Relieving Stress Through Biofeedback Training Barbara Morrell, Ph.D. Michael Maughan, Ed.D. Shannon Coetzee, B.S. Grant Gardner Karstin Slade, B.S. Brigham.

Relieving Stress Relieving Stress Through Biofeedback Through Biofeedback

TrainingTrainingBarbara Morrell, Ph.D.Barbara Morrell, Ph.D.

Michael Maughan, Ed.D.Michael Maughan, Ed.D.Shannon Coetzee, B.S.Shannon Coetzee, B.S.

Grant GardnerGrant GardnerKarstin Slade, B.S.Karstin Slade, B.S.

Brigham Young UniversityBrigham Young UniversityProvo, UtahProvo, Utah

Presented at the AMCAP Spring ConventionPresented at the AMCAP Spring ConventionSalt Lake City, UtahSalt Lake City, Utah

March 29, 2007March 29, 2007

Brigham Young University Stress Brigham Young University Stress Management and Biofeedback LabManagement and Biofeedback Lab

In operation since 1976In operation since 1976

Integral part of the Counseling and Career Integral part of the Counseling and Career CenterCenter

Utilize EMG, Thermal, GSR, HRV & Utilize EMG, Thermal, GSR, HRV & Respiration modalitiesRespiration modalities

350 students seen in 900 sessions per year350 students seen in 900 sessions per year

Purpose of LabPurpose of Lab To Provide Stress Management/Biofeedback To Provide Stress Management/Biofeedback

training to help students:training to help students:

Better manage school and other stressorsBetter manage school and other stressors

Develop Skills to reduce unwanted tensionDevelop Skills to reduce unwanted tension

Lessen interference of stress/anxiety with Lessen interference of stress/anxiety with school performance & overall wellbeingschool performance & overall wellbeing

To Provide an Adjunct to PsychotherapyTo Provide an Adjunct to Psychotherapy

Lab PersonnelLab Personnel

1 Psychologist Lab Supervisor/Admin1 Psychologist Lab Supervisor/Admin

1 Psychologist doing tx (4 hours/week)1 Psychologist doing tx (4 hours/week)

1 Graduate Assistant Coordinator1 Graduate Assistant Coordinator

2-3 Undergraduate lab assistants2-3 Undergraduate lab assistants

Relaxation Skills TrainingRelaxation Skills Training

Body ScanBody Scan AutogenicsAutogenics Diaphragmatic BreathingDiaphragmatic Breathing Progressive Muscle RelaxationProgressive Muscle Relaxation MeditationMeditation VisualizationVisualization Self-HypnosisSelf-Hypnosis Performance RehearsalPerformance Rehearsal

Outreach PresentationsOutreach Presentations

Housing—On and Off campusHousing—On and Off campus

Campus classesCampus classes

Workshops offered in Counseling CenterWorkshops offered in Counseling Center

Stress Management Group in Counseling Stress Management Group in Counseling CenterCenter

Health FairsHealth Fairs

Purpose of Research Purpose of Research

To better understand the experience of To better understand the experience of stress of students referred to the labstress of students referred to the lab

To determine the effectiveness of To determine the effectiveness of biofeedback/relaxation trainingbiofeedback/relaxation training

To increase effectiveness of To increase effectiveness of biofeedback/relaxation trainingbiofeedback/relaxation training

Research QuestionsResearch Questions

What subjective level of stress do students What subjective level of stress do students report on the average?report on the average?

What are the major stress symptoms What are the major stress symptoms reported by students?reported by students?

What are students major stresses?What are students major stresses?

What are the major ways students cope What are the major ways students cope with stress?with stress?

Research QuestionsResearch Questions

How effective is biofeedback/stress How effective is biofeedback/stress management training?management training? Pre-/Post- changes in EMG Readings?Pre-/Post- changes in EMG Readings? Pre-/Post- change in Temp Readings?Pre-/Post- change in Temp Readings?

How do student self-reports of level of How do student self-reports of level of stress change pre- and post- session?stress change pre- and post- session?

Does practice between sessions improve Does practice between sessions improve effectiveness of training?effectiveness of training?

Subjective MeasuresSubjective Measures

Student rating of stress for past weekStudent rating of stress for past week Student beginning and ending BF session Student beginning and ending BF session

rating of stress levelrating of stress level Anonymous Student report of how useful, Anonymous Student report of how useful,

relaxing and effective the session wasrelaxing and effective the session was Student report of between-session practiceStudent report of between-session practice

Skill(s) practiced Skill(s) practiced FrequencyFrequency EffectivenessEffectiveness

Objective MeasuresObjective Measures

EMG and Temperature BF ReadingsEMG and Temperature BF Readings

Pre- and Post-treatment readings by Pre- and Post-treatment readings by sessionsession

Change in Post-treatment readings over Change in Post-treatment readings over several sessionsseveral sessions

