Biofeedback Treatment Research Articles

The Effect of Long-term Biofeedback Therapy on Depression of Elderly Stroke Patients

Background and Objectives: Depression is a common problem after stroke, with a high prevalence. Multiple studies have suggested that biofeedback therapy can effectively treat depression without causing side effects. This research aims to investigate the long-term impact of biofeedback therapy on depression in stroke survivors. Methods: A quasi-experimental study was conducted with 40 stroke patients who were divided into a rehabilitation control group and a rehabilitation group that underwent long biofeedback electromyography exercises. All patients were assessed for their level of depression at the start of the study and again after two years of treatment, after completing occupational therapy sessions with and without biofeedback intervention. Statistical analysis was performed using paired t-tests and correlated t-tests with a significance level (P≤0.05). Results: In both control and intervention groups, no significant differences were observed in the level of depression between the pre-test and post-test stages. However, a crucial difference was observed between the intervention and control groups after using biofeedback. The average depression in patients who used long-term biofeedback decreased after two years compared to the control group (P≤0.05). Conclusion: Long-term utilization of biofeedback therapy impacts the depression levels of stroke patients. This method is highly recommended as a complementary approach to conventional rehabilitation.

Changes in Negative Emotions Across Five Weeks of HRV Biofeedback Intervention were Mediated by Changes in Resting Heart Rate Variability.

Resting heart rate variability (HRV) is typically higher in those with better emotional well-being. In the current study, we examined whether changes in resting HRV mediated changes in negative emotions during a 7-week clinical trial of HRV biofeedback. Younger and older adults were randomly assigned to one of two daily biofeedback practices for 5weeks: (1) engage in slow-paced breathing to increase the amplitude of oscillations in heart rate at their breathing frequency (Osc+); or (2) engage in self-selected strategies to decrease heart rate oscillations (Osc-). We assessed negative emotion using the State Anxiety Inventory (SAI) and Profile of Mood States (POMS). Resting HRV at pre-intervention was significantly higher among those with lower negative emotion scores. Those participants showing greater increases in resting HRV showed greater decreases in negative emotion. In a mediation model with all participants, resting HRV changes significantly mediated the relationship between training performance (i.e., heart rate oscillation during practice sessions) and changes in negative emotion. However, additional analyses revealed this mediation effect was significantly moderated by condition and was only significant in the Osc+ condition. Thus, resting HRV changes mediated how biofeedback to increase amplitude of heart rate oscillations reduced negative emotion.

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study.

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10days, and 40days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n=32) and in-person (n=15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

Psychophysiological and Performance Effects of Biofeedback and Neurofeedback Interventions in a Top 100 Female Chess Player

(1) Background: Previous studies showed that neurofeedback and biofeedback could improve stress levels, enhance self-control over physiological factors, improve behavioral efficiency, and increase reaction speed to stimuli. Specifically, the sensorimotor rhythm stimulation (12–15 Hz) can enhance cognitive functions such as selective attention and working memory. However, there is no study that analyzes the effect of these interventions in chess players. (2) Methods: A Chess Woman Grandmaster and Chess International Master, with an ELO ranking higher than 2350 points, was selected to participate in this case study. The participant conducted a total of 14 sessions of biofeedback and neurofeedback, training in breathing, sensorimotor rhythm stimulation in Cz, skin conductance, temperature, and heart rate variability combined with chess work. Specific and non-specific tasks were designed to evaluate the intervention. (3) Results: The chess player enhanced the heart rate variability during specific and non-specific chess tasks: chess problems, 15 + 10 games, and puzzle rush games. In addition, the sensorimotor rhythm power decreased during the chess problem and increased during the 15 + 10 game and puzzle rush. Also, chess performance and anxiety levels improved after the intervention. (4) Conclusions: Neurofeedback and biofeedback training combined with chess training could improve the performance of chess players.

A Randomized Controlled Trial of the Effects of Organizational Skills Training on Children With Attention Deficit Hyperactivity Disorder in China.

