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Research Papers
The Effects of the Combined Biofeedback and Brief Emotion Regulation Nursing Intervention Based on the Gross Model for Sexually Abused Adolescents
Kim, Jieun , Park, Wanju
J Korean Acad Nurs 2022;52(6):608-623.   Published online December 31, 2022
DOI: https://doi.org/10.4040/jkan.22088
AbstractAbstract PDF
Purpose
This study aimed to evaluate the effects of a combined biofeedback and brief emotion regulation (C-BABER) program for sexually abused adolescents.
Methods
This study employed a non-equivalent control group pretest-posttest design. The participants included 26 sexually abused adolescents from eight Sunflower Centers of South Korea–with 13 in the experimental group and 13 in the control group. The experimental group received four sessions of the individual C-BABER program, each lasting 60 minutes.
Results
Compared with the control group, sexually abused adolescents in the experimental group exhibited significant score differences in traumatic symptoms, including depression (Z = - 2.24, p = .025), dissociation (Z = - 2.21, p = .027), anxiety (Z = - 2.02, p = .044), and posttraumatic stress (Z = - 2.01 p = .045); and impulsivity, including positive urgency (Z = - 3.35, p = .001) and negative urgency (Z = - 2.28, v = .023). Additionally, the experimental group exhibited significant score differences in meta-mood, including emotional attention (Z = - 2.45, p = .014), emotional clarity (Z = - 2.30, p = .021), and emotional repair (Z = - 2.28, p = .022); and emotional regulation modes, including emotional suppression (Z = - 2.65,p = .008) and cognitive reappraisal (Z = - 1.98, p = .047). Regarding bio-attention, significant changes were identified in the experimental group for the bio-attention rate and attention maintenance time in the posttest compared to the pretest (p = .001).
Conclusion
The C-BABER program for sexually abused adolescents is effective in decreasing traumatic symptoms and impulsivity, and in improving meta-mood, emotional regulation mode, and bio-attention. Therefore, we recommend providing sexually abused adolescents the C-BABER program to help them regulate their emotions and effectively adapt to their lives.
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Effects of Electroencephalogram Biofeedback on Emotion Regulation and Brain Homeostasis of Late Adolescents in the COVID-19 Pandemic
Park, Wanju , Cho, Mina , Park, Shinjeong
J Korean Acad Nurs 2022;52(1):36-51.   Published online February 28, 2022
DOI: https://doi.org/10.4040/jkan.21155
AbstractAbstract PDF
Purpose
The purpose of this study was to examine the effects of electroencephalogram (EEG) biofeedback training for emotion regulation and brain homeostasis on anxiety about COVID-19 infection, impulsivity, anger rumination, meta-mood, and self-regulation ability of late adolescents in the prolonged COVID-19 pandemic situation.
Methods
A non-equivalent control group pretest-posttest design was used. The participants included 55 late adolescents in the experimental and control groups. The variables were evaluated using quantitative EEG at pre-post time points in the experimental group. The experimental groups received 10 sessions using the three-band protocol for five weeks. The collected data were analyzed using the Shapiro-Wilk test, Wilcoxon rank sum test, Wilcoxon signed-rank test, t-test and paired t-test using the SAS 9.3 program. The collected EEG data used a frequency series power spectrum analysis method through fast Fourier transform.
Results
Significant differences in emotion regulation between the two groups were observed in the anxiety about COVID-19 infection (W = 585.50, p = .002), mood repair of meta-mood (W = 889.50, p = .024), self-regulation ability (t = - 5.02, p < .001), self-regulation mode (t = - 4.74, p < .001), and volitional inhibition mode (t = - 2.61, p = .012). Neurofeedback training for brain homeostasis was effected on enhanced sensory-motor rhythm (S = 177.00, p < .001) and inhibited theta (S = - 166.00, p < .001).
Conclusion
The results demonstrate the potential of EEG biofeedback training as an independent nursing intervention that can markedly improve anxiety, mood-repair, and self-regulation ability for emotional distress during the COVID-19 pandemic.
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Original Articles
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
J Korean Acad Nurs 2018;48(2):208-220.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.208
AbstractAbstract PDF
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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Effects of Biofeedback Exercise Training in Hemiplegic Patients after Stroke
Keum Soon Kim, So Woo Lee, Myung Ae Choe, Myung Sun Yi, Eun Jung Kim
Journal of Korean Academy of Nursing 2001;31(3):432-442.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.3.432
AbstractAbstract PDF

