Biofeedback-assisted Relaxation 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.

Effects of Virtual Reality-Based Relaxation Techniques on Psychological, Physiological, and Biochemical Stress Indicators.

Various relaxation techniques could benefit from merging with virtual reality (VR) technologies, as these technologies are easily applicable, involving, and user-friendly. To date, it is unclear which relaxation technique using biofeedback combined with VR technology is the most effective. The study aimed to compare the effectiveness of brief VR-based biofeedback-assisted relaxation techniques including electroencephalographic biofeedback, mindfulness-based biofeedback, galvanic skin response biofeedback, and respiratory biofeedback. Forty-three healthy volunteers (age 34.7 ± 7.2 years), comprising 28 (65%) women and 15 (35%) men, were enrolled in the study. All the participants were exposed to four distinct relaxation sessions according to a computer-generated random sequence. The efficacy of relaxation methods was evaluated by examining psychological, physiological, and biochemical stress indicators. All VR-based relaxation techniques reduced salivary steroid hormone (i.e., cortisol, cortisone, and total glucocorticoid) levels and increased galvanic skin response values. Similarly, all interventions led to a significantly reduced subjectively perceived psychological strain level. Three out of the four interventions (i.e., electroencephalographic, respiratory, and galvanic skin response-based biofeedback relaxation sessions) resulted in a decreased self-reported fatigue level. We suggest that newly developed VR-based relaxations techniques are potential tools for stress reduction and might be particularly suitable for individuals who are not capable of adhering to a strict and time-consuming stress management intervention schedule.

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.

Biofeedback as an adjunct to conventional stress management and relaxation techniques in substance abuse disorders: A randomized controlled interventional study

Background: Biofeedback has been employed in substance abuse disorder over the last three decades. Stress, anxiety, and depression are commonly seen in patients with substance abuse disorders. Biofeedback employed in conjunction with other relaxation therapies may be useful in enhancing certain outcome of therapy. Biofeedback either alone for alcoholism or in combination with other relaxation techniques for stimulant and mixed substance abuse and combined with residential treatment program is probably efficacious. Objectives: This study is aimed at assessing effectiveness of biofeedback-assisted relaxation techniques and stress management for substance abuse population. Study Design: A randomized controlled interventional study design was chosen for the research. Methods: The study sample consisted of 60 in-patient males aged 18–55 years, diagnosed with mental and behavioral disorders due to multiple drug use and use of other psychoactive substance, according to the International Classification of Diseases-10, Diagnostic Criteria for Research (1992) criteria (30 in biofeedback and 30 in control groups). The patients were first screened for inclusion criteria and then recruited from CIIMHANS Mental Health Institute of Central India using lottery method for random allocation. A randomized controlled interventional study design was chosen for the research. Sociodemographic data and clinical details of all the patients were assessed using Depression-Anxiety-Stress Scale followed by biofeedback-assisted relaxation techniques, which was conducted for 30 days. Results: The present study shows that there was significant difference in the stress (t = 3.841, P

The effect of stress management incorporating progressive muscle relaxation and biofeedback-assisted relaxation breathing on patients with asthma: a randomised controlled trial

BackgroundPrevious evidence indicates a negative influence of elevated stress on asthma symptoms and asthma-related quality of life.Objective To investigate the effects of stress management (SM; progressive muscle relaxation accompanied by biofeedback-assisted relaxation breathing),on stress levels, asthma control, asthma-related quality of life and physical exercise in patients with intermittent and mild chronic asthma. MethodsThis is a phase 2, two-armed, parallel randomized controlled trial using an intervention SM group (N=23) and a usual care (UC) control group (N=19). The measurements included the Perceived Stress Scale (PSS), the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MAQLQ) and one Likert-type question measuring frequency of weekly exercise. The assessments were carried out at baseline and after 8 weeks. ResultsMost patients had experienced zero or one asthma exacerbation during the previous year, while the mean duration of the disease was about 14 years for both groups. No differences were noted between the two groups at baseline. Patients in the SM group showed significant less perceived stress (p<0.0001), better asthma-related quality of life (regarding symptoms, daily activity/limitations and emotional function) and asthma control (p <0.0001) and higher frequency of physical exercise (p=0.001) than patients in the UC group at the end of the follow-up. ConclusionsThis study provides more evidence in favor of the role of SM in the treatment of asthma. Future studies should replicate and expand these results.

