PSY 351 Biofeedback Training Anxiety Report

This document is a research report for the course PSY 351 Biological Bases of Behaviour, focusing on the effectiveness of biofeedback training in reducing anxiety among university students. The study involved 70 final-year undergraduate students from Murdoch University, who were randomly assigned to either an intervention group receiving biofeedback training or a control group. The research utilized the Depression Anxiety and Stress Scale (DASS-21) and Skin Conductance Level (SCL) to measure anxiety levels. The results indicated that the biofeedback program was effective in significantly reducing anxiety levels in the intervention group compared to the control group. The report includes a detailed methodology, results, and discussion, along with a marking schedule and references. The study concludes that biofeedback is a useful intervention for managing anxiety in university students.

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 1
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Name Sivasankari D/O Rajendran Student No. 32492277
Unit Code PSY 351 Unit Name Biological Bases of Behaviour
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Running head: EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 1
Biological Bases of Behaviour PSY 351
Sivasankari D/O Rajendran
32492277
Manage Anxiety Among University Students
Using Biofeedback Training
2679 words

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 2
Abstract
Researchers have documented that there is a high frequency of mental health
problems such as increase in anxiety level among the graduate students globally.
However, it is noted that not all students are able to seek help on their mental health
issues in their campuses due to limited resources. This study examined the use of
biofeedback program to reduce the anxiety level among the graduate students. 70
final-year undergraduate students from Murdoch University in Australia participated
in this study for a duration of 10 weeks. They were randomly assigned to either the
intervention group or the control group. The experiment used 2 x 2 SPANOVA to
analyse the data from Depression Anxiety and Stress Scale (DASS-21) and Skin
Conductance Level (SCL). The result supported the hypothesis that the biofeedback
program was effective in significantly reducing the anxiety level in the participants
from the intervention group, while the control group did not show any improvement
in their anxiety level. As such, biofeedback program is concluded to be an effective
intervention to reduce anxiety in the graduate students.

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 3
Manage Anxiety Among University Students Using
Biofeedback Training
Practising clinician and metal health policy makers pays more attention on
anxiety disorder as it is the most prevailing psychiatric disorder (Stein &
Vythilingum, 2015). Anxiety is part of our daily life which gives us a vital signal
functions to help us operate our daily task (Rose & Devine, 2014). However, when it
becomes irrepressible and overwhelming on daily situation, anxiety becomes a
disorder (Rose et al., 2014).
Anxiety is found in everyone regardless of age, gender or situation. For the
past few decades, there is an increase in occurrence and severity of psychological
symptoms among students from universities (Ratanasiripong, Sverduk, Prince &
Hayashino, 2012). Students face a certain amount of social and emotional problems
that interferes with their ability to function well in their studies (Lee, Olson, Locke,
Michelson & Odes, 2009). When students get overwhelmed with such pressures and
are unable to cope, the consequences lead them to anxiety, stress, depression,
impulsive behaviours and even suicide (Ratanasiripong et al., 2012). Stunning
statistics have shown that there is an increase in suicides, alcohol related incidents
and other emotional and mental related issues experience by college students
(Taylor, 2006).
Studies have shown that graduate and undergraduate students from Australia,
Greece, Taiwan and Thailand have high prevalence of negative emotions such as
stress, anxiety and depressive symptoms (Ratanasiripong, Kaewboonchoo,
Ratanasiripong, Hanklang & Chumchai, 2015). This is supported by a survey
conducted in 2012 by Association for University and College Counselling Centre
Directors (AUCCCD), which indicates that anxiety is the top existing burden college

