electromyography
Lower diaphragmatic breathing
Defense reaction
Posture Changes, Perceived Strength and SEMG
Erik Peper, Ph.D., BCB, Annette Booiman, MSCT, BCB,
I-Mei Lin, Ph.D., BCB, Richard Harvey, Ph.D., Ashley Del
Nonverbal communication, including projections of how we
feel, is often reflected in body posture. For example, when
standing erect, chest out, we visibly occupy more space
which tends to project power and authority to others. This
study explored how changes in standing body posture af-
fected self-perceptions of ‘strength, power and authority’ on
a subjective rating scale. The subjects were a convenience
sample of 33 physical therapists (average age 46.2 years)
assigned in pairs of ‘testers’ and subjects’ taking turns in
holding out their arms while resisting against downward
pressure. The subjects either stood in an erect posture or in a
slouched posture while they again held out their arm and
attempted to resist the downward pressure. The order of
collapsed or erect posture was countered balanced. Phase
two examined the phenomenon of subjective strength or
weakness during erect or collapsed posture, respectively, by
measuring SEMG of the upper trapezius, medial and ante-
rior deltoid muscles during the two positions. Analysis of
Variance (ANOVA) showed that not only was there greater
muscle strength, but also that 98 % of the participants
subjectively felt stronger when they stood in an erect pos-
ture compared to a collapsed posture (F(1, 58) =85.9,
p\.001). ANOVA also showed the ‘testers’ felt that the
subject were much stronger in their ability to resist the
downward pressure in the erect versus collapsed position
(F(1, 59) =74.6, p\.001). It is possible the testers were
applying greater pressure at varying times, or that subjects’
arms were fatigued at various times, however the subjective
rating downward arm pressure were not significantly dif-
ferent as measured with ttest (erect p=0.46; collapse
p=0.50). ANOVA of the combined SEMG of the
trapezius, medial and anterior deltoid was significantly
higher during the erect compared to the slouched posture
(F(1, 46) =6.69, p\.01). The subjective experience and
objective SEMG measurements can be used to demonstrate
to participants that posture matters! Somatic feedback
should be part of the therapeutic and teaching process of
biofeedback and neurofeedback training. Without teaching
how to change body posture, only one half of the mind–
body equation that underlies health and illness is impacted.
The body is affected by the mind just as the mind effects the
Power position
Somatic feedback
Surface electromyography
Posture Changes with a Seat Insert: Changes
in Strength and Not EMG
Richard Schwanbeck, Erik Peper, Ph.D., BCB, Annette
Booiman, MSCT, BCB, Richard Harvey, Ph.D., I-Mei Lin,
Body posture affects how we perceive ourselves and how
others perceive us. It also has an impact on our physiology
128 Appl Psychophysiol Biofeedback (2015) 40:117–138
and emotions. Adapting an expanded ‘power posture,’ we
experience a change in memory, subjective perception of
strength and energy. The purpose of this research is to ex-
plore the impact the BackJoy
Sitsmart Posture Plus (BSPP)
seat insert on muscle tension and perceived strength. Seven
college students between the ages of 19–41 volunteered to
participate. Surface electromyography was recorded from
the participants’ medial deltoid and the upper trapezius of
the dominant arm while the participant underwent two
muscle resistance tests, one while seated in their normal
(self-determined) ‘comfortable’ upright position and the
other while sitting on a BSPP, which shifts the pelvis from a
posterior to anterior tilt and allows the person sit more
upright. The measurements showed that six of seven par-
ticipants rated their own strength and ability to resist the
downward pressure applied to the wrist was significantly
higher while seated on the BSPP seat insert compared to
sitting normally. There was a high degree of correlation
between the participant and the tester in terms of perceived
resistance to downward pressure, Kendall’s s=.88, p(one-
tailed) =.004. There were no significant difference between
average SEMG measures of the trapezius and deltoid mus-
cles when resisting the downward pressure while sitting on
the BSPP (W/BackJoy) or sitting on the chair compared to
(W/O Backjoy) [M =129.8 mV vs. 128.0 mV, t(6) =0.11,
p=n.s., r =.73 and, M =227.1 mV vs. 222.4 mV,
t(6) =1.35, p=n.s., r =.98, respectively]. This pilot
study supports the concept that posture affects a sense of
personal power. Using the seat insert increased the subjec-
tive sense of strength. This observation is similar to previous
findings that subjects perceive strength and resist downward
pressure on their wrists while in erect versus collapsed
postures. This pilot study demonstrated that the BSPP seat
insert increased subjective experience of strength however
the SEMG recordings did not confirm this subjective expe-
rience. Further research is needed to understand the
mechanisms of perceived versus measured strength.
Nonetheless, more upright postures seem to result in in-
creased strength as compared to less upright postures. Fur-
thermore, if postural adjustments can have such an impact
on our perception of strength, they also can have impacts on
other aspects of our self-perception.