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.

Developing BrightHearts: A Pediatric Biofeedback-Mediated Relaxation App to Manage Procedural Pain and Anxiety.

The objective of this study was to develop a child-friendly biofeedback-mediated relaxation device called BrightHearts. Qualitative data were collected at a tertiary pediatric hospital to inform an iterative design process. Clinicians participated in expert group interviews to identify practical considerations that would facilitate the use of BrightHearts during procedures and provide feedback on prototype designs. Children 7 to 18years of age participated in interactive exhibitions of the prototypes and were interviewed about their experiences using BrightHearts. Twenty-four clinicians participated in 6 group interviews. Thirty-nine children participated in interactive exhibitions, and 21 were interviewed. Clinicians placed high value on the following factors in the management of procedural pain: providing children with an element of control, the use of relaxation techniques, and the use of portable electronic devices such as iPads. They highlighted the need for BrightHearts to be cost effective, portable, and capable of engaging children's interest. They confirmed the utility of developing a biofeedback-assisted relaxation device for children. Based on the factors identified by clinicians, BrightHearts was developed as an iPad application (app) paired with a wireless heart rate monitor. The BrightHearts heart rate biofeedback app displays digital geometric artwork that responds to changes in heart rate. Children 7 to 17years of age understood the concept of biofeedback and operated the app by slowing their heart rates. The BrightHearts app can be used to teach children biofeedback-assisted relaxation. Ongoing studies are evaluating its efficacy for the management of procedural pain in children.

Incorporation of a Stress Reducing Mobile App in the Care of Patients With Type 2 Diabetes: A Prospective Study.

BackgroundSevere and sustained emotional stress creates a physiological burden through increased sympathetic activity and higher energy demand. This may lead to increased oxidative stress and development of the metabolic syndrome. Emotional stress has been shown to contribute to the onset, progression, and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach.ObjectiveThe aim of this study was to assess the effect of using a mobile app of biofeedback-assisted relaxation on weight, blood pressure (BP), and glycemic measures of patients with T2D.MethodsAdult patients with T2D and inadequate glycemic control (hemoglobin A1c [HbA1c]>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, BP, HbA1c, fasting plasma glucose (FPG), triglycerides (TG), and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing biofeedback mobile app and instructed to use it 3 times a day. The mobile app—Serenita—is an interactive relaxation app based on acquiring a photoplethysmography signal from the mobile phone’s camera lens, where the user places his finger. The app collects information regarding the user’s blood flow, heart rate, and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks.ResultsSeven patients completed 8 weeks of the study and 4 completed 16 weeks. At week 8, weight dropped by an average of 4.0 Kg (SD 4.3), systolic BP by 8.6 mmHg (SD 18.6), HbA1c by 1.3% (SD 1.6), FPG by 4.3 mmol/l (4.2), and serum TG were unchanged.ConclusionsStress reduction using a mobile app based on biofeedback may improve glycemic control, weight, and BP.

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.

The Short-Term and Long-Term Effects of Biofeedback-Assisted Relaxation Therapy in Patients With Heart Failure

