This article was downloaded by: [Monash University Library] On: 12 April 2015, At: 09:16 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training a
Areed F. Barabasz Ed.D. & Christopher M. McGeorge M.A. a
b
University of Canterbury , New Zealand
b
Computer Systems and Services , New Zealand Published online: 22 Sep 2011.
To cite this article: Areed F. Barabasz Ed.D. & Christopher M. McGeorge M.A. (1978) Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training, American Journal of Clinical Hypnosis, 21:1, 28-37, DOI: 10.1080/00029157.1978.10403954 To link to this article: http://dx.doi.org/10.1080/00029157.1978.10403954
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.
Downloaded by [Monash University Library] at 09:16 12 April 2015
Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THEAMERICAN JOURNAL OF CLINICAL HYPNOSIS Volume 21, Number 1 , July 1978 Printed in U . S . A .
Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training
Downloaded by [Monash University Library] at 09:16 12 April 2015
AREED F. BARABASZ, Ed.D. University of Canterbury New Zealand
and
CHRISTOPHER M. McGEORGE, M.A. Computer Systems and Services New Zealand
To determine whether or not biofeedback without formal suggestion is effective in training the vasodilation response as contrasted to mediated feedback in hypnosis, 73 subjects were divided into four groups. Gronp A was exposed to typical auditory feedback, but without autogenic phrases or formal suggestions, group B was exposed to false feedback, group C was exposed to relaxation instructions and group D received hypnosis in which suggestions for hand warming were mediated on the basis of subjects’ continuously monitored hand temperature. Analysis of variance computed on the finish minus start temperatures demonstrated no significant differences among groups A, B and C while significant increases in hand temperature were evidenced for group D. A baseline versus treatment condition comparison wichin group D (hypnosis) demonstrated significant hand warming effects. Within group effects for group A (true feedback), group B (false feedback) and group C (relaxation) were not significant. Individual differences were evaluated, and variables that might account for these are discussed.
Research in migraine attack phenomena attack. Peripheral autogenic feedback was has shown autonomic nervous system in- furnished to 28 patients via a “temperature volvement. Both vasodilation and vas- trainer” that showed the patient the extent oconstriction have been observed in the of the difference between midforehead head. Yates (1975) noted that often these temperature and the right index finger temeffects are prodromal rather than occurring perature. It was also noted that subjects during the attack itself. In an investigation practiced ‘ ‘autogenic phrases. ” These of autogenic feedback training in the treat- phrases consisted of suggestions for relaxament of migraine and tension headaches, tion and for an increase in hand temperaSargent, Green and Walter%(1973) pursued ture. Subjects were then asked to imagine their observation of a significant peripheral these situations while exposed to the feedtemperature increase in a patient experienc- back temperature difference information. ing a spontaneous recovery from a migraine The significant temperature differences recorded were a result of increases in hand A portion of this paper was presented to the temperature rather than decreases in Christchurch Medical Research Society, Christforehead temperature. Patients also rechurch New Zealand, September 9 , 1976. Regresported greater feelings of warmth in the sion analysis frequency distribution plots may be hands while experiencing no change in obtained by written request to: Dr. Arreed F. forehead temperature. Barabasz, Department of Psychology, University of Canterbury, Christchurch, New Zealand. The results indicated that increases in pe28
29
Downloaded by [Monash University Library] at 09:16 12 April 2015
BIOFEEDBACK AND HYPNOSIS
ripheral temperature were followed by a substantial reduction in both frequency and severity of migraine headaches and a significant decrease in the use of medication to control migraines was consequently possible. It was noted that vascular dysfunction in the head is linked to general relaxation of sympathetic outflow in contrast to mere hydraulic maneuvering of blood in various parts of the body. These findings were further supported in a later study of the same design (Sargent, Walters and Green, 1973) utilizing a larger sample of subjects. Temperature feedback was credited for the results of these two studies and this served as a stimulus for the present enthusiasm for “biofeedback” temperature training and the extensive development and sale of elaborate equipment. Should biofeedback be given the credit? Both in the preliminary Sargent, Green and Walters (1973a) study and in the later investigation (Sargent, Walters and Green, 1973b) extensive use of suggestion was made for relaxation and increases in hand temperature. The subjects were also encouraged to imagine these conditions while exposed to the biofeedback temperature information. Turin and Johnson ( 1976) claimed biofeedback success without suggestion effects for seven subjects given nine weeks of training. Conclusions, however, noted the subjects ’ use of ‘‘imagery or self-verbalization to aid in increases in peripheral temperature. ” Clearly the imagery and selfverbalizations, not unlike that used in hypnosis, could account for the dramatic results reported in the studies. Similar suggestions were successful in the treatment of Collagens vascular disease by hypnotic imagery (Barabasz and Wright, 1975). Andreychuk and S h i v e r (1975) found no significant difference for hypnosis and biofeedback groups in the treatment of migraine but hypnosis treatment was apparently oriented towards “suggestions for dealing with pain” rather than for peripheral
