The increasingly high prevalence of chronic stress, depression, and anxiety worldwide highlights the urgent need for innovative, accessible and practical approaches to help people develop key skills that will enable them to support and enhance their mental health and wellbeing. Work commitments, family issues, relationship problems, academic challenges, or high expectations to achieve (whether it be on stage, the sports field or in the corporate sector) are constant sources of stress and pressure that can lead to unhelpful and unpleasant emotions. These can interfere with daily life, and the ability to function optimally, undermine one’s sense of happiness, satisfaction and enjoyment of life, and have the potential to lead to serious health conditions. 

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There are a number of evidence-based approaches that can improve wellbeing and performance. The BIO-DASH program incorporates Positive Psychology, Cognitive Behaviour Therapy, Mindfulness and relaxation techniques all of which have been found to be effective in ameliorating anxiety, relieving stress, building positive emotions, and strengthening focus, coping skills, engagement and resilience. 

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Recognising that every individual will have their own unique need for and response to each skill taught, BIO-DASH equips participants with a ‘toolbox’ of strategies that they can draw upon according to their needs.  However, determining which strategies are the most personally effective, how to improve, or even if one is improving with practice can be difficult in the initial stages of skill acquisition especially without objective feedback, making it difficult to maintain engagement and commitment.

That’s where Biofeedback can make a difference…

Our emotional and psychological state is reflected by physiological changes within our body. Heart rate, respiration, galvanic skin response (changes in electrical skin conductance in response to sweating) and brain signals will vary according to whether we are feeling calm, depressed, tense, stressed, or anxious.  These bodily changes can be so subtle that we are often unaware that they are occurring.

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Biofeedback devices can detect these minor changes in physiological signals.  By presenting them as meaningful visual or auditory cues users are able to gain real-time, tangible and objective measures of their personal response to stress and specific stress-reduction techniques. This means that we can tap into and learn to identify the early and subconscious signs of increasing distraction, tension, stress and anxiety and work out the best way to gain control over bodily functions which are not normally thought to be under conscious control. Over time with the right kind of training, application and practice we can even learn to self-regulate these processes automatically without relying  on biofeedback information.  

Biofeedback helps people develop an awareness of the connection between their thoughts, feelings and behaviours and their physiological response. Developing a more nuanced awareness of this mind-body connection enhances the capacity to manage and control the psychological and physical symptoms we experience when anxious or stressed. In addition, the ability to monitor and ‘see’ the beneficial effects of various strategies, even when these may not ‘feel’ obvious, builds confidence in the practical benefits of the techniques and in our competence to use them. This increases perceived control and psychological wellbeing.

What the research shows…

Biofeedback is used to improve physical and mental health, and has been found to be beneficial in the treatment of a variety of medical conditions such as chronic pain, headaches, hypertension, anxiety, Post Traumatic Stress Disorder, depression and Attention Deficit Hyperactivity Disorder (ADHD: Frank et al, 2010).  It has also been incorporated into stress management programs across a number of settings including workplaces, medical and sport contexts.  Biofeedback has been shown to be a valuable adjunct to more traditional psychological and behavioural techniques in reducing stress and improving coping mechanisms (De Witte et al., 2019). Its efficacy for enhancing performance within sports, performing arts, corporate and academic contexts is also well documented.  When biofeedback is integrated with mental skills training it can help individuals achieve an optimal mental and physical state necessary for performing successfully under pressure (Blumenstien & Orbach, 2014).

Historically biofeedback has been applied in clinical settings or a laboratory and guided by a therapist making it costly and inaccessible to many people. More recently rapid advancement in mobile health technology has seen the development of reliable, cost-effective devices that enable training in any setting. BIO-DASH innovatively incorporates a variety of these portable devices into its wellbeing program providing participants with new insights into their physiology and deepening their understanding of their personal mind and body connection. 

