Skip to main content
SpringerLink
Log in

The Raynaud's Treatment Study: Biofeedback Protocols and Acquisition of Temperature Biofeedback Skills

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Abstract

The Raynaud's Treatment Study (RTS) compared temperature biofeedback training and a behavioral control procedure (frontalis EMG biofeedback) with nifedipine-XL and a medication placebo for treatment of primary Raynaud's phenomenon (RP) in a large (N = 313) multicenter trial. The present study describes the RTS biofeedback protocols and presents data on the acquisition of digital skin temperature and frontalis EMG responses in the RTS. The findings point to substantial problems with acquisition of physiological self-regulation skills in the RTS. Only 34.6% of the Temperature Biofeedback group (N = 81) and 55.4% of the EMG Biofeedback group (N = 74) successfully learned the desired physiological response. In contrast, 67.4% of a Normal Temperature Biofeedback group (N = 46) learned hand warming. Multivariate analysis found that coping strategies, anxiety, gender, and clinic site predicted acquisition of hand-warming skills whereas variables related to RP disease severity did not. Physiological data showed vasoconstriction in response to the onset of biofeedback and also found that performance in the initial sessions was critical for successful acquisition. These findings indicate that attention to the emotional and cognitive aspects of biofeedback training, and a degree of success in the initial biofeedback sessions, are important for acquisition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Blanchard, E. B., & Haynes, M. (1975). Biofeedback treatment of a case of Raynaud's disease. Journal of Behavior Therapy and Experimental Psychiatry, 6, 230-234.

    Google Scholar 

  • Brown, K. M., Middaugh, S. J., Haythornthwaite, J., & Bielory, L. (2001). The effects of stress, anxiety and outdoor temperature on the frequency and severity of Raynaud's attacks: The Raynaud's treatment study. Journal of Behavioral Medicine, 24, 137-153.

    Google Scholar 

  • Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283.

    Google Scholar 

  • Cohen, S., Kamarack, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396.

    Google Scholar 

  • Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 71-75.

    Google Scholar 

  • Fahrion, S., Norris, P., Green, A., Green, E., & Snarr, C. (1986). Biobehavioral treatment of essential hypertension: A group outcome study. Biofeedback and Self-Regulation, 11, 257-277.

    Google Scholar 

  • Freedman, R. R. (1991). Physiological mechanisms of temperature biofeedback. Biofeedback and Self-Regulation, 16, 95-115.

    Google Scholar 

  • Freedman, R. R., & Ianni, P. (1983). Self-control of digital temperature: Physiological factors and transfer effects. Psychophysiology, 20, 682-689.

    Google Scholar 

  • Freedman, R. R., & Ianni, P. (1985). Effects of general and thematically relevant stressors in Raynaud's disease. Journal of Psychosomatic Research, 29, 275-280.

    Google Scholar 

  • Freedman, R. R., Ianni, P., & Wenig, P. (1983). Behavioral treatment of Raynaud's disease. Journal of Consulting and Clinical Psychology, 51, 539-549.

    Google Scholar 

  • Freedman, R. R., Ianni, P., & Wenig, P. (1985). Behavioral treatment of Raynaud's disease: Long term follow-up. Journal of Consulting and Clinical Psychology, 53, 136.

    Google Scholar 

  • Freedman, R. R., Lynn, S. J., & Ianni, P. (1982). Behavioral assessment of Raynaud's disease. In F. J. Keefe & J. A. Blumenthal (Eds.), Assessment strategies in behavioral medicine (pp. 99-129). New York: Grue and Station.

    Google Scholar 

  • Grabert, J. C., Bregman, N. J., & McAllister, H. A. (1980). Skin temperature regulation: The effects of suggestion and feedback. International Journal of Neuroscience, 10, 217-221.

    Google Scholar 

  • Graham, D. T., Stern, J. A., & Winour, G. (1958). Experimental investigation of the specificity of attitude hypothesis in psychosomatic disease. Psychosomatic Medicine, 20, 446-457.

    Google Scholar 

  • Jacobsen, A. M., Hackett, T. P., Surman, O. S., & Silverberg, E. L. (1973). Raynaud's phenomenon. Treatment with hypnotic and operant technique. Journal of the American Medical Association, 225, 739-740.

    Google Scholar 

  • Jacobsen, A., Menschreck, T., & Silverberg, E. (1979). Behavioral treatment for Raynaud's disease: A comparative study with long-term follow-up. American Journal of Psychiatry, 136, 844-846.