vasodilation. It was also concluded that the role of suggestibility was the most important variable operating for all treatments. Roberts, Kewman and MacDonald (1972) used five and nine hours of hypnosis and skin temperature feedback to train subjects to raise the tempearture of one hand relative to the other. All experimental subjects atI tained significant skin temperature changes in the expected direction. Interpretations of the study emphasized biofeedback and ignored the possible effects of hypnosis. Maslach, Marshall and Zimbardo (1972) employed hypnosis to simultaneously change the skin temperature of subjects’ two hands in opposite directions. Subjects trained in hypnosis were successful (p < .OOl) in achieving this bilateral difference while waking control subjects were not. It was also noted that verbal feedback given to subjects who succeeded in the bilateral difference in temperature resulted in a loss of the attained difference. This result was explained on the basis of distraction effect of the feedback. No data appeared contrasting hypnosis with biofeedback without suggestion. The purpose of this investigation was to determine whether or not biofeedback without formal suggestion is effective in training the vasodilation response as contrasted to mediated feedback in hypnosis, false feedback or relaxation instructions. METHOD Subjects
Subjects consisted of first year psychology undergraduate student volunteers (N-73) enrolled at the University of Canterbury, Christchurch, New Zealand. All first year students are encouraged to volunteer for at least one research project. Subjects were randomly divided into four groups. The male and female subjects were distributed about equally within groups. The experimenter responsible for the
30
recorded instructions to all groups, relaxation instructions and hypnosis treatments was known to the subjects by exposure to a maximum of six of his large group psychology lectures.
Downloaded by [Monash University Library] at 09:16 12 April 2015
Apparatus
Hand temperature was measured on the basis of temperature of the volar surface of the second digit of the dominant hand. Temperature information was transmitted by a Yellow Springs 700 series thermister amplified and meter displayed on a Biofeedback Technology BFT 302. Data in degrees Fahrenheit were recorded graphically on a Varian G- 15- 1. Procedure
All subjects were seated in a reclining chair in the temperature controlled experimental chamber. Ambient air temperature was held at 20.4”C ? 1.6”C. Subjects’ feet were elevated, level with the seat. Hands and arms rested on 14 cm wide padded arm rests. The four random groups of subjects were designated by letters A , B, C and D. Group A was exposed to typical biofeedback procedure, but without autogenic phrases or formal verbal suggestions for hand warming. The biofeedback equipment and procedure could, however, still imply suggestion. Subjects listened to an audio tape recording of instructions. The instructions explained: “This is an experiment in learning which will show you how to develop a physiological response over which you have no direct control. All you have to do is listen to a tone coming from these headphones and try to lower the sound in pitch.” Subjects were then given an example of the tone change. They were also told it would be necessary to remain awake as well as how to signal the experimenter if uncomfortable or in the event of slipping of a transducer. The instructions concluded:
BARABASZ AND McGEORGE
“You will be told when to commence lowering the tone.” A ten minute waiting period was then observed and temperature baseline data was collected for the last five minutes. The instruction “please commence lowering the tone now” was then given and the actual tone generated by the BFT 302 followed. The auditory tone change coincided with finger tempearture change. Group B served as a false feedback control group. Subjects received the same recorded instructions as group A. However, following the instruction “please commence lowering the tone now” a prerecorded unvarying tone was transmitted to the subject’s earphones. The tone was set at the same level and frequency as initially received by group A. Group C served as a relaxation control group. Subjects listened to an audio tape recording of basic instructions. They were told: “All you have to do, is to listen to my instructions carefully and just do exactly what I tell you to do.” They were also told it would be necessary to remain awake as well as how to signal the experimenter as for groups A and B. Following the baseline data collection period relaxation instructions (Barabasz, 1977) were administered. Group D listened to the same audio tape recording of basic instructions as group C. Following baseline data collection subjects were then exposed to passive hypnosis in which suggestions were mediated on the basis of temperature data continuously displayed to the experimenter. The hypnotic induction, as in an earlier study (Barabasz, 1976) was considered to be nonauthoritarian in nature. The word “hypnosis” was not used at any time. No test measures of hypnotic capacity were employed. Subjects were initially given relaxation instructions with a gradual transition to suggestions. First, it was suggested that “in such a deep state of relaxation you may become aware of an increase in salivation; if this occurs