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 4
students, followed by depression and relationship problems (Mistler, Reetz,
Krylowicz, & Barr, 2012). This leads to a next level on how the students cope with
it.
Each individual has their own coping styles and different ability to manage
their stress and anxiety (Ratanasiripong, Sverduk, Hayashino & Prince, 2010). Some
students seek help for their mental health conditions (Ratanasiripong et al., 2010),
which creates a need to have a more thorough and adequate treatment options for
them (Ratanasiripong et al., 2012). Looking at treatments, anxiety can be treated in
many ways, such as counselling, psychotherapy, drugs or CBT (Henriques, Keffer,
Abrahamson & Jeanne Horst, 2011; Ratanasiripong et al., 2012; Ratanasiripong et
al., 2015). However, it is important to develop and implement an intervention that
can be used easily by large numbers of students and be readily accessible,
economical and have minimal side effects (Henriques et al., 2011).
Students with anxiety may experience psychophysiological effects such as
increased respiratory drive, increased in heart rate, decreased blood flow to the skin,
increased in body temperature and muscle spasm (Vitasari, Wahab, Herawan &
Sinnadurai, 2011). As such, biofeedback program is one of the most suitable
protocol for students as it is designed to reduce anxiety with breathing assessment,
relaxation, music therapy, and visualisation (Henriques et al., 2011; Vitasari et al.,
2011; Ratanasiripong et al., 2012; Ratanasiripong et al., 2015). Biofeedback is a
useful treatment that helps to demonstrate a person’s mind and body interaction
(Peper, Nemoto, Lin, & Harvey, 2015). It is a simple technology, comprehensible,
cost effective and readily available (Ratanasiripong et al., 2010). According to
Pastor, Menéndez, Sanz & Abad (2008), biofeedback is a device which supports the
user to obtain their desired control over their physiological processes and serve as a

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 5
mirror to reflect back their own physiological responses. This enables them to keep
their anxiety level, stress, depression, tension and many other issues under their
control (Ratanasiripong et al., 2010).
Technology has improved vastly over the past few decades that video games
and graphics has attracted a lot of the kids and youth attention (Knox, Lentini,
Cummings, McGrady, Whearty & Sancrant, 2011). This video game technology has
been implemented in biofeedback system, which enables students to get engaged in
the learning of deep breathing, imagery and relaxation (Knox et al., 2011).
Knox, Lentini & Aiton (2011) conducted a research with anxious children
aged 7 to 19 years. The children were asked to do a game-based biofeedback coupled
with relaxation training and psychoeducation. The results showed that game-based
biofeedback training has helped the anxious children to pay more attention compared
to those children without the biofeedback training. This gives a suggestion that
biofeedback is beneficial in improving the attention problem experienced by anxious
children (Knox et al., 2011).
Henriques et al. (2011) conducted a study for 4 weeks with 9 psychology
students who were reported to have anxiety. They were instructed to use the
computer-based biofeedback for 20 days, where their heart rate is being monitored
by the system. Thereafter, submit a Mood and Anxiety Symptom Questionnaire. The
overall result showed that the biofeedback technique has indeed reduced the self-
reported anxiety and negative temperament among the students (Henriques et al.,
2011).
However, Henriques et al. (2011) conducted another study with an immediate
versus delayed treatment design, ensuring that all the participants in both the group
received the training. The results revealed that the biofeedback program did not

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 6
elevate positive mood in the student participants even though some participants have
reported a reduction in their anxiety level after the intervention (Henriques et al.,
2011).
To ascertain the previous studies, the present study is aimed to determine the
effectiveness of game-based biofeedback program among the graduate students as
not much research has been done on this basis. From the research examined, it was
anticipated that regardless of gender, the game-based biofeedback program reduced
the anxiety level among the participants. It was hypothesised that students who
received consistent biofeedback training, displayed a significant drop in their anxiety
level compared to those without the training. It is also hypothesized that the
intervention group are able to control their skin conductance level (SCL) after going
through the biofeedback training program.
Method
Design
A 2 X 2 factorial design was used to examine the effectiveness of
biofeedback training on the anxiety level shown in the participants. Results were
obtained from the Depression Anxiety and Stress Scale (DASS) and Skin
Conductance Level (SCL).
Participants
This experimental study was conducted with 70 final-year undergraduate
students from Murdoch University in Australia. The participants were randomly
divided into 2 groups: an “Intervention” group and “Control” group. Each group
consisted of 35 participants. The intervention group consisted of 19 females and 16
male participants with an age range between 21 to 56 years (M = 28.09, SD = 6.92).

