Biofeedback-assisted Relaxation Training Research Articles

Reducing Stress and Anxiety in First-Year Undergraduates Through Biofeedback-Assisted Relaxation Training.

Background:College students face many stressors daily, often resulting in psychological challenges such as heightened anxiety and depression. Biofeedback is becoming aware of and learning to modify the body's physiological functions. This study aimed to evaluate the efficacy of biofeedback relaxation training in mitigating stress and anxiety levels among medical undergraduates. Methods:This pretest-posttest control group design study was conducted following the ethics committee's approval. The study selected first-year MBBS students based on their elevated stress and anxiety scores and divided them into intervention and control groups. The study involved subjecting the intervention group to 10 sessions of biofeedback relaxation training, while the control group was not given any treatment. Stress and anxiety levels were assessed before and after the intervention of 10 to 12 weeks using the Perceived Stress Scale-14 and Cognitive Test Anxiety Scale. Results:The study involved 93 students, with 47 of them in the intervention group and the remaining 46 in the control group. After biofeedback, the intervention group showed significantly lower stress and anxiety scores than the control group. Conclusion:Biofeedback training effectively reduced stress and anxiety levels among undergraduate medical students. Biofeedback techniques can be implemented in college settings to support student mental wellness.

Offering biofeedback assisted relaxation training in a virtual world: Considerations and future directions.

Objective: As the landscape of health care continues to shift, providing mental health and pain management services via telehealth is becoming an ideal option to increase accessibility of care Research demonstrates the benefit of biofeedback-assisted relaxation training (BART) for children During the COVID-19 pandemic, clinicians required to use telehealth needed an alternative to provide ongoing services This commentary seeks to illustrate the benefits of offering BART virtually with discussing considerations and future directions Method: An existing BART protocol was modified for telehealth delivery Variations to the approach included increased psychoeducation, more parental engagement, and a greater focus on mobile applications (apps) in treatment Mobile apps were used to introduce relaxation strategies, encourage practice outside of session, and obtain physiological measurements pre- and postpractice of relaxation strategies Results: Clinicians quickly pivoted their approach and provided services without interruption Protocol changes illustrated the need for more thorough description of treatment sessions, increased focus on privacy and ethical considerations, and age-related factors Conclusions: As the uncertainty of the pandemic continues, it is important for clinicians to innovate to provide effective remote clinical interventions for patients and families Future research studies examining the provision of BART via telehealth and its impact on pain and overall functioning are warranted (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Identifying innovative modalities to offer biofeedback assisted relaxation training (BART) to pediatric populations with chronic medical conditions is critical in increasing accessibility of care Clinicians may consider modifying their BART protocols to offer this intervention via telehealth or in a hybrid manner (PsycInfo Database Record (c) 2021 APA, all rights reserved)

BrightHearts: A pilot study of biofeedback assisted relaxation training for the management of chronic pain in children with cerebral palsy.

BackgroundChronic pain is estimated to impact one‐in‐three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP.AimTo investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixed‐methods study design.MethodsBiofeedback assisted relaxation training was delivered via BrightHearts, an iOS application. Inclusion criteria were as follows: CP; self‐reported chronic pain; age 9‐18 years; and fluent English speaker. Children used BrightHearts for ten minutes daily, over four weeks. Qualitative post‐intervention interviews were undertaken (child, parent) and quantitative pre‐post measures (child) were gathered including pain intensity (numerical rating scale), and anxiety intensity (numerical rating scale). Content analysis was conducted for qualitative data. Descriptive statistics and exploratory analyses were performed for quantitative data.ResultsTen children participated (n = 3 male, mean age = 13.1 years SD = 2.5 years, GMFCS level I = 4, II = 2, III = 3, IV = 1). Predominant movement disorder was spasticity (n = 7) and dyskinesia, mainly dystonia (n = 3). Content analysis suggested an overarching theme “BrightHearts is a good thing to put in my toolbox” providing an overall representation of participants’ experiences. For many, BrightHearts was a valuable supplement to children's pain management strategies: “The source of the pain is still there, but the actual effect of the pain isn't so relevant.” Four sub‐themes were identified: “Managing my pain;” “Managing my anxiety and stress,” “Helping me do what I need to do;” and “Fitting it into my life.” Some participants reported improvements in their anxiety management, and others described benefits in sleep and school following improved pain/anxiety management. A range of practical and personal factors within this heterogeneous group presented barriers to using BrightHearts including limited time, attention, and boredom. Seven‐out‐of‐eight children would recommend BrightHearts to others with chronic pain and six‐out‐of‐eight noticed a difference in their pain since using BrightHearts (n = 2 missing data). Non‐significant reductions in pain or anxiety intensity scores were found following the intervention.ConclusionThis pilot suggests BrightHearts is an acceptable and feasible intervention for chronic pain management in children with CP and may be useful for some children as part of a multimodal approach.