Downloaded by [Monash University Library] at 09:16 12 April 2015
BIOFEEDBACK AND HYPNOSIS
for you just swallow normally and let it take you deeper and deeper. ” Upon observation of the patient’s swallowing, hand warming imagery and direct suggestions began. The swallowing response appeared to occur for all subjects and confirmation was independently supported by a graduate student observer undergoing training in hypnosis. Direct verbal reinforcement for responses in the desired direction was also given for every .2”F increase appearing on the BFT 302 meter. Verbal reinforcement consisted of simple phrases such as “good,” “that’s just fine,”and “you’re doing fine, just continue doing that. ”
RESULTS
31
symmetrical distribution whose variance is a function of the degrees of freedom. If, otherwise, there are real contrast effects for some or all subjects then those distributions of F”*may become skewed or even multimodal, with clusters of outliers. This latter situation can arise when the subjects are heterogenous in their responses to treatment. We suspected that this could occur here, even to the extent of attenuating the validity of the ANOVA model used, and have therefore accepted the graphical method of data presentation, so that deviant subjects can be identified for further study .2 Each five minute period of the total 15 minutes recording was designated as a sample block. The baseline period constituted block one, while the ten minute treatment period constituted blocks two and three. Temperatures were noted at 15 second intervals within each block. The sixty temperature figures for each subject were reduced by regression analysis to twelve figures. These twelve figures yielded the intercept and slope of each block of data, thereby describing the absolute temperature behavior of the subjects. The F ratios derived from the regression analysis were plotted in frequency distributions by taking their logarithms. The square roots of the F ratios, from the regression analysis of the temperature data, were used to plot the equivalent t distribution of the first and third five minute blocks. These plots appear in Figures 1 , 2 , 3 and 4. The plots presented in Figures 2 (false feedback, group B) and 3 (relaxation, group C)follow the t distribution relatively closely. The results show these treatments to have no significant effect on skin temperature. The plot presented in Figure 4 (group D, hypnosis) does not follow the t distribution.
Analysis 1 - Graphic output from the Varian G-15-1 was scored on the basis of the finish (taken at end of treatment) minus start (taken at end of 5 minute baseline) temperatures for each subject. The data for group A (X = .63”F),group B (X = .94”F), group C (X = 1.3”F) and group D (X = 6.43”F) was subjected to a one-way fixed effects model analysis of variance. An F of 5.22 was generated demonstrating a significant difference (p < .01) among the groups. The mean of group D was the most discrepant in a positive direction. A further analysis of variance was performed on groups A , B and C . This .50) analysis generated an F of .536 (p which was not significant ( a = .05). Analysis 2 - While the analysis of variance for groups A, B and C was not significant among groups, temperature increases of certain subjects in these groups were noted by inspection. The graphic output for groups A , B , C and D was, therefore, further analysed. By definition, F( 1 ,K) = T2 (K) where K is any degrees of freedom. Hence, for the null hypothesis of nocontrast between treatments (oneof which * Special thanks are extended to Professor R . A. may be a control) the distribution of individ- McCiregson, University of Canterbury, for his asual F”* values should center on 0 and have a sistance in the analysis of the data.
FIGURE 1 GROUP A TRUE FEEDBACK BASELINE BLOCK ONE VS BLOCK THREE
__--
Block one
Downloaded by [Monash University Library] at 09:16 12 April 2015
Block three
FIGURE 2 GROUP 8 FALSE FEEDBACK BASELINE BLOCK ONE VS BLOCK THREE
-_--
Block one
Downloaded by [Monash University Library] at 09:16 12 April 2015
81oc k t h re@
FIGURE 3 GROUP C RELAXATION BASELI NE BLOCK ONE VS BLOCK THREE
__--
Downloaded by [Monash University Library] at 09:16 12 April 2015
I
Block one 81oc k three
FIGURE
t
GROUP D HYPNOSI S BASELINE BLOCK ONE VS BLOCK THREE
Downloaded by [Monash University Library] at 09:16 12 April 2015
_---
Block one Block t h ree
Downloaded by [Monash University Library] at 09:16 12 April 2015
36
BARABASZ AND McGEORGE
Significant treatment effect in terms of skin temperature, is evident. The plot presented in Figure 1 (group A , true biofeedback) exhibits some difference in trend between block one and block three. These data were further examined by plotting block one against block three. The bivariate plot presented in Figure 5 (group A , true biofeedback) shows the treatment had no significant effect on skin temperature. Simple temperature biofeedback produced results not signficantly different
from false feedback or relaxation instructions with respect to finish minus start temperatures among groups or in terms of baseline to final treatment blocks within groups. Hypnosis, incorporating mediated biofeedback information significantly influenced the degree of peripheral vasodilation in the desired direction, in contrast with true biofeedback, false feedback, and relaxation groups. Three subjects demonstrated a slight (typically . 1 - .3"F) decrement in hand warming immediately following the verbal reinforcements.
