The Effects of Neurofeedback Training on Physical, Psychoemotional Stress Response and Self-Regulation for Late Adolescence: A Non-Randomized Trial

Moon-Ji Choi; Wan-Ju Park

doi:10.4040/jkan.2018.48.2.208

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Choi and Park: The Effects of Neurofeedback Training on Physical, Psychoemotional Stress Response and Self-Regulation for Late Adolescence: A Non-Randomized Trial

Original Article

J Korean Acad Nurs 2018;48(2):208-220.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.2.208

The Effects of Neurofeedback Training on Physical, Psychoemotional Stress Response and Self-Regulation for Late Adolescence: A Non-Randomized Trial

Moon-Ji Choi, Wan-Ju Park

College of Nursing, Kyungpook National University, Daegu, Korea

Address reprint requests to : Park, Wan-Ju College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-420-4977 Fax: +82-53-421-2758 E-mail: wanjupark@knu.ac.kr

Received 5 July 2017 Revised 9 April 2018 Accepted 10 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The aim of this study was to analyze the effects of neurofeedback training for reducing stress and enhancing self-regulation in late adolescence to identify the possibility of use for nursing intervention.

Methods

A nonequivalent control group pre-post quasi-experimental design was used. Participants were 78 late adolescents assigned to the experimental group (n=39) that received the neurofeedback training and the control group (n=39). Data were collected on heart rate variability (HRV) and skin conductance level (SCL) to assess stress-biomarker response. The questionnaire contained 164 items from: Positive and Negative Affect Schedule (PANAS), Symptom Checklist-90-Revised (SCL-90-R) and Self-regulatory Ability scale. The neurofeedback training was based on the general adaptation syndrome and body-mind medicine. The intervention was conducted in a total of 10 sessions for 30 minutes per session with high-beta, theta and sensory motor rhythm training on scalp at central zero.

Results

There were significant difference in standard deviation of normal to normal interval (p=.036) in HRV and SCL (p=.029) of stress-biomarker response between the two groups. Negative affect (p=.036) in PANAS and obsessive compulsive (p=.023) and depression (p<.001) in SCL-90-R were statistically significant. Self-regulation mode (p=.004) in self-regulation ability scale showed a significant difference between the two groups.

Conclusion

The results indicated that the neurofeedback training is effective in stress-biomarkers, psy-choemotional stress response and self-regulation. Therefore, neurofeedback training using neuroscientific approach based on brain-mind-body model can be used as an effective nursing intervention for late adolescents in clinics and communities for effective stress responses.

Keywords: Neurofeedback, Stress, Physiological, Stress, Psychological, Self-control, Adolescent

References

1. Walker EF, Walder DJ, Reynolds F. Developmental changes in cortisol secretion in normal and at-risk youth. Development and Psychopathology. 2001; 13(3):721–732.

2. Hall GS. Adolescence. New York: Appleton and Company;1904. p. 81.

3. Rice VH. Handbook of stress, coping, and health: Implications for nursing research, theory, and practice. 2nd ed. Los Angeles (CA): Sage;2012. p. 1–588.

4. Statistics Korea. Health insurance review & assessment service [Internet]. Daejeon: Statistics Korea;c2017. [cited 2017 Apr 18]. Available from:. http://kostat.go.kr/portal/korea/index.action.

5. Korean Journal of Stress Research. Understanding about stress science. Seoul: Shinkwang;1997. p. 486.

6. Chang HK. Theoretical issues in mind-body medicine. Korean Association of Mediational Healing. 2010; 1(1):1–16.

7. Cheong MJ, Jo HI, Chae EY. Meta analysis on the effects of neuro-feedback training programme. Journal of the Korea Academia-Industrial Cooperation Society. 2016; 17(12):582–593. https://doi.org/10.5762/KAIS.2016.17.12.582.

8. Thompson M, Thompson L. The neurofeedback book: an introduction to basic concepts in applied psychophysiology. 2nd ed. Wheat Ridge (CO): Association for Applied Psychophysiology & Biofeedback;2015. p. 857.

