EMG Biofeedback and Stress Related Disorders
In todays world of conveniences, people are losing the
ability
to cope with stress. This inability to cope is causing a build
of stress and increasing the number of stress related disorders.
Prolonged stress can cause many problems such as the ones that
will be discussed here, plus many other problems are caused by
stress. Through EMG biofeedback one can learn to relax when in
stressful situations or whenever they experience a stress
related disorder.
Sean Pauly
TMJ
TMJ, or temporomandibular joint, is the connection between
your
jaw bone and your cranium; just in front of your ears. The jaw
bone is only connected by a few muscles and ligaments. For the
most part your jaw bone is free-floating, only being suspended
by your soft tissue. Because it is connected only by soft
tissue many things can go wrong. The condyle, a ball that the
jaw bone pivots on, could be out of alignment. The
interarticulated disk, which separates the bones of the jaw and
head, could be in the wrong place; resulting in an audible click
as the condyle slips in and out of the disk. The muscles or
ligaments can be tensed or inflamed and limit the range of
movement of your jaw. There are many possible ways that can TMJ
can take place, and for some people they may not even know they
have it.
Some possible signs of TMJ are headaches located in either
temple. Stiffness and soreness in the neck, face, and jaw.
Many times TMJ can cause myofascial pain, which is pain
throughout your facial muscles. Bruxism, or grinding of the
teeth, may also be a sign due to the grinding nature of the jaw.
Bruxism normally occurs while we sleep, so it is hard to know
whether we do grind our teeth. There are also some self-tests
that can be done to determine whether you have TMJ or not. "The
main one is to put resistance against your jaw and push against
the resistance in all directions; left, right, down, and up. If
there is soreness the muscles of your jaw could be inflamed or
fatigued. This can cause either tightness or slack in the jaw,
and it will not function properly." (Schwartz, 1959) Stress is
also a factor in TMJ. Stress can tense the muscles and cause
the forenamed problems.
Some basic treatments for TMJ are heat and cold. Heat helps
the blood flow through the muscles and helps in the rebuilding
of the muscle, while cold can reduce the pain and swelling.
Various splints are also used to help ease the burden the jaw
and to also reposition the jaw. A number of medications can
also be used, ranging from pain killers to anti-depressants.
Although most doctors do not like to use pain killers as they
might hide useful symptoms. Another type of therapy is used for
TMJ, it is called TENS. TENS stands for transcutaneous
electrical nerve stimulation. The object of this therapy is to
"pass short pulses of mild electric current through electrodes
placed on the skin. These electrical signals 'compete' with the
pain signals and prevent the nerves from transmitting the pain
messages to the brain."(Kaplan & Williams, 1988)
Recently EMG biofeedback has become more mainstream in
treatments ranging from stress-related disorders to muscle
spasms. EMG, or electromyograph, biofeedback measures the
electrical impulses coming from the muscle. If the muscle is
stressed and tense it will produce a larger amount of electrical
impulses than one that is relaxed. That is why EMG biofeedback
is being used on stressed muscles. With the feedback we can
learn to control and relax our muscles at will. This can reduce
the amount of problems associated with tight muscles, such as
TMJ. If a TMJ sufferer is experiencing pain through tight
muscles they can learn to loosen these muscles through
relaxation. The basis of biofeedback is to allow the patient to
get feedback from their muscles and learn to reduce the number
of electrical impulses, hence a more relaxed muscle. "Actually,
the biofeedback machine doesn't do anything except provide
information. But during the last fifteen years or so that it
has been in use, it has demonstrated the capacity to reinforce
relaxation training to a very remarkable degree, even though the
patient may not be consciously aware of its effect."(Goldman &
McCullough, 1987)
EMG biofeedback works well with TMJ because if it is caused
due
to muscle tension, there are two main muscles responsible for
moving the jaw. They are the temporalis muscle located around
your temples and moving down to the jaw and the main muscle of
the jaw, the masseter. That is the big muscle right at the
angle of your jaw. There are also a few smaller muscles the
medial and lateral pterygoid muscles. These muscles are less
significant but they can also be responsible for TMJ. A
biofeedback trainer would place an electrode probably over the
masseter, this would give feedback on the electrical activity of
the masseter in hopes of learning to relax and loosen the muscle
to prevent many of the problems that many of the TMJ sufferers
endure.
References
1) Schwartz, Laszlo, D.D.S. Disorders of the
Temporomandibular Joint Diagnosis, Management, Relation to
Occlusion of Teeth. W.B. Saunders Company, Philadelphia. 1959
2) Kaplan, Andrew S., D.M.D. & Gray Williams Jr., The TMJ
Book. Pharos Books, New York. 1988
3) Goldman, Richard A., D.D.S. & Virginia McCullough, TMJ
Syndrome The Overlooked Diagnosis. Congdon & Weed, Inc., New
York. 1987
Kirsten Decker
Hypertension
Hypertension, better known as high blood pressure, is on of
the
most common stress related disorders, affecting nearly 20% of
Americans (Microsoft, 1994). About 10% of all people with
hypertension are also diagnosed with secondary hypertension,
meaning that it results from some other physical condition. The
other 90% are affected by essential hypertension, which has no
structural cause (Bernstein, 1994), but can cause lethal damage.