Biofeedback-Assisted Relaxation Training: A Clinically Effective Treatment Protocol

Purchasing biofeedback instruments and learning the technical process of operating each biofeedback instrument with a human subject are not enough. These steps are necessary, but they do not clearly guide one as to how the instruments should be used. A treatment protocol is required that provides an explanation of the patient's current suffering or problem, as well as a rationale for using biofeedback training in a fashion that can reasonably be expected to relieve that suffering. Such models or protocols are necessary to organize the process of the biofeedback training and provide a reasonable explanation to motivate the trainee/client. Experience shows that clients who understand how the intervention is relevant for their complaint apply themselves more fully and follow through with any homework more reliably. There are a number of such protocols, including biofeedback-assisted relaxation training, the breath training and respiratory biofeedback model, resonance frequency heart rate variability training, the neuromuscular rehabilitation model, various neurofeedback training models, and psychophysiological psychotherapy. This article will introduce biofeedback-assisted relaxation training (BART). BART is a widely applied biofeedback protocol in clinical practice and has been documented as effective in clinical studies from 1969 to the present, for anxiety disorders, diabetes, headaches, and a variety of other common medical and psychological conditions.

Biofeedback-Assisted Relaxation Therapy on Women with Breast Cancer after Mastectomy: Effects of EMG-HRV Biofeedback on Psychological Symptoms

Abstract Introduction: Breast cancer patients usually react to mastectomy surgery by increased levels of stress, anxiety and depression which requires effective interventions. The aim of present research was to investigate the effects of an Electromyography (EMG) and heart rate variability (HRV) biofeedback-assisted relaxation training to alleviate the psychological symptoms of mastectomy breast cancer women. Method: In a randomized controlled trial design about 14 mastectomy women were randomly chosen and divided into two groups and measures of Depression Anxiety Stress Scale were gathered for them. The experimental group received biofeedback-assisted relaxation training, whereas no intervention administered on the control group. All subjects again completed the DASS scales afterwards. Indices of smooth artifact free surface Electromyography (sEMG) and HRV biofeedback recorded using a Biofeedback 2000 x-pert system Version 4. Data were analyzed by a General Linear Model: Multivariate Analysis of Variance statistical analysis. Results: Depression, anxiety, and stress average scores showed a significant difference after biofeedback intervention. Significant differences were observed in the sEMG and Heart Rate Variability-Index (HRV-Index) measures of the two groups with better results for the experimental subjects as well. Conclusion: The biofeedback-assisted relaxation training could effectively decrease negative psychological symptoms of the mastectomy breast cancer patients due to sEMG and HRV positive changes and is then recommended for these patients in the course of their treatment.

Guided imagery for treating hypertension in pregnancy.

Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.

