Decreased Systolic Blood Pressure through Operant Conditioning Techniques in Patients with Essential Hypertension

Benson, Herbert; Shapiro, David; Tursky, Bernard; Schwartz, Gary E.

doi:10.1126/science.173.3998.740

Cited by 183 publications

(53 citation statements)

References 14 publications

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“…Numerosos estudios, aplicando biofeedback de la tensión arterial, han conseguido disminuciones importantes, entre 4 y 8 mm de Hg tanto en tensión arterial sistólica como en diastólica (Blanchard, 1979;Young y Blanchard, 1980), o hasta 23 mm de Hg (Benson et al, 1971) o un 25% de reducción en tensión arterial diastólica (Elder et al, 1973). A pesar de ello, otros estudios como los de Patel, han demostrado que utilizando una combinación de biofeedback de la tensión arterial junto con relajación, la mejoría era superior.…”

Section: A Fase: Miller Y El Condicionamiento Operante De Las Funcionunclassified

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

Pastor

Balaña

2002

Acción psicol.

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ResumenEl surgimiento de las técnicas de biofeedback, ha sido uno de los fenómenos más importantes ocurridos en este siglo en el campo de la psicología clínica. No sólo se ha demostrado la posibilidad de aplicar las técni-cas operantes al aprendizaje de funciones autonómicas y viscerales, sino también la posibilidad de aplicar estas técnicas, con fines de intervención terapéutica en multitud de trastornos psicosomáticos.Este artículo pretende ofrecer una visión histórica general sobre los inicios y evolución de las técnicas de biofeeback, hasta la actualidad, aportando una revisión bibliográfica sobre las diferentes técnicas de biofeedback y sus aplicaciones clínicas en distintos trastornos: estrés, migrañas, cefaleas tensionales, dolores, hipertensión, enfermedad de Rainaud, etc.Palabras clave. Biofeedback, respuestas psicofisiológicas. AbstractThe emergence of biofeedback techniques has been one of the most important phenomena that has taken place in the last century in the field of clinical psychology. It has been proved the possibilities of applying operant techniques not only to the learning of autonomous and visceral functions, but also to apply them for therapeutic purposes in many psychosomatic dysfunctions.This article purports to offer a historical and general perspective of the outset and technical evolution of the biofeedback, until today by means of an intemized bibliographical review of the main clinical applications in different disorders such as stress, migraine, headache, pains, hypertension, sickness of Raynaud, etc.

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Section: A Fase: Miller Y El Condicionamiento Operante De Las Funcionunclassified

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

Pastor

Balaña

2002

Acción psicol.

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“…In most clinical applications of blood pressure feedback, however, patients are, often unavoidably, informed of the response to be controlled and the direction of the desired change 625 1977, 103, 625-631 NUMBER 4 (WINTER) 1977 (e.g., Benson, Shapiro, Tursky, and Schwartz, 1971;Goldman, Kleinman, Snow, Bidus, and Korol, 1975;Kristt and Engel, 1975). In these studies, large blood-pressure reductions have been reported over numerous sessions.…”

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confidence: 99%

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS¹

Hager

Feldman

1977

J of App Behav Analysis

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Forty normal male volunteers were randomly assigned to one of four experimental conditions and instructed to raise and lower their systolic blood pressure. Subjects received either beat-to-beat feedback contingent on pressure changes, noncontingent beat-to-beat feedback, noncontingent feedback presented randomly with respect to the occurrence of each heart beat, or instructions alone. The order of increase and decrease trial blocks was counterbalanced across groups. Subjects receiving contingent feedback were monetarily rewarded for appropriate pressure changes. Subjects receiving noncontingent feedback received rewards and feedback equal to the mean received by the contingent group. Subjects in the instructions-only condition were also paid this bonus but were informed of their earnings only at the conclusion of the experiment. Results indicated that in the presence of instructions, feedback, whether contingent or noncontingent, added little to subjects' ability to control pressure during a single session. Theoretical and clinical implications are discussed.DESCRIPTORS: systolic blood pressure, biofeedback, visceral learning, behavioral control, instructions, reinforcement, monetary reinforcers, adult males It is well established that human subjects can learn to control either systolic or diastolic blood pressure through the use of feedback and reward for variations in pressure with each beat of the heart (Shapiro, Tursky, Gershon, and Stern, 1969;Shapiro, Tursky, and Schwartz, 1970;Shapiro, Schwartz, and Tursky, 1972). In these experiments, blood pressure is tracked and feedback provided by inflating a cuff to a constant pressure, set to either the systolic or diastolic level for a brief trial interval, and providing a feedback signal at either the presence or absence of Korotkoff (K) shapes systolic blood pressure by raising the cuff pressure between trials (cuff inflations) if K sounds appear on 75 % or more of the heart beats, or lowering the cuff pressure if K sounds appear on 25 % or less of the heart beats in a given trial. The reverse relationship between pressure and K sounds is used to track diastolic pressure.Experiments with this method have normally shown that when subjects are not informed of the specific response or direction of change required of them, noncontingent or random feedback is inferior to contingent feedback in producing blood-pressure changes. This is not surprising, because uninstructed subjects given noncontingent feedback have no information about what they are being asked to do. Characteristically, these subjects show a tendency for blood pressure to decrease over a session (Shapiro et al., 1970).In most clinical applications of blood pressure feedback, however, patients are, often unavoidably, informed of the response to be controlled and the direction of the desired change 625 1977, 103, 625-631 NUMBER 4 (WINTER) 1977