Cardiac rate and cardiac outflow are elevated along with renin
secretion, which causes the body to retain water and salt,
resulting in a elevation of blood volume. This means the heart
has to work harder, which can lead to structural damage in the
heart as well as Chronic Heart Failure. Prolonged high blood
pressure may also damage cerebral arterial walls leading to a
stroke (Fox, 1993). Hypertension is usually treated with
diuretic drugs that increase urine volume and decrease blood
volume, therefore, decreasing blood pressure. Sympathetic
blocking drugs, or drugs that block beta andrenergic receptors
and decrease cardiac rate are also used (Fox, 1993). However,
these medications can produce a variety of side effects, such
as: drowsiness, weight gain, and impotence (Goldberger,
Breznitz, 1993). The long term effects have shown to increase
the patients risk of developing Coronary Heart Disease (Mahoney,
Fehmi & Shor, 1996). For this reason, many people with
hypertension have turned to alternative treatments that don't
present these problems.
Biofeedback assisted relaxation training has been the
preferred
method for decades. Originally, the constant cuff method was
used to obtain a non-invasive measure of blood pressure with
each heart beat and to feed this information back to the
subjects on a continuous basis (Shapiro, Tursky, Greshon, &
Stern, 1969). This was moderately successful, except the cuff
was very uncomfortable and the whole procedure was not easily
transferred to the outside world where it really mattered. The
most acceptable form of biofeedback training for the treatment
of hypertension has been the use of electromyographic feedback.
The EMG detects levels of muscle tension through electrodes that
are placed on the desired muscles and provides continuous visual
feedback with the use of a dial. During a feedback session, the
patient is instructed to relax using any relaxation method and
return to a Parasympathetic Nervous System dominated mode. This
allows for the excretion of water, which lowers the blood volume
and heart rate. The progressive relaxation method developed by
Jacobson (1938) is the most widely used with EMG feedback. It
teaches patients to tense a group of muscles for a few seconds,
then to relax them and remember the way it fells to relax those
muscles. The patient usually begins with the frontalis muscles
and continues until the whole body is relaxed. This method
should be practiced at home, as well as in the lab to teach the
patient to relax in any setting and situation. While in the
lab, the patient runs through this procedure before being
connected to the EMG machine. Then, electrodes are placed in
the desired spot and the patient runs through the method again.
A baseline is first recorded, consisting of five minutes of the
patient continuing the relaxation without any feedback. Next,
the patient receives ten minutes of feedback to try to
consciously reduce their muscle tension. After this, another
five minute baseline is taken without feedback to the patient,
followed by a final ten minute feedback segment. During the
feedback, the patient tries to keep the dial as low as possible
by keeping their muscles relaxed. Usually a threshold is set as
a goal for the patient to try to stay below. A speaker can be
set up to provide an annoying click or noise to alert the
patient when they go above their threshold. This helps the
patient to learn to be aware of the tension in their body and to
control it when it rises.
Many studies have been done to try and determine the most
successful method of blood pressure reduction. For decades,
this was proven to be EMG biofeedback along with progressive
relaxation training. According to David Jacobs (1983), EMG
feedback works best because it is recording off of striated
muscles which are innervated by the Central Nervous System,
while other feedback methods involve training visceral organs.
Both these methods lead to the same results, except people are
more aware of the processes controlled by the CNS. This is why
EMG feedback has lasted throughout the decades as a successful
means of blood pressure regulation. Steve Fahrion of the
Menninger Institute has developed a new combo of EMG feedback
and temperature feedback to teach patients to learn to relax
their body while also warming their hands and feet. This method
seems to be successful in reducing mean arterial pressure in
mild hypertensives. In conclusion, hypertension is a very
serious condition that is becoming more common amongst adults.
Fortunately, hypertensive patients can seek refuge through the
use of EMG biofeedback, which is becoming more and more accepted
in the medical community.
References
1) Microsoft Encyclopedia Encarta. Hypertension. 1994
2) Bernstein, D.A., Stewart, A.C., Roy, E.J., Srull, T.K., &
Wickens, C.D. Psychology. Houghton Mifflin Company, Boston.
1994
3) Fox, S.I. Human Physiology. Wm. C. Brown Publishers,
Dubuque. 1993
4) Fox, S.I. Human Physiology. Wm. C. Brown Publishers,
Dubuque. 1993
5) Goldberger, L., Breznitz, S. Handbook of Stress:
Theoretical and Clinical Aspects. The Free Press, New York.