Background Relaxation techniques can reduce sympathetic nervous system activation and stress, potentially improving heart failure patients’ physical and psychological outcomes. Purpose To examine the effects of biofeedback-assisted relaxation (BFAR) therapy in patients with heart failure. Methods A prospective randomized control study was conducted. Participants in the treatment group received BFAR therapy, while participants in the control group received standard of care. Short-term outcomes were physical symptoms and psychosocial variables measured at baseline and 3 months; long-term outcomes were cardiac events and mortality assessed at 12 months. Results Fifty-two heart failure patients participated in the study: 23 (mean age 60.0 ± 13.7 years; 60.9% male; 39.1% New York Heart Association III/IV) in the treatment group and 29 (mean age 59.2 ± 12.2 years; 72.4% male; 48.3% New York Heart Association III/IV) in the control group. Short-term effects of BFAR on outcome variables were not significantly different between treatment and control groups. However, longer event-free survival was found in the treatment group compared with the control group ( p = .019). Conclusions/Implications for Practices BFAR therapy is effective to improve cardiac event-free survival of heart failure patients and can be applied to clinical setting.

Effectiveness of Progressive Muscle Relaxation and Biofeedback Relaxation in Lowering Physiological Arousal among Students with Regard to Personality Features

BackgroundStudents make a rather specific population, which has to overcome many obstacles in order to pursue their academic goals (Pierceall, Keim 2007). Special programmes for stress prevention, based on relaxation training are being established in universities. The effectiveness of these programmes is constantly assessed and ways of their improvement are being studied (Jones, Johnston 2000, Beddoe, Murphy, 2004). One of the directions for such studies is the studying the effectiveness of relaxation training in relation to personality characteristics. However, there is lack of studies analysing the impact of personality features on individual's ability to relax and ability to learn to relax. Both biofeedback-assisted and progressive muscle relaxation are regarded as interventions aimed at lowering stress response. These methods help to train relaxation skills as well. The aim of the study was to assess the effectiveness of biofeedback-assisted relaxation as well as progressive muscle relaxation in lowering psychophysiological parameters with regard to personality features. MethodThe subjects of the study were 122 university students. 105 (85 female and 20 male) of them, aged 18 to 36 (mean age 21.13 (SD 2.58), participated in all relaxation training sessions. Participants were randomly assigned into three different groups: a) four progressive muscle relaxation sessions (n = 34) or b) four biofeedback-assisted relaxation sessions (n = 35). Subjects in the c) control group participated only in the 1st and the 6th session without relaxation training (n = 36). Biofeedback-assisted relaxation was conducted using device NeXus – 10 (The Netherlands). Results and conclusionsBoth relaxation methods proved to be effective in lowering psychophysiological variables. Methods of lowering psychophysiological variables should be applied with regard to personality traits of individuals: the course (of four sessions) of both types of relaxation helps to lower skin conductance in persons with higher scores of openness, agreeableness and conscientiousness and helps to lower heart rate in persons with higher scores of neuroticism and extraversion.

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.

EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION AND BIOFEEDBACK – ASSISTED RELAXATION IN REDUCING PERCEIVED STRESS AMONG STUDENTS WITH REGARD TO PERSONALITY FEATURES

Background . The aim of the study was to assess the effectiveness of biofeed- back-assisted relaxation as well as progressive muscle relaxation in reducing per- ceived stress with regard to personality features. Method . The subjects of the study were 177 university students, 143 of which participated in the course of six sessions. The subjects participated either in four progressive muscle relaxation sessions (n=47) or four biofeedback-assisted relaxation sessions (n=48). Subjects in the comparison group participated only in the 1 st and the 6 th sessions without relaxation training. Biofeedback-assisted relaxation was conducted using NeXus – 10 device (The Neth- erlands). Results and conclusions. Both relaxation methods proved to be effective in reducing perceived stress. Changes in perceived stress were related to the type of relaxation, personality characteristics, and their intensity.

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.

The “Duhhh Factor”

Patients can learn self-regulation skills and biofeedback-assisted relaxation in the office, yet fail to show symptomatic improvement. In many cases, the individual is perpetuating behavior in the workplace or elsewhere that hinders healing and symptom reduction, or exacerbates their complaints. A brief case example of a 25-year-old male with repetitive motion injury from computer use serves to illustrate the problem. The biofeedback practitioners used cognitive reframing and humor to assist the patient to accept work and “workstyle” changes facilitating symptom reduction.

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.