Preliminary DataPreliminary Data

Data Collected from 09/2006 & 01/2007Data Collected from 09/2006 & 01/2007

Participants: N =158Participants: N =158

BF Sessions: N = 282BF Sessions: N = 282

Range: 1-13 sessionsRange: 1-13 sessions

Modal session #: 1 sessionModal session #: 1 session

Anonymous Satisfaction surveys: N = 177Anonymous Satisfaction surveys: N = 177

Referral Sources to LabReferral Sources to Lab

CounselorReferral

ClassAssignment

Self/Physician/Parent/Other

Percent of Lab Participants by Percent of Lab Participants by Class and GenderClass and Gender

0

5

10

15

20

25

30

Fresh Soph Junior Senior Grad0

10

20

30

40

50

60

70

Male Female

Top Stress Symptoms Endorsed by Top Stress Symptoms Endorsed by Students Referred to LabStudents Referred to Lab

Most Frequently Endorsed Stress Symptoms by Percentage

13%

12%

10%

9%9%

9%

9%

6%

4%

19%Feeling Overwhelmed

Feeling Anxious

Feeling Depressed

Muscle Tension/Pain

Sleep Problems

Headaches

Difficulty Concentrating

Excessive Worry

Fatigue

Others Combined

Top Stressors Endorsed by Top Stressors Endorsed by Students Referred to LabStudents Referred to Lab

Top Stressors by Percentage

15%

12%

11%

11%7%

6%

5%

5%

4%

24%

Homework

Classes/School

Tests

Too much to do

Opposite sex

Lack of sleep

Family

Lack of Money

Inadequacy/Inferiority

Others Combined

Top Coping Strategies EndorsedTop Coping Strategies Endorsed

Top Coping Techniques by Percentage

10%

9%

9%

8%

7%7%6%4%

4%

36%

Relaxation Techniques

Pray

Sleep

Talk to Friends

Ignore/Procrastinate

Talk to Family

Exercise

Relax

Endure

Others Combined

Intake FormIntake Form

Intake FormIntake Form

Recording FormRecording Form

Tracking FormTracking Form

Preliminary ResultsPreliminary Results

Students anonymously reported on average Students anonymously reported on average that their BF sessions were:that their BF sessions were:

Not Informative Not Informative Very Informative Very Informative

0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 99 10 10

Not Relaxing Not Relaxing Very Relaxing Very Relaxing

0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 99 10 10

Not UsefulNot Useful Very Useful Very Useful

0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 99 10 10

Results of Home PracticeResults of Home Practice

Average Usefulness rating of those Average Usefulness rating of those who practiced was who practiced was 6.64 out of 106.64 out of 10

(10 point scale: O = Least useful; 10 = useful)(10 point scale: O = Least useful; 10 = useful)

49% of students reported they 49% of students reported they practiced relaxation techniques practiced relaxation techniques during the previous weekduring the previous week

Self-Report Rating of Stress Self-Report Rating of Stress Pre-and Post-TreatmentPre-and Post-Treatment

Avg Change = 3.555 (10 point scale: 0 = not stressed; 10 = most stressed)Avg Change = 3.555 (10 point scale: 0 = not stressed; 10 = most stressed)

5.92

2.36

0

1

2

3

4

5

6

7

Pre Post

Pre- and Post- Frontal Pre- and Post- Frontal EMG RecordingsEMG Recordings

Ave Change = 2.285Ave Change = 2.285

4.873

2.588

0

1

2

3

4

5

6

Pre Post

EM

G (

mic

roV

olt

s)

Pre- and Post- Hand Temperature Pre- and Post- Hand Temperature RecordingsRecordings

Ave Change = -.573Ave Change = -.573

90.798

91.364

90.5

90.6

90.7

90.8

90.9

91

91.1

91.2

91.3

91.4

91.5

Pre Post

Te

mp

era

ture

(d

eg

ree

s F

)

Preliminary ConclusionsPreliminary Conclusions BF sessions are effective in reducing stress BF sessions are effective in reducing stress

level in the short run based on subjective data level in the short run based on subjective data and EMG/Temp readingsand EMG/Temp readings

Students overwhelmingly report BF sessions to Students overwhelmingly report BF sessions to be helpfulbe helpful

Only half of BF trainees are engaging in home Only half of BF trainees are engaging in home practice of relaxation techniquespractice of relaxation techniques

Those who practice relaxation techniques report Those who practice relaxation techniques report it to be usefulit to be useful

Future InvestigationFuture Investigation

Do Pre-Post EMG/Temp BF readings improve Do Pre-Post EMG/Temp BF readings improve significantly over multiple sessions?significantly over multiple sessions?

Do weekly and pre-session subjective ratings Do weekly and pre-session subjective ratings decrease significantly over multiple sessions?decrease significantly over multiple sessions?

Do Students who practice show significantly Do Students who practice show significantly greater improvement compared to those who greater improvement compared to those who don’t?don’t?

How do therapy clients compare to non-clients?How do therapy clients compare to non-clients?