Erik Peper, PhD, BCB
1600 Holloway Avenue
San Francisco, CA 94132 USA
Surface electromyography
Pilot study
*ERP and EEG Oscillations Study of Facial
Expression Processing Deficits in Autism
Jon Frederick, Ph.D., Yao Wang, M.S., Tato Sokhadze,
Ph.D., Lonnie Sears, Ph.D., Allan Tasman, M.D., Manuel
F. Casanova, M.D.
Autism spectrum disorder (ASD) is one of neurodevelop-
ment disorders, which presents with impairments in com-
munication and social skills, and stereotyped, repetitive
patterns of behavior. Disturbances of affective reactivity
and innate inability to perceive and respond to the social
cues including facial emotional expressions in a typical and
appropriate manner are the hallmark deficits of ASD. The
study used event-related potentials (ERP) and single-trial
induced EEG gamma oscillations recording in a modifi-
cation of a ‘‘Theory-of-mind’’ (ToM) test using facial
emotional expression recognition to test emotional re-
sponsiveness in children with autism and typical age-mat-
ched children. Autism is featured by difficulty in decoding
affective facial cues. The goal of the study was to find the
differences between ASD group (N =19, mean age 16.3
4.9 years) and typically developing children (CNT group,
N=21, 14.9 4.5 years) in behavioral (reaction time and
accuracy), induced gamma and ERP correlates of pro-
cessing emotional information from facial expressions. The
task had four different conditions: either to identify the
gender or the emotion of the face. Dense-array EEG was
recorded using EGI system. The ERP components analyzed
in the study were parieto-occipital N170, frontal P3a, and
parietal P3b, while induced gamma oscillations were
recorded at 8 frontal and parietal sites. ERP measures
yielded following group differences: N170 showed a more
negative amplitude in the ASD group than controls when
identifying emotional faces (F =5.66, p=0.023). The
latency of N170 was prolonged in the ASD group
(F =7.54, p=0.01). The ASD group had a larger frontal
P3a amplitude as compared to controls when differentiating
emotions (F =5.15, p=0.03). In the emotion recognition
conditions, P3b had larger amplitude in autism (F =4.17,
p=0.049). Induced gamma (35–45 Hz) oscillations in
ASD showed significant differences from controls at all 8
sites of recording in facial emotion discrimination condi-
tion (p\0.05). These results indicate that more effort is
required for an individual with autism to recognize emotion
rather than gender from viewing a face. Abnormal pro-
cessing of emotional stimuli may provide an explanation
for some of the social and communicative deficits observed
in children with autism.
Appl Psychophysiol Biofeedback (2015) 40:117–138 129
Jon Frederick, PhD, Assistant Professor
1301 East Main Street
Murfreesboro, TN 37132 USA
Event related potentials
Single trial induced EEG
Autism spectrum disorder
Emotional recognition
Pharmaco-EEG: A Study of Individualized
Medicine in Clinical Practice
Ron J. Swatzyna, Ph.D., LCSW, BCN-C, BCIA-EEG,
Gerald P. Kozlowski, Ph.D., BCN
The recent introduction of the Research Domain Criteria
(RDoC) project is an initiative by the National Institute of
Mental Health (NIMH) to develop innovative ways of
identifying and classifying mental disorders through dis-
covery of neurobiological features that underlie observable
behaviors. The NIMH is discouraging researchers from
simply collecting symptoms based on DSM categories.
One of the objectives in our clinical practice has been to
collect electroencephalography (EEG) and quantitative
EEG (qEEG) data. In the past 5 years, we have identified a
subset of refractory cases (n =386) found to contain
commonalities of a small number of electrophysiological
features in the following diagnostic categories: mood,
anxiety, autistic spectrum, and attention deficit disorders,
Four abnormalities were noted in the majority of medica-
tion failure cases and these abnormalities did not appear to
significantly align with their diagnoses. Those were: en-
cephalopathy, focal slowing, beta spindles, and transient
discharges. To analyze the relationship noted, they were
tested for association with the assigned diagnoses. Fisher’s
Exact Test and Binary Logistics Regression found very
little (6 %) association between particular EEG/qEEG ab-
normalities, i.e. neurobiomarkers and diagnoses. These
findings suggest that EEG/qEEG may give additional in-
formation to understand pharmacotherapy failures.
Ron J. Swatzyna, Ph.D, LCSW, BCN-C, BCIA-EEG,
1001 West Loop S. #215
Houston, TX 77027 USA
Research domain criteria
Mental disorders
Calibrating Respiratory Strain Gauge
Measurements: What the Numbers Mean
for Monitoring Respiration
Erik Peper, Ph.D., Grant Hayes Groshans, James
Johnston, Richard Harvey, Ph.D.