PURPOSE: The purpose of this study was to investigate the effects of biofeedback exercise training on muscle activity and activities of daily livings (ADL) in hemiplegic patients. An experimental group consisting of 17 people, was given biofeedback exercise training for 30- 60 minutes per week for 5 weeks, while a control group consisting of 18 people, was given normal exercise with quasi-experimental design. RESULT: The results of the study show that biofeedback exercise is effective for improving muscle activity in hemiplegic patients, especially in the hemiplegic limbs. However, this study found no significant differences in ADL and IADL between the experimental and the control groups. It implies that ADL and IADL may not be improved for a short period of time, such as 5 weeks, for people with more than five years of hemiplegia. The study suggests that the effect of biofeedback exercise on ADL and IADL should be determined in hemiplegic patients in acute stage.

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A Study on the Effect of Self-Management and Relaxation Training through Biofeedback on Influencing the Stress Response and Immune Functions
Soowoo Lee, Keum Soon Kim, Sung Hoi Park
Journal of Korean Academy of Nursing 1999;29(4):855-869.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.4.855
AbstractAbstract PDF

The purpose of this study was to test the effectiveness of self-management relaxation training through biofeedback and progressive muscle relaxation methods. The effectiveness of the experimental methods was tested by measuring the degree of symptoms of stress(SOS), the McNair's profile of Mood STates(POMS), the levels of ephinephrine, norepinephrine, pulse rate, blood pressure and natural killer cells. The subjects of this study were sixty six nursing students divided into four groups two groups were the biofeedback and progressive muscle relaxation groups, the other two groups served as control groups. One was a group of sophomores with no experience at all, the other a junior group without self-management or relaxation training. This study was condicted for eight weeks of clinical practice from April, 26th 1998 to June, 20th 1998. Biofeedback training was done with software developed by J&J company(1-410 form for abdominal respiration training). Progressive muscle relaxation training was done with an audiotape recorded according to Jacobson's Theory. The data were analyzed with frequencies, means, and analysis of cobariance using the SPSS program and the significance level of statistics was 5%. The results of the study are : 1) The importance of clinical practice stress reduction is shown in that the level of symptoms of stress in the experimental groups in clinical practice was higher than in the group receiving only a lecture. 2) The relaxation training methods of biofeeback and progressive muscle relaxation were effective in reducing the symptoms of stress under the clinical practice stress conditions. 3) The effectiveness of the biofeedback training relaxation method to reduce symptoms of stress was higher than that of progressive muscle relaxation. 4) The relaxation training methods of biofeedback and progressive muscle relaxation were effective in reducing stressful mood states. 5) The relaxation training methods of bioffedback and progressive muscle relaxation were not effective in reducing epinephrine and norepinephrine levels. 6) The relaxation training methods of biofeedback and progressive muscle relaxation were effective in increasing the number of natural killer cells. 7) The relaxation training methods of biofeedback and progressive muscle relaxation were effective in decreasing high systolic and diastolic values of blood pressure and high pulse rates. In summary, the relaxation methods of biofeedback and progressive muscle relaxation in reducing clinical practice stress were effective in lowering the level of symptoms of stress and the profile of stressful mood states. They were also effective in lowering high blood pressure and pulse rates. The relaxation methods were effective in increasing the number of natural killer cells as part of the immune function. However, relaxation methods were not effective symptoms of stress was more effective than the progressive muscle relaxation method.

