1. CONCLUSIONS AND DISCUSSION
The Efficacy of Stress Management and Biofeedback Training as an Adjunct to Psychotherapy for University Students
Counseling & Career Center
Stress Management &
Biofeedback Services
BRIGHAM YOUNG UNIVERSITY
Barbara Morrell, Ph.D, Dianne Nielsen, Ph.D., Maureen Rice, Ph.D.,
David Erekson, Luke Marvin, and Loren Brown
Brigham Young University
PURPOSE
Biofeedback has been shown to reduce anxiety and depression (Gorman, J.M., & Sloan, R.P. (2000); Siepmann et al, 2008). The purpose of the study was to demonstrate therapeutic outcome for students receiving stress management and biofeedback training in addition to psychotherapy in the Brigham Young University Counseling and Psychological Services. Therapeutic outcome was assessed by the Outcome Questionnaire (OQ-45, Lambert, 1994).
METHODS
Participants were students who received psychotherapy from January, 2009 to December 2012 (N= 6804) in Counseling and Psychological Services. Of the sample, 315 received multiple sessions of biofeedback training, and 369 received only one session. Of the entire sample 56% were female and 44% male. The average age was (+/ SD). The ethnic composition was 87.6% White, 5.6% Hispanic, 2.4% Asian 1.2% Pacific Islander, 0.9% American Indian, 0.7% Black, and 1.6% other or not specified..
Analysis of Covariance Summary
Sum of Squares df
Mean Square F
Corrected Model 3 **
Intercept 1
44.619**
Initial OQ Score **
Multiple Biofeedback Sessions
7.539**
Error
3625
Total
3628
**p < 0.01
RESULTS
Differences in initial OQ score and final OQ score between those who attended no biofeedback, one session and multiple sessions of biofeedback were analyzed with a MANOVA . Significant differences were found between groups on total OQ-45 change (p = .018). Those receiving 1 or less biofeedback sessions averaged 8 points of change while hose receiving 2 or more biofeedback sessions averaged 11 points of change. Post-hoc tests revealed significantly higher initial scores as well as significantly more positive change among those with multiple biofeedback sessions. Because it was unclear if significant change in this group was related to initial symptom severity or multiple biofeedback sessions an ANCOVA was run controlling for initial severity and number of sessions. Amount of change over the course of therapy was significant (p< .01), independent of initial symptom severity.
Additionally, a multilevel analysis of biofeedback and outcome on the OQ-45 in CAPS from 1996 to 2012 found that the total number of biofeedback sessions in a course of therapy predicted a more rapid decrease in OQ-45 scores (p = .005), controlling for initial severity. .
Stress Management and Biofeedback Training consisted of 45-minute sessions of stress management education; muscle tension/hand temperature/galvanic skin response and/or heart rate variability (HRV) biofeedback; and relaxation skills Training. Students were encouraged to practice relaxation skills regularly and use them to manage stress, improve sleep, manage headaches, decrease muscle tension and pain, improve performance on tests, etc depending on individual needs. Downloadable relaxation recordings and stress management education were provided on the Biofeedback Services website. Most session were conducted by graduate biofeedback assistants.
The Outcome Questionnaire 45 (OQ-45) is a self-report instrument of general distress heavily loaded on items relating to stress and anxiety. It was administered before every session of individual therapy. A score of 63 or above is the cutoff score for the clinical range. The OQ has a three-week test-retest reliability of .84 and internal consistency of .93 for undergraduate students (Lambert et al., 2004). It has demonstrated sensitivity to change, having many items that change when individuals are treated while remaining constant without treatment (Vermeersch et al, 2000).
CONCLUSIONS AND DISCUSSION
This study contributes evidence that stress management and biofeedback training is an effective adjunct to therapy as measured by the OQ-45. The results indicate that the more training clients receive in calming down “at will” the more they improve. They support the need to include more mindfulness, biofeedback and relaxation training in psychology training programs and for psychologists to include biofeedback or other ANS regulation training as part of treatment. Biofeedback as practiced at CAPS is cost effective as most sessions are conducted by graduate students trained by faculty. Further research will study the integration of HRV biofeedback with psychotherapy. Limitations include lack of diversity of the client population for purposes of generalization.