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Applied Psychophysiology and Biofeedback

, Volume 38, Issue 1, pp 57–69 | Cite as

Peak High-Frequency HRV and Peak Alpha Frequency Higher in PTSD

  • Helané Wahbeh
  • Barry S. Oken
Article

Abstract

Posttraumatic stress disorder (PTSD) is difficult to treat and current PTSD treatments are not effective for all people. Despite limited evidence for its efficacy, some clinicians have implemented biofeedback for PTSD treatment. As a first step in constructing an effective biofeedback treatment program, we assessed respiration, electroencephalography (EEG) and heart rate variability (HRV) as potential biofeedback parameters for a future clinical trial. This cross-sectional study included 86 veterans; 59 with and 27 without PTSD. Data were collected on EEG measures, HRV, and respiration rate during an attentive resting state. Measures were analyzed to assess sensitivity to PTSD status and the relationship to PTSD symptoms. Peak alpha frequency was higher in the PTSD group (F(1,84) = 6.14, p = 0.01). Peak high-frequency HRV was lower in the PTSD group (F(2,78) = 26.5, p < 0.00005) when adjusting for respiration rate. All other EEG and HRV measures and respiration were not different between groups. Peak high-frequency HRV and peak alpha frequency are sensitive to PTSD status and may be potential biofeedback parameters for future PTSD clinical trials.

Keywords

Posttraumatic stress disorder Combat veterans Heart rate variability Peak alpha frequency Biofeedback 

Notes

Acknowledgments

This work was supported in part by National Institute of Health grants T32AT002688, K01AT004951, U19AT002656, UL1RR024140, K24AT005121, and a Tartar Trust Grant. Special thanks to Roger Ellingson, Irina Fonareva, Jennifer Bishop and Elena Goodrich for their assistance with this study.

