Advertisement

Biofeedback pp 255-279 | Cite as

Behavioral Treatment of Raynaud’s Syndrome

  • Richard S. Surwit
  • John S. Jordan

Abstract

Raynaud’s Disease is a syndrome of disrupted peripheral bloodflow first described by Maurice Raynaud in 1862. A triphasic color change, usually exhibited in the digits of the hands or feet, is the hallmark of the disorder: sudden blanching and numbness of the affected part, due to localized arteriolar constriction; cyanosis, in which the pallor previously observed evolves into a blue color, characteristic of deoxygenated tissue and attributed to retarded blood flow in dilated capillaries and venules; and reactive hyperemia, characterized by the spread of red oxygenated blood through the upper level of the epidermis. This last phase is often accompanied by burning and tingling and lasts until the skin returns to its normal pink color. Only a minority of patients actually exhibit the classic triphasic color change, however, isolated pallor or cyanosis are much more likely (Porter, Rivers, Anders, & Baur, 1981). Typically, ischemia starts in the fingertips and progresses proximally to a variable degree, but rarely involves the palm. Occasionally, the earlobes, cheeks, and tip of the nose may also be affected (Hoffman, 1980). Attacks may last from minutes to hours and usually involve a local sensation of coldness, a loss of manual dexterity and considerable pain that can result in the interruption of routine activity. In severe cases, patients experience chronic vasoconstriction or such frequent episodes of cyanosis that gangrene or small nutritive lesions and ulcerations can appear at the distal end of the digits. Although cold stimulation is the most reliable eliciting stimulus, emotional stress has also been reported to produce these attacks (e.g., Mittlemann & Wolff, 1939).