In addition to attention and hyperactivity problems, children with attention deficit hyperactivity disorder (ADHD) have poorer organizational skills needed to manage time and materials. This study examines the improvement of organizational skills in children with ADHD by studying organizational skills training (OST). This was a prospective, randomized controlled trial. Between September 2023 and January 2024, 70 children with a diagnosis of ADHD and at least one domain of executive dysfunction (EF) were divided into two groups. The conventional group was treated with medication, biofeedback, and behavioral interventions based on the children's actual condition. The OST group received OST in addition to the conventional group. The mean age of the children was 8.33 ± 1.62 years. A total of 66 children completed the intervention and follow-up, 32 in the conventional group and 34 in the OST group. There were no differences between the two groups of children in terms of their preintervention scores on the BRIEF, SNAP-IV, or IVA-CPT. Postintervention scores on the behavioral scales decreased (p < .05), and IVA-CPT scores increased (p < .05) in both groups compared with those in the preintervention period. The OST group had a lower BRIEF (p = .019) and SNAP-IV Attention deficit subscale (p = .046) and a higher IVA-CPT Attention deficit Index (p = .032) than the conventional group after the intervention. The percentage of children with a normal BRIEF total score in the OST group was 79.41% (27/34) after the intervention, which was greater than the 37.50% (12/32) in the conventional group (p = .001). Compared with the OST group, children in the conventional group were at greater risk of having BRIEF scores that remained abnormal after the intervention. Analysis of covariance revealed a statistically significant effect of group (p = .008), preintervention BRIEF (p < .001), and participation score (p = .036) on postintervention BRIEF. OST can further improve organizational skills in daily life in children with ADHD while improving core symptoms of attention deficit in addition to conventional treatment. The effect of OST on BRIEF is also influenced by the child's BRIEF status at the baseline level and the level of cooperation during the intervention. The randomized controlled trial registration number was ChiCTR2300075744.

An Articulatory Analysis of American English Rhotics in Children With and Without a History of Residual Speech Sound Disorder.

This study investigated articulatory patterns for American English /ɹ/ in children with and without a history of residual speech sound disorder (RSSD). It was hypothesized that children without RSSD would favor bunched tongue shapes, similar to American adults reported in previous literature. Based on clinical cueing practices, it was hypothesized that children with RSSD might produce retroflex tongue shape patterns at a higher relative rate. Finally, it was hypothesized that, among children who use a mixture of bunched and retroflex shapes, phonetic context would impact tongue shape as reported in the adult literature. These hypotheses were tested using ultrasound data from a stimulability task eliciting /ɹ/ in syllabic, postvocalic, and onset contexts. Participants were two groups of children/adolescents aged 9-15 years: 36 with RSSD who completed a study of ultrasound biofeedback treatment and 33 with no history of RSSD. Tongue shapes were qualitatively coded as bunched or retroflex using a flowchart from previous research. Children with no history of RSSD were found to use bunched-only tongue shape patterns at a rate higher than adults, but those who used a mixture of shapes for /ɹ/ followed the expected phonetic contextual patterning. Children with RSSD were found to use retroflex-only patterns at a substantially higher rate than adults, and those using a mixture of shapes did not exhibit the expected patterning by phonetic context. These findings suggest that clients receiving ultrasound biofeedback treatment for /ɹ/ may be most responsive to clinician cueing of retroflex shapes, at least early on. However, retroflex-only cueing may be a limiting and insufficient strategy, particularly in light of our finding of a lack of typical variation across phonetic contexts in children with remediated /ɹ/. Future research should more specifically track cueing strategies to better understand the relationship between clinician cues, tongue shapes, and generalization across a range of contexts. https://doi.org/10.23641/asha.26801050.

Analysis of the therapeutic effect of pestle needle and EEG biofeedback and methylphenidate in the treatment of attention-deficit/hyperactivity disorder.

This research aimed to analyze the therapeutic effect of the pestle needle combined with electroencephalogram (EEG) biofeedback and methylphenidate in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children. Seventy-eight children with ADHD were selected and randomized into a control group and an observation group (n = 39 each). The control group received EEG biofeedback and methylphenidate treatment, whereas the observation group received pestle needle therapy on this basis. Both groups received continuous treatment for 3 mo. The clinical efficacy, scores of Conners Parents Symptom Questionnaire (PSQ), Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), and Pittsburgh Sleep Quality Index (PSQI), EEG θ/β changes in values, serum indicators such as adrenocorticotropic hormone (ACTH) and cortisol (CORT), and incidence of adverse reactions were compared in the two groups. The total effective rate of the observation group was 92.31% (36/39), which was higher than the control group's 69.23% (27/39) (P < 0.05). After treatment, reduced PSQ scores, PSQI scores, EEG θ/β values, and ACTH levels and elevated IVA-CPT and CORT levels were observed in both groups; the observation group had the best improvement effect after treatment (P < 0.05). Pestle needle combined with EEG biofeedback and methylphenidate in the treatment of ADHD children can elevate the IVA-CPT score, improve EEG waves and sleep quality, regulate serum indicators such as ACTH and CORT, reduce behavioral problem scores, and have high efficacy and safety.NEW & NOTEWORTHY The pestle needle combined with EEG biofeedback and methylphenidate in ADHD children can elevate the IVA-CPT score. The pestle needle combined with EEG biofeedback and methylphenidate in ADHD children can improve EEG waves. The pestle needle combined with EEG biofeedback and methylphenidate in ADHD children can improve sleep quality. The pestle needle combined with EEG biofeedback and methylphenidate in ADHD children can regulate serum indicators.

