1. Biofeedback Training for University Students: Skills for a Lifetime of Health Barbara Morrell, Ph.D. Michael L. Maughan, Ed.D. Shannon Coetzee., B.S. Dianne Nielsen, Ph.D. Russell Bailey, B.S. Brigham Young University American Psychological Association Annual Convention Boston, Massachusetts August 15, 2008

2. Abstract The University is an ideal setting to teach stress management skills, as college students cope with more difficult coursework and increasingly complex adult roles and responsibilities. Biofeedback training teaches students skills for better coping, functioning, and health in the present and may help to lay the foundation for a lifetime of health and wellness. Research conducted in the BYU Counseling Center Stress Management and Biofeedback lab demonstrates that biofeedback and relaxation training is effective for decreasing levels of stress and improving coping, as demonstrated by Frontal EMG and Temperature readings, and by self-reports. Students also report satisfaction with their biofeedback training and that their practice between sessions is effective.

3. Brigham Young University Stress Management and Biofeedback Lab Operating since 1976 Integral part of the Counseling and Career Center Utilize EMG, Thermal, GSR, HRV & Respiration modalities Staffed by Ph.D. Psychologists and Graduate Students. 470 students seen in 800 sessions per year

4. Purpose of Lab To Provide Stress Management/Biofeedback training to help students: – Better manage school and other stressors – Develop Skills to reduce unwanted tension – Lessen interference of stress/anxiety with school performance & overall wellbeing To Provide an Adjunct to Psychotherapy

5. Relaxation Skills Training Body Scan Autogenics Diaphragmatic Breathing Progressive Muscle Relaxation Meditation Visualization Self-Hypnosis Performance Rehearsal

6. Outreach Housing Campus classes Workshops offered in Counseling Center Health Fairs Community Groups

7. Purpose of Research To better understand the experience of stress of students referred to the lab To determine the effectiveness of biofeedback/relaxation training To increase effectiveness of biofeedback/relaxation training

8. Research Questions How effective is biofeedback/stress management training? – Pre-/Post- changes in EMG Readings? – Pre-/Post- change in Temp Readings? How do student self-reports of level of stress change pre- and post- session? Does practice between sessions improve effectiveness of training?

9. Subjective Measures Student rating of stress for past week Student beginning and ending BF session rating of stress level Anonymous Student report of how useful, relaxing and effective the session was Student report of between-session practice – Skill(s) practiced – Frequency – Effectiveness

10. Objective Measures Frontal EMG and Temperature BF Readings – Pre- and Post-treatment readings by session

11. Data Collection Data Collected from 09/2006 to 04/2008 Participants: N =659 BF Sessions: N = 1170 Range: 1-13 sessions Modal session #: 1 session

12. Referral Sources to Lab

13. Gender

14. Year in School

15. Top Stressors

16. Stress Symptoms

17. Coping Strategies

18. Pre- and Post- Frontal EMG Readings Mean change = 2.22, SD = 4.17, t = 15.78, p<.001

19. Pre- and Post- Skin Temperature Readings Mean change = -1.34, SD = 3.05, t = -13.06, p. 001

20. Self-Report Rating of Stress Pre-and Post-Treatment Mean change = 3.22, SD = 1.8, t = 54.114, p <.001

21. Satisfaction Survey Students anonymously reported on average that their BF sessions were: Not Informative Very Informative 0 1 2 3 4 5 6 7 8 9 10 Not Relaxing Very Relaxing 0 1 2 3 4 5 6 7 8 9 10 Not Useful Very Useful 0 1 2 3 4 5 6 7 8 9 10

22. Results of Home Practice Average Usefulness rating of those who practiced was 6.64 out of 10 (10 point scale: O = Least useful; 10 = useful) 49% of students reported they practiced relaxation techniques during the previous week

23. Preliminary Conclusions BF sessions are effective in reducing stress level in the short run based on subjective data and EMG/Temp readings Students overwhelmingly report BF sessions to be helpful Only half of BF trainees are engaging in home practice of relaxation techniques Those who practice relaxation techniques report it to be useful

24. Future Research Do Pre-Post EMG/Temp BF readings improve significantly over multiple sessions? Do weekly and pre-session subjective ratings decrease significantly over multiple sessions? Do Students who practice show significantly greater improvement compared to those who don’t? Does Biofeedback training improve subjective ratings of health and well-being over time?

25. Future Research How do therapy clients compare to non- clients on biofeedback readings pre-and post- session and in change over time? How does the outcome for clients using biofeedback as an adjunct to psychotherapy compare to those who don’t, as measured by the Outcome Questionnaire-45 (OQ-45).