Keywords

Behavioral Treatment Skin Temperature Carpal Tunnel Syndrome Biofeedback Training Progressive Muscle Relaxation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abboud, F. M., Eckstein, J. W., Lawrence, M. S., and Hoak, J. C. (1967). Preliminary observations on the use of intra-arterial reserpine in Raynaud’s phenomenon. Circulation, 36 (no. 4, Suppl. II) 11–49Google Scholar
  2. Adair, J., and Theobald, D. (1978). Raynaud’s phenomenon: treatment of a severe case with biofeedback. Journal of the Indiana State Medical Association, 71, 990–993.PubMedGoogle Scholar
  3. Allen, E. V., and Brown, G. E. (1932). Raynaud’s disease: A critical review of the minimal requisite for diagnosis. American Journal of Medical Sciences, 183, 187–200.CrossRefGoogle Scholar
  4. Barber, T. X. (1970). LSD, marihuana, yoga, and hypnosis. Chicago, IL: Aldine. Blanchard, E. B., and Haynes, M. R. (1975). Biofeedback treatment of a case of Raynaud’s disease. Journal of Behavior Therapy and Experimental Psychiatry, 6, 230–234.Google Scholar
  5. Blanchard, E. B., and Young, L. D. (1973). Self-control of cardiac functioning: A promise as yet unfulfilled. Psychology Bulletin, 79, 145–163.CrossRefGoogle Scholar
  6. Burton, A. C., and Edholm, O. G. (1954). Man in a cold environment: Physiological and pathological effects of exposure to low temperatures. Baltimore, MD: Williams and Wilkins.Google Scholar
  7. Carlson, J. G. (1977). Locus of control and frontal electromyographic response training Biofeedback and Self-Regulation, 2, 259–271.PubMedCrossRefGoogle Scholar
  8. Chatterjee, D. S., Petrie, A., and Taylor, W. (1978). Prevalence of vibration-induced white finger in flourspar mines in Weardale. British Journal of Industrial Medicine, 35, 208–218.PubMedGoogle Scholar
  9. Coffman, J. D. (1979). Vasodilators in peripheral vascular disease. New England Journal of Medicine, 300, 232–236.CrossRefGoogle Scholar
  10. Cohen, R., and Coffman, J. D. (1981). Beta adrenergic vasodilator mechanism in the finger. Circulation Research, 49, 1196–1201.PubMedCrossRefGoogle Scholar
  11. Conner, C. S. (1983). Nifedipine: Two new uses. Drug Intelligence and Clinical Pharmacy, 17, 457–458.PubMedGoogle Scholar
  12. DeGood, D. E., and Redgate, E. S. (1982). Interrelationship of plasma cortisol and other activation indices during EMG biofeedback training. Journal of Behavioral Medicine, 5, 213–224.PubMedCrossRefGoogle Scholar
  13. DeTakats, E., and Fowler, E. F. (1962). Raynaud’s phenomenon. Journal of the American Medical Association, 179, 1–8.CrossRefGoogle Scholar
  14. Folkow, B. (1955). Nervous control of the blood vessels. Physiological Review, 35, 629–663.Google Scholar
  15. Fotopoulos, S. S., and Binegar, G. A. (1977). Differences in baseline and volitional control of EEG (8–12Hz and 13–20Hz), EMG and skin temperature: Internal versus external orientation. (Abstract). Biofeedback and Self-Regulation 2, 357–358.Google Scholar
  16. Freedman, R., Lynn, S., Ianni, P. and Hale, P. (1981). Biofeedback treatment of Raynaud’s disease and phenomenon. Biofeedback and Self-Regulation, 6, 355–364.PubMedCrossRefGoogle Scholar
  17. Freedman, R. R., Ianni, P. and Wenig, P. (1983). Behavioral treatment of Raynaud’s disease: Long-term follow-up. Journal of Consulting and Clinical Psychology, 53, 136.CrossRefGoogle Scholar
  18. Freedman, R. R., Ianni, P. and Wenig, P. (1984). Behavioral treatment of Raynaud’s phenomenon in scleroderma. Journal of Behavioral Medicine 1, 343–354.CrossRefGoogle Scholar
  19. Freedman, R. R., Ianni, P. and Wenig, P. (1985). Behavioral treatment of Raynaud’s disease. Journal of Consulting and Clinical Psychology, 51, 539–549.CrossRefGoogle Scholar
  20. Gifford, R. W., and Hines, E. A. (1957). Raynaud’s disease among women and girls. Circulation, 16, 1012–1021.PubMedCrossRefGoogle Scholar
  21. Goldie, R. G. (1976). The effects of hydrocortisone on responses to and extraneuronal uptake of (-)-isoprenaline in rat and guinea-pig atria. Clinical and Experimental Pharmacology and Physiology, 3, 225–233.PubMedCrossRefGoogle Scholar