50
1 I
15 LO
I I I
0
35
30
I
25
I I
20 15
10
I
w z 0
x 5
0
0
0 - I
m
- 5 -1 0 -1 5
- 20 -2 5 m m
o m
m N
o N
-
m
7
o
m
o
I
BLOCK THREE t
.
m
-
I
.
o -
I
"
m
o
l
l
~
37
BIOFEEDBACK AND HYPNOSIS
Downloaded by [Monash University Library] at 09:16 12 April 2015
DISCUSSION The results of this investigation support the use of hypnosis in peripheral vasodilation training with obvious implications for the treatment of migraine. Removal of formal suggestions apparently precluded the effectiveness of biofeedback. Simple auditory reinforcement for responses in the desired direction was inadequate. The data also fail to support Stern and Pavloski’s (1974) finding that the greatest effect of biofeedback can be achieved in five minutes. Although not significant, there appeared to be a tendency for false feedback and relaxation subjects to do better than the true feedback subjects. The true feedback subjects may have been distracted by having to process the changing feedback information. Maslach, Marshall and Zimbardo (1972) found verbal feedback in hypnosis resulted in a loss of temperature response. This reaction occurred in only three hypnosis group D subjects. These hand warming decrements were slight and not lasting in effect. This inconsistency might be accounted for by variations in the type of verbal reinforcement used in the two studies. While the majority of subjects apparently responded to mediated feedback in hypnosis, the type of concentration required in the hypnotic passive volition training may be disturbed by having to attend to the experimenter’s verbal reinforcements. While hypnosis appears to offer the most promising approach in peripheral vasodilation training, the complexity of such mind body interactions clearly indicates the need for
further research to reveal factors accommodating individual differences. Department of Psychology University of Canterbury Christchurch 1, New Zealand
REFERENCES ANDREYCHUK, T . & SKRIVER, C. Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Clinical and Experimental Hypnosis, 1975, 3, 172-183. BARABASZ, A . F. New techniques in behavior therapy and hypnosis. South Orange, N.J.: Power Publishers, Inc., 1977. BARABASZ, A. F. Treatment of insomnia in depressed patients by hypnosis and cerebral electrotherapy. American Journal of Clinical Hypnosis, 1976, 19, 2, 12Ck122. BARABASZ, A. F. & WRIGHT,G. W. Treatment of collagen vascular disease by hypnotic imagery. Hypnosis Quarterly, 1975, 19, 1, 15-16. MASLACH, C., MARSHALL, G. & ZIMBARDO, P. G . Hypnotic control of peripheral skin termperature: A case report. Psychophysiology, 9, 6, 600-605. ROBERTS, A . H., KEWMAN, D. G. & MACDONALD, H. Voluntary control of skin tempearture: Unilateral changes using hypnosis and auditory feedback. Presented at the Annual Meeting of the Biofeedback Research Society, 1972. SARGENT, J. D., GREEN,E. E. & WALTERS, E. D. Preliminary report on the use of autogenic feedback training in the treatment of migraine and tension headaches. Psychosomatic Medicine, 1973a, 35, 129-135. SARGENT, J. D., WALTERS, E. D. & GREEN,E. E. Psychosomatic self-regulation of migraine. Seminars in Psychiatry, 1973b, 5, 415-428. STERN,P. M. & PAVLOSKI, R. P. Operant conditioning of vasoconstriction: A verification. Journal of Experimental Psychology, 1974, 102, 330-332. T U R I NA. , & JOHNSON, W. G. Biofeedback for migraine headaches. Archives of General Psychiatry, 1976,33,517-519. YATES,A . J. Theory and practice in behavior therapy. New York: John Wiley and Sons, Inc., 1975, p. 207.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training a
Areed F. Barabasz Ed.D. & Christopher M. McGeorge M.A. a
b
University of Canterbury , New Zealand
b
Computer Systems and Services , New Zealand Published online: 22 Sep 2011.