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 7
The control group consisted of 18 females and 17 male participants with an age
range between 21 to 34 years (M = 25.54, SD = 2.49).
Materials
The experiment used a Depression Anxiety and Stress Scale (DASS-21),
which is a self-administered questionnaire containing 21 items. This questionnaire is
designed carefully to measure the magnitude of 3 negative emotions such as
depression, stress and anxiety (DAS) (Parkitny & McAuley, 2010). Participants will
answer the 4-point scale, where the higher score in each subscale indicates the higher
severity of DAS (Parkitny et al., 2010).
The Test-retest reliability for DASS is: depression (r) = .71), anxiety (r) = .79
and stress (r) = .81. Lovibond & Lovibond (1995) stated that the validity between the
DASS depression scale and the Beck depression scale (BDI) is (r) = .81 and a
correlation of (r) = .74 between DASS and BDI. BDI fails to distinguish the
difference between the 3 emotions compared to DASS (Lovibond et al., 2010).
The multimedia biofeedback training used the software named ‘Wild Divine’.
The software was installed on a HP laptop running Windows 7. An “IOM” electronic
biofeedback monitor (model: HR001.1) comprising of three finger sensor was used
to measure heart rate and skin conductance level (SCL). For this experiment, we
only used 2 sensors which monitored the SCL.
Procedures
This experiment was conducted for 10 weeks. During the first week, all 70
participants were advised to complete a consent form. Questions from the
participants were promptly answered by us before the commencement of the
experiment.

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 8
Participants were randomly divided into two groups “Intervention” group and
“Control” group. Participants were than instructed to complete the DASS by
following the instruction given on the handout.
After completing the handout, participants launched the ‘Wild Divine’
software in the HP laptop that was provided to them. The IOM sensor was attached
to the participant’s index and ring fingers of their non-dominant hand, to record the
electrodermal activity, SCL. Participants ensured that the pads of their fingers rested
comfortably inside the sensors with the flaps going over their fingernails.
Participants were reminded to keep their hands still as much as they could to
minimise movement artefacts. Those participants who could not produce enough
sweat gland activity, they were advised to wrap their hand with a soft cloth to keep
their hand warm.
To begin, participants relaxed quietly for 5 minutes while a baseline of their
SCL was recorded by the software. Thereafter, participants performed a test for 5
minutes, in a form of a car race. Their goal was to win the race and it can only be
achieved when they are relaxed. If they are anxious, the car will move slowly. Their
performance was monitored but no instruction where given on how to control their
anxiety level.
From week 2 to week 9, participants from the Intervention group where given
1 hour each week, to use the ‘Wild Divine’ biofeedback training program. A real-
time feedback on their SCL and heart rate was given to them so that they can
monitor their performance. For the Control group, participants simply ended classes
without the opportunity to engage in the biofeedback training.

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 9
In week 10, procedures of week 1 was repeated. Participants completed the
DASS, a baseline measurement of the mean SCL was recorded, followed by
recording of the mean SCL during the test.
Results
A 2 x 2 split plot ANOVA (SPANOVA) was used to examine the influence
of Biofeedback training program based on DASS-21 and SCL scores from the
participants of intervention group and control group in week 1 and week 10.
Initial scores obtained in week 1 for the intervention group (M = 22.89, SD =
6.38) and control group (M = 22.71, SD = 6.67) showed no significant difference
between the means of the DASS scores. However, the scores obtained in week 10
between intervention group (M = 27.97, SD = 6.12) and control group (M = 35.03,
SD = 7.66) showed that the control group had higher mean score for DASS
compared to intervention group. Hence, a significant main effect between the two
groups was obtained F (1, 68) = 4.84, p < .05. A significant interaction between time
and condition was reported, F (1, 68) = 90.08, p < .05.
For the SCL, initial scores in week 1 for the intervention group (M = .39, SD
= .20) and control group (M = .37, SD = .04) showed no significant difference in the
means. However, at week 10 the result was significant, intervention group (M = .11,
SD = 0.5) and control group (M = .43, SD = .19). Thus, a significant main effect of
time was obtained F (1, 68) = 40.03, p < .05. By analysing the means, it indicated
that intervention group (M = .25, SE = .02) had lower SCL scores than the control
group (M = .40, SE = .02).
An independent sample t-test was conducted to compare the DASS scores.
During week 1, the intervention group (M = 22.89, SD = 6.39) and control group (M
= 22.71, SD = 6.67) showed that there was no significant difference is the DASS

