Effectiveness of Biofeedback Therapy As Measured by the Outcome Questionnaire
*George Maycock, Ed.D., Certified Biofeedback Therapist
Associate Professor
Department of Leadership and Educational Studies
Appalachian State University
Katherine B. Olson, Certified Biofeedback Therapist
Wellness Center Coordinator
Annas Student Support Building
Appalachian State University
Abstract
The Outcome Questionnaire showed significant (t= 3.75, p= 0.001) relief in symptom distress, including anxiety and stress, for clients receiving biofeedback services at a university wellness center. This corresponded with subjective ratings, which showed that 86% of the clients had improvement in symptoms. Also, EMG measures showed a significant (t= 3.78, p= 0.000) mean decrease in muscle tension. Those clients showing the greatest symptom relief experienced improvement in one or more biofeedback measures (EMG, EDR, temperature) and decreased OQ scores below distress levels. It appeared that biofeedback therapy was successful in reducing stress symptoms for most of the clients. Results also indicated that the Outcome Questionnaire may be a useful measure for documenting the outcome of biofeedback treatment.
Purpose of Study
The Purpose of this study was to determine the effectiveness of biofeedback therapy using the Outcome Questionnaire. Biofeedback services were offered to students through the Wellness Center at a medium sized state university. The purpose of the Wellness Center is to help students learn to manage the physical and psychological effects of stress, as well as offering lifestyle management resources such as nutrition education, smoking cessation, weight management, alcohol and drug education and risk management, and peer education outreach programs.
Participants
Participants were 63 students at the university who received biofeedback services and completed the Outcome Questionnaire instrument during the two-year period from May 1998 to May 2000. Most of the students were referred to biofeedback services by university physicians, counselors, faculty, or were self-referred.
Method
Biofeedback was provided and measures recorded using a J&J I-330 with standard electrode placement for EMG, EDR, and temperature. Biofeedback therapy was provided by a trained therapist and supervised practicum students. A student receiving biofeedback therapy usually had one 50-minutes session per week. During biofeedback therapy sessions students learned progressive muscle relaxation, imagery, and hand warming techniques successively as sessions progressed. Case files were examined to obtain biofeedback measures during a two and a half minute pre-baseline period prior to any training. This information was compared to the individual's final session where a two and a half minute baseline measure was also taken prior to training during that session. The therapist's case closing summary notes were used to determine symptoms at the client's last session. Symptoms were rated by a trained biofeedback therapist who had not provided biofeedback training for the cases studied. Symptoms were rated on the following scale: (1) no change, (2) slightly improved, (3) somewhat improved, (4) markedly improved.
Client progress was measured by the Outcome Questionnaire (OQ) which was administered prior to treatment and again following the final session of services. The OQ was designed by Lambert (1983) to measure subjective discomfort, including anxiety and stress, interpersonal relations, level of comfort or dissatisfaction with social role, and a total score. A high score may indicate a large number of symptoms of distress, such as anxiety, depression, and stress. The test-retest reliability is .84 and criterion related validity correlations with other instruments are .63 (Beck Depression Scale), .88 (Tailor Manifest Anxiety Scale) and .64 (State-Trait Inventory).
Results
The most predominant primary symptoms of students receiving biofeedback were general stress (36%), followed by anxiety (30%), headaches (9%), panic attacks (9%), irritable bowel syndrome (6%) and insomnia (5%). Secondary symptoms included IBS/digenstive problems (31%) and headaches (27%).
A statistically significant decrease was found from pre to post test measures on the Outcome Questionnaire (OQ) (t= 3.75, p= .001). OQ mean total scores were at 66.00 on the pretest, which is above the cutoff of 63, indicating they felt high distress. Scores decreased to a mean of 53.00, which is considered a significant and reliable reduction by the test manual. Subscale scores for symptom distress (anxiety & stress) were at 41.24 prior to biofeedback services, which is above the cutoff indicating significant distress. Sixty one percent had OQ measure above the cutoff for severe distress prior to biofeedback services. Following biofeedback services the mean decreased to 31.86 which was a statically significant decrease (t= 4.30, p= .000) and below the distress cutoff. Significant decreases also occurred on the subscale scores for interpersonal relations (t= 2.34, p= .03) and level of comfort with social role (t= 2.66, p= .01). All but one of the 21 clients who took the OQ before and after services showed improvement in their scores and had scores below the cutoff for distress.
Symptom ratings at the last session for all clients indicated that 14% showed no change, 39% slight improvement, 35% somewhat improved, and 9% markedly improved. Most of the clients that showed no improvement in symptoms discontinued services after only one session. The average number of biofeedback sessions for all clients was 3.3.
Overall for the 63 biofeedback clients, EMG measures significantly decreased for the baseline measures from the first to last therapy session. The EMG average decrease was from 8.72 to 6.33, which was a statistically significant decrease (t= 3.78, p= .000). Changes in EDR and temperature were not statistically significant. There was also a statistically significant negative correlation between the OQ interpersonal relations subscale scores and the number of sessions of biofeedback (r= -.252, p= .05). The more biofeedback sessions that client had the lower interpersonal relations distress score.
For the twenty eight clients (44%) that showed the most symptom relief, all but three showed an improved biofeedback reading on one or more modalities. Sixteen reduced EMG measure by an average of 5.5 points, fifteen reduced EDR measures by 5.4 points and twelve increased temperature by 4.8 degrees. Only nine of these clients had taken the OQ pretest. Their average subjective discomfort score on the pretest was 38 and total score averaged 63. These scores were above the cutoff indicating considerable distress.
Discussion
The Outcome Questionnaire showed significant relief in symptom distress, including anxiety and stress, for the clients receiving biofeedback services. This corresponded with the subjective ratings of symptoms, where 86 percent of the clients showed improvements in symptoms. Also, EMG measures showed a significant mean decrease in muscle tension for these individuals. Those clients showing the most significant symptom relief experienced improvements in one or more of the biofeedback measure (EMG, EDR, temperature). Based on this information it appeared that biofeedback services were successful in reducing stress symptoms for most of the students. It also appears that the Outcome Questionnaire may be a useful measure for documenting the outcome of biofeedback treatment.
References
Lambert, M.J. (1983). The Assessment of psychotherapeutic Outcome. New York: Wiley & sons.
*Communications should be addressed to: George Maycock, Ed.D., Leadership and Educational Studies, Appalachian State University, Post Office Box 32086