  22. Grahm, D. T. (1955). Cutaneous vascular reactions in Raynaud’s disease and in states of hostility, anxiety, and depression. Psychosomatic Medicine, 17, 200–207.Google Scholar
  23. Grahm, D. T., Stern, J. A., and Winokur, C. (1958). Experimental investigation of the specificity of attitude hypothesis in psychosomatic disease. Psychosomatic Medicine, 20, 446–457.Google Scholar
  24. Guglielmi, R. S., Roberts, A. H., and Patterson, R. (1982). Skin temperature biofeedback for Raynaud’s disease: A double-blind study. Biofeedback and Self-Regulation, 7, 99–120.PubMedCrossRefGoogle Scholar
  25. Hadfield, A. (1920). The influence of suggestion on body temperature. Lancet, 2, 82–89.Google Scholar
  26. Halperin, J. L., and Coffman, J. D. (1979). Pathophysiology of Raynaud’s disease. Archives of Internal Medicine, 139, 89–92.PubMedCrossRefGoogle Scholar
  27. Hoffman, G. S. (1980). Raynaud’s disease and phenomenon. American Family Physician, 21, 91–97.PubMedGoogle Scholar
  28. Jacobson, A. M., Hackett, T. P., Surman, O. S., and Silverberg, E. L. (1973). Raynaud’s phenomenon: Treatment with hypnotic and operant technique. Journal of the American Medical Association, 225, 739–470.PubMedCrossRefGoogle Scholar
  29. Jacobson, A. M., Manschreck, T. C., and Silverberg, E. (1979). Behavioral treatment for Raynaud’s disease: A comparative study with long-term follow-up. American Journal of Psychiatry, 136, 844–846.PubMedGoogle Scholar
  30. Jevning, R., Wilson, A. F., and Davidson, J. M. (1978). Adrenocortical activity during meditation. Hormone Behavior, 10, 54–60.CrossRefGoogle Scholar
  31. Keefe, F. J. (1975). Conditioning changes in differential skin temperature. Perceptual and Motor Skills, 40, 283–288.PubMedCrossRefGoogle Scholar
  32. Keefe, F. J., Kopel, S., and Gordon, S. (1978). A practical guide to behavioral assessment. New York: Springer.Google Scholar
  33. Keefe, F. J., Surwit, R. S., and Pilon, R. N. (1979). A one-year follow-up of Raynaud’s patients treated with behavioral therapy techniques. Journal of Behavioral Medicine, 2, 385–391.PubMedCrossRefGoogle Scholar
  34. Keefe, F. J., Surwit, R. S., and Pilon, R. N. (1980). Biofeedback, autogenic training and progressive relaxation in the treatment of Raynaud’s disease. Journal of Applied Behavior Analysis, 13, 3–11.PubMedCrossRefGoogle Scholar
  35. Keefe, F. J., Surwit, R. S., and Pilon, R. N. (1981). Collagen vascular disease: Can behavior therapy help? Journal of Behavior Therapy and Experimental Psychiatry, 12, 171–175.PubMedCrossRefGoogle Scholar
  36. Kontos, H. A., and Wasserman, A. J. (1969). Effects of reserpine in Raynaud’s phenomenon. Circulation, 3, 259–266.CrossRefGoogle Scholar
  37. Lanyon, R. I. (1966). The MMPI and prognosis in stuttering therapy. Journal of Speech and Hearing Disorders, 31, 186–191.PubMedGoogle Scholar
  38. Lanyon, R. I. (1973). Psychological Screening Inventory Manual. Goshen, N.Y.: Research Psychologist Press.Google Scholar
  39. Lewis, T. (1949). Vascular disorders of the limbs: Described for practitioners and students. London: Macmillan.Google Scholar
  40. Lipkin, M., McDevitt, E., Schwartz, M., and Duryee, A. (1945). On the effects of suggestion in the treatment of vasospastic disorders of the extremities. Psychosomatic Medicine, 7, 152–159.Google Scholar
  41. Mackiewisz, A., and Piskorz, A. Raynaud’s phenomenon following long-term repeated action of great differences of temperature. Journal of Cardiovascular Surgery, 18, 151–154.Google Scholar
  42. Maslach, C., Marshall, G., and Zimbardo, P. G. (1972). Hypnotic control of peripheral skin temperature: A case report. Psychophysiology, 9, 600–605.PubMedCrossRefGoogle Scholar
  43. May, D., and Weber, C. (1976). Temperature feedback training for symptoms reduction in primary and secondary Raynaud’s disease. Biofeedback and Self-Regulation, 1, 317.Google Scholar
  44. Meichenbaum, D. (1977). Cognitive-behavior modification. New York: Plenum Press.Google Scholar