Exploring the feasibility of heart rate variability biofeedback for individuals with tetraplegia: A pilot clinical trial.

This study aimed to determine the feasibility of using commercially available heart rate variability (HRV) biofeedback training to improve physiological and self-reported stress and anxiety among adults with tetraplegia. HRV biofeedback teaches individuals to effectively modify their HRV levels in synchronization with their respiration rate and amplitude. Thirty participants with tetraplegia were enrolled and allocated into one of two study arms: biofeedback or control. The study was conducted remotely from June 2022 through February 2023. Participants in the biofeedback arm received eight HRV training sessions with physiological monitoring, while participants in the control arm received physiological monitoring only. Outcome measures included feasibility, percentage of time spent in the low-frequency range, the Depression Anxiety Stress Scale-21, the Subjective Units of Distress Scale, and the State-Trait Anxiety Inventory-Y Form. Feasibility was demonstrated with 100% completion of the protocol and no participant withdrawals due to adverse events. The biofeedback arm showed a greater percentage of time spent in the low-frequency range and reported greater improvement in anxiety from baseline to Session 8 on the Subjective Units of Distress Scale compared to the control arm. However, no differences were found between study arms on the Depression Anxiety Stress Scale-21 and State-Trait Anxiety Inventory-Y Form. This study demonstrated that a remotely delivered, self-administered HRV biofeedback intervention could feasibly be delivered to individuals with tetraplegia who report moderate-to-high levels of anxiety. Trends in the reduction of physiological and self-reported anxiety were observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

SPECIAL ISSUE: Lessons Learned: A Pilot Study on the Feasibility of Using Biofeedback Monitoring in a Remote Setting with Special Forces Veterans in Saipan

In 2019, our team traveled internationally to test the effectiveness of a physiological assessment and heart rate variability (HRV) biofeedback program for a group of highly accomplished Special Forces Wounded Warriors participating in an international rehabilitative adaptive event. The intent was to offer biofeedback in a remote setting for managing and measuring stress while performing highly stressful tasks. The evaluation took place 8,000 miles from the mainland United States on the island of Saipan, the site of a tremendous battle during World War II. To our knowledge, a biofeedback system of this type has never been employed in a remote setting with this population. The transport of biofeedback equipment came with unique challenges as did providing an internet-based biofeedback project in a remote setting. Although HRV and health-related data were collected by study staff, the analysis of the data is not included in this manuscript. The purpose of this article is to provide information on key factors to consider when providing biofeedback in a remote setting, including data collection and storage in a limited internet service area; safe transport of equipment; and tools for successful biofeedback training in an isolated, international setting. We hope the information in this article will guide practitioners who plan to do similar types of biofeedback studies and interventions in the future.

Heart Rate Variability Biofeedback Intervention Programme to Improve Attention in Primary Schools.

The importance of attentional capacity for academic performance is highlighted by the increasing demands placed on students during primary school. Between the ages of 7 and 12, there is an evolutionary improvement in attentional capacity and the school environment is considered an appropriate setting in which to develop programmes to improve attention. Heart rate variability is an appropriate indicator of attentional capacity. For all these reasons, a heart rate variability biofeedback intervention focused on breathing was developed and implemented to improve attention. The intervention consisted of two phases. In the first phase, the school teachers were trained to develop the intervention; in the second, students received five individual sessions from their teachers. In each individual session, they learned to breathe to increase their heart rate variability. A total of 272 girls and 314 boys (N = 586) aged 7-12years participated in the programme. To study the impact of the intervention on three primary school age groups, the attention of Control and Experimental groups was assessed before and after the implementation of the programme. According to the data obtained, despite developmental improvements, the students who participated in the programme showed an increase in heart rate variability and an improvement in attentional capacity, with a greater impact on the first cycle of primary school. The usefulness of heart rate variability biofeedback interventions in improving attention in primary school is discussed and arguments for their use in children are presented.