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing Inc.Google Scholar
  2. Angelakis, E., Lubar, J. F., Stathopoulou, S., & Kounios, J. (2004). Peak alpha frequency: An electroencephalographic measure of cognitive preparedness. Clinical Neurophysiology, 115(4), 887–897. doi: 10.1016/j.clinph.2003.11.034.PubMedCrossRefGoogle Scholar
  3. Angelakis, E., Stathopoulou, S., Frymiare, J. L., Green, D. L., Lubar, J. F., & Kounios, J. (2007). EEG neurofeedback: A brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly. Clin Neuropsychol, 21(1), 110–129.PubMedCrossRefGoogle Scholar
  4. Aysin, B., & Aysin, E. (2006). Effect of respiration in heart rate variability (HRV) analysis. Conf Proc IEEE Eng Med Biol Soc, 1, 1776–1779. doi: 10.1109/IEMBS.2006.260773.PubMedGoogle Scholar
  5. Baehr, E., Rosenfeld, J. P., Baehr, R., & Earnest, C. (1999). Clinical use of an alpha asymmetry neurofeedback in the treatment of mood disorders. In A. Abarbanel & J. R. Evans (Eds.), Introduction to quantitative EEG and neurofeedback (pp. 181–201). Massachusetts: Academic Press.CrossRefGoogle Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory -Second Edition Manual. San Antonio: Harcourt Brace & Company.Google Scholar
  7. Begic, D., Hotujac, L., & Jokic-Begic, N. (2001). Electroencephalographic comparison of veterans with combat-related post-traumatic stress disorder and healthy subjects. International Journal of Psychophysiology, 40(2), 167–172.PubMedCrossRefGoogle Scholar
  8. Berg, A. O., Breslau, N., Goodman, S. N., Lezak, M. D., Matchar, D. B., Mellman, T. A., et al. (2007). Treatment of PTSD: An assessment of the evidence. Washington, DC: National Academies Press.Google Scholar
  9. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90. doi: 10.1007/BF02105408.PubMedCrossRefGoogle Scholar
  10. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673.PubMedCrossRefGoogle Scholar
  11. Blume, W. T. (2006). Drug effects on EEG. Journal of Clinical Neurophysiology, 23(4), 306–311. doi: 10.1097/01.wnp.0000229137.94384.fa.PubMedCrossRefGoogle Scholar
  12. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55(7), 626–632.PubMedCrossRefGoogle Scholar
  13. Bruce, M. L. (2010). Suicide risk and prevention in veteran populations. Annals of the New York Academy of Sciences, 1208, 98–103. doi: 10.1111/j.1749-6632.2010.05697.x.PubMedCrossRefGoogle Scholar
  14. Brunello, N., Davidson, J. R., Deahl, M., Kessler, R. C., Mendlewicz, J., Racagni, G., et al. (2001). Posttraumatic stress disorder: Diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology, 43(3), 150–162.PubMedCrossRefGoogle Scholar
  15. Buckley, T. C., Holohan, D., Greif, J. L., Bedard, M., & Suvak, M. (2004). Twenty-four-hour ambulatory assessment of heart rate and blood pressure in chronic PTSD and non-PTSD veterans. Journal of Traumatic Stress, 17(2), 163–171. doi: 10.1023/B:JOTS.0000022623.01190.f0.PubMedCrossRefGoogle Scholar
  16. Cahn, B. R., & Polich, J. (2006). Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological Bulletin, 132(2), 180–211.PubMedCrossRefGoogle Scholar
  17. Clark, M. E., & Hirschman, R. (1990). Effects of paced respiration on anxiety reduction in a clinical population. Biofeedback and Self Regulation, 15(3), 273–284.PubMedCrossRefGoogle Scholar
  18. Cohen, H., Kotler, M., Matar, M. A., Kaplan, Z., Loewenthal, U., Miodownik, H., et al. (1998). Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biological Psychiatry, 44(10), 1054–1059.PubMedCrossRefGoogle Scholar
  19. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564–570.PubMedCrossRefGoogle Scholar
  20. Department of Veteran Affairs and Department of Defense. (2010). VA/DoD clinical practice guideline for the management of post-traumatic stress. Washington, DC: Veterans Health Administration, Department of Veteran Affairs, Department of Defense.Google Scholar
  21. Ehlers, C. L., Hurst, S., Phillips, E., Gilder, D. A., Dixon, M., Gross, A., et al. (2006). Electrophysiological responses to affective stimuli in American Indians experiencing trauma with and without PTSD. Ann NY Acad Sci, 1071, 125–136.PubMedCrossRefGoogle Scholar