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 10
scores t (68) = 0.11, p = 0.91. However, in week 10 the intervention group (M =
27.97, SD = 6.12) and control group (M = 35.03, SD = 7.66) showed that there was a
significant difference is the DASS scores t (68) = 0.79, p = 0.01. The results suggest
that the control group scored higher in DASS compared to the intervention group.
The paired sample t-test for DASS score was performed to examine the
difference between the means of two different group pairs at two different times (T1)
and (T2). Intervention group, DASS T1 (M = 22.89, SD = 6.38) and DASS T2 (M =
27.97, SD = 6.12). As for the controlled group, DASS T1 (M = 22.71, SD = 6.67)
and DASS T2 (M = 35.03, SD = 7.66). The paired sample t-test revealed that there
was a significant difference found in the intervention groups between (DASS T1)
and (DASS T2), t (34) = 8.38, p < .05. A significant difference was also found in the
control group between DASS T1 and DASS T2, t (34) = 26.78, p < .05. The T2
result of control group was significantly higher than T1 result.
The independent t-test conducted for SCL in T1 showed for intervention
group (M = 0.39, SD = 0.20) and control group (M = 0.37, SD = 0.41) the result was
not significant t (68) = .63, p > .05. Where else for SCL in T2, the intervention group
(M = 0.11, SD = 0.5) and control group (M = 0.43, SD = 0.19) showed the results
was a significant t (68) = 9.74, p < .05.
The paired sample t-test was performed to examine the difference between
the means of two different group pairs at two different times (T1) and (T2).
Intervention group, SCL T1 (M = 0.38, SD = 2.0) and SCL T2 (M = 0.12, SD =
0.05). As for the controlled group, SCL T1 (M = 0.37, SD = 0.04) and SCL T2 (M =
0.43, SD = 0.19). The paired samples t-test revealed that for the intervention group
the SCL score was significant, t (34) = 7.77, p < .05 where else for control group
there was no significant difference in the SCL score, t (34) = 1.79, p > .05.

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 11
Discussion
The overall results showed that after the training, the intervention group has
lower level of DAS compared to those of control group which is supported by the
hypothesis.
This result is supported by a study conducted by Vitasari et al. (2011), where
the study was conducted in a similar way for 10 weeks with 2 groups, intervention
and control group. The participants where students with high anxiety level. They
were evaluated on the 1st session, 4th session, 7th session and 10th session for their
heart and breathing rate. The results showed that after the completion of the 10th
sessions, students are able to reduce their anxiety level by controlling their heartbeat
and respiration (Vitasari et al., 2011).
Another study by Ratanasiripong et al. (2015) was conducted with 60
students from the nursing faculty for 4 weeks. They were divided into 2 groups,
intervention and control group, to investigate the effectiveness of biofeedback
training in reducing the symptoms of DAS. The results indicated that the
biofeedback program was effective in significantly reducing the levels of DAS in the
nursing students compared to the control group, where their anxiety and depression
level showed an increase.
For the present research, it was noted that the intervention group self-reported
DASS score for week 10 was slightly sig higher than the scores obtained in week 1.
But the SCL showed that their depression, anxiety and stress level had decreased in
week 10 compared to week 1. It is predicated that the increased DASS score could
be due the fatigue level or academic stress (ref).
Despite the results were supportive to the hypothesis for the present study, it
was noted that there were some limitations. The participants did not report if they

