David A. Wittrock

Cardiac response to relevant stimuli as an adjunct in diagnosing post-traumatic stress disorder: Replication and extension

The utility of measurement of heart rate (HR) responses to relevant auditory cues(combat sounds) in distinguishing between Vietnam veterans with PTSD and those with combat experience but without PTSD was replicated in a new sample of 59 PTSDs and 12 non-PTSD combat veterans. Although the new sample of PTSDs remained responsive to the relevant stimuli, HR values were consistently about 6 BPM lower than the values observed in the original sample. Psychological measures of anxiety and/or depression failed to discriminate among the PTSD samples between subjects who show HR responses to combat sounds and those who do not respond

A controlled comparison of thermal biofeedback and relaxation training in the treatment of essential hypertension: II. Effects on cardiovascular reactivity.

In the course of conducting a controlled comparison of progressive muscle relaxation and thermal biofeedback as possible substitutes for second-stage (sympatholytic) antihypertensive medications, we measured reactivity (heart rate, systolic blood pressure, and diastolic blood pressure) to three different stressors (mental arithmetic, cold pressor, and negative mental imagery) before and after treatment and drug withdrawal. Neither treatment was consistently effective in reducing reactivity across a variety of stressors. Relaxation led to more reductions in some aspect of reactivity than did biofeedback. The modest level of reductions in reactivity were seen more for mental arithmetic and systolic blood pressure.

Three studies on the relation of process to outcome in the treatment of essential hypertension with relaxation and thermal biofeedback

Abstract During the course of a controlled comparison of thermal biofeedback and progressive muscle relaxation as treatments for essential hypertension three studies investigating the relationship of process variables to outcome were conducted. The three variables investigated were expectancies, skill acquisition, and home practice. For patients receiving progressive muscle relaxation, perceptions of deep relaxation during treatment sessions were most strongly related to outcome. For thermal biofeedback patients, expectancies and skill acquisition variables were both related to outcome. Frequency of home practice was related to successful outcome for both treatment groups.

Effects of 24-hour ambulatory blood pressure monitoring on daily activities.

Compared the self-monitored activities, locations, and postural positions of 28 hypertensives while they wore an alarm watch and then while they wore a 24-hr ambulatory blood pressure monitor (ABPM) to see if wearing the ABPM led to alterations in behavior. Within the limitations of the study (no counterbalancing of order and twice as many ABPM measures as watch measures), we found significant differences in frequency of being at home or in miscellaneous settings, in standing and reclining positions, and in mental, physical and miscellaneous activities between the two occasions.

Hand temperature norms for headache, hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.

The effects of thermal biofeedback and autogenic training of cardiovascular reactivity: The joint USSR-USA behavioral hypertension treatment project

Cardiovascular reactivity (heart rate, systolic, and diastolic BP) to mental arithmetic and cold pressor were measured before and after treatment as part of the cross-cultural (USSR and USA) evaluation of thermal biofeedback and autogenic training (in comparison with self-relaxation) as treatments for mild hypertension in unmedicated males. There were no statistically reliable decreases in cardiovascular reactivity from before to after treatment. However, downward shifts in basal levels of systolic and diastolic BP at post-treatment led treated patients to have lower stress-induced levels of BP.

Evaluation of a minimal-therapist-contact thermal biofeedback treatment program for essential hypertension

We compared a clinic-based regimen of 16 individual sessions (2 per week) of thermal biofeedback with a largely home-based regimen of 5 sessions (spread over 8 weeks) for the treatment of essential hypertension in patients who required at least two drugs to maintain control of blood pressure (BP). On the basis of the clinical end point of being successfully withdrawn from the second stage medication while BP remained under control, the clinic-based regimen (5 of 9) was superior (X<(1)=4.0,p<.05) to the home-based regimen (1 of 9). Internal analyses point to more frequently obtaining a hand temperature of at least 95° F by the office-based patients as possibly the reason for the difference.

Biochemical changes associated with thermal biofeedback treatment of hypertension

Fifty-two hypertensive patients whose blood pressure (BP) was controlled on two medications received either 16 sessions of thermal biofeedback (n=30) for hand warming or 8 sessions of progressive muscle relaxation (n=22) prior to medication withdrawal. A number of biochemical measures, including plasma norepinephrine (NEPI) (supine and standing), plasma renin activity, plasma aldosterone, and urinary sodium and potassium, were taken before treatment and after treatment while medication remained constant. Results for the biofeedback-treated patients showed significant reductions in mean arterial pressure as well as in both supine and standing NEPI, while the other biochemical measures were unchanged. There were no significant changes on any variable for the relaxation-treated patients. Although the group data support a reduction in peripheral sympathetic tone as associated with the decrease in BP for the thermal biofeedback condition, dose-response relations were not significant.

End organ changes associated with the self-regulatory treatment of mild essential hypertension?

M-mode echocardiograms were obtained on unmedicated males with mild hypertension before and after treatment with thermal biofeedback, autogenic training, or self-relaxation. Although patients for whom diastolic blood pressure (DBP) was successfully reduced showed trends toward reduction in left ventricular parameters while unsuccessful patients showed no changes, the results were not significant. For the four patients with borderline left ventricular hypertrophy, there was a strong trend (p=.06) for successful treatment to lead to a reduction in left ventricular mass. Moreover, across the whole sample, reduction in left ventricular mass was related (r=.30) to decrease in DBP.

A preliminary investigation of prediction of mean arterial pressure after self-regulatory treatments

This study investigated the ability of pretreatment variables from three different domains (social-demographic, psychological, and psychophysiological) to predict posttreatment mean arterial pressure (MAP) for 59 unmedicated males with mild hypertension who were participating in a cross-cultural (USA-USSR) comparison of autogenic training and thermal biofeedback to a self-relaxation control. The overall multiple regression equation consisted of two variables and indicated that higher diastolic blood pressures during a cold pressor task were predictive of greater MAP reductions while higher scores on the Irritability subscale of the Buss-Durkee Hostility Scale were predictive of less MAP reductions. Suggestions for future research in this area are provided.