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“…One approach, referred to as a contingent model (Brady & Harris, 1977), has emphasized environmental and behavioral interactions that occur as a consequence of significant physiological changes (i.e., a specified physiological response is treated as an operant). Most studies have used either heart rate or blood pressure as the operant and have focused on the role of behavioral influences in the etiology of hypertension (Benson, Herd, Morse, & Kelleher, 1969;Benson, Shapiro, Tursky, & Schwartz, 1971;Engel & Schneiderman, 1984;Harris, Gilliam, Findley, & Brady, 1973;Talan & Engel, 1986). The other approach, referred to as a concurrent model (Brady & Harris, 1977), has emphasized concomitant physiological changes associated with environmental and behavioral interactions.…”

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Behavioral and Pharmacological Modulation of Respiration in Rhesus Monkeys

Howell

Landrum

1994

J Exper Analysis Behavior

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Changes in respiration associated with schedule-controlled behavior were determined in seated rhesus monkeys prepared with a pressure-displacement head plethysmograph for monitoring ventilation continuously during behavioral experiments. Subjects were trained to press a lever under fixed-ratio 40 and fixed-interval 300-s schedules of stimulus termination. Episodic increases in ventilation were closely associated with periods of responding under both schedules. Recurring episodes of increased ventilation occurred during fixed-ratio responding, and were separated by brief 10-s timeouts during which ventilation decreased. Under the fixed-interval schedule, both ventilation and response rate typically increased as the 300-s interval elapsed. The effects of cocaine, caffeine, and two adenosine agonists, 5'-N-ethylcarboxamidadenosine (NECA) and 2-(carboxyethylphenylamino)adenosine-5'-carboxamide (CGS 21680), on behavior and respiration were determined using a cumulative-dosing procedure. Drug-induced suppression of behavior eliminated the episodic increases in ventilation during the performance components of both schedules. Schedule-related increases in ventilation were compared to those produced by elevated levels of CO2 in inspired air. Exposure to 4% CO2 mixed in air increased ventilation in all subjects, and the combined effects of CO2 exposure and schedule-controlled responding on respiration appeared to be additive. The results suggest that behavioral activities may increase ventilation through increased metabolic demand and increased CO2 production.Key words: respiration, caffeine, cocaine, adenosine, fixed-interval schedule, fixed-ratio schedule, stimulus-termination schedule, plethysmograph, lever press, rhesus monkeyThe influence of operant conditioning on physiological systems has been studied actively within the framework of two general experimental approaches. One approach, referred to as a contingent model (Brady & Harris, 1977), has emphasized environmental and behavioral interactions that occur as a consequence of significant physiological changes (i.e., a specified physiological response is treated as an operant). Most studies have used either heart rate or blood pressure as the operant and have focused on the role of behavioral influences in the etiology of hypertension

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Decreased Systolic Blood Pressure through Operant Conditioning Techniques in Patients with Essential Hypertension

Cited by 183 publications

References 14 publications

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS¹

Behavioral and Pharmacological Modulation of Respiration in Rhesus Monkeys

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Decreased Systolic Blood Pressure through Operant Conditioning Techniques in Patients with Essential Hypertension

Cited by 183 publications

References 14 publications

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

Revisión sobre las técnicas de Biofeedback y sus aplicaciones [Biofeedback techniques and their applications: A review]

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS1

Behavioral and Pharmacological Modulation of Respiration in Rhesus Monkeys

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THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS¹