9. Koberda JL, Koberda P, Moses A, Winslow J, Bienkiewicz A, Koberda L. Z-score LORETA neurofeedback as a potential therapy in depression and anxiety. NeuroConnections. 2014; Spring. 52–55.

10. Hammond DC. QEEG-Guided neurofeedback in the treatment of obsessive compulsive disorder. Journal of Neurotherapy. 2003; 7(2):25–52. http://doi.org/10.1300/j184v07n02_03.

11. Lee KH. A Study on how Neurofeedback system reduces stress level of employee [master’s thesis]. [Seoul]: Hanyang University;2016. p. 1–68.

12. Kum MH, Kang YM, Kim HK, Jung HS, Han MY. Study on brain function enhancement and the effects of stress reduction through neuro-feedback training on nursing students of Busan. The Korean Journal of Health Service Management. 2012; 6(2):111–119. http://doi.org/10.12811/kshsm.2012.6.2.111.

13. Selye H. Forty years of stress research: Principal remaining problems and misconceptions. Canadian Medical Association Journal. 1976; 115(8):53–56.

14. Barrows KA, Jacobs BP. Mind-body medicine. An introduction and review of the literature. Medical Clinics of North America. 2002; 86(1):11–31. https://doi.org/10.1016/S0025-7125(03)00069-5.

15. Abell N. The Index of Clinical Stress: A brief measure of subjective stress for practice and research. Social Work Research and Abstracts. 1991; 27(2):12–15. http://doi.org/10.1093/swra/27.2.12.

16. Oh SD, Kim SJ. The effects of modeumbook-play group music therapy program on the stress and self-esteem of university student. The Journal of the Research and Information Service. 2013; 13:81–90.

17. Kwon RH. The effects of biofeedback training on stress and academic resilience of the nursing students [master’s thesis]. [Seoul]: Seoul National University;2012. p. 1–71.

18. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology. 1988; 54(6):1063–1070. http://doi.org/10.1037/0022-3514.54.6.1063.

19. Lee HH, Kim EJ, Lee MK. A validation study of Korea positive and negative affect schedule: The PANAS scales. Korean Journal of Clinical Psychology. 2003; 22(4):935–946.

20. Derogatis LR, Cleary PA. Confirmation of the dimensional structure of the scl-90: A study in construct validation. Journal of Clinical Psychology. 1977; 33(4):981–989. http://doi.org/10.1002/1097-4679(197710)33:4<981::aid-jclp2270330412>3.0.co;2-0.

21. Kim KI, Kim JH, Won HT. Korean manual of symptom checklist-90-revision. Seoul: Jung Ang Juk Sung Publisher;1984. p. 10.

22. Kuhl J, Fuhrmann A. Decomposing self-regulation and self-control: The volitional components inventory. Heck-hausen J, Dweck CS, editors. Motivation and Self-Regualtion Across the Life Span. 2nd ed. Cambridge: Cambridge University Press;1998. p. 48. http://doi.org/10.1017/cbo9780511527869.003.

23. Yoon YS. Self-regulation related variable of adolescent [dissertation]. [Seoul]: Sookmyung University;2007. p. 98.

24. Demos JN. Getting started with neurofeedback. New York: W. W. Norton& Company;2005. p. 1–280.

25. Collura TF. Technical foundations of neurofeedback. New york: Routledge;2014. p. 266.

26. Corrales MM, Torres BDLC, Esquivel AG, Salazar MAG, Orellana JN. Normal values of heart rate variability at rest in a young, healthy and active Mexican population. Health. 2012; 4(7):377–385. http://doi.org/10.4236/health.2012.47060.

27. Friedrich EVC, Courellis H, Tonnesen AL, Gevirtz R, Pineda JA. Is heart rate variability a predictor for neurofeedback effects? Müller-Putz G, Bauernfeind G, Brunner C, Steyrl D, Wriessnegger S, Scherer R, editors. Proceedings of the 6th international brain-computer interface conference; 2014 Sep 16-19. Graz: Graz University of Technology Publishing House;c2014. p. 88–91.