  22. Etkin, A., & Wager, T. D. (2007). Functional neuroimaging of anxiety: A meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), 1476–1488.PubMedCrossRefGoogle Scholar
  23. First, M., Spitzer, R., Gibbon, M., & Williams, J. (2002). Structured clinical interview for DSM-IV-TR Axis 1 disorders-patient edition (SCID-I/P, 11/2002 revision). New York, New York: Biometrics Research Department.Google Scholar
  24. Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression & Anxiety, 28(9), 750–769. doi: 10.1002/da.20767.CrossRefGoogle Scholar
  25. Gaal, Z. A., Boha, R., Stam, C. J., & Molnar, M. (2010). Age-dependent features of EEG-reactivity-Spectral, complexity, and network characteristics. Neuroscience Letters,. doi: 10.1016/j.neulet.2010.05.037.Google Scholar
  26. Ginsberg, J. P., Berry, M. E., & Powell, D. A. (2010). Cardiac coherence and posttraumatic stress disorder in combat veterans. Alternative Therapies in Health and Medicine, 16(4), 52–60.PubMedGoogle Scholar
  27. Goodnick, P. J., Jerry, J., & Parra, F. (2002). Psychotropic drugs and the ECG: Focus on the QTc interval. Expert Opinion on Pharmacotherapy, 3(5), 479–498. doi: 10.1517/14656566.3.5.479.PubMedCrossRefGoogle Scholar
  28. Gordon, E., Palmer, D. M., & Cooper, N. (2010). EEG alpha asymmetry in schizophrenia, depression, PTSD, panic disorder, ADHD and conduct disorder. Clin EEG Neurosci, 41(4), 178–183.PubMedCrossRefGoogle Scholar
  29. Gordon, J. S., Staples, J. K., Blyta, A., Bytyqi, M., & Wilson, A. T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69(9), 1469–1476.PubMedCrossRefGoogle Scholar
  30. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res, 57(1), 35–43.PubMedCrossRefGoogle Scholar
  31. Grunert, B. K., Weis, J. M., Smucker, M. R., & Christianson, H. F. (2007). Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 317–328.PubMedCrossRefGoogle Scholar
  32. Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child and Adolescent Psychiatric Clinics of North America, 14(1), 105–123, vii.Google Scholar
  33. Hanslmayr, S., Sauseng, P., Doppelmayr, M., Schabus, M., & Klimesch, W. (2005). Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects. Association for Applied Psychophysiology and Biofeedback, 30(1), 1–10.CrossRefGoogle Scholar
  34. Hickling, E. J., Sison, G. F, Jr, & Vanderploeg, R. D. (1986). Treatment of posttraumatic stress disorder with relaxation and biofeedback training. Biofeedback and Self Regulation, 11(2), 125–134.PubMedCrossRefGoogle Scholar
  35. Hofmann, S. G., Litz, B. T., & Weathers, F. W. (2003). Social anxiety, depression, and PTSD in Vietnam veterans. Journal of Anxiety Disorders, 17(5), 573–582.PubMedCrossRefGoogle Scholar
  36. Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6, 65–70.Google Scholar
  37. Houle, M. S., & Billman, G. E. (1999). Low-frequency component of the heart rate variability spectrum: A poor marker of sympathetic activity. American Journal of Physiology, 276(1 Pt 2), H215–H223.PubMedGoogle Scholar
  38. Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R., & McFall, M. (2009). Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans. Journal of Traumatic Stress, 22(4), 303–306. doi: 10.1002/jts.20423.PubMedCrossRefGoogle Scholar
  39. Jokic-Begic, N., & Begic, D. (2003). Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD). Nordic Journal of Psychiatry, 57(5), 351–355. doi: 10.1080/08039480310002688.PubMedCrossRefGoogle Scholar
  40. Jung, T. P., Makeig, S., Westerfield, M., Townsend, J., Courchesne, E., & Sejnowski, T. J. (2000). Removal of eye activity artifacts from visual event-related potentials in normal and clinical subjects. Clinical Neurophysiology, 111(10), 1745–1758.PubMedCrossRefGoogle Scholar
  41. Keane, T., Fairbank, J. A., Caddell, J., Zimering, R., Taylor, K., & Mora, C. (1989). Clinical evaluation of a measure to assess combat exposure. A Journal of Consulting and Clinical Psychology, 1(1), 53–55. doi: 10.1037/1040-3590.1.1.53.Google Scholar
