Advertisement

Biofeedback and Self-regulation

, Volume 12, Issue 2, pp 71–92 | Cite as

Cost effectiveness of biofeedback and behavioral medicine treatments: A review of the literature

  • Carol J. Schneider
Presidential Address

Abstract

This paper reviews multicomponent behavioral medicine studies that contain cost-effectiveness andor cost-benefit data relevant to the field of biofeedback and relaxation training, primarily when assisted by biofeedback, with or without stress management, in the treatment of psychosomatic illness and pain. A model for evaluating biofeedback treatment is presented. Cost-effectiveness data concerning reduction in physician visits and/or medication use, decrease in medical care costs to patients, reduction in hospital stays and rehospitalization, reduction of mortality, and enhanced quality of life are reviewed. Evidence suggests that multicomponent behavioral medicine treatments are cost-effective on all dimensions reviewed. Cost/benefit ratios range between 1:2 and 1:5, with a median of 1:4. Evidence that could increase the cost effectiveness of biofeedback is reviewed.

Descriptor Key Words

cost effectiveness cost-benefit biofeedback relaxation training behavioral medicine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavioral change.Psychological Review, 84 191–215.Google Scholar
  2. Beaton, R., Egan, K., Betrus, P., & Nakagawa, H. (1982). Cost-benefit analysis of out-patient stress response management training.Proceedings of the 13th Annual Meeting of the Biofeedback Society of America, 27–30.Google Scholar
  3. Blanchard, E., Andrasik, F., Appelbaum, K., Evans, D., Jurish, S., Teders, S., Rodichok, L., & Barron, K. (1985). The efficacy and cost effectiveness of minimal-therapist-contact, non-drug treatments of chronic migraine and tension headache.Headache, 25 214–220.Google Scholar
  4. Blanchard, E., Jaccard, J., Andrasik, F., Guarnieri, P., & Jurish, S. (1985). Reduction in headache patients' medical expenses associated with biofeedback and relaxation treatments.Biofeedback and Self-Regulation, 10 63.Google Scholar
  5. Blanchard, E., McCoy, G., Musso, A., Gerardi, M., Pallmeyer, T., Gerardi, R., Cotch, P., Siracusa, K., & Andrasik, F. (1986). A controlled comparison of thermal biofeedback and relaxation training in the treatment of essential hypertension: Short-term and long-term outcome.Behavior Therapy, 17 563–579.Google Scholar
  6. Blanchard, E., & Schwartz, S. (1987). Adaptation of a multi-component treatment for irritable bowel syndrome to a small-group format.Proceedings of the 18th Annual Meeting of the Biofeedback Society of America, 1–3.Google Scholar
  7. Blanchard, E., & Young, L. (1974). Clinical applications of biofeedback training: A review of the evidence. In L. DiCara, T. X. Barber, J. Kamiya, N. Miller, D. Shapiro, & J. Stoyva (Eds.),Biofeedback and Self-Control (pp. 3–39). Chicago: Aldine.Google Scholar
  8. Bootman, J., Rowland, C., & Wertheimer, A. (1979). Cost-benefit analysis: A research tool for evaluating innovative health programs.Evaluation and Health Professions, 2 129–154.Google Scholar
  9. Bradley, L., Young, L., Anderson, K., McDaniel, L., Turner, R., & Agudelo, C. (1984). Psychological approaches to the management of arthritis pain.Social Science and Medicine, 19 1353–1360.Google Scholar
  10. Bradley, L., Young, L., Anderson, K., Turner, R., Agudelo, C., McDaniel, L., Pisko, E., Semble, E., & Morgan, T. (in press). Effects of psychological therapy on pain behavior of rheumatoid arthritis patients: Treatment outcome and six-month follow-up.Arthritis and Rheumatism.Google Scholar
  11. Budzynski, T., Stoyva, J., & Peffer, K. (1977). Biofeedback techniques in psychosomatic disorders. In E. Foa & A. Goldstein (Eds.),Handbook of behavioral interventions. New York: Wiley.Google Scholar
  12. Charlesworth, E., Williams, B., & Baer, P. (1984). Stress management at the worksite for hypertension: Compliance, cost-benefit, health care and hypertension-related variables.Psychosomatic Medicine, 46 387–397.Google Scholar
