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Systematic Review of Biofeedback Interventions for Addressing Anxiety and Depression in Children and Adolescents with Long-Term Physical Conditions

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Abstract

Children and adolescents with long-term physical conditions are at increased risk of psychological problems, particularly anxiety and depression, and they have limited access to evidence-based treatment for these issues. Biofeedback interventions may be useful for treating symptoms of both psychological and physical conditions. A systematic review of studies of biofeedback interventions that addressed anxiety or depression in this population was undertaken via MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases. Primary outcomes included changes in anxiety and depression symptoms and ‘caseness’. Secondary outcomes included changes in symptoms of the associated physical condition and acceptability of the biofeedback intervention. Of 1876 identified citations, 9 studies (4 RCTs, 5 non-RCTs; of which all measured changes in anxiety and 3 of which measured changes in depression) were included in the final analysis and involved participants aged 8–25 years with a range of long-term physical conditions. Due to the heterogeneity of study design and reporting, risk of bias was judged as unclear for all studies and meta-analysis of findings was not undertaken. Within the identified sample, multiple modalities of biofeedback including heart rate variability (HRV), biofeedback assisted relaxation therapy and electroencephalography were found to be effective in reducing symptoms of anxiety. HRV was also found to be effective in reducing symptoms of depression in two studies. A range of modalities was effective in improving symptoms of long-term physical conditions. Two studies that assessed acceptability provided generally positive feedback. There is currently limited evidence to support the use of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions. Although promising, further research using more stringent methodology and reporting is required before biofeedback interventions can be recommended for clinical use instead or in addition to existing evidence-based modalities of treatment.

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Funding

None of the authors have any financial, personal or research-related conflicts to declare with regard to this study. Philip Ruppeldt’s time was funded via a summer student grant from Auckland University.

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Authors and Affiliations

  1. Department of Psychological Medicine, University of Auckland, Level 12, Support Block, Auckland Hospital, Park Road, Grafton, Auckland, 1142, New Zealand

    Hiran Thabrew

  2. University of Auckland, Level 12, Support Block, Auckland Hospital, Park Road, Grafton, Auckland, 1142, New Zealand

    Philip Ruppeldt

  3. North Carolina Central University, 1801, Fayetteville St., Durham, NC, 27707, USA

    John J. Sollers III

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Appendix

Appendix

1. Psycinfo search strategy

2. exp anxiety disorders/

3. (anxi* or obsessive compulsive or phobi*).tw.

4. ((procedur* or treat* or manage*) adj6 anxiety).tw.

5. ((hospi* or clinic*) adj3 anxiety).tw.

6. or/1-5

7. exp biofeedback, psychology/ or exp neurofeedback/

8. (psychosomatic or cardiac control or emotional regulation or heart rate or psychophysiology or EMG or neurotherapy or cognitive feedback).tw.

9. (heart rate adj3 monitoring).tw.

10. exp Behavior Therapy/ or exp Cognitive Therapy/

11. (c-cbt or computeri*ed cbt or computer cbt or electronic* cbt or electronic management).tw.

12. computeri*ed cognitive behavioural therapy.tw.

13. computeri*ed cognitive behavioral therapy.tw.

14. computeri*ed behavioral therapy.tw.

15. (computer adj3 (cbt or cognitive behavioural therapy or cognitive behavioral therapy or behavioral therapy or behavioural therapy or cognitive therapy)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier]

16. computeri*ed behavioural therapy.tw.

17. CCBT.tw.

18. or/7-9

19. or/10-17

20. infant.tw.

21. child.tw.

22. adolesc*.tw.

23. (baby or babies or newborn* or new-born* or neonat* or neo-nat* or toddler* or preschool* or pre-school* or schoolchild* or school-child*).tw.

24. (boy* or girl*).tw.

25. (teen* or preteen* or pre-teen* or youth* or young* person* or young* people*).tw.

26. (pediatr* or paediatr* or juveni* or minors).tw.

27. or/20-26

28. depression/

29. depressive disorder/ or depressive disorder, major/ or depressive disorder, treatment-resistant/

30. (depressive or depressed or depression).tw.

31. or/28-30

32. randomize controlled trial/

33. controlled clincial trial.pt.

34. randomi#ed.ab.

35. placebo*.ab.

36. randomly.ab.

37. trial.ab.

38. clinical trials as topic.sh.

39. groups.ab.

40. or/32-39

41. search:.tw. or meta-analysis.mp,pt. or review.pt. or di.xs. or associated.tw.