Brief Report: Baseline HRV Time Domain Parameters Predict Trauma and Depression Symptom Change in Veterans with PTSD Undergoing Biofeedback.

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clinic resources; however, there is a dearth of knowledge on the number of clinical sessions needed to significantly reduce trauma and depression symptoms. We conducted a series of linear regression models using baseline, post-intervention, and follow-up data from intervention group participants (N = 18) who engaged in a pilot waitlist-controlled study testing the efficacy of a 3-session mobile app-adapted HRV biofeedback intervention for veterans with PTSD. Based on Nunan et al. (Pacing and Clinical Electrophysiology 33:1407-1417, 2010) short-term norms, we found that pre-intervention RMSSD in the normal range significantly predicted PTSD and depression symptom improvement. Findings suggest the utility of baseline RMSSD as a useful metric for predicting HRV biofeedback treatment outcomes for veterans with PTSD and comorbid depression. Those with below-normal baseline RMSSD may likely need additional sessions or an alternative treatment to show clinically meaningful symptom improvement.

Clinical Observation of Acupuncture Combined with Biofeedback Electrical Stimulation in the Treatment of Female Stress Urinary Incontinence.

To investigate the clinical efficacy of acupuncture combined with biofeedback electrical stimulation on female stress urinary incontinence. Ninety patients diagnosed in a hospital between January 2020 and January 2021 were randomly divided into three groups (A, B and C). Group A was treated with biofeedback electrical stimulation, 3 times a week for 30min for 15 times. Group B used acupuncture treatment, including Guanyuan, Qihai, Zhongji, Zusanli, Sanyinjiao and Yinlingquan, once a day, Monday-Friday, 30min each, for a total of 10 times. Group C was treated with acupuncture combined with biofeedback electrical stimulation. All three groups were combined with pelvic floor muscle training. Following treatment, the changes in class I and II muscle fibre strength, ICI-Q-SF score and urine leakage in the 1-hour pad test were compared. Prior to treatment, there was no significant difference in the general data of the three patient groups, as well as class I and II muscle fibre strength, ICI-Q-SF score and 1-hour urinary pad test (P > 0.05). Following treatment, class I and II muscle fibre strength in groups A and C improved compared with before, with statistical significance (P < 0.05); there was no significant difference in group B (P > 0.05). In the three groups, ICI-Q-SF scores and 1-hour urinary pad test results were lower compared with before (P < 0.05), with those in group C better than those in groups A and B (P < 0.05). The treatment efficiency of the three patient groups was 86.7%, 83.3% and 96.7%, respectively. Combined acupuncture and biofeedback electrical stimulation can improve pelvic floor muscle strength, urine leakage and quality of life, and can be superior to biofeedback and acupuncture treatment alone.

Biofeedback therapy using Cerebri for the prevention of migraine attacks in adults with episodic migraine (BioCer): a randomized, wait-list controlled trial – the study protocol

Introduction Biofeedback is a non-pharmacological treatment option valued for its minimal risk of adverse events and offers a safe alternative for individuals seeking preventive care for migraine. Despite level A evidence for migraine prevention, biofeedback treatment is still unavailable to most patients. We developed a novel medical device (Cerebri) for multimodal biofeedback treatment that omits the need for healthcare personnel involvement. Cerebri consists of a smartphone application (app) and two wireless sensors. Unique in its approach, the Cerebri app seamlessly integrates three biofeedback modalities – heart rate variability, temperature, and electromyography – making it a comprehensive, therapist-independent solution for non-pharmacological migraine management. Methods Biofeedback therapy using Cerebri for the prevention of migraine attacks in adults with episodic migraine (The BioCer study) was an open-label, randomized, waitlist-controlled, multicenter trial. This study investigated the safety and efficacy of daily home-based biofeedback sessions using the Cerebri device. A total of 286 participants will be randomized to either a 12-week intervention arm or waitlist control arm. The primary outcome was the change in the mean number of migraine days from baseline to the last 28-day period during the treatment phase in the treatment group compared with the control group. The primary outcome variable was prospectively collected through daily eDiary entries. Ethics and Dissemination Approval from the ethics committee and competent authorities was obtained prior to study initiation. Participation was voluntary and informed and written consent was obtained prior to inclusion. The results of this trial will be published in peer-reviewed international medical journals and communicated to patients and healthcare personnel through the relevant channels. Trial registration numbers EUDAMED: CIV-NO-22-08-040446 REK (Regional Committees for Medical and Health Research Ethics): 502734 Date of approval 2022-10-14 Trial registration: NCT05616741, 2022-11-15, https://clinicaltrials.gov/study/NCT05616741

