Evaluate two quantitative articles on biofeedback research
Biofeedback was a technique developed in the 1960s to teach the individuals who utilize it, methods to control their body purposes, such as the individual heart rate (Bauer, Hagen & Millman, 2013; Ratanasiripong, Kaewboonchoo, Ratanasiripong, Hanklang & Chumchai, 2015). Biofeedback is a mind-body process of self-regulation that is effective for a variety of medical situations, to improve the overall health and performance (Bauer et al., 2013; Ratanasiripong et al., 2015).
The individual whom utilize biofeedback equipment enable themselves to become mindful of their physiological functions and to study how to implement changes in their views, feelings, and actions to improve their current state physiological functioning (Bauer et al., 2013). The individual does this by using the breathing sensors, which monitors their breathing by aiding them to breath slower and deeper (Bauer et al., 2013).
Biofeedback is utilized to treat many different health conditions (Bauer et al., 2013), research has shown that it improves the symptoms of high blood pressure, stroke, asthma, Raynaud’s disease, constipation, chemotherapy-related nausea and vomiting, headaches, incontinence, irritable bowel syndrome, and chronic pain (Bauer et al., 2013). Studies have shown it has also been proven to relieve mental health symptoms, such as stress, anxiety, and depression (Bauer et al., 2013).
Biofeedback & Mental Health
Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing
In this study conducted in Thailand, the authors were concerned with the global prevalence of mental health problems within the graduate student population on university campuses, and due to the limited mental health resources available on the schools, they looked to alternative interventions, such as biofeedback (Ratanasiripong et al., 2015). The study was designed to investigate if the use of biofeedback could reduce symptoms of stress, anxiety, and depression (Ratanasiripong et al., 2015).
For the study, a sample of 60 graduate students was randomly selected, of which ninety-seven percent were female and three percent male (Ratanasiripong et al., 2015). The student’s ages ranged between 21 and 52. They were then randomly assigned to either the control group or the biofeedback intervention group (Ratanasiripong et al., 2015). If the participant was assigned to the biofeedback intervention group, they were each given a portable biofeedback device to use for four weeks and received one training session teaching them how to use the mobile biofeedback equipment to help manage symptoms of stress, anxiety, and depression. The participants in the control group did not receive any training or equipment to use (Ratanasiripong et al., 2015).
To measure the findings, all of the participants completed a pre and post preintervention survey package, which included the Perceived Stress Scale, State Anxiety Scale, Center for Epidemiological Study-Depression Scale, and a brief demographic questionnaire. The study findings showed that in the area of stress, the biofeedback group had a significant decrease in the Perceived Stress Scale over the four weeks, while the control group had a slight increase. About anxiety, the biofeedback group had a substantial reduction in the STAI-State Anxiety Scale score over the four weeks, while the control group had an increase (Ratanasiripong et al., 2015). And lastly, the results for depression declared that the biofeedback group had a significant decrease in the Center for Epidemiological Study-Depression Scale score over the four weeks, while the control group had an increase (Ratanasiripong et al., 2015).
The ethical questions that arise from this research are related to the limitations of the study. One is the population sample coming from one graduate program. The biofeedback training did show to be an effective form of intervention to reduce levels of stress, anxiety, and depression for graduate students in the public health nursing program significantly at this one university, however, they may be other factors associated with this program at this university that may not represent the population. Another factor to the question was that ninety-seven present of the participant were women and that all the participants were in Thailand. These limitations of the study could raise questions regarding the reliability and validity of the results because they can create bias.
The intent to improve reliability and validity future research studies should expand the population to include multiple graduate student majors, numerous universities, various countries, and more male participants. An added influence to improve validity and reliability is to cover long term impact of biofeedback interventions by conducting a longitudinal study with annual follow-ups.
Biofeedback & Physical Health
Biofeedback in the treatment of headache and other childhood pain
The prevalence of headaches, and especially migraine, has been most extensively studied (Hermann & Blanchard, 2002). It is estimated that among adults worldwide, 50% are diagnosed with a current headache disorder and, among those individuals, 30% or more suffer from migraines (Hermann & Blanchard, 2002). Up to 40% of school children have at least one headache weekly, while migraine has been reported to affect between 3 and 10% of children and adolescents depending on age and sex (Hermann & Blanchard, 2002). The commonness of headaches tends to be somewhat higher (Hermann & Blanchard, 2002) and seems to have increased over the past 25 years (Hermann & Blanchard, 2002). The increase shows an alarming prediction because not only are headaches painful for the sum they can be disabling (Hermann & Blanchard, 2002).
