Outcomes for Biofeedback Training and Psychotherapy in a University Counseling Center Barbara Morrell, Ph.D, Dianne Nielsen, Ph.D., Matt Reiser, David Erekson, Brian Hansen, Rebecca Canate, Lynda Silva, Jennie Bingham, Jason Katzenbach, & Rachel Doyle Brigham Young University The Outcome Questionnaire 45 (OQ-45) was administered before every session of biofeedback and individual therapy but not more than once a week. 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, Morton, et al., 2004). It has demonstrated sensitivity to change, having many items that change when individuals are treated while remaining constant without treatment (Vermeersch, Lambert, & Burlingame, 2000). PURPOSE The purpose of the study was to demonstrate therapeutic outcome for students receiving stress management/biofeedback training in addition to psychotherapy in the Brigham Young University Counseling Center. Therapeutic outcome was assessed by the Outcome Questionnaire (OQ-45, Lambert, 1994) a leading edge therapy outcome instrument. The OQ-45 is a self-report instrument of general distress heavily loaded on items relating to stress and anxiety and has been used to assess outcome for therapy clients in the counseling center since RESULTS A MANOVA was conducted in order to assess differences in initial score and last score between those who had received any biofeedback and those who had received none; those who had received multiple biofeedback sessions; a single biofeedback session; or no biofeedback sessions. No significant difference in change scores was found between those in therapy who had received biofeedback and those who had not. However, a significant multivariate effect was found between groups who had received multiple, one, or no biofeedback sessions (p <.001). 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 additional ANCOVA was conducted with initial OQ-45 score included as a covariate. Amount of change over the course of therapy was still found to be significant (p<.01), independent of initial symptom severity. METHODS Participants were 2042 students who received psychotherapy from January, 2009 to August Of the sample, 236 received at least one session of stress management/ biofeedback training, with 203 receiving only one session and 33 experiencing multiple sessions, 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.. CONCLUSIONS This study contributes evidence that stress management/ biofeedback training is effective for reducing general distress in university students as measured by the OQ-45, an instrument generally used for psychotherapy outcome. It is especially important in demonstrating a cumulative effect of multiple sessions of stress management/biofeedback training, which is difficult to demonstrate with biofeedback data alone. Stress management/biofeedback as done at BYU is more cost effective than therapy because it is administered primarily by graduate students. It is offered as an adjunct to therapy or to students seeking help for stress issues who are not seeking therapy. Limitations of the study include lack of random assignment to treatment categories, lack of ethnic and cultural diversity of the sample, and lack of generalization to other populations. Sample & Normative GroupsAverage Pre-TX OQ-45: All Biofeedback Lab clients63.00 Counseling Center Psychotherapy Clients Undergraduate Student Normative Sample Concurrent Validity for the OQ-45 Validity Coefficient State Trait Anxiety Inventory (STAI)- State Anxiety Scale.64 Beck Depression Inventory.62 SCL-90- General Severity Index72 Inventory of Interpersonal Problems.63 Analysis of Covariance Summary Sum of Squaresdf Mean SquareF Corrected Model ** Intercept ** Initial OQ Score ** Multiple Biofeedback Sessions ** Error Total **p < 0.01 Stress Management & Biofeedback Services BRIGHAM YOUNG UNIVERSITY Counseling & Career Center Stress Management/Biofeedback Training consisted of Stress management education; EMG/Temp/SR or HRV (emWave PC) Basic Introductory Training; and Relaxation Skills Training. Students were encouraged to use relaxation recordings and other Services website resources to master relaxation techniques outside of biofeedback appointments.