1993
6) White, Tursky. Clinical Biofeedback: Efficacy and
Mechanisms. The Guilford Press, New York. 1982
Eli Poblitz
Electromyography Training for Anxiety
Everyone experiences anxiety, which is a feeling of
apprehensive tension or uneasiness which stems from the
anticipation of imminent danger, in which the source is largely
unknown or unrecognized. Many of the psychiatric and
psychosomatic syndromes are viewed as chronic defenses against
anxiety. However, the consequence of anxiety need not be
neurosis but may be integrated into healthy behavior with the
use of self regulation to maintain a homeostatic balance.
When anxiety intrudes on the daily function of life, it is
likely to be diagnosed as an anxiety disorder. As with any
stimulus a massive dose can defeat its own purpose by causing an
over reaction, or even complete paralysis. A break down can
occur because the individual can not discover the meaning as to
why he or she has anxiety. Chronic anxiety has a number of
effects on the body. There tends to be three groups: those in
which the skeletal muscle are mainly involved, those in which
the smooth muscle are mainly involved, and those in which
skeletal and smooth musculature appear equally involved.
Skeletal musculature involves the striated muscle and the
complex side effects from anxiety include: jerking of the limbs
before going to sleep (restless leg), facial twitches,
unsteadiness of voice, a feeling of unsteadiness, and even the
inability to move at all. Individuals with smooth muscle, or
cardiovascular, manifestations have symptoms such as precordial
pressure, palpitation, throbbing sensations, fast pulse, and
high blood pressure. The last grouping has predominantly
gastrointestinal effects caused be both smooth and skeletal
muscle together.
Current treatments for chronic anxiety include medication,
psychotherapy, biofeedback, meditation, and various other
methods that relieve stress. Several classes of drugs have
shown promise as effective anti-panic drugs, but there are many
proven side effects from them. Biofeedback is the alternative
choice to those who do not want to use drugs for their anxiety.
Biofeedback teaches the individual how to self-regulate their
body, which can include temperature, muscle tension, state of
consciousness, and arousal levels.
At present, facial electromyography, with electrodes on
combinations of muscles that produce a particular expressive
pattern, and observer based measurement of the action muscles
provides the best independent evidence of emotion specific
neurophysiological activity (Edman and Friezen, 1978; Izard,
1979; Rusalova, Izard and Simonov, 1975; Schwartz et. al 1976).
EMG therapist generally use the frontalis muscle of the
forehead to evaluate emotion specific characteristics of the
muscle activity. EMG training for general anxiety was fir
studied in 1973 (Raskin, Johnson, and Rondestvedt). Their
hypothesis was that successful training in the reduction of the
frontalis muscle activity would have the generalized effect of
reducing anxiety. Subjects were 10 patients who suffered from
very sever anxiety whom had failed other forms of treatment.
They were given training in frontalis muscle activity reduction
with auditor feedback. The subjects were given a 65 item mood
list each session. All ten subjects were able to reduce
frontalis muscle activity. However 6 of 10 showed no
improvement in overall anxiety level while those who did could
only do so alone. Five out of six subjects did improve with
their insomnia condition. An important finding was profound
subjective anxiety was sometimes accompanied by deep relaxation,
and overall, the subjects subjective rating did not correlate
significantly with frontalis muscle levels. The results were not
to encouraging, but it must be remembered that the subjects were
affected with severe long standing anxiety.
Canter, Kondo, and Knott (1975) compared the relative
efficacy
of general relaxation techniques and specific frontalis
training. Twenty eight subjects with anxiety neurosis with
complaints of muscular tension were used. Patients were divided
into two groups; one with chronic anxiety and the other half
with acute panic episodes. None were on medication during the
treatment. The subjects were given one of two treatments (with
the same amount of chronic anxiety in each group): frontalis
feedback with use of EMG and auditory feedback, and the other
used progressive relaxation (alternately tensing and relaxing of
the muscles). Patient and therapist ratings were reported in
addition to measuring the frontalis muscle at the beginning and
end of each training period. Both training techniques led to a
significant reduction in frontalis muscle activity, accompanied
by a reduction in anxiety as rated both subjectively and
objectively, but the decline for the feedback group was much
more significant than the other group. Le Boeuf (1974) found
that as a result of EMG frontalis training, his chronically
anxious patients with predominantly musculature symptoms showed
significant improvement in both specific symptoms and general
anxiety. But Le Boeuf showed that clients with predominantly
autonomic symptoms did not improve significantly.
Taken as a whole, these studies suggest that EMG feedback
training may be an effective treatment for anxiety, but that its
exact mechanism of action remains unclear at this time. A
reduction in EMG activity may be adequate to decrease subjective
anxiety levels, but the learning of EMG control does not seem to
be the crucial component of the anxiety treatment sessions which
include verbal instruction for muscle relaxation along with the
opportunity of the patient to engage in verbal therapy with the
therapist. There are difficulties as to sorting out the
specific contribution of EMG training for chronic anxiety
because EMG therapy is confounded with therapeutic therapy.
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This page last edited October 23, 1996
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