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The Comparison of the Effectiveness of Pelvic Floor Muscle Exercise and Biofeedback Treatment for Stress Incontinence in Korean Women
Young Hee Choi, Myung Sook Sung, Jae Yup Hong
Journal of Korean Academy of Nursing 1999;29(1):34-47.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.1.34
AbstractAbstract PDF

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows: 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P=0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P=0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P=0.000). 3. The lower urinary symptoms Daily frequency(P=0.000), nocturia(P=0.000), urgency(P=0.000), bladder pain(P=0.000), unexplained incontinence(P=0.048), wearing protection(P=0.022), changing outer clothing(P=0.005), hesitancy(P=0.008), intermittent stream(P=0.000), abnormal strength of stream(P=0.004), retention(P=0.000), incomplete emptying(P=0.000), and inability to stop mid steam(P=0.006) of the lower urinary symptoms in the biofeedback group were significantly decreased. 4. The sexual matters The dry vagina(P=0.004) and pain during sexual intercourse(P=0.002) in the biofeedback group was significantly decreased. 5. The life style. The fluid intake restriction(P=0.007), affected daily task(P=0.003), avoidance of places & situation(P=0.003), interference in Physical activity(P=0.002), interference in relationship with other people(P=0.01), and feeling about the rest of life with urinary symptom(P=0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.

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Pelvic Floor Muscle Exercise by Biofeedback and Electrical Stimulation to Reinforce the Pelvic Floor Muscle after Normal Delivery
In Sook Lee, Euy Soon Choi
Journal of Korean Academy of Nursing 2006;36(8):1374-1380.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2006.36.8.1374
AbstractAbstract PDF
Purpose

This study was conducted to investigate the effectiveness of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal delivery.

Methods

The subjects of this study were 49 (experimental group: 25, control group: 24) postpartum women who passed 6 weeks after normal delivery without complication of pregnancy, delivery and postpartum. The experimental group was applied to the pelvic muscle enforcement program by biofeedback and electrical stimulation for 30 minutes per session, twice a week for 6 weeks, after then self-exercise of pelvic floor muscle was done 50-60 repetition per session, 3 times a day for 6 weeks. Maximum pressure of pelvic floor muscle contraction (MPPFMC), average pressure of pelvic floor muscle contraction (APPFMC), duration time of pelvic floor muscle contraction (DTPFMC) and the subjective lower urinary symptoms were measured by digital perineometer and Bristol Female Urinary Symptom Questionnaire and compared between two groups prior to trial, at the end of treatment and 6 weeks after treatment.

Results

The results of this study indicated that MPPFMC, APPFMC, DTPFMC were significantly increased and subjective lower urinary symptoms were significantly decreased after treatment in the experimental group than in the control group.

Conclusions

This study suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for reinforcing pelvic floor muscle after normal delivery.

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Effects of Abdominal Breathing Training Using Biofeedback on Stress, Immune Response and Quality of Life in Patients with a Mastectomy for Breast Cancer
Keum Soon Kim, So Woo Lee, Myoung Ae Choe, Myung Sun Yi, Smi Choi, So Hi Kwon
Journal of Korean Academy of Nursing 2005;35(7):1295-1303.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.7.1295
AbstractAbstract PDF
Purpose

This study was to determine the effects of abdominal breathing training using biofeedback on stress, immune response, and quality of life.

Methods

The study design was a nonequivalent control group pretest-posttest, quasi-experimental design. Twenty-five breast cancer patients who had completed adjuvant chemotherapy were enrolled. The experimental group(n=12) was provided with abdominal breathing training using biofeedback once a week for 4 weeks. State anxiety, cancer physical symptoms, serum cortisol, T cell subsets(T3, T4, T8), NK cell and quality of life were measured both before and after the intervention.

Results

Though state anxiety, cancer physical symptoms, and serum cortisol were reduced after 4 weeks of abdominal breathing training using biofeedback, there was no statistical significance. It showed, however, improvement in quality of life (p=.02), and T3(p=.04).

Conclusion

Abdominal breathing training using biofeedback improves quality of life in breast cancer patients after a mastectomy. However, the mechanism of this beneficial effect and stress response requires further investigation with special consideration in subject selection and frequency of measurement. Nurses should consider this strategy as a standard nursing intervention for people living with cancer.