These mobile devices which measure galvanic skin response, respiration, and brain activity have been shown to lead to greater reductions in stress and anxiety, improve mental performance, attention and reaction times and relieve post-traumatic stress symptoms with relatively brief training sessions (Balconi et al., 2017; Crivell et al., 2019; Schuurmens et al., 2019).  For instance, 30 minutes of biofeedback training using a portable galvanic skin response biofeedback instrument can produce immediate short-term reductions in psychological and physiological measures of stress (Dillon et al., 2016). Other studies investigating neurofeedback headbands have shown that people can learn to reliably manipulate their brain activity to be in a state of relaxation or concentration with just 60-90 second training blocks (Kovacevic et al., 2015). Positive longer-term effects have also been noted with more prolonged training. Young people with clinical mental disorders were able to reduce depression, anger, anxiety and stress over a six week period with bi-weekly, 15-minute biofeedback sessions (Schuurmens et al., 2019). The fact that these benefits were maintained even after the training had been completed highlights the efficacy of using biofeedback to enable people to learn the skills to self-regulate and gain control over their wellbeing.    

Combining biofeedback, relaxation, focus and health-promotion strategies with gamification has the additional benefit of improving engagement, motivation and adherence to healthy behaviour changes (Dillon et al, 2016; Johnson et al., 2016). Incorporating competitive game play elements (points, levels, challenges, badges, feedback) may also lead to a better transfer of skills to real-world situations. Often wellbeing or health-promotion skills are taught and honed within familiar and calm environments so individuals do not have the opportunity to learn to modulate their stress response under more challenging and distracting conditions and in different contexts.  Competitive biofeeback games can induce stress, simulating real-world conditions and are more likely to lead to improved performance or more effective stress management when people are actually under pressure in their daily lives (De Witte et al., 2019; Dillon et al, 2016). BIO-DASH uses competitive game-based biofeedback to maximise opportunities for participants to learn to self-regulate under various conditions so that they are well equipped to manage their stress response in a real-world context.   

References

Balconi, M., Fronda, G., Venturella, I., & Crivelli, D. (2017). Conscious, pre-conscious and unconscious mechanisms in emotional behaviour: Some applications to the mindfulness approach with wearable devices. Applied Sciences, 7, 1280.

Blumenstein, B., & Orbach, L. (2014). Biofeedback for sport and performance enhancement. In Oxford Handbooks online. Oxford University Press.

Crivelli, D., Fronda, G., Venturella, I., & Balconi, M. (2019). Supporting mindfulness practices with brain-sensing devices. Cognitive and electrophysiological evidences. Mindfulness, 10, 301-311.

De Witte, N. A., Buyck, I., & Daele, T. V. (2019). Combining biofeedback with stress management interventions: A systematic review of physiological and psychological Effects.  Applied Psychophysiology and Biofeedback, 44, 71–82.

Dillon, A., Kelly, M., Robertson, I. H., & Robertson, D. A. (2016). Smartphone applications utilizing biofeedback can aid stress reduction. Frontiers in Psychology, 7, 832. 

Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback medicine: Who, when, why and how? Mental Health in Family Medicine, 7, 85-91.

Johnson, D., Deterding, S., Kuhn, K., Staneva, A., Stoyanov, S., & Hides, L. (2016). Gamification for health and wellbeing: A systematic review of the literature. Internet Interventions, 6, 89-106.

Kovacevic, N., Ritter, P., Tays, W., Moreno, S., & McIntosh, A. R. (2015). ‘My virtual dream’: Collective neurofeedback in an immersive art environment.  PLoS ONE, 10(7).

Schuurmens, A. A., Nijhof, K. S., Scholte, R., Popma, A., & Otten, R. (2019). A novel approach to improve stress regulation among traumatized youth in residential care: Feasibility study testing three game-based meditation interventions. Early Intervention in Psychiatry, 14, 476–485. 

Mental Health Services in Australia’ available from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/summary/prevalence-and-policies

‘Depression” available from https://www.who.int/news-room/fact-sheets/detail/depression

‘Investing in treatment for depression and anxiety leads to fourfold return’ available from https://www.who.int/news-room/detail/13-04-2016-investing-in-treatment-for-depression-and-anxiety-leads-to-fourfold-return

‘Australia amongst the most depressed, anxious countries in the world’ available from https://ajp.com.au/news/australia-among-depressed-anxious-countries-world/

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