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 12
have any comorbid disorders. The present study has 2 dropouts, reducing the
participant number to 68 and evaluation was only done in week 1 and week 10.
For future research, it is encouraged for participants to provide their
psychophysiological status to have a promising result on the effectiveness of
biofeedback training. Furthermore, evaluation could be done at a frequent interval to
monitor the progress of their anxiety level.
In conclusion, biofeedback intervention has proven to have worked well for
many students to aid them in reducing the anxiety level and many other areas. They
are able to alter their psychological functions to improve their health and
performance.
Lack of depth of explanation of what biofeedback is, how it works and the
theory behind it. There was no rationale given for the study. Results were not
reported in the right order. No discussion of how the SCL findings compared with
past research. DASS explanation needs to be supported by reference to empirical
research.
Mark – 17.1/30
PSY351 Marking Schedule: Lab Report
Students Name: Date:
This marking schedule is designed to give you feedback on the structure and content of your lab
report. This schedule makes it easier for standardisation and consistency in marking, as well as
providing clarity and consistency in expectations across courses.
 This marking schedule is based on ones you have received previously (for example in
PSY211 Psychological Methods I) so these criteria should NOT be a surprise to you.
 Do not try to add the ticks to determine your grade.
 Your grade is based on the relative quality and balance of your argument.
Title
Yes Part No
Concise, stating theoretical issue or variable under
investigation
X
Abstract
Yes Part No
Summarises purpose, method, results and x

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 13
interpretation
Appropriate length and style x
x
Introduction
Intro
Yes Part No
Statement description of topic X
Moves from general to specific issues X
Indicates the motivation for the present study X
Definition of concepts and terms X
Body – Account of Theoretical Background
Yes Part No
Adequately describes theory / theories X
Relates relevant findings from previous research to
theory
X
Present Study
Yes Part No
Develops logical rationale for present study X
Clear and logical explanation of experimental aims X
Clear and logical hypotheses expressed in terms of
experimental variables
X
Method
Participants
Yes Part No
Adequate description – number, age, gender, etc X
Population from which the sample was drawn X
Materials
Yes Part No
All relevant materials mentioned X
Adequate description of materials X
Indicates what tests/tasks were intended to measure X
Indicates which experimental task used which
materials
X
Procedure
Yes Part No
Adequate description of procedure X
Adequate description of dependent variables (DVs) X
Presented in chronological order enabling future
replications
x
Results
Yes Part No
Presented in logical sequence X
Reports descriptive statistics appropriately X

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 14
Results
Yes Part No
Interprets descriptive statistics appropriately X
Reports inferential statistics appropriately X
Interprets inferential statistics appropriately X
States explicitly why statistics were calculated X
Does not repeat information in text/tables/figures
APA style tables and figures – titled, numbered,
labelled
Appropriately references figures and tables in text
Accurate data manipulation – accuracy of data
analysis and interpretation
X
Discussion
Yes Part No
Describes how present findings relate to hypotheses X
Comparison of results with previous research –
consistency, reasons why they are similar/different
X X
Discussed methodological strengths and what
alternative interpretations they rule out
X
Discussed methodological weaknesses and what
alternative interpretations they fail to rule out
X
Discusses theoretical implications of findings and
draws sensible conclusions
X X
Makes sensible, specific suggestions for the
implications of the findings for organisations or
individuals
X
Makes sensible, specific suggestions for future
research
X
Concluding statement X
References
Reference List
Yes Part No
Reference list is in the correct APA style. X
Complete list of sources cited within the text (and no
additional ones not cited).
X
Referencing
Yes Part No
Correct APA style of referencing within the text. X
Adequate frequency of references. X
Ample and broad use of the literature. Did
utilise/consider information from key researchers in
this field.
X
All points other than the author’s own referenced (as
appropriate)
x