About the success of Biofeedback and the reduction of headaches and migraine pain is attributed to physiological factors of the individual (Hermann & Blanchard, 2002). Physiological factors are based on the regulation of specific physiological processes, such as extreme muscle tension (Hermann & Blanchard, 2002). It is believed that when the pressure is absent, the underlying pain problem dissipates (Hermann & Blanchard, 2002). In other words, learned control of the relevant physiological process, through biofeedback techniques should lead to corresponding pain relief.
In this article review, the authors provide detailed summaries of three studies that have been conducted to evaluate the effectiveness of biofeedback techniques in the treatment of childhood headaches and migraines (Hermann & Blanchard, 2002). The article starts by discussing the methods of treatment used for the studies selected (Hermann & Blanchard, 2002). The format of treatment delivery for the evaluation was of both, clinic-based treatment, which typically consists of 10–12 biofeedback sessions that were administered by a trained clinician (Hermann & Blanchard, 2002). The second was a home-based format, in which the children typically receive about training with therapist-guided biofeedback sessions, with the remaining treatments are consisting of self-initiated, manual-guided home gatherings (Hermann & Blanchard, 2002).
The authors disclosed that there is no significant difference in efficacy between the home-based format versus the clinic-based form. Research statistically shows that home-based methods tend to show lesser enhancement then clinic-base; however, both tend to show significant individual improvement (Hermann & Blanchard, 2002). As an example, in one of the studies, about 69% of the children that were shown clinical improvement as compared to the 100% that was obtained from clinic-based biofeedback (Hermann & Blanchard, 2002).
Next, the article compares the biofeedback prevalence between children and adults regarding the hypothesis that biofeedback can influence headache and migraine discomfort (Hermann & Blanchard, 2002). The results showed that children suffering from headaches and migraines benefit significantly higher from the utilization of biofeedback techniques to assist in alleviating pain than in adults (Hermann & Blanchard, 2002). The analysis indicated that children achieved a mean headache and migraine reduction of around 62% as compared to a 38% reduction in adults (Hermann & Blanchard, 2002).
The research then shows the prevalence of the hypothesis and findings that biofeedback has been proven and quantified to be significantly successful in alleviating headage and migraine symptoms in children (Hermann & Blanchard, 2002). The article stated that more than two-thirds of the children could potentially be classified as treatment victory based on the 50% symptom reduction rate that was shown (Hermann & Blanchard, 2002).
The factor to highlight within the studies evaluated is that they provided 6-month or 1-year follow-up data to give a sustained dataset (Hermann & Blanchard, 2002). Research indicated that the reduction in headaches and migraines was maintained or had been improved even more significant during the follow-up period, and also reported continued improvements from the 1-year up to the 3-year follow-up (Hermann & Blanchard, 2002).
A potential question that was formed while reading the article and one that needs to be addressed is whether the treatment success was the result of biofeedback or was it due to the placebo effect. Within the study, the authors indicate how children are more acceptable to the placebo effect because they are highly vulnerable to wishful thinking and expectations of hope. The placebo effect may demonstrate why adults with headaches and migraines have scored lower when utilizing biofeedback as a method for the treatment of the pain.
A potential limitation that was identified within the research is that the authors did not disclose any demographic data regarding the participants, the lack of information could affect the validity and reliability of the findings because it did not give a point of reference for how the researcher based their information gathering methods for replication. An example of this is the if data is derived from children located in a rural area or from children from an urban environment. Having differing situations such as the quiet countryside equated to the hustle and bustle of an inner metropolitan town could potentially have very differing results. A secondary demographic that is missing is the developmental level of the child. The developmental level gives a point of reference when looking at the potential placebo effect and how a child adapts to their surroundings or mimics their surroundings. The developmental level is also required to identify the individual’s cognitive capacity to benefit from the use of biofeedback techniques.
Improvement to the validity and reliability of these findings, it would be attractive to seek out children who are susceptible to headaches and migraines in various parts of the world as well as a longitudinal format to see if biofeedback treatment can prove to reduce headaches and migraines and not be limited to the individual environment or their culture.
Bauer, B. A., Hagen, P. T., & Millman, M. (Eds.). (2013).
Mayo Clinic Book of Alternative Medicine & Home Remedies
. Time Home Entertainment.
- Hermann, C., & Blanchard, E. B. (2002). Biofeedback in the Treatment of Headache and Other Childhood Pain.
Applied Psychophysiology & Biofeedback
(2), 143–162. Retrieved from
- Ratanasiripong, P., Kaewboonchoo, O., Ratanasiripong, N., Hanklang, S., & Chumchai, P. (2015). Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing.
Nursing Research & Practice