In biofeedback training respiration strain gauges are used to
learn more about a subject’s breathing patterns. Clinicians are
interestedin how large the volume of the breath is and how the
volume of the breath is distributed between the abdomen and
the thorax. Two strain gauges are placed: one around the
abdomen and one around the thorax to monitor this. Ideally,
for clinicians to produce most accurate interpretations, the
sensitivity of both strain gauges will be equal. This study
developed a calibration procedure to measure the accuracy of
respiratory strain gauges. A convenience sample of 14 strain
gauges used as parts of a laboratory class were selected
calibrating the length sensitivity of the sensors. For example
their sensitivity was measured by stretching them in sys-
tematic 5 mm increments from 0 to 40 mm, which was re-
peated a second time a month later. The results showed that
within any single strain gauge, there were repeatable linear
readings when stretched systematically between 0–40 mm
during two trials 1 month apart. On the other hand, mea-
surements between strain gauges varied significantly where
the relative stretch between gauges varied significantly
ranging from 16 to 55 units. The relative sensitivity to stretch
was measure by slope of the line. The average slope for the
sensors was 0.82; range 0.33–1.5. The study provides a de-
tailed calibration procedure that practitioners can use to
measure and compare sensitivity of strain gauges. The study
also describes a methodology to correct for the difference in
sensitivity between strain gauges. The findings point out that
practitioners should always use the same sensor on the same
location when repeated measures are desired and, should
apply a correction value for strain gauges with different
sensitivities placed, for example on the thorax and abdomen.
Erik Peper, PhD
San Francisco State University
1600 Holloway Avenue
San Francisco, CA 94132 USA
510 681 6301
Respiration strain gauges
130 Appl Psychophysiol Biofeedback (2015) 40:117–138
Oral Presentations
Accuracy of QEEG on Classifying Performance
Based Attention Deficits and Executive Dysfunctions
on ADHD: A Validation Study
Luis Aguerrevere, Ph.D.
The current study examined the classification accuracy of a
quantitative electroencephalographic (QEEG)-procedure
for use in the assessment of attention deficit-hyperactivity
disorder (ADHD). QEEG indicators were compared with
established measures of continuous performance (the
Conner’s Continuous Performance Task; CPT) and ex-
ecutive functions (the Wisconsin Card Sorting Test;
WCST). Data were collected from 68 patients clinically
classified as ADHD. Z-score peak frequency analysis from
a referential montage located at frontal, midline, and pos-
terior locations, were conducted before treatment. Results
indicated that QEEG activity was significantly correlated
with the CPT clinical index and the WCST total categories
completed. In addition, the QEEG activities were highly
accurate in differentiating participants with only attention
deficit from those who also show executive dysfunction on
the WCST (p\.001). The sensitivity of the QEEG to
classify those with executive dysfunction was greater than
75 % with specificity greater than 89 %. These results
suggest that QEEG is a valid measure of ADHD symptoms.
Clinical implications are discussed.
Luis Aguerrevere, PhD
2100 N Raguet, HSTC Bld Room 105
Nacogdoches, TX 75965 USA
Attention deficit-hyperactivity disorder
Executive dysfunction
The Effect of EEG Biofeedback on Second Language
Acquisition in Adults: A Pilot Study
Robert Nicks
The purpose of this study was to examine the influences of
neurofeedback training on the rate of language learning in
adults attempting to learn a second language. To this end, a
number of studies have successfully used neurofeedback
training to improve reading skills in children with dyslexia
(Breteler, Arns, Peters, Giepmans, & Verhoeven 2010;
Nazari, Mosanezhad, Hashemi, & Jahan, 2012). The
purpose of the current study was to expand those studies,
and determine whether neurofeedback training would re-
sult in increased improvement in performance on reading
tasks in English as second language learners. The par-
ticipants were four international males enrolled in English
Learning courses at a Southwestern university. First, par-
ticipants were assessed for English speaking ability using a
reading subtest in the Wechsler’s Wide Range Achieve-
ment Test (WRAT). Then, participants were each assigned
to a baseline condition in which they received random
feedback (i.e. sham), and after predetermined number of
sessions, they received neurofeedback training (referential
Beta and decrease Theta activity training on sites F3, F4,
F7, and T3), intending to target language areas and atten-
tion. Participants completed either sham or neurofeedback
training sessions twice weekly for 40 min each over a
9-week period. Outcomes were measured using the Vis-
agraph eye tracking system for reading, and the indepen-
dent variables were: number of fixations, number of
regressions, rate of reading with comprehension, and per-
centage of comprehension questions correct while reading
a page long story. After visual analysis of the results, two
participants demonstrated improved reading rates with
comprehension when training on neurofeedback compared
to sham. This effect was observed only in the participants
who exhibited lower levels of English proficiency. The
findings suggest that neurofeedback training could be a
promising program to increase the rate of language ac-
quisition in English language learners. However, further
research is necessary to demonstrate its full utility.
Robert Nicks
4541 NE Stallings Dr #401
Nacogdoches, TX 75965 USA
Language acquisition
English as second language
The Use of Device-Guided Breathing in the Treatment
of Hypertension: A Meta-Analytic Review
Fredric Shaffer, Ph.D., BCB, Christopher L. Zerr, Jabari
A. Allen
A meta-analysis on the effect of device-guided breathing
(DGB) on hypertension was conducted to evaluate whether
DGB lowers blood pressure (BP) in adults. Data were
collected using PubMed, MEDLINE, and Google Scholar,
Appl Psychophysiol Biofeedback (2015) 40:117–138 131
and independently extracted and coded by researchers. A
total of 10 randomized controlled studies were selected for
analysis, which featured 573 hypertensive patients (56 %
male, average age of 56.6 years) training for an average of
7.7 weeks. Eight studies used a device known as RESPe-
RATE, while two used a Breathe with Interactive Music
(BIM) device (both developed by InterCure Ltd., Israel).