DeLight: biofeedback through ambient light for stress intervention and relaxation assistance

Light is a common ambient medium to express additional information in a peripheral and calm way, but it is also an environmental stimulant to create atmosphere, evoke moods, and provide immersive experiences. Through the design of the DeLight system, we aim to establish a biofeedback-driven lighting environment that informs users about their stress level for intervention and assists them in biofeedback relaxation training. In this study, DeLight is interfaced with a heart rate variability biofeedback system with two modes for different purposes: stress intervention and relaxation assistance. We evaluated the prototype of DeLight in two user studies. The results of the first study show that DeLight has the potential for stress intervention; the HRV biofeedback through the changes of ambient light could improve a user’s awareness of stress and trigger behavioral conditioning, such as deep breathing. The results of the second study confirm that DeLight has potential as a new biofeedback interface for relaxation assistance; biofeedback through an immersive lighting environment can support physiological regulation as effectively as graphic biofeedback; it offers enhanced relaxation effects regarding both subjective experience and physiological arousal. These findings suggest that the biofeedback-driven ambient light can perform as persuasive technology in the domain of health self-management. The combination of decorative and informative aspects enables the lighting interface to offer the users a comfortable and relaxing condition for biofeedback-assisted relaxation training.

Biofeedback-assisted relaxation training helps women with breast cancer after mastectomy: Effects of EMG-HRV biofeedback on psychological symptoms

Aim The aim of present research was to investigate the effects of EMG-HRV biofeedback-assisted relaxation training on psychological and physiological symptoms of breast cancer women after mastectomy. Methods About 14 breast cancer women in one of the Tehran hospital's in-patient service were chosen and divided to experimental and control groups. Informed consent was provided from subjects and research design approved in the Ethics' Committee of Semnan University. Measures of DASS scale were gathered from all subjects before any intervention and experimental group were received 8 sessions of biofeedback-assisted relaxation training over 4 weeks interval, whereas no intervention made on control group. All patients were asked again to complete the DASS scale afterwards. Indices of smooth artifact free sEMG and HRV biofeedback were recorded using a Biofeedback 2000 x-pert system Version 4. Results Data were extracted and analyzed by GLM statistical analysis. Conclusions Results were shown significantly differences for depression, anxiety and stress measures after 8 sessions biofeedback treatment. Significantly differences were also observed in the sEMG and HRV measures of two groups during baseline (0) middle phase (4) and termination phase (8) of the training sessions with better results for experimental subjects as well. It was concluded that biofeedback-assisted relaxation training could effectively decrease negative psychological symptoms of the breast cancer patients after mastectomy due to EMG-HRV positive changes.

Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol.

Decreased heart rate variability (HRV) is associated with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSD's effects on the autonomic stress response and the potential influence of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population randomly assigned to experimental HRV biofeedback-assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self-reported use of mental health services. Future PRESTINT training could be appropriate for efficiently teaching self-help skills to reduce the psychological harm following trauma exposure by increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following a stressful situation.

Integration of Biofeedback into Pediatric Multidisciplinary Programs at Children's Mercy Hospital Kansas City

Research supports multidisciplinary care as an efficacious, and cost-effective approach for treating pain.An interdisciplinary approach to treatment for chronic pain in children and adolescents has been successfully implemented at Children's Mercy Hospital Kansas City. The hospital has supported the establishment and growth of an Integrative Pain Management Team (IPMT), an Abdominal Pain Program (APP), and recently has added multidisciplinary teams that deal with a variety of difficult, chronic gastrointestinal issues. Biofeedback-assisted relaxation training (BART) has been integrated into the Abdominal Pain and Integrative Pain Management programs and is a valued component of their comprehensive treatment care plans. A description of current biofeedback training protocols, training modalities, therapeutic games, and home practice tools is provided.

Guided imagery for treating hypertension in pregnancy

Background Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. Objectives To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). Data collection and analysis Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. Main results We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). Authors' conclusions There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.