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Effect of Progressive Muscle Relaxation using Biofeedback on Perceived Stress, Stress Response, Immune Response and Climacteric Symptoms of Middle-Aged Women
Ihn Sook Jeong
Journal of Korean Academy of Nursing 2004;34(2):213-224.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.2.213
AbstractAbstract PDF
Purpose

This study was aimed to evaluate the effect of progressive muscle relaxation training using biofeedback on perceived stress, stress response, immune response and climacteric symptoms.

Method

This was a crossover, pre-post test design. The study subjects are 36 middle-aged women who were selected at 2 public health centers. The independent variable was Biofeedback training for 4 weeks, twice a week and home training for 4 weeks. Dependent variables were perceived stress, stress response, immune response, and climacteric symptoms measured with Hildtch's scale (1996).

Result

Progressive muscle relaxation training using biofeedback was not effective in reducing perceived stress, but it was shown to be effective in reducing physiological stress responses such as pulse rate and EMG. Though blood pressure and skin conductance were repeatedly down, and skin temperature slowly increased, there were no statistically significant differences. Progressive muscle relaxation training using biofeedback was not effective in reducing serum cortisol, enhancing immune responses, or decreasing climacteric symptoms.

Conclusion

The findings point to a pressing need for further, well-controlled and designed research with consideration in selection of subjects and instruments, frequency of measurements, the sampling method, and intervention modalities.

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Effects of Upper Extremity Exercise Training Using Biefeedback and Constraint-induced Movement on the Upper Extremity Function of Hemiplegic Patients
Keum Soon Kim, Ji Yeon Kang
Journal of Korean Academy of Nursing 2003;33(5):591-600.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.5.591
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the effects of exercise training using biofeedback and constraint-induced movement on the upper extremity function of hemiplegic patients.

Method

A non-equivalent pretest-posttest design was used. Study subjects were a conveniently selected group of 40 hemiplegic patients(20 experimental subjects, 20 control subjects) who have been enrolled in two community health centers. After biofeedback training the subjects of experimental group were given constraint-induced movement, involving restraint of unaffected U/E in a sling for about 6 hours in a day over a period of two weeks, while at the same time intensively training the affected U/E. Outcomes were evaluated on the basis of the U/E motor ability(hand function, grip power, pinch power, U/E ROMs), and motor activity(amount, quality).

Result

1. After 2 weeks of treatment, the motor abilities of affected U/E(hand function, grip power, pinch power, ROMs of wrist flexion, elbow flexion and shoulder flexion/extension) were significantly higher in subjects who participated in exercise training than in subjects in the control group with no decrement at 4-week follow-up. However, there was no significant difference in wrist extension between experimental or control group. 2. After 2 weeks of treatment, the amount of use and the quality of motor activity of affected U/E were significantly higher in subjects who participated in exercise training than in subjects in the control group with no decrement at 4-week follow-up.

Conclusion

The above results state that exercise training using biofeedback and constraint-induced movement could be an effective intervention for improving U/E function of chronic hemiplegic patients. Long-term studies are needed to determine the lasting effects of constraint-induced movement.

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Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial
Kyung In Jeong, Ja Yun Choi
J Korean Acad Nurs 2017;47(6):842-853.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.6.842
AbstractAbstract PDF
Abstract Purpose

This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education.

Methods

Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students’ skill training, and evaluators’ training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing.

Results

ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p<.001), clinical judgment (F=18.33, p<.001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=-0.38, p=.704) between the experimental and control groups.

Conclusion

This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.

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Effects of Self-directed Feedback Practice using Smartphone Videos on Basic Nursing Skills, Confidence in Performance and Learning Satisfaction
Seul Gi Lee, Yun Hee Shin
J Korean Acad Nurs 2016;46(2):283-292.   Published online April 29, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.2.283
AbstractAbstract PDF
Purpose

This study was done to verify effects of a self-directed feedback practice using smartphone videos on nursing students' basic nursing skills, confidence in performance and learning satisfaction.