42. exp animals/ not humans.sh.

43. 40 not 42

44. 43 and 41 and 31 and 27 and 19 and 18 and 6

45. (43 or 41) and 31 and 27 and 19 and 18 and 6

46. ((procedur* or treat* or manage*) adj3 anxiety).tw.

47. exp anxiety/

48. exp anxiety disorders/

49. (anxi* or obsessive compulsive or phobi*).tw.

50. ((hospi* or clinic*) adj3 anxiety).tw.

51. or/46-50

52. or/11-17

53. 52 and 51

54. 52 and 51 and 43

55. 52 and 51 and 43 and 27

56. 52 and (51 or 31) and 43 and 27

57. (51 or 31) and (18 or 19) and 43 and 27

58. (51 or 31) and (52 or 18) and 43 and 27

59. (51 or 31) and (52 or 7) and 43 and 27

60. (51 or 31) and (52 or 7) and (43 or 41) and 27

61. user-computer interface/

62. computer systems/ or computers.mp. or microcomputers/ or computers, handheld/

63. software/

64. therapy, computer-assisted/

65. computer-assisted instruction/

66. video games/

67. computer graphics/

68. ((virtual or augment* or VR or AR) adj3 (environ* or world* or object* or treatment* or system* or program* or rehabilitat* or realit*)).tw.

69. (computer adj3 (simulat* or graphic* or game* or gaming or interact*)).tw.

70. (computer adj1 assist* adj1 (therap* or treat*)).tw.

71. (computer adj1 generat* adj1 (environmen* or object*)).tw.

72. (video adj1 (game* or gaming)).tw.

73. cellular phone/

74. (cellphone* or cell phone* or mobile phone* or mobile telephone*).tw.

75. (app or apps).tw.

76. (handheld* or hand-held*).tw.

77. (smartphone* or smart phone* or iphone* or i-phone* or nokia* or blackberr* or symbian* or ipad* or i-pad* or ipod* or i-pod* or android* or htc*).tw.

78. MP3-player/

79. Computers, Handheld/

80. computers, handheld.tw.

81. (palm adj3 computer*).tw.

82. (personal digital or pda).tw.

83. (tablet* adj3 (device* or comput*)).tw.

84. (ehealth or e-health or mhealth or m-health or mobile health).tw.

85. ((internet or website* or web-site* or web or www) adj3 surf*).tw.

86. (cyber or online or on-line*).tw.

87. (interactive adj3 (video* or technolog* or multimedia or multi-media* or communicat* or computer* or televis*)).tw.

88. software.tw.

89. ((health* or treat* or therap* or intervention* or assist* or selfmanag* or self-manag*) adj6 (computer* or technolog* or software*)).tw.

90. or/61-89

91. (51 or 31) and (90 or 18) and 43 and 27

92. exp pain/

93. exp complex regional pain syndromes/

94. exp rheumatic diseases/

95. exp neoplasms/

96. exp diabetes mellitus/

97. exp asthma/

98. exp brain injuries/

99. exp inflammatory bowel diseases/

100. exp anemia, sickle cell/

101. exp skin diseases/

102. Chronic Disease/

103. Cystic Fibrosis/

104. Bronchopulmonary Dysplasia/

105. Kidney Failure, Chronic/

106. heart diseases/ or exp heart defects, congenital/

107. exp liver diseases/

108. exp brain damage, chronic/

109. respiratory tract disease/ or exp bronchiectasis/

110. ((chronic* or longterm* or long-term*) adj5 (condition* or ill* or disease*)).tw.

111. (kidney* or renal or cystic or heart or cardiac or colon or lung or lungs or asthma* or diabet* or rheumat* or arthrit* or fibromyalg* or cancer* or neoplas* or tumor* or tumour* or malignan* or carcinoma*).tw.

112. (brain or head) adj5 (trauma* or injur*)).tw.

113. (bowel* adj5 (condition* or disease* or illness* or inflam*)).tw.

114. or/92-113

115. 114 and 90 and (51 or 31) and 43 and 27

116. 114 and 90 and 43 and 27 and 18 and 19

117. 114 and 90 and 43 and 27 and (18 or 19)

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Thabrew, H., Ruppeldt, P. & Sollers, J.J. Systematic Review of Biofeedback Interventions for Addressing Anxiety and Depression in Children and Adolescents with Long-Term Physical Conditions. Appl Psychophysiol Biofeedback 43, 179–192 (2018). https://doi.org/10.1007/s10484-018-9399-z

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