Compared with controls, DGB resulted in non-significant
reductions with trivial effect sizes in both systolic (Cohen’s
d=-0.12, SE =0.09, z =-1.39, p=0.16, 95 %
C.I. =-0.29 to 0.05) and diastolic (Cohen’s d =-0.16,
SE =0.09, z =-1.89, p=0.06, 95 % C.I. =-0.33 to
0.01) BP measures. Moderator analyses revealed no sig-
nificant differences in effect size for the type of hyper-
tension (essential, secondary, or mild) or whether or not the
authors had a conflict of interest with the manufacturers of
the device. These findings challenge the efficacy of DGB as
a non-pharmacological treatment for hypertension. Further
research should implement significantly longer training
periods and incorporate follow-up assessment at 6 and
12 months to better evaluate DGB’s potential.
Fredric Shaffer, PhD, BCB
100 E. Normal St.
Kirksville, MO 63501 USA
Device guided breathing
Blood pressure
HRV Biofeedback in Grandmothers: Evaluation
of Intervention Parameters
Jaclene Zauszniewski, Ph.D., RN-BC, FAAN
Heart rate variability (HRV) biofeedback is a well-known
technique for reducing stress by encouraging slow, paced
breathing that is synchronized with heart rate to achieve
coherence. HRV biofeedback has been found to be ef-
fective for individuals who face daily, ongoing stress,
such as family caregivers who include grandmothers
raising grandchildren. Studies of HRV biofeedback in
grandmothers raising grandchildren show lower stress,
fewer negative emotions and cognitions, and higher co-
herence scores. However, to promote sustained self-
regulation and the ability to manage stress over time, it is
critical to evaluate this intervention from the intervention
recipient’s perspective. This secondary analysis of data
from 20 grandmothers raising grandchildren examined six
intervention parameters, as evaluated by the intervention
recipient: necessity, acceptability, feasibility, fidelity,
safety, and effectiveness, in relation to 4 weeks of
biofeedback training. A descriptive design was used in a
convenience sample of 20 grandmothers raising grand-
children to examine their responses to open-ended ques-
tions that assessed the six intervention parameters after
they used a biofeedback device on a daily basis for
4 weeks. The responses were collated and analyzed for
trends and persisting themes. The findings showed that
80 % of the grandmothers believed they needed the
biofeedback, and 90 % said that others like them would
need it. One fourth (25 %) had limited interest in doing
biofeedback, 45 % found it to be challenging, and 15 %
said it was uncomfortable for them. However, 95 % of the
grandmothers reported successful learning of the breath-
ing technique to achieve coherence, and 45 % identified
the biofeedback intervention as the most helpful aspect of
all the study procedures. As the ultimate goal of
biofeedback training is to improve or maintain health
through independent self-regulation of thoughts, emo-
tions, and behaviors associated with stress reduction
without the use of special devices, it is important for in-
tervention recipients to recognize the need for the tech-
nique, to assess it as acceptable, feasible, and safe, to
learn it successfully, and to experience its beneficial ef-
fects. The findings from this study indicate generally
positive evaluations of HRV biofeedback intervention
parameters, and support the use of HRV biofeedback in
grandmothers raising grandchildren.
Jaclene Zauszniewski, PhD, RN-BC, FAAN
2120 Cornell Road
Cleveland, OH 44106 USA
Heart rate variability biofeedback
Stress management
Treatment efficacy
Integrating Biofeedback and Hypnosis
Rebecca Kajander, MPH, BSN, CPNP, CPMHS, BCIA
Biofeedback and hypnosis are mind/body strategies that
enable individuals to develop voluntary control over
physiologic processes for the purpose of health and well-
being. Children and adolescents are very good at using the
combination of biofeedback and hypnosis to manage health
issues such as headaches, Irritable Bowel Syndrome, sleep
132 Appl Psychophysiol Biofeedback (2015) 40:117–138
disturbance, anxiety, tics, and habits. This presentation will
use lecture, video, and demonstration to discuss common
ground between biofeedback and hypnosis. Examples of
how each technique can support the other will be given.
Case examples will be used to demonstrate how biofeed-
back and hypnosis can be taught to children/adolescence
who experience headache, anxiety and sleep issues.