  42. Kemp, A. H., Griffiths, K., Felmingham, K. L., Shankman, S. A., Drinkenburg, W., Arns, M., et al. (2010). Disorder specificity despite comorbidity: Resting EEG alpha asymmetry in major depressive disorder and post-traumatic stress disorder. Biological Psychology, 85(2), 350–354. doi: 10.1016/j.biopsycho.2010.08.001.PubMedCrossRefGoogle Scholar
  43. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627. doi: 10.1001/archpsyc.62.6.617.PubMedCrossRefGoogle Scholar
  44. Kimerling, R., Gima, K., Smith, M. W., Street, A., & Frayne, S. (2007). The Veterans health administration and military sexual trauma. American Journal of Public Health, 97(12), 2160–2166. doi: 10.2105/AJPH.2006.092999.PubMedCrossRefGoogle Scholar
  45. Kinder, L. S., Bradley, K. A., Katon, W. J., Ludman, E., McDonell, M. B., & Bryson, C. L. (2008). Depression, posttraumatic stress disorder, and mortality. Psychosomatic Medicine, 70(1), 20–26.PubMedCrossRefGoogle Scholar
  46. Klimesch, W. (1999). EEG alpha and theta oscillations reflect cognitive and memory performance: A review and analysis. Brain Research. Brain Research Reviews, 29(2–3), 169–195.PubMedCrossRefGoogle Scholar
  47. Knott, V., Mahoney, C., Kennedy, S., & Evans, K. (2001). EEG power, frequency, asymmetry and coherence in male depression. Psychiatry Research, 106(2), 123–140.PubMedCrossRefGoogle Scholar
  48. Lakusic, N., Fuckar, K., Mahovic, D., Cerovec, D., Majsec, M., & Stancin, N. (2007). Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction. Military Medicine, 172(11), 1190–1193.PubMedGoogle Scholar
  49. Lande, R. G., Williams, L. B., Francis, J. L., Gragnani, C., & Morin, M. L. (2010). Efficacy of biofeedback for post-traumatic stress disorder. Complementary Therapies in Medicine, 18(6), 256–259. doi: 10.1016/j.ctim.2010.08.004.PubMedCrossRefGoogle Scholar
  50. Lockwood, A., Steinke, D. T., & Botts, S. R. (2009). Medication adherence and its effect on relapse among patients discharged from a Veterans Affairs posttraumatic stress disorder treatment program. Annals of Pharmacotherapy, 43(7), 1227–1232. doi: 10.1345/aph.1M017.PubMedCrossRefGoogle Scholar
  51. Malik, M. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation, 93, 1043–1065.CrossRefGoogle Scholar
  52. Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, J. M., Bowman, L., Landbloom, R. P., et al. (2005). The cost of treating anxiety: The medical and demographic correlates that impact total medical costs. Depression and Anxiety, 21(4), 178–184.PubMedCrossRefGoogle Scholar
  53. McMenamin, B. W., Shackman, A. J., Greischar, L. L., & Davidson, R. J. (2010). Electromyogenic artifacts and electroencephalographic inferences revisited. Neuroimage, 54(1), 4–9. doi: 10.1016/j.neuroimage.2010.07.057.PubMedCrossRefGoogle Scholar
  54. Mellman, T. A., Knorr, B. R., Pigeon, W. R., Leiter, J. C., & Akay, M. (2004). Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biological Psychiatry, 55(9), 953–956.PubMedCrossRefGoogle Scholar
  55. Metzger, L. J., Paige, S. R., Carson, M. A., Lasko, N. B., Paulus, L. A., Pitman, R. K., et al. (2004). PTSD arousal and depression symptoms associated with increased right-sided parietal EEG asymmetry. Journal of Abnormal Psychology, 113(2), 324–329.PubMedCrossRefGoogle Scholar
  56. Michael, A. J., Krishnaswamy, S., & Mohamed, J. (2005). An open label study of the use of EEG biofeedback using beta training to reduce anxiety for patients with cardiac events. Neuropsychiatric Disease and Treatment, 1(4), 357–363.PubMedGoogle Scholar
  57. Moore, N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical Electroencephalography, 31(1), 1–6.PubMedGoogle Scholar
  58. Morarend, Q. A., Spector, M. L., Dawson, D. V., Clark, S. H., & Holmes, D. C. (2011). The use of a respiratory RATE biofeedback device to reduce dental anxiety: An exploratory investigation. Association for Applied Psychophysiology and Biofeedback, 36(2), 63–70.CrossRefGoogle Scholar