28. Goodman MS, Castro N, Sloan M, Sharma R, Widdowson M, Herrera E, et al. A neurovisceral approach to autism: Targeting self-regulation and core symptoms using neurofeedback and biofeedback. NeuroRegulation. 2018; 5(1):9–29. https://doi.org/10.15540/nr.5.1.9.

29. Ahn DH. Mental disorders in adolescents. Journal of Korean Medical Association. 2009; 52(8):745–757. https://doi.org/10.5124/jkma.2009.52.8.745.

30. Ahn SK. A study on the effect prefrontal lobe neurofeedback training on the primary student about selfregulation ability. Journal of the Korea Academia-Industrial cooperation Society. 2010; 11(11):4161–4166. https://doi.org/10.5762/KAIS.2010.11.11.4161.

Figure 1.

(A) Conceptual framework of this study. (B) Process contents of neurofeedback training.

Figure 2.

Research flow diagram.

Table 1.

Homogeneity of General Characteristics and Study Variables between Experimental and Control Groups (N=78)

Characteristics/Variables	Categories/Scales	Subgroup	Exp. (n=39)	Cont. (n=39)	χ²/t/Z	p
			n (%)/M±SD	n (%)/M±SD
Gender	Female		30 (76.9)	27 (69.2)	0.59	.444
	Male		9 (23.1)	12 (30.8)
Age (yr)	14~19		14 (37.5)	15 (36.5)	0.22	.637
	20~24		25 (62.5)	24 (63.5)
Religion	Yes		6 (15.4)	9 (23.1)	0.74	.389
	No		33 (84.6)	30 (76.9)
Economic status	Good		33 (84.6)	30 (76.9)	0.74	.389
	Bad		6 (15.4)	9 (23.1)
Substance addiction	Yes		12 (30.8)	11 (28.2)	0.06	.804
	No		27 (69.2)	28 (71.8)
Behavioral addiction	Yes		18 (46.2)	13 (33.3)	1.34	.247
	No		21 (53.8)	26 (66.7)
Living	Dormitory		11 (28.2)	9 (23.1)	0.31	.587
	With family		25 (64.1)	27 (69.2)
	Alone		3 (7.7)	3 (7.7)
Stress level	Index of clinical stress		2.77±0.82	2.59±0.86	0.96	.339
Physical stress response	HRV	SDNN	80.32±35.29	92.26±54.50	−0.57^†	.572
	SC	SCL	1.49±1.23	1.01±0.81	−1.82^†	.068
Emotional stress response	PANAS	Positive	2.45±0.58	2.58±0.66	−0.98	.332
		Negative	2.09±0.71	2.03±0.66	0.40	.694
Psychiatric stress response	SCL-90-R	SOM	50.92±7.74	50.17±7.17	0.44	.662
		O-C	61.37±6.59	60.94±7.23	0.27	.788
		I-S	56.22±7.09	55.80±7.50	0.25	.804
		DEP	60.05±7.29	57.08±8.81	1.62	.111
		ANX	48.10±5.07	47.42±5.21	0.58	.566
		HOS	44.59±6.88	44.07±4.97	0.39	.701
		PHOB	41.06±3.44	40.85±3.60	0.26	.795
		PAR	42.99±5.16	45.33±5.47	−1.94	.056
		PSY	44.95±5.05	44.45±4.47	0.46	.646
Self regulation	Self-regulatory ability	Self-regulation mode	2.90±0.78	3.01±0.58	−0.68	.496
		Volitional inhibition mode	3.10±0.57	2.82±0.65	1.80	.077

ANX=Anxiety; Cont.=Control group; DEP=Depression; Exp.=Experimental group; HOS=Hostility; HRV=Heart rate variability; I-S=Interpersonal sensitivity; M±SD=Mean±Standard deviation; O-C=Obsessive compulsive; PANAS=The positive and negative affect schedule; PAR=Paranoid Ideation; PHOB=Phobic anxiety; PSY=Psychoticism; SC=Skin conductance; SCL=Skin conductance level; SCL-90-R=Symptom checklist-90-revised; SDNN=Standard Deviation of Normal to Normal Interval; SOM=Somatization.