    Google Scholar 

  • Jobe, J. B., Sampson, J. B., Roberts, D. E., & Beetham, W. P., Jr (1982). Induced vasodilation as treatment for Raynaud's disease. Annals of Internal Medicine, 97, 706-709.

    Google Scholar 

  • Jobe, J. B., Sampson, J. B., Roberts, D. E., & Kelly, J. A. (1986). Comparisons of behavioral treatments for Raynaud's disease. Journal of Behavioral Medicine, 9, 89-96.

    Google Scholar 

  • Keefe, F. J. (1978). Biofeedback vs instructional control of skin temperature. Journal of Behavioral Medicine, 1, 383-390.

    Google Scholar 

  • Keefe, F., & Gardner, E. (1979). Learned control of skin temperature: Effects of short and long-term biofeedback training. Behavior Therapy, 10, 202-210.

    Google Scholar 

  • Keefe, F., Surwit, R., & Pilon, R. (1979). A 1-year follow-up of Raynaud's patients treated with behavioral therapy techniques. Journal of Behavioral Medicine, 2, 385-391.

    Google Scholar 

  • King, N. J., & Montgomery, R. B. (1980). Biofeedback-induced control of human peripheral temperature: A critical review of the literature. Psychological Bulletin, 88, 738-752.

    Google Scholar 

  • Lang, P. J., Greenwald, M. K., Bradley, M. M., & Hamm, A. O. (1993). Looking at pictures: Affective, facial, visceral and behavioral reactions. Psychophysiology, 30, 261-273.

    Google Scholar 

  • LeRoy, T. A., & Medsger, T. A., Jr (1992). Raynaud's phenomenon: A proposal for classification. Clinical Experimental Rheumatology, 10, 485-488.

    Google Scholar 

  • Libo, L. M., & Arnold, G. E. (1983). Does training to criterion fluence improvement? A follow-up study of EMG and thermal biofeedback. Journal of Behavioral Medicine, 6, 397-404.

    Google Scholar 

  • Maricq, H. R. (1992). Capillaroscopy in Raynaud's syndrome. Vascular Medicine Review, 3, 3-20.

    Google Scholar 

  • Maricq, H. R., Carpentier, P. H., Weinrich, M. C., Keil, P. E., Palesch, Y., Biro, C., Vionnet-Fuasset, M., Jiguet, M., & Valter, I. (1997). Geographic variation in the prevalence of Raynaud's phenomenon: A 5 region comparison. Journal of Rheumatology, 24, 879-889.

    Google Scholar 

  • Maricq, H. R., & Weinrich, M. C. (1988). Diagnosis of Raynaud's phenomenon assisted by color charts. Journal of Rheumatology, 15, 454-459.

    Google Scholar 

  • McCanne, T. R., & Anderson, J. A. (1897). Emotional responding following experimental manipulation of facial electromyographic activity. Journal of Personality and Social Psychology, 52, 759-768.

    Google Scholar 

  • Melin, B., & Fagerstrom, K. O. (1981). Treatment of peripheral vasospasm. Scandanavian Journal of Behavioral Therapy, 10, 97-110.

    Google Scholar 

  • Melin, B., & Fagerstrom, K. O. (1996). A one year follow-up of a placebo-controlled behavioral treatment of peripheral vasospasm. Scandinavian Journal of Behavioral Therapy, 25, 27-35.

    Google Scholar 

  • Melin, B., & Sandqvist, D. (1994). Effects of thematically relevant visual stimuli in Raynaud's disease. Scandinavian Journal of Behavioral Therapy, 23, 53-60.

    Google Scholar 

  • Middaugh, S., Woods, E. S., Kee, W. G., Harden, R. N., & Peters, J. R. (1991). Biofeedback-assisted relaxation training for the aging chronic pain patient. Biofeedback and Self-Regulation, 16, 361-377.

    Google Scholar 

  • Mittleman, B., & Wolff, H. (1939). Affective states and skin temperature: Experimental study of subjects with “cold hands” and Raynaud's syndrome. Psychosomatic Medicine, 1, 271-292.

    Google Scholar 

  • Raynaud's Treatment Study (RTS) Investigators. (2000). Comparison of sustained-release nifedipine and temperature biofeedback for primary Raynaud's phenomenon: Results from a randomized clinical trial with one-year follow-up. Archives of Internal Medicine, 160, 1101-1108.

    Google Scholar 

  • Rose, G. D., & Carlson, J. G. (1987). The behavioral treatment of Raynaud's disease: A review. Biofeedback and Self-Regulation, 12, 257-272.

    Google Scholar 

  • SAS Institute Inc. (1990). SAS/STAT users guide (Version 6, 4th ed., Vol. 2). Cary, NC: The SAS Institute.