To cite this article: Areed F. Barabasz Ed.D. & Christopher M. McGeorge M.A. (1978) Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training, American Journal of Clinical Hypnosis, 21:1, 28-37, DOI: 10.1080/00029157.1978.10403954 To link to this article: http://dx.doi.org/10.1080/00029157.1978.10403954
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.
Downloaded by [Monash University Library] at 09:16 12 April 2015
Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THEAMERICAN JOURNAL OF CLINICAL HYPNOSIS Volume 21, Number 1 , July 1978 Printed in U . S . A .
Biofeedback, Mediated Biofeedback and Hypnosis in Peripheral Vasodilation Training
Downloaded by [Monash University Library] at 09:16 12 April 2015
AREED F. BARABASZ, Ed.D. University of Canterbury New Zealand
and
CHRISTOPHER M. McGEORGE, M.A. Computer Systems and Services New Zealand
To determine whether or not biofeedback without formal suggestion is effective in training the vasodilation response as contrasted to mediated feedback in hypnosis, 73 subjects were divided into four groups. Gronp A was exposed to typical auditory feedback, but without autogenic phrases or formal suggestions, group B was exposed to false feedback, group C was exposed to relaxation instructions and group D received hypnosis in which suggestions for hand warming were mediated on the basis of subjects’ continuously monitored hand temperature. Analysis of variance computed on the finish minus start temperatures demonstrated no significant differences among groups A, B and C while significant increases in hand temperature were evidenced for group D. A baseline versus treatment condition comparison wichin group D (hypnosis) demonstrated significant hand warming effects. Within group effects for group A (true feedback), group B (false feedback) and group C (relaxation) were not significant. Individual differences were evaluated, and variables that might account for these are discussed.
Research in migraine attack phenomena attack. Peripheral autogenic feedback was has shown autonomic nervous system in- furnished to 28 patients via a “temperature volvement. Both vasodilation and vas- trainer” that showed the patient the extent oconstriction have been observed in the of the difference between midforehead head. Yates (1975) noted that often these temperature and the right index finger temeffects are prodromal rather than occurring perature. It was also noted that subjects during the attack itself. In an investigation practiced ‘ ‘autogenic phrases. ” These of autogenic feedback training in the treat- phrases consisted of suggestions for relaxament of migraine and tension headaches, tion and for an increase in hand temperaSargent, Green and Walter%(1973) pursued ture. Subjects were then asked to imagine their observation of a significant peripheral these situations while exposed to the feedtemperature increase in a patient experienc- back temperature difference information. ing a spontaneous recovery from a migraine The significant temperature differences recorded were a result of increases in hand A portion of this paper was presented to the temperature rather than decreases in Christchurch Medical Research Society, Christforehead temperature. Patients also rechurch New Zealand, September 9 , 1976. Regresported greater feelings of warmth in the sion analysis frequency distribution plots may be hands while experiencing no change in obtained by written request to: Dr. Arreed F. forehead temperature. Barabasz, Department of Psychology, University of Canterbury, Christchurch, New Zealand. The results indicated that increases in pe28
29
Downloaded by [Monash University Library] at 09:16 12 April 2015
BIOFEEDBACK AND HYPNOSIS
ripheral temperature were followed by a substantial reduction in both frequency and severity of migraine headaches and a significant decrease in the use of medication to control migraines was consequently possible. It was noted that vascular dysfunction in the head is linked to general relaxation of sympathetic outflow in contrast to mere hydraulic maneuvering of blood in various parts of the body. These findings were further supported in a later study of the same design (Sargent, Walters and Green, 1973) utilizing a larger sample of subjects. Temperature feedback was credited for the results of these two studies and this served as a stimulus for the present enthusiasm for “biofeedback” temperature training and the extensive development and sale of elaborate equipment. Should biofeedback be given the credit? Both in the preliminary Sargent, Green and Walters (1973a) study and in the later investigation (Sargent, Walters and Green, 1973b) extensive use of suggestion was made for relaxation and increases in hand temperature. The subjects were also encouraged to imagine these conditions while exposed to the biofeedback temperature information. Turin and Johnson ( 1976) claimed biofeedback success without suggestion effects for seven subjects given nine weeks of training. Conclusions, however, noted the subjects ’ use of ‘‘imagery or self-verbalization to aid in increases in peripheral temperature. ” Clearly the imagery and selfverbalizations, not unlike that used in hypnosis, could account for the dramatic results reported in the studies. Similar suggestions were successful in the treatment of Collagens vascular disease by hypnotic imagery (Barabasz and Wright, 1975). Andreychuk and S h i v e r (1975) found no significant difference for hypnosis and biofeedback groups in the treatment of migraine but hypnosis treatment was apparently oriented towards “suggestions for dealing with pain” rather than for peripheral