Optimal Timing for Initiation of Biofeedback-Assisted Relaxation Training in Hospitalized Coronary Heart Disease Patients With Sleep Disturbances

Clinical studies have shown that biofeedback-assisted relaxation positively influences the treatment outcomes of sleep disturbance. However, there are only few studies reporting the timing of relaxation training initiation, and the relationships between the timing of initiation and the effectiveness of relaxation remain unclear. The aim of this study was to determine the optimal timing for initiating nurse-led biofeedback-assisted relaxation on hospitalized coronary heart disease patients with sleep disturbance. An experimental pretest and repeated posttest design was used to compare the effectiveness of nurse-led biofeedback-assisted relaxation. A total of 128 patients with coronary heart disease were randomly assigned to 1 of 4 groups: morning group, night group, morning-night group, or control group. Outcome measures included self-report of sleep-related indicators, the scores of the Pittsburgh Sleep Quality Index (PSQI) and the Zung's Self-rating Anxiety Scale (SAS), and the dosage of sleep medication used. A 2-way analysis of variance and a simple effect test were used to analyze the differences among the 4 groups. No significant differences could be detected at baseline. Compared with the control group, the nurse-led biofeedback-assisted relaxation yielded a greater benefit for patients in the 3 intervention groups. Group and time factors (pretest-protest) could explain the variation in the effectiveness of this program (main effect P < .01). There were statistical differences among the groups: patients in the night group (FSOL = 33.15, P < .001; FTST = 17.99, P < .001; FSE = 10.26, P = .002; FPSQI = 27.38, P < .001; FSAS = 54.39, P < .001, respectively) and in the morning-night group (FSOL = 33.62, P < .001; FTST = 34.13, P < .001; FSE = 24.04, P < .001; FPSQI = 31.26, P < .001; FSAS = 73.93, P < .001, respectively) had slightly shorter sleep latency, experienced fewer awakenings, reported higher sleep quality, and used significantly fewer sleep medications than the morning group did (F = 32.97, P < .001). The timing of the initiation of nurse-led biofeedback-assisted relaxation was 1 of the factors affecting the effectiveness of relaxation. Relaxation training either at night or in the morning-night combination could effectively enhance sleep quality and decrease the need for of sleep medications in hospitalized patients with sleep disturbance.

Ready, Set, Relax: Biofeedback-Assisted Relaxation Training (BART) in a Pediatric Psychiatry Consultation Service

Biofeedback-assisted relaxation training (BART) can treat several common pediatric presentations, including chronic pain and anxiety. Its effectiveness, applicability to a variety of conditions, and equipment portability make it an ideal treatment approach for use in an inpatient pediatric consultation-liaison service. Since there is a paucity of published research on the utility of BART in this setting, we studied pediatric patients (≥8y), medically-admitted to Boston Children's Hospital, and referred to the Psychiatry Consultation Service for assistance in managing pain, anxiety or both. The patients received at least 1 session of BART. In addition to heart rate variability and skin temperature data collection, participants completed the Wong-Baker FACES Pain Rating Scale and a brief mood/affective state rating scale (Youth Feelings Scale) before and after the BART sessions. A total of 152 sessions were conducted with 66 patients across 11 referring services. BART was successfully used 61% of the time on the medical floor with common barriers involving patient unavailability or refusal. The patients completed an average of 1.57 sessions per admission. The post-BART session pain and mood ratings significantly improved over the presession ratings. Patients with both pain and anxiety reported the greatest changes across sessions in comparison with those with only pain or anxiety. Higher heart rate variability was observed in the "pain-only" group. The use of BART in a consultation-liaison setting demonstrates promising utility in working with patients with pain, anxiety, or a combination of symptoms. BART was well-received by patients with subjective reports of benefit across sessions.

Feasibility and impact of multidisciplinary training of an evidence-based intervention within a pediatric psychiatry consultation service.