Rebecca Kajander, MPH, BSN, CPNP, CPMHS, BCIA
2828 Chicago Ave. S.
Minneapolis, MN 55407 USA
Optimal health
Effects of Biofeedback on Distress in a University
Counseling Center
Adriana Kipper-Smith, Ph.D., HSP
Although biofeedback (BF) (i.e., respiration and HRV) is
commonly provided to students at the Vanderbilt Univer-
sity Psychological and Counseling Center (PCC), it is un-
clear if this intervention is effective in this context as no
extensive evaluation of its effectiveness has been yet
conducted. The purpose of this study is to analyze symp-
tom data that is collected in the context of routine care to
determine if BF is more effective than treatment as usual in
reducing psychological distress. This study also examines
if students that receive a combination of treatment as usual
and BF report less psychological distress than those that
receive either treatment alone. The current research study
will examine outcomes on self-report and structured in-
terview measures to determine if students that receive BF
report significant reductions in distress after the treatment.
Examination of treatment outcome directly informs efforts
to improve the services available to students. Of note, this
study began data collection in the summer of 2014 and we
are still working toward our goal of having 30 participants
in each treatment modality: Treatment as Usual/Individual
Therapy (TAU), Biofeedback only (BF), TAU + BF. This
presentation will focus on the analysis of the preliminary
results of a small sample derived from each condition.
More specifically, we will present the results of five par-
ticipants from each treatment condition. For this project,
we plan to conduct a general qualitative analysis oriented
by exploration and inductive logic (Kazdin, 2003; Patton,
2002), emphasizing understanding of the participants’ so-
cial, biological, and psychological makeup. Beginning with
random sampling (i.e., the first five participants of each
condition), we will analyze the data gleaned from inter-
views and self-report measures at three assessments points:
Pre-assessment, Post-intervention assessment, and 1-month
Adriana Kipper-Smith, PhD, HSP
2015 Terrace Place
Nashville, TN 37215 USA
College students
Intervention efficacy
Qualitative analysis
Working with Disadvantaged Children for Social
Change in Mexico, Part II
Scheherazade Shamsavari St. Martin, Ph.D., A.T.R., Dr.
Jaime Agustin Alvarez Gonzalez; Dr. Filipe Jose de Jesus
Alvarez Cibrian
The signing of the official protocol for the treatment for
children victimized by violence was designed to address
the problem of child sexual abuse. The treatment incor-
porates art therapy, somatic education and autogenic
breathing/biofeedback. Since June of 2013, 220 profes-
sionals, including medical doctors from the Ministry of
Health, hospital leaders, educators in the federal schools,
and attorneys from the Human Rights Commission of the
State of Jalisco have been trained to conduct interventions.
The training of medical doctors has included non-instru-
mental biofeedback methods, as well as art therapy, music,
somatic training, autogenic breathing, and temperature
control; the teachers have received training to help improve
children’s reading in the classroom; parents and children
engage in kinesthetic activities such as forming letters with
each of the children’s bodies, while the other children
watch. It is hoped that one leader from each state will be
able to attend our conference next year in Austin, Texas, to
support expansion of the use of biofeedback in the treat-
ment of children throughout the US/Mexico border states,
and to establish a foundation for a future exchange in-
ternship program.
Scheherazade Shamsavari St. Martin, Ph.D., A.T.R.
2274 Chanate Road
Santa Rosa, CA 95404 USA
Appl Psychophysiol Biofeedback (2015) 40:117–138 133
Disadvantaged children
Social change
Sexual abuse
Biofeedback treatment
The Nonlinear Index SD1 Predicts Diastolic Blood
Pressure and HRV Time and Frequency Domain
Measurements in Healthy Undergraduates
Christopher Zerr, Alexander Kane, Teresa Vodopest,
Jabari Allen, Joe Hannan, Alec Cangelosi, Dan Owen,
Marissa Fabbri, Chris Williams, Brian Cary, Amanda
Crawford, Alex West, Reejan Shrestha, Joe Palcheff,
Tommy Barylski
The present study explored the predictive relationship be-
tween the nonlinear index SD1, diastolic and systolic blood
pressure, four heart rate variability (HRV) time domain,
and three frequency domain measurements in healthy un-
dergraduates. SD1 is the standard deviation of the distance
of each point from the y =x axis of a Poincare
´plot. SD1
measures short-term HRV in milliseconds, which makes it
appropriate for brief measurement periods, and correlates
with baroreceptor reflex sensitivity. Twenty-nine under-
graduates (15 male and 14 female), 19–24 years of age,
participated in this study. A Thought Technology Pro-
Infiniti system monitored ECG and respiration.
Active ECG 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 sternum. A respirometer was positioned over the navel
to measure abdominal excursion and respiration rate.
Subjects were stabilized for 5 min and then monitored for
5 min sitting upright, with eyes open, no feedback, and
instructions to breathe normally. Data were artifacted
within CardioPro and then detrended in Kubios 2.1 using a
smoothness priors procedure. Frequency domain analysis
utilized a Fast Fourier Transformation (FFT)-based
Welch’s periodogram procedure. While SD1 was unrelated
to systolic blood pressure, it predicted diastolic blood
pressure, F(1, 27) =6.77, p=0.015, eta-squared =0.20.