vasodilation. It was also concluded that the role of suggestibility was the most important variable operating for all treatments. Roberts, Kewman and MacDonald (1972) used five and nine hours of hypnosis and skin temperature feedback to train subjects to raise the tempearture of one hand relative to the other. All experimental subjects atI tained significant skin temperature changes in the expected direction. Interpretations of the study emphasized biofeedback and ignored the possible effects of hypnosis. Maslach, Marshall and Zimbardo (1972) employed hypnosis to simultaneously change the skin temperature of subjects’ two hands in opposite directions. Subjects trained in hypnosis were successful (p < .OOl) in achieving this bilateral difference while waking control subjects were not. It was also noted that verbal feedback given to subjects who succeeded in the bilateral difference in temperature resulted in a loss of the attained difference. This result was explained on the basis of distraction effect of the feedback. No data appeared contrasting hypnosis with biofeedback without suggestion. The purpose of this investigation was to determine whether or not biofeedback without formal suggestion is effective in training the vasodilation response as contrasted to mediated feedback in hypnosis, false feedback or relaxation instructions. METHOD Subjects
Subjects consisted of first year psychology undergraduate student volunteers (N-73) enrolled at the University of Canterbury, Christchurch, New Zealand. All first year students are encouraged to volunteer for at least one research project. Subjects were randomly divided into four groups. The male and female subjects were distributed about equally within groups. The experimenter responsible for the
30
recorded instructions to all groups, relaxation instructions and hypnosis treatments was known to the subjects by exposure to a maximum of six of his large group psychology lectures.
Downloaded by [Monash University Library] at 09:16 12 April 2015
Apparatus
Hand temperature was measured on the basis of temperature of the volar surface of the second digit of the dominant hand. Temperature information was transmitted by a Yellow Springs 700 series thermister amplified and meter displayed on a Biofeedback Technology BFT 302. Data in degrees Fahrenheit were recorded graphically on a Varian G- 15- 1. Procedure
All subjects were seated in a reclining chair in the temperature controlled experimental chamber. Ambient air temperature was held at 20.4”C ? 1.6”C. Subjects’ feet were elevated, level with the seat. Hands and arms rested on 14 cm wide padded arm rests. The four random groups of subjects were designated by letters A , B, C and D. Group A was exposed to typical biofeedback procedure, but without autogenic phrases or formal verbal suggestions for hand warming. The biofeedback equipment and procedure could, however, still imply suggestion. Subjects listened to an audio tape recording of instructions. The instructions explained: “This is an experiment in learning which will show you how to develop a physiological response over which you have no direct control. All you have to do is listen to a tone coming from these headphones and try to lower the sound in pitch.” Subjects were then given an example of the tone change. They were also told it would be necessary to remain awake as well as how to signal the experimenter if uncomfortable or in the event of slipping of a transducer. The instructions concluded:
BARABASZ AND McGEORGE
“You will be told when to commence lowering the tone.” A ten minute waiting period was then observed and temperature baseline data was collected for the last five minutes. The instruction “please commence lowering the tone now” was then given and the actual tone generated by the BFT 302 followed. The auditory tone change coincided with finger tempearture change. Group B served as a false feedback control group. Subjects received the same recorded instructions as group A. However, following the instruction “please commence lowering the tone now” a prerecorded unvarying tone was transmitted to the subject’s earphones. The tone was set at the same level and frequency as initially received by group A. Group C served as a relaxation control group. Subjects listened to an audio tape recording of basic instructions. They were told: “All you have to do, is to listen to my instructions carefully and just do exactly what I tell you to do.” They were also told it would be necessary to remain awake as well as how to signal the experimenter as for groups A and B. Following the baseline data collection period relaxation instructions (Barabasz, 1977) were administered. Group D listened to the same audio tape recording of basic instructions as group C. Following baseline data collection subjects were then exposed to passive hypnosis in which suggestions were mediated on the basis of temperature data continuously displayed to the experimenter. The hypnotic induction, as in an earlier study (Barabasz, 1976) was considered to be nonauthoritarian in nature. The word “hypnosis” was not used at any time. No test measures of hypnotic capacity were employed. Subjects were initially given relaxation instructions with a gradual transition to suggestions. First, it was suggested that “in such a deep state of relaxation you may become aware of an increase in salivation; if this occurs