    Google Scholar 

  • Sedlacek, K. (1979). Biofeedback for Raynaud's disease. Psychosomatics, 20, 535-541.

    Google Scholar 

  • Sedlacek, K. (1989). Biofeedback treatment of primary Raynaud's disease. In J. V. Basmajian (Ed.), Biofeedback: Principles and practice for clinicians (3rd ed., pp. 317-321). Baltimore: Williams & Wilkins.

    Google Scholar 

  • Sedlacek, K., & Taub, E. (1996). Biofeedback treatment of Raynaud's disease. Professional Psychology: Research and Practice, 27, 548-553.

    Google Scholar 

  • Shapiro, D., & Schwartz, G. E. (1972). Biofeedback and visceral learning: Clinical applications. Seminars Psychiatry, 4, 171-184.

    Google Scholar 

  • Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologist Press.

    Google Scholar 

  • Stambrook, M., Hamel, E. R., & Carter, S. A. (1988). Training to vasodilate in a cooling environment: A valid treatment for Raynaud's phenomenon? Biofeedback and Self-Regulation, 13, 9-23.

    Google Scholar 

  • Stoffer, G. R., Jensesn, J. A. S., & Nesset, B. L. (1979). Effects of contingent versus yoked temperature feedback on voluntary temperature control and cold stress tolerance. Biofeedback and Self-Regulation, 4, 51-61.

    Google Scholar 

  • Surwit, R. (1973). Biofeedback: A possible treatment for Raynaud's disease. Seminars in Psychiatry, 5, 483-489.

    Google Scholar 

  • Surwit, R. S. (1982). Behavioral treatment of Raynaud's syndrome in peripheral vascular disease. Journal of Consulting and Clinical Psychology, 50, 922-933.

    Google Scholar 

  • Surwit, R. S., Williams, R. B., Jr, & Shapiro, D. (1982). Behavioral approaches to cardiovascular disease. New York: Academic Press.

    Google Scholar 

  • Taub, E. (1977). Self-regulation of human tissue temperature. In G. Schwartz & J. Beatty (Eds.), Biofeedback: Theory and practice (pp. 265-300). New York: Academic Press.

    Google Scholar 

  • Taub, E., & School, P. J. (1978). Some methodological considerations in thermal biofeedback training. Behavior Research Methods and Instrumentation, 10, 617-622.

    Google Scholar 

  • Thompson, B., Geller, N. L., Hunsberger, S., Frederick, M., Hill, R., Jacob, R. G., et al. (1999). Designing clinical trails with behavioral and pharmacologic interventions: The Raynaud's treatment study. Controlled Clinical Trials, 20, 52-63.

    Google Scholar 

  • Tibbetts, V., Charbonneau, J., & Peper, E. (1987). Adjunctive strategies to enhance peripheral warming: Clinical techniques. Biofeedback and Self-Regulation, 12, 313-320.

    Google Scholar 

  • Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston, MA: The Health Institute.

    Google Scholar 

  • Wrigley, F. M., & Flavahan, N.A. (1996). Raynaud's phenomenon. Rheumatic Disease Clinics of North America, 22, 765-781.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical University of South Carolina, Charleston, South Carolina

    Susan J. Middaugh

  2. Johns Hopkins University, Baltimore, Maryland

    Jennifer A. Haythornthwaite

  3. Clinical Trials & Surveys Corporation, Baltimore, Maryland

    Bruce Thompson & Kathleen M. Brown

  4. National Heart, Lung, and Blood Institute, Bethesda, Maryland

    Robin Hill

  5. Wayne State University, Detroit, Michigan

    Robert R. Freedman

  6. UMDNJ New Jersey Medical School, Newark, New Jersey

    Virginia Attanasio

  7. University of Pittsburgh, Pittsburgh, Pennsylvania

    Rolf G. Jacob & Michael Scheier

  8. Medical University of South Carolina, Charleston, South Carolina

    Edwin A. Smith

Authors
  1. Susan J. Middaugh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer A. Haythornthwaite
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bruce Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robin Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kathleen M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert R. Freedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Virginia Attanasio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rolf G. Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Scheier
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Edwin A. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Middaugh, S.J., Haythornthwaite, J.A., Thompson, B. et al. The Raynaud's Treatment Study: Biofeedback Protocols and Acquisition of Temperature Biofeedback Skills. Appl Psychophysiol Biofeedback 26, 251–278 (2001). https://doi.org/10.1023/A:1013182519331

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1013182519331

Search

Navigation