  45. Mendlowitz, M., and Naftchi, N. (1959). The digital circulation in Raynaud’s disease. American Journal of Cardiology, 4, 580–584.CrossRefGoogle Scholar
  46. Mittelmann, B., and Wolff, H. G. (1939). Affective states and skin temperature: Experimental study of subject with “cold hands” and Raynaud’s syndrome. Psychosomatic Medicine, 1, 271–292.Google Scholar
  47. Nickerson, M. Vasodilator drugs. (1970). In L. S. Goodman and A. Gilman (Eds.), The pharmacologic basis of therapeutics. New york: Macmillan.Google Scholar
  48. Olsen, N., and Nielsen, S. L. (1978). Prevalence of primary Raynaud’s phenomenon in young females. Scandanavian Journal of Clinical Laboratory Investigation, 37, 761–764.CrossRefGoogle Scholar
  49. Paskowitz, D. A., and Orne, M. T. (1974). Visual effects on alpha feedback training. Science, 181, 360–363.CrossRefGoogle Scholar
  50. Patton, H. D. (1965). The autonomic nervous system. In T. C. Ruch, H. D. Patton, J. W. Woodbury, and A. L. Towe (Eds.), Neurophysiology (pp. 226–235 ). Philadelphia, PA: W. B. Saunders.Google Scholar
  51. Peacock, J. H. (1959). Peripheral venous blood concentration of epinephrine and norepinephrine in primary Raynaud’s disease. Circulation Research, 7, 821–827.PubMedCrossRefGoogle Scholar
  52. Porter, J. M., Rivers, S. P., Anderson, C. J., and Baur, G. M. (1981). Evaluation and management of patients with Raynaud’s syndrome. The American Journal of Surgery, 142 183–189.CrossRefGoogle Scholar
  53. Pratt, G. H. (1949). Surgical management of vascular disease. Philadelphia, PA: Lea and Febiger. Rapaport, S. I., Fetcher, E. S., and Hall, J. F. (1948). Physiological protection of the extremities from severe cold. Federal Proceedings, 7, 99.Google Scholar
  54. Raynaud, M. (1862). De l’asphyxie locale et de la gangrène symétrique des extremités. Paris: Rignoux.Google Scholar
  55. Reinking, R. H. (1977). The influence of internal-external control and trait anxiety on acquisition of EMG control. (Abstract). Biofeedback and Self-Regulation, 2, 357–358.Google Scholar
  56. Roberts, A. H., Schuler, J., Bacon, J. R., Zimmerman, R. L., and Patterson, R. (1975). Individual differences and autonomic control: Absorption, hypnotic susceptibility, and the unilateral control of skin temperature. Journal of Abnormal Psychology, 84, 272–279.PubMedCrossRefGoogle Scholar
  57. Romeo, S. G., Whalen, R. E., and Tindall, J. P. (1970). Intra-arterial administration of reserpine. Its use in patients with Raynaud’s disease or Raynaud’s phenomenon. Archives of Internal Medicine, 125, 825–829.PubMedCrossRefGoogle Scholar
  58. Schmid, P. G., Eckstein, J. W., and Abboud, F. M. (1976). Comparison of effects of deoxycorticosterone and dexamethasone on cardiovascular responses to norepinephrine. Journal of Clinical Investigation, 46, 590–597.CrossRefGoogle Scholar
  59. Schwartz, G. E. (1973). Biofeedback as therapy: Some theoretical and practical issues. American Psychologist, 28, 666–673.PubMedCrossRefGoogle Scholar
  60. Sedlacek, K. (1979), Biofeedback for Raynaud’s disease. Psychosomatics, 20, 535–541.PubMedGoogle Scholar
  61. Shapiro, D., and Schwartz, G. E. (1972). Biofeedback and visceral learning: Clinical applications. Seminars in Psychiatry, 4, 171–184.PubMedGoogle Scholar
  62. Smith, C. D., and McKendry, R. J. R. (1982). Controlled trial of nifedipine in the treatment of Raynaud’s phenomenon. Lancet, 2 (8311), 1299–1301.PubMedCrossRefGoogle Scholar
  63. Sokolov, Y. N. (1963) Perception and the conditioned reflex. London: Pergamon.Google Scholar
  64. Spittell, J. A. (1972). Raynaud’s phenomenon and allied vasospastic condition. In J. F.Google Scholar
  65. Fairbairn, J. C. Juergens, and A. Spittell (Eds.), Allen-Barker Hines peripheral vascular diseases (4th ed., pp. 387–420). Philadelphia, PA: W. B. Saunders.Google Scholar
  66. Surwit, R. S. Raynaud’s disease. (1973). In L. Birk (Ed.), Biofeedback: Behavioral Medicine (pp. 123–130 ). New York: Crune and Stratton.Google Scholar