  59. Mukherjee, S., Yadav, R., Yung, I., Zajdel, D. P., & Oken, B. S. (2011). Sensitivity to mental effort and test-retest reliability of heart rate variability measures in healthy seniors. Clinical Neurophysiology, 122(10), 2059–2066. doi: 10.1016/j.clinph.2011.02.032.PubMedGoogle Scholar
  60. Muraoka, M. Y., Carlson, J. G., & Chemtob, C. M. (1998). Twenty-four-hour ambulatory blood pressure and heart rate monitoring in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11(3), 473–484.PubMedCrossRefGoogle Scholar
  61. Nunez, P. L., & Pilgreen, K. L. (1991). The spline-Laplacian in clinical neurophysiology: A method to improve EEG spatial resolution. Journal of Clinical Neurophysiology, 8(4), 397–413.PubMedCrossRefGoogle Scholar
  62. Nunez, P. L., Wingeier, B. M., & Silberstein, R. B. (2001). Spatial-temporal structures of human alpha rhythms: Theory, microcurrent sources, multiscale measurements, and global binding of local networks. Human Brain Mapping, 13(3), 125–164.PubMedCrossRefGoogle Scholar
  63. Oken, B. S., Kishiyama, S., & Salinsky, M. C. (1995). Pharmacologically induced changes in arousal: Effects on behavioral and electrophysiologic measures of alertness and attention. Electroencephalography and Clinical Neurophysiology, 95(1995), 359–371.PubMedCrossRefGoogle Scholar
  64. Olgin, J., & Zipes, D. (2007). Specific arrhythmias: Diagnosis and treatment. In P. Libby, R. Bonow, D. Mann, & D. Zipes (Eds.), Braunwald’s heart disease: A textbook of cardiovascular medicine. St. Louis, Mo: WB Saunders.Google Scholar
  65. Osaka, M. (1984). Peak alpha frequency of EEG during a mental task: Task difficulty and hemispheric differences. Psychophysiology, 21(1), 101–105.PubMedCrossRefGoogle Scholar
  66. Pagani, M., Montano, N., Porta, A., Malliani, A., Abboud, F. M., Birkett, C., et al. (1997). Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation, 95(6), 1441–1448.PubMedCrossRefGoogle Scholar
  67. Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta brainwave neuro-feedback therapy for Vietnam veterans with combat-related post-traumatic stress disorder. Medical Psychotherapy, 4, 47–60.Google Scholar
  68. Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133(5), 725–746.PubMedCrossRefGoogle Scholar
  69. Pomeranz, B., Macaulay, R. J., Caudill, M. A., Kutz, I., Adam, D., Gordon, D., et al. (1985). Assessment of autonomic function in humans by heart rate spectral analysis. American Journal of Physiology, 248(1 Pt 2), H151–H153.PubMedGoogle Scholar
  70. Rabe, S., Beauducel, A., Zollner, T., Maercker, A., & Karl, A. (2006). Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident. Journal of Abnormal Psychology, 115(4), 687–698.PubMedCrossRefGoogle Scholar
  71. Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K. C., Burns, R. M., & Caldarone, L. B. (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: Possible explanations. Journal of Traumatic Stress, 23(1), 59–68. doi: 10.1002/jts.20486.PubMedGoogle Scholar
  72. Randall, D. C., Brown, D. R., Raisch, R. M., Yingling, J. D., & Randall, W. C. (1991). SA nodal parasympathectomy delineates autonomic control of heart rate power spectrum. American Journal of Physiology, 260(3 Pt 2), H985–H988.PubMedGoogle Scholar
  73. Ritz, T., & Dahme, B. (2006). Implementation and interpretation of respiratory sinus arrhythmia measures in psychosomatic medicine: Practice against better evidence? Psychosomatic Medicine, 68(4), 617–627. doi: 10.1097/01.psy.0000228010.96408.ed.PubMedCrossRefGoogle Scholar
  74. Salinsky, M. C., Oken, B. S., & Morehead, L. (1991). Test-retest reliability in EEG frequency analysis. Electroencephalography and Clinical Neurophysiology, 79(5), 382–392.PubMedCrossRefGoogle Scholar
  75. Salinsky, M. C., Oken, B. S., Storzbach, D., & Dodrill, C. B. (2003). Assessment of CNS effects of antiepileptic drugs by using quantitative EEG measures. Epilepsia, 44(8), 1042–1050.PubMedCrossRefGoogle Scholar