Downloaded by [Monash University Library] at 09:16 12 April 2015
BIOFEEDBACK AND HYPNOSIS
for you just swallow normally and let it take you deeper and deeper. ” Upon observation of the patient’s swallowing, hand warming imagery and direct suggestions began. The swallowing response appeared to occur for all subjects and confirmation was independently supported by a graduate student observer undergoing training in hypnosis. Direct verbal reinforcement for responses in the desired direction was also given for every .2”F increase appearing on the BFT 302 meter. Verbal reinforcement consisted of simple phrases such as “good,” “that’s just fine,”and “you’re doing fine, just continue doing that. ”
RESULTS
31
symmetrical distribution whose variance is a function of the degrees of freedom. If, otherwise, there are real contrast effects for some or all subjects then those distributions of F”*may become skewed or even multimodal, with clusters of outliers. This latter situation can arise when the subjects are heterogenous in their responses to treatment. We suspected that this could occur here, even to the extent of attenuating the validity of the ANOVA model used, and have therefore accepted the graphical method of data presentation, so that deviant subjects can be identified for further study .2 Each five minute period of the total 15 minutes recording was designated as a sample block. The baseline period constituted block one, while the ten minute treatment period constituted blocks two and three. Temperatures were noted at 15 second intervals within each block. The sixty temperature figures for each subject were reduced by regression analysis to twelve figures. These twelve figures yielded the intercept and slope of each block of data, thereby describing the absolute temperature behavior of the subjects. The F ratios derived from the regression analysis were plotted in frequency distributions by taking their logarithms. The square roots of the F ratios, from the regression analysis of the temperature data, were used to plot the equivalent t distribution of the first and third five minute blocks. These plots appear in Figures 1 , 2 , 3 and 4. The plots presented in Figures 2 (false feedback, group B) and 3 (relaxation, group C)follow the t distribution relatively closely. The results show these treatments to have no significant effect on skin temperature. The plot presented in Figure 4 (group D, hypnosis) does not follow the t distribution.
Analysis 1 - Graphic output from the Varian G-15-1 was scored on the basis of the finish (taken at end of treatment) minus start (taken at end of 5 minute baseline) temperatures for each subject. The data for group A (X = .63”F),group B (X = .94”F), group C (X = 1.3”F) and group D (X = 6.43”F) was subjected to a one-way fixed effects model analysis of variance. An F of 5.22 was generated demonstrating a significant difference (p < .01) among the groups. The mean of group D was the most discrepant in a positive direction. A further analysis of variance was performed on groups A , B and C . This .50) analysis generated an F of .536 (p which was not significant ( a = .05). Analysis 2 - While the analysis of variance for groups A, B and C was not significant among groups, temperature increases of certain subjects in these groups were noted by inspection. The graphic output for groups A , B , C and D was, therefore, further analysed. By definition, F( 1 ,K) = T2 (K) where K is any degrees of freedom. Hence, for the null hypothesis of nocontrast between treatments (oneof which * Special thanks are extended to Professor R . A. may be a control) the distribution of individ- McCiregson, University of Canterbury, for his asual F”* values should center on 0 and have a sistance in the analysis of the data.
FIGURE 1 GROUP A TRUE FEEDBACK BASELINE BLOCK ONE VS BLOCK THREE
__--
Block one
Downloaded by [Monash University Library] at 09:16 12 April 2015
Block three
FIGURE 2 GROUP 8 FALSE FEEDBACK BASELINE BLOCK ONE VS BLOCK THREE
-_--
Block one
Downloaded by [Monash University Library] at 09:16 12 April 2015
81oc k t h re@
FIGURE 3 GROUP C RELAXATION BASELI NE BLOCK ONE VS BLOCK THREE
__--
Downloaded by [Monash University Library] at 09:16 12 April 2015
I
Block one 81oc k three
FIGURE
t
GROUP D HYPNOSI S BASELINE BLOCK ONE VS BLOCK THREE
Downloaded by [Monash University Library] at 09:16 12 April 2015
_---
Block one Block t h ree
Downloaded by [Monash University Library] at 09:16 12 April 2015
36
BARABASZ AND McGEORGE
Significant treatment effect in terms of skin temperature, is evident. The plot presented in Figure 1 (group A , true biofeedback) exhibits some difference in trend between block one and block three. These data were further examined by plotting block one against block three. The bivariate plot presented in Figure 5 (group A , true biofeedback) shows the treatment had no significant effect on skin temperature. Simple temperature biofeedback produced results not signficantly different
from false feedback or relaxation instructions with respect to finish minus start temperatures among groups or in terms of baseline to final treatment blocks within groups. Hypnosis, incorporating mediated biofeedback information significantly influenced the degree of peripheral vasodilation in the desired direction, in contrast with true biofeedback, false feedback, and relaxation groups. Three subjects demonstrated a slight (typically . 1 - .3"F) decrement in hand warming immediately following the verbal reinforcements.