^†Value of z by Mann-Whitney test.

Table 2.

Comparisons of Study Variables between Experimental and Control Groups (N=78)

Variable	Scale	Subgroup	Group^†	Pre-test	Post-test	Difference	t/Z	p
				M±SD	M±SD	M±SD
Physical	HRV	SDNN	Exp.	80.32±35.29	105.66±78.87	25.34±66.23	−2.09^††	.036
stress response			Cont.	92.26±54.50	83.37±58.84	−8.89±72.77
	SC	SCL	Exp.	1.49±1.23	1.09±0.67	−0.40±1.10	−2.18^††	.029
			Cont.	1.01±0.81	1.12±0.71	0.11±0.69
Emotional	PANAS	Positive	Exp.	2.45±0.58	2.51±0.65	0.06±.0.55	1.55	.126
stress response			Cont.	2.58±0.66	2.50±0.59	−0.08±0.48
		Negative	Exp.	2.09±0.71	1.66±0.73	−0.43±0.61	−2.15	.036
			Cont.	2.03±0.66	1.91±0.74	−0.12±0.65
Psychiatric	SCL-90	SOM	Exp.	50.92±7.74	50.64±7.50	−0.28±6.77	0.93	.355
stress response			Cont.	50.17±7.17	49.81±6.83	−0.36±7.24
		O-C	Exp.	61.37±6.59	58.17±7.50	−3.20±8.01	−2.35	.023
			Cont.	60.94±7.23	62.39±6.02	1.45±6.18
		I-S	Exp.	56.22±7.09	57.40±8.46	1.18±8.70	1.62	.111
			Cont.	55.80±7.50	52.89±6.73	−2.91±7.20
		DEP	Exp.	60.05±7.29	56.21±7.76	−3.84±7.89	−3.99	<.001
			Cont.	57.08±8.81	60.07±8.97	2.99±9.68
		ANX	Exp.	48.10±5.07	46.51±4.19	−1.59±6.34	−0.86	.393
			Cont.	47.42±5.21	47.44±4.93	0.02±6.08
		HOS	Exp.	44.59±6.88	43.54±3.81	−1.05±5.66	−0.17	.868
			Cont.	44.07±4.97	43.68±3.90	−0.39±4.47
		PHOB	Exp.	41.06±3.44	41.50±2.25	0.44±3.51	−0.16	.870
			Cont.	40.85±3.60	42.44±3.75	1.59±3.81
		PAR	Exp.	42.99±5.16	44.19±5.71	1.20±4.79	1.41	.164
			Cont.	45.33±5.47	44.66±4.37	−0.67±5.42
		PSY	Exp.	44.95±5.05	44.51±4.40	−0.44±6.45	−0.44	.661
			Cont.	44.45±4.47	44.42±5.01	−0.03±6.51
Self-regulation	Self-regulat	tory Self-regulation	Exp.	2.90±0.78	3.50±0.81	0.60±0.72	3.05	.004
	ability sca	ale mode	Cont.	3.01±0.58	3.04±0.60	0.03±0.44
		Volitional inhib	bition Exp.	3.10±0.57	2.97±0.88	−0.13±1.04	−1.25	.218
		mode	Cont.	2.82±0.65	3.00±0.79	0.18±1.12

ANX=Anxiety; Cont.=Control group; DEP=Depression; Exp.=Experimental group; HOS=Hostility; HRV=Heart rate variability; I-S=Interpersonal sensitivity; M±SD=Mean±Standard deviation; O-C=Obsessive compulsive; PANAS=The positive and negative affect schedule; PAR=Paranoid Ideation; PHOB=Phobic anxiety; PSY=Psychoticism; SC=Skin conductance; SCL=Skin conductance level; SCL-90-R=Symptom checklist-90-revised; SD=Standard deviation; SDNN=Standard Deviation of Normal to Normal Interval; SOM=Somatization.

^†39 people in each of the experimental and control groups; ^††Value of z by Mann-Whitney test.

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