  13. Croog, S., Levine, S., Testa, M., Brown, B., Bulpitt, C., Jenkins, C., Klerman, G., & Williams, G. (1986). The effects of antihypertensive therapy on the quality of life.New England Journal of Medicine, 314 1657–1664.Google Scholar
  14. Devine, E., & Cook, T. (1983). A meta-analytic analysis of effects of psychoeducational interventions on length of postsurgical hospital stay.Nursing Research, 32 267–274.Google Scholar
  15. Fahrion, S., Norris, P., Green, E., Green, A., & Schnar, R. (1987). Biobehavioral treatment of essential hypertension: A group outcome study.Biofeedback and Self Regulation, 11 257–278.Google Scholar
  16. Fahrion, S. (in press). Cost effectiveness in biobehavioral treatment of hypertension.Biofeedback and Self-Regulation.Google Scholar
  17. Flor, H., Haag, G., Turk, D., & Koehler, H. (1983). Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain.Pain, 17 21–31.Google Scholar
  18. Friedman, M., & Ulmer, D. (1984).Treating Type A behavior and your heart. New York: Ballantine.Google Scholar
  19. Friedman, M., Ulmer, D., Brown, B., Breall, W., & Dixon, T. (1986). Alteration of Type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary results of the recurrent coronary prevention project.American Heart Journal, 112 653–665.Google Scholar
  20. Gill, J., Pride, D., Friedman, M., Thoreson, C., Powell, L., Ulmer, D., Brown, B., & Drews, F. (1985). Reduction in Type A behavior in healthy middle-aged American military officers.American Heart Journal, 110 503–514.Google Scholar
  21. Glass, G. (1976). Primary, secondary, and meta-analysis of research.Educational Research, 10 3–8.Google Scholar
  22. Gonick, U., Farrow, I., Meier, M., Ostman, G., & Frolick, L. (1981). Cost effectiveness of behavioral medicine procedures in the treatment of stress-related disorders.American Journal of Clinical Biofeedback, 4 16–24.Google Scholar
  23. Jacobs, D. (1983, December). Toward a formula for professional survival in troubled times.APA Newsletter, p. 3.Google Scholar
  24. Jacobs, D. (in press). Cost effectiveness of specialized psychological programs for reducing hospital stays and outpatient visits.Journal of Clinical Psychology.Google Scholar
  25. Jurish, S., Blanchard, E., Andrasik, F., Teders, S., Neff, D., & Arena, J. (1983). Home- versus clinic-based treatment of vascular headache.Journal of Consulting and Clinical Psychology, 51 743–751.Google Scholar
  26. Keefe, F., & Hoelscher, T. (1987). Biofeedback in the management of chronic pain syndromes. In J. Hatch, J. Fisher, & J. Rugh (Eds.),Biofeedback, Studies in clinical efficacy (pp. 211–253). New York: Plenum Press.Google Scholar
  27. Keefe, F., Surwit, R., & Pilon, R. (1979). A one-year follow-up of Raynaud's patients treated with behavioral therapy techniques.Journal of Behavioral Medicine, 2 385–391.Google Scholar
  28. Levin, H. (1983).Cost effectiveness: A primer. Beverly Hills: Sage.Google Scholar
  29. Linton, S. (1986). Behavioral remediation of chronic pain: A status report.Pain, 24 125–141.Google Scholar
  30. Mager, E. (1982). Biofeedback therapy impact on patient utilization of health care sevices.Dissertation Abstracts International, 44, 1969B. (University Microfilms No. 8323562).Google Scholar
  31. Manuso, J. (1983). The Equitable Life Assurance Society program.Preventive Medicine, 12 658–662.Google Scholar
  32. Marzuk, P. (1985). Biofeedback for hypertension: A position paper of the Health and Public Policy Committee, American College of Physicians.Annals of Internal Medicine, 102 709–715.Google Scholar
  33. McGrady, A., Fine, T., Woerner, M., & Yonker, R. (1983). Maintenance of treatment effects: Biofeedback-assisted relaxation in patients with essential hypertension.American Journal of Clinical Biofeedback, 6 34–38.Google Scholar
  34. Norris, P. (1986). On the status of biofeedback and clinical practice.American Psychologist, 41 1009–1010.Google Scholar
  35. Olbrisch, M. (1981). Evaluation of a stress management program for high utilizers of a prepaid university health service.Medical Care, 19 153–159.Google Scholar
  36. Patel, C. (1975). Yoga and biofeedback in the management of “stress” in hypertensive patients.Clinical Science and Molecular Medicine, 48 171–174.Google Scholar