SD1 predicted four HRV time domain measures: HR Max–
HR Min, F(1, 27) =57.79, p=0.001, eta-squared =0.68
RMSSD, F(1, 27) =3309.98, p=0.001, eta-
squared =0.99, pNN50, F(1, 27) =25.94, p=0.001, eta-
squared =0.76, and SDNN, F(1, 27) =174.51,
p=0.001, eta-squared =0.87. SD1 also predicted three
HRV frequency domain measures: low-frequency power,
F(1, 27) =85.08, p=0.001, eta-squared =0.76, high-
frequency power, F(1, 27) =237.60, p=0.001, eta-
squared =0.90, and total power, F(1, 27) =173.90,
p=0.001, n2 =0.87. Based on these findings, clinicians
should consider utilizing SD1 to assess clients who re-
semble our healthy undergraduates. Future researchers
should replicate these findings with a clinical population.
Fredric Shaffer, PhD, BCB
100 E. Normal St.
Kirksville, MO 63501 USA
Heart rate variability
Blood pressure
College students
Are Blanketing and Stem Artifacts Real?
Christopher L. Zerr, Alexander Kane, Teresa Vodopest,
Jabari Allen, Marissa Fabbri, Chris Williams, Alec
Cangelosi, Joe Hannan, Dan Owen, Brian Cary, and Fred
Shaffer, Ph.D., BCB
This within-subjects study investigated the magnitude of
blanketing and stem artifacts in temperature measurement.
Blanketing artifact raises finger temperature by trapping
heat in multiple layers of tape. Stem artifact lowers finger
temperature when the first 3 inches of a thermistor cable
are not secured against the skin. Sixty undergraduates (30
men and 30 women), 19–24 years of age, participated in
this experiment. A Thought Technology ProComp
finiti system monitored finger temperature using four
identical SA9310M thermistors with a 1-inch bead in a 70
degrees F room. A thermistor was attached to the dorsal
aspect of the second phalange of the middle and first finger
of each hand using a single layer of Curad
1-inch wide
Gentle Paper tape placed around the circumference of a
thermistor bead and along the next 3 inches of its cable.
Subjects sat upright with their hands resting on their thighs
with no feedback for 2 min to measure initial finger tem-
perature to control for differences in blood perfusion. To
measure the magnitude of blanketing artifact, two extra
layers of tape were wrapped around the thermistor bead on
the right middle finger, while the right index finger retained
its single layer. To measure the magnitude of stem artifact,
the 8 cm strip of tape was removed from the left middle
hand so that the cable no longer touched the skin, while the
cable remained attached to the skin on the left first finger.
Subjects continued to sit upright without feedback for
5 min to measure both artifacts. After adjustment for dif-
ferences between middle and first finger perfusion during
the baseline period, data were analyzed using a General
134 Appl Psychophysiol Biofeedback (2015) 40:117–138
Linear Model (GLM) analysis. A significant blanketing
artifact that averaged 0.87 degree F was found,
F(1,58) =44.06, p=.0001, g
=0.43, and Cohen’s
d=1.74, while there was no evidence of stem artifact.
Fredric Shaffer, PhD, BCB
100 E. Normal St.
Kirksville, MO 63501 USA
Stem artifact
Does Inhalation-to-Exhalation Ratio Matter
in Heart Rate Variability Biofeedback?
Christopher L. Zerr, Alexander Kane, Teresa Vodopest,
Jabari Allen, Joe Hannan, Marissa Fabbri, Chris Williams,
Alec Cangelosi, Dan Owen, Brian Cary, and Fred Shaffer,
Ph.D., BCB
This randomized controlled study examined whether in-
halation-to-exhalation ratio affects HRV frequency domain
and time domain measures. Twenty-six undergraduates (10
female and 16 male) participated in this study. A Thought
Technology ProComp Infiniti
system monitored ECG,
respiration, temperature, and skin conductance. Active
ECG electrodes were placed on the upper chest below the
sternum and the reference centered on the xyphoid process.
A respirometer was positioned over the naval in order to
measure abdominal excursion and respiration rate. A skin
conductance sensor was placed on the palmar aspect of the
second phalange of both the index and ring fingers. Finally,
a thermistor was taped to the web dorsum of the non-
dominant hand. Participants were randomly assigned to
begin with one of two conditions, either a 1:2 inhalation–
exhalation ratio or a 1:1 inhalation–exhalation ratio. All
participants were monitored during both ratios and com-
pliance with breathing ratio instructions was confirmed.
Participants were instructed to sit quietly with their back
straight and their hands on their thighs, and to breathe
following a visual pacer for each 10-min recording session.
Between conditions, participants sat quietly without
breathing ratio instructions, a visual pacer, or feedback for
5 min to minimize carryover. Data were analyzed using a
GLM analysis with family wise correction. Participants
successfully followed the visual pacer and breathed at
6 bpm in both inhalation-to-exhalation ratio conditions.
The breathing ratio did not affect heart rate, skin conduc-
tance, temperature, or HRV time domain or frequency
domain measurements. Two nonlinear measurements, DFA
alpha1 and sample entropy were affected by breathing ra-
tio. DFA alpha1 was greater during a 1:1 ratio, F(1,
24) =6.06, p=0.02, g
=.20, Cohen’s d =1.00, while
SampEn was greater during a 1:2 ratio, F(1,
23) =1157.40, p=0.001, g
=.98, Cohen’s d =14.00.