Methods

In this study an experimental study with a post-test only control group design was used. Twenty-nine students were assigned to the experimental group and 29 to the control group. Experimental treatment was exchanging feedback on deficiencies through smartphone recorded videos of nursing practice process taken by peers during self-directed practice.

Results

Basic nursing skills scores were higher for all items in the experimental group compared to the control group, and differences were statistically significant ["Measuring vital signs" (t=-2.10, p=.039); "Wearing protective equipment when entering and exiting the quarantine room and the management of waste materials" (t=-4.74, p<.001) "Gavage tube feeding" (t=-2.70, p=.009)]. Confidence in performance was higher in the experimental group compared to the control group, but the differences were not statistically significant. However, after the complete practice, there was a statistically significant difference in overall performance confidence (t=-3.07. p=.003). Learning satisfaction was higher in the experimental group compared to the control group, but the difference was not statistically significant (t=-1.67, p=.100).

Conclusion

Results of this study indicate that self-directed feedback practice using smartphone videos can improve basic nursing skills. The significance is that it can help nursing students gain confidence in their nursing skills for the future through improvement of basic nursing skills and performance of quality care, thus providing patients with safer care.

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Effects of Neurofeekback Training on EEG, Continuous Performance Task (CPT), and ADHD Symptoms in ADHD-prone College Students
ManHee Ryoo, ChongNak Son
J Korean Acad Nurs 2015;45(6):928-938.   Published online December 31, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.6.928
AbstractAbstract PDF
Purpose

This study explored the effects of neurofeedback training on Electroencephalogram (EEG), Continuous Performance Task (CPT) and ADHD symptoms in ADHD prone college students.

Methods

Two hundred forty seven college students completed Korean Version of Conners' Adult ADHD Rating Scales (CAARS-K) and Korean Version of Beck Depression Inventory (K-BDI). The 16 participants who ranked in the top 25% of CAARS-K score and had 16 less of K-BDI score participated in this study. Among them, 8 participants who are fit for the research schedule were assigned to neurofeedback training group and 8 not fit for the research schedule to the control group. All participants completed Adult Attention Deficiency Questionnaire, CPT and EEG measurement at pretest. The neurofeedback group received 15 neurofeedback training sessions (5 weeks, 3 sessions per week). The control group did not receive any treatment. Four weeks after completion of the program, all participants completed CAARS-K, Adult Attention Deficiency Questionnaire, CPT and EEG measurement for post-test.

Results

The neurofeedback group showed more significant improvement in EEG, CPT performance and ADHD symptoms than the control group. The improvements were maintained at follow up.

Conclusion

Neurofeedback training adjusted abnormal EEG and was effective in improving objective and subjective ADHD symptoms in ADHD prone college students.

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Effects of Electric Stimulation and Biofeedback for Pelvic Floor Muscle Exercise in Women with Vaginal Rejuvenation Women
Jung Bok Lee, So Young Choi
J Korean Acad Nurs 2015;45(5):713-722.   Published online October 30, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.5.713
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the effects of pelvic floor muscle exercise using electric stimulation and biofeedback on maximum pressure of vaginal contraction, vaginal contraction duration and sexual function in women who have had vaginal rejuvenation.

Methods

The research design was a non-equivalent control group non-synchronized design study. Participants in this study were women who had vaginal rejuvenation at C obstetrics and gynecology hospital. The 15 participants in the experimental group were given pelvic floor muscle exercise using electric stimulation and biofeedback and the 15 participants in the control group received self pelvic floor muscle exercise.

Results

For maximum pressure of vaginal contraction, the experimental group showed a statistically significant increase compared to than the control group (t=5.96, p<.001). For vaginal contraction duration, the experimental group also showed a statistically significant increase compared to the control group (t=3.23, p=.003). For women's sexual function, the experimental group showed a significant increase when compared to the control group in total sexual function scores (t=3.41, p=.002).

Conclusion

The results indicate that pelvic floor muscle exercise with electric stimulation and biofeedback after vaginal rejuvenation is effective in strengthening vaginal contraction pressure, vaginal contraction and that it also positively functions to increase women's sexual function.

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