  67. Surwit, R. S. (1982). Behavioral treatment of Raynaud’s syndrome in peripheral vascular disease. Journal of Consulting and Clinical Psychology, 50, 922–932.PubMedCrossRefGoogle Scholar
  68. Surwit, R. S., and Feinglos, M. N. (1984). Relaxation induced improvement in glucose tolerance is associated with decreased plasma cortisol. Diabetes Care, 7, 203–204.PubMedGoogle Scholar
  69. Surwit, R. S., and Fenton, C. H. (1980). Feedback and instruction in the control of digital skin temperature. Psychophysiology, 17, 129–132.PubMedCrossRefGoogle Scholar
  70. Surwit, R. S., and Keefe, F. J. (1983). The blind leading the blind: problems with the “doubleblind” design in clinical biofeedback research. Biofeedback and Self-Regulation, 8, 1–8.PubMedCrossRefGoogle Scholar
  71. Surwit, R. S., Shapiro, D., and Feld, J. L. (1976). Digital temperature autoregulation and associated cardiovascular changes. Psychophysiology, 13, 242–248.PubMedCrossRefGoogle Scholar
  72. Surwit, R. S., Pilon, R. N., and Fenton, C. H. (1978). Behavioral treatment of Raynaud’s disease. Journal of Behavioral Medicine, 1, 323–335.PubMedCrossRefGoogle Scholar
  73. Surwit, R. S., Bradner, M. N., Fenton, C. H., and Pilon, R. N. (1979). Individual differences in response to the behavioral treatment of Raynaud’s disease. Journal of Consulting and Clinical Psychology, 47, 363–367.PubMedCrossRefGoogle Scholar
  74. Surwit, R. S., Allen, L. M., Gilgor, R. S., and Duvic, M. (1982). The combined effect of prazosin and autogenic training on cold reactivity in Raynaud’s phenomenon. Biofeedback and Self-Regulation, 7, 537–544.PubMedCrossRefGoogle Scholar
  75. Surwit, R. S., Williams, R. B., and Shapiro, D. (1982). Behavioral approaches to cardiovascular disease. New York: Academic Press.Google Scholar
  76. Surwit, R. S., Allen, L. M., Gilgor, R. S., Schanberg, S., Kuhn, C., and Duvic, M. (1983). Neuroendocrine response to cold in Raynaud’s syndrome. Life Sciences, 32, 995–1000.PubMedCrossRefGoogle Scholar
  77. Surwit, R. S., Gilgor, R. S., Allen, L. M., and Neal, J. A. (1983). Intra-arterial reserpine for Raynaud’s syndrome, Archives of Dermatology, 119, 733–735.PubMedCrossRefGoogle Scholar
  78. Surwit, R. S., Gilgor, R. S., Allen, L. M., and Duvic, M. (1984). A double-blind study of prazosin in the treatment of Raynaud’s phenomenon in scleroderma. Archives of Dermatology, 120, 329–331.PubMedCrossRefGoogle Scholar
  79. Taub, E. (1977). Self regulation of human tissue temperature. In G. E. Schwartz and J. Beatty (Eds.), Biofeedback: Theory and research (pp. 265–300 ). New York: Academic Press.Google Scholar
  80. Taub, E., and Emurian, C. S. (1976). Feedback-aided self-regulation of skin temperature with a single feedback locus. I. Acquisition and reversal training. Biofeedback and SelfRegulation, 1, 147–168.PubMedCrossRefGoogle Scholar
  81. Taub, E., and Stroebel, C. F. (1978). Biofeedback in the treatment of vasoconstrictive syndromes. Biofeedback and Self-Regulation, 3, 363–373.PubMedCrossRefGoogle Scholar
  82. Therault, G., DeGuire, L., Gingras, S., and Laroche, G. (1982). Raynaud’s phenomenon in forestry workers in Quebec. Canadian Medical Association Journal, 126, 1404–1408.Google Scholar
  83. Varadi, D. P., and Lawrence, A. M. (1969). Suppression of Raynaud’s phenomenon by methyldopa. Archives of Internal Medicine, 124, 13–18.PubMedCrossRefGoogle Scholar
  84. Wells, D. T., Feather, B. W., and Headrick, M. W. (1973). The effects of immediate feedback upon voluntary control of salivary rate. Psychophysiology, 10, 501–509.PubMedCrossRefGoogle Scholar
  85. Willerson, J. T., Thompson, R. H., Hookman, P., Herdt, J., and Decker, J. L. (1970). Re-serpine in Raynaud’s disease and phenomenon: Short-term response to intra-arterial injection. Annals of Internal Medicine, 72, 17–27.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1987

Authors and Affiliations

  • Richard S. Surwit
    • 1
  • John S. Jordan
    • 1
  1. 1.Behavioral Physiology Laboratory, Department of PsychiatryDuke University Medical CenterDurhamUSA

Personalised recommendations