Overall, inhalation-to-exhalation ratio does not appear to
influence the time and frequency domain measurements
that clinicians typically use during HRV biofeedback, and
should be chosen based on client preference. Future re-
searchers should replicate these findings with clinical
Fredric Shaffer, PhD, BCB
100 E. Normal St.
Kirksville, MO 63501 USA
Heart rate variability
Breathing ratio
Dyslexia in Three Siblings: Assessment
and Treatment Findings
Thomas Collura, Ph.D., MSMHC, Christen Stahl, M.A.
The presentation will describe assessment and treatment
results with three siblings who were all diagnosed with
dyslexia, and presented for neurofeedback treatment.
Assessments included QEEG, a comprehensive neurocog-
nitive checklist, a computerized interactive cognitive
assessment, and verbal reports. Family history and current
dynamics were included in considerations and plans.
Treatment consisted of neurofeedback, biofeedback, cog-
nitive-behavioral intervention, meta-cognitive strategies,
and family counseling. Outcomes will be presented in
terms of QEEG and behavioral changes, and results of
repeat assessments. This case provides the valuable op-
portunity to examine the role of familial traits, as well as
environmental influences. The treatment progress yielded
insight regarding the common mechanisms of dysfunction
in the siblings, and common responses to interventions.
The QEEG patterns did not follow those commonly re-
ported for dyslexia, and revealed issues with regard to
neuronal timing and self-regulation which compromised
performance not only in reading, but in writing, planning,
and related function.
Thomas Collura, PhD, MSMHC
195 Willis Street
Bedford, OH 44146 USA
Appl Psychophysiol Biofeedback (2015) 40:117–138 135
(440) 232 9100
Neurofeedback treatment
Biofeedback treatment
Heart Rate Variability and Brain Imaging
Yoko H.W. Tsui-Caldwell, B.S.
Major depressive disorder (MDD) is one of the most
common psychiatric illnesses. Individuals with MDD ex-
perience significant emotional distress. Some of the severe
MDD patients have structural and functional abnormalities
in three cortical regions of interest (ROI): anterior cingu-
late cortex, hippocampus, and amygdala. Common inter-
ventions for MDD include: pharmacology and
psychotherapy. One of the adjunct therapy options is heart
rate variability (HRV) biofeedback training. Depressed
individuals report lower levels of depression symptoms
after employing HRV biofeedback technique. The pro-
posed presentation seeks to examine effects of HRV
training on depressive symptoms and connectivity between
the three ROIs.
Yoko H.W. Tsui-Caldwell, BS
500N 541E
Provo, UT 84606 USA
Major depressive disorder
Heart rate variability biofeedback
Brain imaging
Brain structure abnormalities
Heart Coherence Training Combined with Back
School in Patients with Chronic Low Back Pain
Remko Soer, Ph.D.
The aim of this study was to explore on which variables a
stress reduction program based on heart coherence can en-
hance the effects of a back school in patients with chronic
non specific low back pain and to explore possible mod-
erators for treatment success. A retrospective explorative
design was carried out with 170 patients with chronic non
specific low back pain. 89 Patients were admitted to back
school (BS) and 81 patients were selected for back school
and heart coherence training (BS-HCT). Six sessions of
Heart coherence were provided. At T0 (baseline) and T1
(discharge), the Numeric Rating Scale for pain (NRS pain),
Roland Morris Disability Questionnaire (RMDQ), Pain
Disability Index (PDI) and Rand-36 were administered in
both groups. Both groups improved significantly on NRS
pain, RMDQ, PDI and most of the Rand-36 subscales. On
physical functioning, the BS-HCT group improved sig-
nificantly more than the BS group (p=0.02) but not after
Bonferroni correction. Significant moderate correlations
(r =0.39 and r =0.48) were found between the change of
heart coherence and change of PDI and RMDQ respec-
tively, but not with other variables. Baseline characteristics
were not related to change on heart coherence. Providing
HCT was more effective on physical functioning compared
to a Back School program. Change in heart coherence was
related significantly to 2 out of 12 analyses. Placebo con-
trolled and blinded studies are needed to confirm this.
Characteristics of individuals who might benefit remain
unknown. Evidence of this study is considered a level C,
because of its pragmatic clinical character.
Remko Soer, PhD
PO Box 70.000
Enschede, Overijssel 7500KB Enschede
Heart coherence training
Back pain
Back Schools
Clinical Conditions Respond to Select Modalities
of Biofeedback
Angelo Bolea, Ph.D.