The Role of Pelvic Floor Muscle Exercise in Erectile Dysfunction

PURPOSE: This study aimed to determine the role or applicability of pelvic floor muscle exercise for erectile dysfunction.METHODS: This narrative review was conducted by searching terms such as “erectile dysfunction”, “erection dysfunction”, “sexual dysfunction”, and “pelvic floor muscle training”, “pelvic floor muscle exercise”, “pelvic floor exercise”, “randomized controlled trials”, “randomized clinical trials” in PubMed, Google Scholar, Scopus, and Web of Science.RESULTS: Seven articles met the inclusion criteria. Six studies applied pelvic floor muscle exercise, electrical stimulation, and biofeedback treatment to patients with erectile dysfunction after radical prostatectomy. Only three studies showed that treatment in the intervention group had a significant effect on erectile function. Considering these results, the study subjects who applied the three treatment methods presented above were mainly patients with erectile dysfunction caused by prostate cancer surgery.CONCLUSIONS: Seven randomized controlled trials showed no significant effect of pelvic floor muscle exercise on erectile dysfunction. However, they are thought to have applicability as a method for treating erectile dysfunction. In studies of erectile dysfunction caused by radical prostatectomy, homogeneity in the age, duration of erectile dysfunction, and nerve-sparing surgery should be ensured between the intervention and control groups. First, future clinical research is required to determine whether existing methods and concurrent treatment with drugs, such as sildenafil (Viagra) and tadalafil (Cialis) can shorten the recovery period of erectile function. Second, clinical research is needed to analyze the differences in changes in erectile function between those performing aerobic exercise and pelvic floor muscle exercise combined and those performing only pelvic floor muscle exercise.

Physiological Targets for Orthostatic Hypotension: Improving Nonpharmacological Interventions in Patients with Orthostatic Cerebral Hypoperfusion.

Orthostatic hypotension (OH) is a form of orthostatic intolerance (OI) and a key physiological indicator of autonomic dysfunction that is associated with an increased risk of major cerebrocardiovascular events. Symptoms of cerebral hypoperfusion have been reported in patients with OH, which worsens symptoms and increases the risk of syncope. Since pharmacological interventions increase blood pressure (BP) independent of posture and do not restore normal baroreflex control, nonpharmacological treatments are considered the foundation of OH management. While reductions in cerebral blood flow velocity (CBFv) during orthostatic stress are associated with a decrease in end-tidal CO2 (EtCO2) and hypocapnia in patients with OI, their contribution to the severity of OH is not well understood. These measures have been physiological targets in a wide variety of biofeedback interventions. This study explored the relationship between cardiovascular autonomic control, EtCO2 and cerebral hypoperfusion in patients (N = 72) referred for OI. Patients with systolic OH were more likely to be male, older, demonstrate reduced adrenal and vagal baroreflex sensitivity, and reduced cardiovagal control during head-up tilt (HUT) than patients without systolic OH. Greater reduction in CBFv during HUT was associated with a larger reduction in ETCO2 and systolic BP during HUT. While deficits in cardiovascular autonomic control played a more important role in systolic OH, reduced EtCO2 was a major contributor to orthostatic cerebral hypoperfusion. These findings suggest that biofeedback treatments targeting both the autonomic nervous system and EtCO2 should be part of nonpharmacological interventions complementing the standard of care in OH patients with symptoms of cerebral hypoperfusion.

Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study.

Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach. The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being. To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV. In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant. In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.

Self-regulation training improves stress resilience in elite pre-pubescent female gymnasts.

In the context of young female athletes, namely elite gymnasts, effective stress management strategies not only enhance performance, but also reduce the risk of injuries and promote overall well-being. This study aims to investigate the effects of biofeedback-based training on stress management in prepubescent elite female gymnasts, recognizing its pivotal role in promoting healthy growth and proper training load management. Eight elite young female athletes from a top flight French national league club participated in an experimental condition involving four-week biofeedback training program to improve self-regulation skills, during both rest and stress phases. Additionally, each subject experienced a control condition, with entailed exposure to domain-specific motivational videos. Comprehensive evaluations of physiological parameters were conducted to assess the impact of biofeedback training, both before and after the training, as well as during the stress and recovery phases. Furthermore, an interoceptive body awareness test, using the MAIA questionnaire, was performed. The results highlight a significant enhancement of the self-regulatory skills of the gymnasts in managing the selected physiological parameters-peripheral temperature (p < 0.05) and blood volume pressure (p < 0.05)-after the biofeedback treatment. Moreover, psychological data from the MAIA questionnaire revealed a noteworthy increase in interoceptive awareness (p < 0.001), particularly in the subscales of Not Distracting (p < 0.001), Attention regulation (p < 0.05), Emotional awareness (p < 0.05), and Self-regulation (p < 0.05). Thus, we conclude that biofeedback training improves self-regulatory and psychological resilience under stressful conditions, while reducing sensitivity to gymnastics-specific stress.

Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations.

Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students. A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models. Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness ( β = 10.27 [95% confidence interval {CI}, 7.40-13.13; P < .001] and β = 3.42 [95% CI, 0.98-5.85; P = .006], respectively) and lower openness ( β = -4.95; 95% CI, -7.40 to -2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological ( P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological ( β = -5.66; 95% CI, -10.83 to -0.50; P = .03) and physiological stress reduction ( β = -0.002; 95% CI, -0.003 to -0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction ( β = -7.87; 95% CI, -13.05 to -2.68; P = .003). Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.

Thoracoabdominal Wall Motion–Guided Biofeedback Treatment of Abdominal Distention: A Randomized Placebo-Controlled Trial

Abdominal distention results from abdominophrenic dyssynergia (ie, diaphragmatic contraction and abdominal wall relaxation) in patients with disorders of gut-brain interaction. This study aimed to validate a simple biofeedback procedure, guided by abdominothoracic wall motion, for treating abdominal distention. In this randomized, parallel, placebo-controlled trial, 42 consecutive patients (36 women and 6 men; ages 17-64 years) with meal-triggered visible abdominal distention were recruited. Recordings of abdominal and thoracic wall motion were obtained using inductance plethysmography via adaptable belts. The signal was shown to patients in the biofeedback group, who were taught to mobilize the diaphragm. In contrast, the signal was not shown to the patients in the placebo group, who were given a placebo capsule. Three sessions were performed over a 4-week intervention period, with instructions to perform exercises (biofeedback group) or to take placebo 3 times per day (control group) at home. Outcomes were assessed through response to an offending meal (changes in abdominothoracic electromyographic activity and girth) and clinical symptoms measured using daily scales for 7 days. Patients in the biofeedback group (n= 19) learned to correct abdominophrenic dyssynergia triggered by the offending meal (intercostal activity decreased by a mean ± SE of 82% ± 10%, anterior wall activity increased by a mean ± SE of 97% ± 6%, and increase in girth was a mean ± SE of 108% ± 4% smaller) and experienced improved clinical symptoms (abdominal distention scores decreased by a mean ± SE of 66% ± 5%). These effects were not observed in the placebo group (all, P < .002). Abdominothoracic wall movements serve as an effective biofeedback signal for correcting abdominophrenic dyssynergia and abdominal distention in patients with disorders of gut-brain interaction. ClincialTrials.gov, Number: NCT04043208.

A Synthesized Model for Applying Stress Management and Biofeedback Interventions in Research Utilization: A Systematic Review and Meta-analysis.

Stress management and biofeedback interventions have been shown to be effective in improving mental and physical health outcomes. However, previous research studies and synthesized models for applying these interventions in research utilization are insufficient. This study aimed to synthesize a model for applying stress management and biofeedback interventions in research utilization. A systematic review and meta-analysis were conducted according to the PRISMA guidelines.Multiple studies were used to assess the effectiveness of applying stress management and biofeedback interventions published from 2017 to 2023. The process included identifying the research questions, conducting a comprehensive literature search, assessing study quality, extracting data, synthesizing the data, analyzing and interpreting the findings, drawing conclusions, and making recommendations. The results indicated a significant mean effect size without evidence of publication bias. The effect sizes of the subgroups among the study variables were not significantly different [Q = 4.02, p = .26]. However, there were significant differences regarding the mean effect sizes among the studies [Q = 63.59, p < .001] and also in terms of the test of subgroups among the participants [Q = 8.49, p = .04]. The results emphasize the importance of evidence-based practice and highlight the need for ongoing evaluation and refinement of interventions. The proposed model was supported by related theories and research studies in order to ensure the robustness and reliability to guide practice and future research in the field of biofeedback interventions. By following this model, researchers and practitioners can ensure that stress management and biofeedback interventions are evidence-based and are effective in improving mental and physical health outcomes.