How does biofeedback reduce clinical symptoms and do memories and beliefs have biological consequences? Toward a model of mind-body healing.

Changes in the magnitude and direction of physiological measures (EMG, EEG, temperature, etc.) are not strongly related to the reduction of clinical symptoms in biofeedback therapy. Previously, nonspecified perceptual, cognitive, and emotional factors related to threat perception (Wickramasekera, 1979, 1988, 1998) may account for the bulk of the variance in the reduction of clinical symptoms. The mean magnitude of these previously nonspecified or placebo factors is closer to 70% when both the therapist and patient believe in the efficacy of the therapy. This powerful placebo effect is hypothesized to be an elicited conditioned response (Wickramasekera, 1977a, 1977c, 1980, 1985) based on the memory of prior healings. These memories of healing are more resistant to extinction if originally acquired on a partial rather than continuous reinforcement schedule. High and low hypnotic ability in interaction with threat perception (negative affect) is hypothesized to contribute to both the production and reduction of clinical symptoms. High and low hypnotic ability respectively are hypothesized to be related to dysregulation of the sympathetic and parasympathetic arms of the autonomic nervous system. Biofeedback is hypothesized to be most effective for reducing clinical symptoms in people of low to moderate hypnotic ability. For people high in trait hypnotic ability, training in self-hypnosis or other instructional procedures (e.g., autogenic training, progressive muscle relaxation, mediation, CBT, etc.) will produce the most rapid reduction in clinical symptoms.

Is religiousness a correlate of absorption? Implications for psychophysiology, coping, and morbidity.

CONTEXT: Evidence synthesized from social epidemiology, psychophysiology, and behavioral medicine suggests that religiousness may represent a significant correlate of absorption, a construct for which few if any psychosocial determinants have been identified. OBJECTIVE: To examine the association between absorption and intrinsic and extrinsic religiousness. PARTICIPANTS: 83 respondents of a self-administered survey of adult survivors of cancer or other life-threatening diseases, recruited from participants in a pilot study of psychosocial factors related to recovery from illness. MAIN MEASURES: Tellegen Absorption Scale and Religious Orientation Scale. RESULTS: Absorption, as assessed by the Tellegen Absorption Scale, was positively and significantly associated with intrinsic religiousness, as measured by the Religious Orientation Scale. Predominantly intrinsic subjects had absorption scores at least 20% higher than did predominantly extrinsic, proreligious, or nonreligious subjects. DISCUSSION: Prior research has found that absorption and hypnotizability have psychophysiological correlates, and that religiousness shows protective effects against morbidity and mortality. In light of this work, the present findings suggest that certain religious cognitions, emotions, or experiences may generate an internally focused state that enhances health and attenuates disease through self-soothing psychophysiological mechanisms.

Observation of a paradoxical temperature increase during cognitive stress in some chronic pain patients.

A total of 224 chronic pain somatoform disorder patients without obvious pathophysiology or psychopathology were found to have colder hands than nonpatients. A paradoxical temperature increase (PTI) in response to a cognitive stressor (mental arithmetic) was noted in a subset of these chronic pain patients. Patients were defined as "PTI" responders if, during cognitive stress, an increase in digital temperature occurred over a prior eyes closed resting condition. It was found that 49.4% of males and 42.6% of females in a total sample of 224 patients demonstrated PTI. The PTI patients had significantly colder hands than non-PTI patients prior to stress. A concurrent SCL measure of sympathetic activation found no difference between the PTI and non-PTI groups either at baseline or during cognitive stress. It appears from this data that PTI is specific to the peripheral vascular system of these patients and may be a marker of psychophysiological dissociation or trauma blocked from consciousness.

Morbid obesity, absorption, neuroticism, and the high risk model of threat perception.

We studied 70 morbidly obese patients, candidates for gastric exclusion surgery. We found that their mean absorption score was significantly lower and that their mean neuroticism score significantly higher than a matched control group. These results are consistent with predictions from the High Risk Model of Threat Perception (Wickramasekera, 1979, 1986, 1988, 1993a). People high in neuroticism are hypothesized to be hypersensitive to threat and, therefore, at greater risk for stress related psychobiological disorders. But if they are also low in absorption, they are hypothesized to have poor conscious perception of psychosocial threats and, therefore, they develop a very restricted range of psychosocial methods of coping with such threats. Consequently, lows may be mainly restricted to behavioral methods of coping like feeding and drinking to self-soothe unconscious aversive emotions associated with autonomic dysregulation and elevated parasympathetic tone. Their skeptical, rational, pragmatic cognitive style drives them to perceive medical surgical solutions to weight gain as more credible than psychosocial weight reduction programs.

On the interaction of hypnotizability and negative affect in chronic pain. Implications for the somatization of trauma.

The high risk model of threat perception predicts that high hypnotizability is a risk factor for trauma-related somatization. It is hypothesized that high hypnotizability can increase experimentally induced threat or negative affect, as measured by skin conductance level, in a linear or dose-response manner. This hypothesized interaction of hypnotic ability and negative affect was found in a consecutive series of 118 adult patients with chronic pain symptoms. Larger increases in skin conductance levels during cognitive threat were significantly related to higher levels of hypnotizability. In addition, individuals with high hypnotizability retained higher skin conductance levels than individuals with low hypnotizability after stress. The clinical implications of the interaction of hypnotizability and negative affect during threat perception and delayed recovery from threat perception are discussed in terms of cognitive mechanisms in the etiology and therapy of trauma-related dissociative disorders.

Somatization. Concepts, data, and predictions from the high risk model of threat perception.

Eighty-three consecutive patients with chronic somatic complaints seen prior to therapy were tested on the eight factors of the High Risk Model of Threat Perception. Thirty-two percent were high and 28% were low on hypnotic ability, which is more highs and lows than would be expected in a normal population. In the high and low hypnotic ability somatizers, the distribution of somatic and psychological symptoms is significantly different from the moderate group. Counterintuitively, hypnotic ability and major life change were orthogonal to all of the other risk factors. These findings are consistent with eight of nine predictions from the High Risk Model of Threat Perception.

Psychophysiological and clinical implications of the coincidence of high hypnotic ability and high neuroticism during threat perception in somatization disorders.

The electrodermal response to cognitive threat of unhypnotized female patients with somatic symptoms and high on both hypnotic ability and neuroticism (H-H) was found to be significantly higher (p < .01) than that of a matched group of female patients moderate on hypnotic ability and low on neuroticism (M-L). On verbal report the H-H and the M-L groups did not differ, but they were significantly different on a measure of self-deception (L scale) or repression. The above findings are consistent with predictions from the High Risk Model of Threat Perception (HRMTP), which states that people in the H-H group are both chronically and acutely more reactive to threat than the people in the M-L group. This finding may have important theoretical, clinical, and financial implications for the diagnosis, therapy, and prevention of somatization disorders seen in primary medical care.

A conditioned response model of the placebo effect predictions from the model.

A model of the placebo response as a conditioned response (CR) is presented and predictions from this model are listed. Through association with active ingredients (UCS), neutral (CS) places, persons, procedures, and things can come to acquire the ability to reduce pain, anxiety, and depressive responses. One major counterintuitive prediction from the model is that therapists who routinely use active ingredients (UCS) or powerful drugs will get stronger placebo effects than those who routinely use "inert" ingredients (CS) or weak drugs. Developmentally, placebo responding appears to involve two successive conditioning stages, which may involve first the left and later the right hemisphere in right-handed subjects. The relationship between placebo responding and hypnotizability is discussed.