The goal of this presentation is to show the importance of
aligning the biofeedback modality to match symptom
complexes within the Quadrant Brain Theoretical Frame-
work. This presentation will focus on five unusual critical
clinical conditions: (1) Complex Tourette Syndrome, (2)
Huntington’s Disorder, (3) Capgras Syndrome, (4) Co-
tard’s Disorder and (5) Circulatory Embolism-Thought
Disorder. Brain Based Disconnection theory was employed
to align biofeedback presenting symptom complex to make
clinical decisions on choice of biofeedback modality, ap-
plication site, and neurobehavorial intervention. Thermal
Training was used for Embolism and Cotard’s; EMG was
employed for Tourette; EEG was used for Caparas and
Huntington’s. All were successful outcomes with a 2 year
136 Appl Psychophysiol Biofeedback (2015) 40:117–138
follow-up. All patients were evaluated by MRI and neu-
ropsychological testing. Three were treated while inpatient
and two were outpatients. Number of sessions ranged from
20 to 100 1 h sessions. Neurobehavioral Intervention ac-
companied the biofeedback treatment. A full description of
the total treatment approaches will be made to help
broaden the application base of Biofeedback: Thermal,
EMG, EEG, and Behavioral.
Angelo Bolea, PhD
403 Duvall Lane
Annapolis, MD 21403 USA
Biofeedback modality
Tourette syndrome
Huntington’s disorder
Capgras syndrome
Heart Rate Variability Predicts Female Sexual
Arousal Dysfunction and Overall Sexual
Amelia Stanton
Heart rate variability (HRV) is a measure of autonomic
nervous system activity, which reflects an individual’s
ability to adapt to physiological and environmental changes.
Low resting HRV has been linked to several mental health
conditions, including depression, anxiety, and alcohol de-
pendence (Kemp et al., 2010; Kemp, Quintana, Felming-
ham, Matthews, & Jelinek, 2012; Quintana, Guastella,
McGregor, Hickie, & Kemp, 2013). HRV has also been used
as a method for indexing the relative balance of sympathetic
nervous system (SNS) activity to parasympathetic nervous
system activity. This balance—in particular, moderately
dominant SNS activity—has been shown to play a sig-
nificant role in women’s genital sexual arousal in the
laboratory; however, the role of SNS activity in clinically
relevant sexual arousal function is unknown. The present
study assessed the feasibility of using HRV as an index of
women’s self-reported sexual arousal function outside the
laboratory. Sexual arousal function, overall sexual function,
and resting HRV were assessed in 72 women, aged 18–39.
Women with below average HRV were significantly more
likely to report sexual arousal dysfunction (p\.001) and
overall sexual dysfunction (p\.001) than both women with
average HRV and women with above average HRV. In
conclusion, HRV may be a useful index of female sexual
arousal function and overall sexual function.
Amelia Stanton
Department of Psychology, 108 E. Dean Keeton Stop
Austin, TX 78712
Mental health
Heart rate variability
Sexual dysfunction
Sexual arousal
Integrating Hypnotic Language and Behavioral
Principles for Complex Cases
Howard Hall, Ph.D., Psy.D., BCB
The field of clinical hypnosis has paid very close attention
to the use of language to enhance therapeutic changes,
even when one is not explicitly utilizing hypnotic inter-
ventions. Such hypnotic use of language can produce
dramatic effects on both physiology and behavioral out-
comes. Outside of the field of clinical hypnosis there are
also many effective evidence-based cognitive behavioral
therapy approaches, such as Acceptance and Commitment
Therapy, relaxation based therapy including biofeedback,
and the principal of Reciprocal Inhibition for reversing
complex somatic presentations. When used separately, all
of these approaches have been shown to have some effi-
cacy. However, when combined, clinical case studies
from my practice of over 25 years seeing primarily
complex patients within a tertiary medical center, will be
presented to illustrate how robust this integrative ap-
proach can be: For example, such an integrative approach
has been employed for the management and treatment of
chronic pain problems, severe habit disorders, function-
al/conversion disorders, chronic functional breathing re-
lated problems, and to enhance athletic performances. The
use of language within the field of medicine, however
tends to be very disease oriented. Even the use of lan-
guage for treatment is often context as a metaphor or a
battle against a symptom or disease. Similarly, parents,
children, and adult patients tend to be over focused on
their symptoms and may use language (and self-talk) in
nontherapeutic ways. Thus this workshop will not just be
a didactic lecture for the integration of hypnotic language
and behavioral principles for the practitioner but will also
include hands-on experiences demonstrating how changes
in language can impact behavior and symptoms. In ad-
dition, a metaphor will be provided that may be useful in
Appl Psychophysiol Biofeedback (2015) 40:117–138 137
helping patients to change their own language toward
more a therapeutic direction.
Howard Hall, PhD, PsyD, BCB
16310 Parkland Drive
Cleveland, OH 44120 USA
(216) 844-3230
Integrative treatment approach
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138 Appl Psychophysiol Biofeedback (2015) 40:117–138
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Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
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Valid peripheral temperature measurements ensure the integrity of client assessment and biofeedback training. Accurate measurements require understanding of the signal and potential influences on measurement fidelity, and developing bulletproof monitoring procedures. In addition to their use in temperature biofeedback, thermistors can assist heart rate variability biofeedback practice and monitor breathing when a respirometer is not available.
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