  37. Patel, C., Marmot, M., & Terry, D. (1981). Controlled trial of biofeedback-aided behavioral methods in reducing mild hypertension.British Medical Journal [Clinical Research], 28 2005–2008.Google Scholar
  38. Patel, C., Marmot, M., Terry, D., Carruthers, M., Hunt, B., & Patel, M. (1985). Trial of relaxation in reducing coronary risk: Four-year follow-up.British Medical Journal, 290 1103–1105.Google Scholar
  39. Roberts, A. (1985). Biofeedback: Research, training, and clinical roles.American Psychologist, 40 938–941.Google Scholar
  40. Roberts, A. (1986). Biofeedback, science, and training.American Psychologist, 41 1010.Google Scholar
  41. Schwartz, G. (1987, March).Biofeedback: An integrated health science. Paper presented at the meeting of the Biofeedback Society of America, Boston.Google Scholar
  42. Shellenberger, R., & Green, J. (1986).From the ghost in the box to successful biofeedback training. Greeley, Colorado: Health Psychology Publications.Google Scholar
  43. Shellenberger, R., Turner, J., Green, J., & Cooney, J. (1986). Health changes in a biofeedback and stress management program.Clinical Biofeedback and Health, 9 23–24.Google Scholar
  44. Silver, B., & Blanchard, E. (1978). Biofeedback or relaxation training in the treatment of psychophysiologic disorders: Or, are the machines really necessary?Journal of Behavioral Medicine, 1 217–239.Google Scholar
  45. Steig, R., & Williams, P. (1983). Cost effectiveness study of multidisciplinary pain treatment of industrial-injured workers.Seminars in Neurology, 3 375.Google Scholar
  46. Taub, E., Culp., C., & Mager, E. (in press). Cost effectiveness of biofeedback treatment in a hospital outpatient clinic.Biofeedback and Self-Regulation.Google Scholar
  47. Tenders, S., Blanchard, E., Andrasik, F., Jurish, S., Neff, D., & Auna, J. (1984). Relaxation training for tension headache: Comparative efficaacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure.Behavior Therapy, 15 59–70.Google Scholar
  48. Thompson, M. (1980).Benefit-cost analysis for program evaluation. Beverly Hills: Sage.Google Scholar
  49. Toevs, C., Kaplan, R., & Atkins, C. (1984). The costs and effects of behavioral programs in chronic obstructive pulmonary disease.Medical Care, 22 1088–1099.Google Scholar
  50. Toomin, M., & Toomin, H. (1975). GSR biofeedback in psychotherapy: Some clinical observations.Psychotherapy: Theory, Research, and Practice, 12 41–45.Google Scholar
  51. Walker, S. (1985).Effects of a stress management/performance enhancement program on average monthly production. Unpublished manuscript.Google Scholar
  52. Weiss, S. (1987, March).Health promotion at the worksite: Cost effective? Paper presented at the meeting of the Biofeedback Society of America, Boston.Google Scholar
  53. Williams, R. (1984). Type A behavior and coronary heart disease: Something old, something new.Behavioral Medicine Update, 6 29–33.Google Scholar
  54. Wolf, S., & Fischer-Williams, M. (1987). The use of biofeedback in disorders of motor function. In J. Hatch, J. Fisher, & J. Rugh (Eds.),Biofeedback studies in clinical efficacy (pp. 153–177). New York: Plenum Press.Google Scholar
  55. Wolpe, J., & Lazarus, A. (1966).Behavior therapy techniques, New York: Pergamon Press.Google Scholar
  56. Wright, C. (1979). Seeking a new medical horizon: Towards a rational approach for reducing the contribution of psychosocial stress to illness behaviors.Dissertation Abstracts International, 40 3979B-3980B. (University Microfilms No. 8003029).Google Scholar
  57. Yates, B. (1980).Improving effectiveness and reducing costs in mental health. Springfield, Illinois: Thomas.Google Scholar
  58. Yates, B. (1985). Cost-effectiveness analysis and cost benefit analyses: An introduction.Behavioral Assessment, 7 207–234.Google Scholar
  59. Zeckhauser, R. (Speaker). (1987, March). Symposium on cost-effectiveness [cassette recording]. Presented at the meeting of the Biofeedback Society of America, Boston.Google Scholar

Copyright information

© Plenum Publishing Corporation 1987

Authors and Affiliations

  • Carol J. Schneider
    • 1
  1. 1.Colorado Center for Biobehavioral HealthBoulder

Personalised recommendations