50
1 I
15 LO
I I I
0
35
30
I
25
I I
20 15
10
I
w z 0
x 5
0
0
0 - I
m
- 5 -1 0 -1 5
- 20 -2 5 m m
o m
m N
o N
-
m
7
o
m
o
I
BLOCK THREE t
.
m
-
I
.
o -
I
"
m
o
l
l
~
37
BIOFEEDBACK AND HYPNOSIS
Downloaded by [Monash University Library] at 09:16 12 April 2015
DISCUSSION The results of this investigation support the use of hypnosis in peripheral vasodilation training with obvious implications for the treatment of migraine. Removal of formal suggestions apparently precluded the effectiveness of biofeedback. Simple auditory reinforcement for responses in the desired direction was inadequate. The data also fail to support Stern and Pavloski’s (1974) finding that the greatest effect of biofeedback can be achieved in five minutes. Although not significant, there appeared to be a tendency for false feedback and relaxation subjects to do better than the true feedback subjects. The true feedback subjects may have been distracted by having to process the changing feedback information. Maslach, Marshall and Zimbardo (1972) found verbal feedback in hypnosis resulted in a loss of temperature response. This reaction occurred in only three hypnosis group D subjects. These hand warming decrements were slight and not lasting in effect. This inconsistency might be accounted for by variations in the type of verbal reinforcement used in the two studies. While the majority of subjects apparently responded to mediated feedback in hypnosis, the type of concentration required in the hypnotic passive volition training may be disturbed by having to attend to the experimenter’s verbal reinforcements. While hypnosis appears to offer the most promising approach in peripheral vasodilation training, the complexity of such mind body interactions clearly indicates the need for
further research to reveal factors accommodating individual differences. Department of Psychology University of Canterbury Christchurch 1, New Zealand
REFERENCES ANDREYCHUK, T . & SKRIVER, C. Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Clinical and Experimental Hypnosis, 1975, 3, 172-183. BARABASZ, A . F. New techniques in behavior therapy and hypnosis. South Orange, N.J.: Power Publishers, Inc., 1977. BARABASZ, A. F. Treatment of insomnia in depressed patients by hypnosis and cerebral electrotherapy. American Journal of Clinical Hypnosis, 1976, 19, 2, 12Ck122. BARABASZ, A. F. & WRIGHT,G. W. Treatment of collagen vascular disease by hypnotic imagery. Hypnosis Quarterly, 1975, 19, 1, 15-16. MASLACH, C., MARSHALL, G. & ZIMBARDO, P. G . Hypnotic control of peripheral skin termperature: A case report. Psychophysiology, 9, 6, 600-605. ROBERTS, A . H., KEWMAN, D. G. & MACDONALD, H. Voluntary control of skin tempearture: Unilateral changes using hypnosis and auditory feedback. Presented at the Annual Meeting of the Biofeedback Research Society, 1972. SARGENT, J. D., GREEN,E. E. & WALTERS, E. D. Preliminary report on the use of autogenic feedback training in the treatment of migraine and tension headaches. Psychosomatic Medicine, 1973a, 35, 129-135. SARGENT, J. D., WALTERS, E. D. & GREEN,E. E. Psychosomatic self-regulation of migraine. Seminars in Psychiatry, 1973b, 5, 415-428. STERN,P. M. & PAVLOSKI, R. P. Operant conditioning of vasoconstriction: A verification. Journal of Experimental Psychology, 1974, 102, 330-332. T U R I NA. , & JOHNSON, W. G. Biofeedback for migraine headaches. Archives of General Psychiatry, 1976,33,517-519. YATES,A . J. Theory and practice in behavior therapy. New York: John Wiley and Sons, Inc., 1975, p. 207.
