Journal List > J Korean Acad Nurs > v.48(2) > 1003301

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

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.

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Figure 1.
(A) Conceptual framework of this study. (B) Process contents of neurofeedback training.
jkan-48-208f1.tif
Figure 2.
Research flow diagram.
jkan-48-208f2.tif
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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