To train clinicians on a multidisciplinary pediatric consultation-liaison (CL) psychiatry service to administer an evidence-based intervention, biofeedback-assisted relaxation training (BART), in the inpatient medical setting and obtain their opinions about BART's utility and feasibility in the CL setting. Attendings and trainees on a multidisciplinary pediatric CL service received 3 h of BART training and completed a 10-item questionnaire designed to assess opinions about BART at two time points: after training but prior to using the intervention with patients and again 3 months after implementing the intervention in their clinical practice. Nineteen clinicians administered BART with 28 patients across the study period, and clinicians rated BART positively after training and significantly more positively after utilizing BART in the clinical setting. From post-training to post-implementation, trainees reported significant increases in their opinions that BART increased parent and patient receptiveness to psychiatric consultation (p<0.05) and attendings reported significant increases in their opinions that BART enhanced clinical intervention (p<0.05). BART training on a multidisciplinary CL service was well received by clinicians and patients and may enhance psychiatry trainees' repertoire of cognitive-behavioral and evidence-based interventions.

Physiological Monitoring and Biofeedback-Assisted Relaxation Training for Panic Disorder in a Case of Complex Developmental Trauma

This article describes the effective use of physiological monitoring and biofeedback-assisted relaxation training as primary interventions for the treatment of panic disorder in a 31-year-old woman with a history of complex developmental trauma. A biopsychosocial perspective of panic disorder grounded in learning theory and informed by trauma practice was used to examine the role of multiple causational factors in the development of panic disorder and to discuss intervention strategies addressing the interconnected nature of the biological and psychosocial realms of the human experience. The client participated in 2 pretreatment (intake interview and formal testing) and 14 outpatient therapy sessions at a biofeedback clinic over a period of 6 months. Treatment-outcome data indicated a marked decrease in acute symptoms as measured by the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory–Second Edition (MMPI-2).

Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

Background. Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance. Method. A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training. Results. Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training. Conclusion. Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

Single-session Biofeedback-assisted Relaxation Training in Children With Sickle Cell Disease

Sickle cell disease (SCD) pain remains difficult to manage. This pilot study evaluated single-session biofeedback-assisted relaxation training (BART) for SCD pain in children. Ten participants (mean = 12.1 y) completed a 1-hour BART session using thermal biofeedback and home practice. Participants demonstrated changes in peripheral body temperature after the training session (d = 1.08) and at 6-week follow-up (d = 0.97) relative to their baseline visit. Reductions in patient-reported pain frequency were found after completing BART. Health-related quality of life and pain-related disability improvements were observed; however, effect sizes were small to minimal. Single-session BART may be a promising, complementary approach to medical management of pediatric SCD pain.

Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance. A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training. Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training. Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

A Pilot Study to Assess the Efficacy of Biofeedback-Assisted Relaxation Training as an Adjunct Treatment for Pediatric Functional Dyspepsia Associated with Duodenal Eosinophilia

To conduct a pilot study examining whether adding biofeedback-assisted relaxation training (BART) to medication treatment results in better clinical outcomes than medication treatment alone for children with functional dyspepsia (FD) associated with duodenal eosinophilia, a subgroup of children with recurrent abdominal pain. Twenty children were randomly assigned to receive a standardized medication treatment or medication plus 10 sessions of BART. Children and parents completed psychosocial functioning and quality of life measures at baseline, posttreatment, and 6 months. Children rated pain daily via PDA. Physicians provided biweekly assessments of clinical improvement. Children receiving medication plus BART demonstrated better outcomes on pain intensity, duration of pain episodes, and clinical improvement than children receiving medication alone. BART is a promising adjunctive treatment for pediatric FD associated with duodenal eosinophilia. Electronic daily diaries appear to be a useful approach to assessing changes in self-reported pain ratings in this population.

The Biofeedback Program at Children's Mercy Hospitals and Clinics

Abstract The following article provides a description of the history and development of the biofeedback-assisted relaxation training (BART) program at Children's Mercy Hospitals and Clinics. Biofeedback is an integral component of the multidisciplinary Abdominal Pain and Integrative Pain Management programs. A description of currently employed biofeedback-assisted relaxation training protocols, including alternative training tools (e.g., novel biofeedback games) intended to improve practice compliance is provided. Finally, biofeedback implementation strategies and barriers are considered also.