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 15
Appendices
Yes Part No
Clearly organised
Referred to appropriately in main text
Style and Presentation
Yes Part No
Presents a cohesive argument X
Evidence provided for claims made X
Findings are fully interpreted X
Logical links made between theory and empirical
method and results
X
Considers alternative interpretations and offers
balanced argument
X
Communicates points clearly X
Coverage of points reflects their importance X
Clear and concise prose X
Objective style X
Third person and past tense X
Correct spelling, grammar and punctuation X
Neat presentation and legible X

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 16
Reference
Henriques, G., Keffer, S., Abrahamson, C., & Jeanne Horst, S. (2011). Exploring the
effectiveness of a computer-based heart rate variability biofeedback program
in reducing anxiety in college students. Applied Psychophysiology and
Biofeedback, 36(2), 101-112. doi:10.1007/s10484-011-9151-4
Knox, M., Lentini, J., & Aiton, S. (2011). Effects of Game-Based Relaxation
Training on Attention Problems in Anxious Children. Toledo, OH: The
University of Toledo College of Medicine.
Knox, M., Lentini, J., Cummings, T. S., McGrady, A., Whearty, K., & Sancrant, L.
(2011). Game-based biofeedback for paediatric anxiety and depression.
Mental health in family medicine, 8(3), 195.
Lee, D., Olson, E. A., Locke, B., Michelson, S. T., & Odes, E. (2009). The effects of
college counseling services on academic performance and retention. Journal
of College Student Development, 50(3), 305-319.
Lovibond, S. H., & Lovibond, P. F. (1995). The structure of negative emotional
states: Comparison of the depression anxiety stress scales (DASS) with the
beck depression and anxiety inventories. Behaviour Research and Therapy,
33(3), 335-343. doi:10.1016/0005-7967(94)00075-U
Mistler, B. J., Reetz, D. R., Krylowicz, B., & Barr, V. (2012). The association for
university and college counseling center directors annual survey. Association
for University and College Counseling Center Directors (Producer).
Retrieved from URL: Http://www. Aucccd. Org.
Parkitny, L., & McAuley, J. (2010). The depression anxiety stress scale (DASS).
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Pastor, M. C., Menéndez, F. J., Sanz, M. T., & Abad, E. V. (2008). The influence of

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 17
respiration on biofeedback techniques. Applied Psychophysiology and
Biofeedback, 33(1), 49-54.
Peper, E., Nemoto, S., Lin, I., & Harvey, R. (2015). Seeing is believing: Biofeedback
as a tool to enhance motivation for cognitive therapy. Biofeedback (Online),
43(4), 168. doi:10.5298/1081-5937-43.4.03
Ratanasiripong, P., Kaewboonchoo, O., Ratanasiripong, N., Hanklang, S., &
Chumchai, P. (2015). Biofeedback intervention for stress, anxiety, and
depression among graduate students in public health nursing. Nursing
Research and Practice, 2015. doi:10.1155/2015/160746
Ratanasiripong, P., Sverduk, K., Hayashino, D., & Prince, J. (2010). Setting up the
next generation biofeedback program for stress and anxiety management for
college students: A simple and cost-effective approach. College Student
Journal, 44(1), 97
Ratanasiripong, P., Sverduk, K., Prince, J., & Hayashino, D. (2012). Biofeedback
and counseling for stress and anxiety among college students. Journal of
College Student Development, 53(5), 742.
Rose, M., & Devine, J. (2014). Assessment of patient-reported symptoms of anxiety.
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Stein, D. J., & Vythilingum, B. (2015). Anxiety disorders and gender. Cham:
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Symptoms | Anxiety and Depression Association of America, ADAA. (2015,
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http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-
gad/symptoms
Taylor, Y. (2006). College of the overwhelmed: The campus mental health crisis and

EFFECTIVENESS OF BIOFEEDBACK INTERVENTION 18
what to do about it. Journal of College and Character, 7(8)
doi:10.2202/1940-1639.1223
Vitasari, P., Wahab, M. N. A., Herawan, T., & Sinnadurai, S. K. (2011).
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