  76. Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29(8), 727–735. doi: 10.1016/j.cpr.2009.08.006.PubMedCrossRefGoogle Scholar
  77. Schoormans, D., & Nyklicek, I. (2011). Mindfulness and psychologic well-being: Are they related to type of meditation technique practiced? Journal of Alternative and Complementary Medicine, 17(7), 629–634. doi: 10.1089/acm.2010.0332.CrossRefGoogle Scholar
  78. Seal, K. H., Cohen, G., Waldrop, A., Cohen, B., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug Alcohol Depend, 2011 Jan 28 [Epub ahead of print].Google Scholar
  79. Shankman, S. A., Silverstein, S. M., Williams, L. M., Hopkinson, P. J., Kemp, A. H., Felmingham, K. L., et al. (2008). Resting electroencephalogram asymmetry and posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 190–198. doi: 10.1002/jts.20319.PubMedCrossRefGoogle Scholar
  80. Shin, L. M., Rauch, S. L., & Pitman, R. K. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Sciences, 1071, 67–79.PubMedCrossRefGoogle Scholar
  81. Silva, F. (1991). Neural mechanisms underlying brain waves: From neural membranes to networks. Electroencephalography and Clinical Neurophysiology, 79(1991), 81–93.CrossRefGoogle Scholar
  82. Solomon, S. D., & Davidson, J. R. (1997). Trauma: Prevalence, impairment, service use, and cost. Journal of Clinical Psychiatry, 58(Suppl 9), 5–11.PubMedGoogle Scholar
  83. Stecker, T., Fortney, J., Owen, R., McGovern, M. P., & Williams, S. (2010). Co-occurring medical, psychiatric, and alcohol-related disorders among veterans returning from Iraq and Afghanistan. Psychosomatics, 51(6), 503–507. doi: 10.1176/appi.psy.51.6.503.PubMedGoogle Scholar
  84. Suris, A., & Lind, L. (2008). Military sexual trauma: A review of prevalence and associated health consequences in veterans. Trauma Violence Abuse, 9(4), 250–269. doi: 10.1177/1524838008324419.PubMedCrossRefGoogle Scholar
  85. Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Association for Applied Psychophysiology and Biofeedback, 36(1), 27–35. doi: 10.1007/s10484-010-9141-y.CrossRefGoogle Scholar
  86. Tatrow, K., Blanchard, E. B., & Silverman, D. J. (2003). Posttraumatic headache: An exploratory treatment study. Association for Applied Psychophysiology and Biofeedback, 28(4), 267–278.CrossRefGoogle Scholar
  87. Thibodeau, R., Jorgensen, R. S., & Kim, S. (2006). Depression, anxiety, and resting frontal EEG asymmetry: A meta-analytic review. Journal of Abnormal Psychology, 115(4), 715–729.PubMedCrossRefGoogle Scholar
  88. Veltmeyer, M. D., Clark, C. R., McFarlane, A. C., Felmingham, K. L., Bryant, R. A., & Gordon, E. (2005). Integrative assessment of brain and cognitive function in post-traumatic stress disorder. Journal of Integrative Neuroscience, 4(1), 145–159.PubMedCrossRefGoogle Scholar
  89. Veltmeyer, M. D., McFarlane, A. C., Bryant, R. A., Mayo, T., Gordon, E., & Clark, C. R. (2006). Integrative assessment of brain function in PTSD: Brain stability and working memory. Journal of Integrative Neuroscience, 5(1), 123–138.PubMedCrossRefGoogle Scholar
  90. Whitham, E. M., Pope, K. J., Fitzgibbon, S. P., Lewis, T., Clark, C. R., Loveless, S., et al. (2007). Scalp electrical recording during paralysis: Quantitative evidence that EEG frequencies above 20 Hz are contaminated by EMG. Clinical Neurophysiology, 118(8), 1877–1888. doi: 10.1016/j.clinph.2007.04.027.PubMedCrossRefGoogle Scholar
  91. Yildiz, M., & Ider, Y. Z. (2006). Model based and experimental investigation of respiratory effect on the HRV power spectrum. Physiological Measurement, 27(10), 973–988. doi: 10.1088/0967-3334/27/10/004.PubMedCrossRefGoogle Scholar
  92. Zucker, T. L., Samuelson, K. W., Muench, F., Greenberg, M. A., & Gevirtz, R. N. (2009). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: A pilot study. Association for Applied Psychophysiology and Biofeedback, 34(2), 135–143. doi: 10.1007/s10484-009-9085-2.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Neurology, Oregon Health & Science UniversityPortlandUSA

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