Biofeedback Federation of Europe 23rd Meeting Abstracts

Elena Barel, Luciana Lorenzon

The integration of virtual reality (VR) and biofeedback represents a new and promising therapeutic approach for treating various disorders, in particular phobias and anxiety. This innovative synergy combines immersion in controllable and customizable virtual environments with real-time monitoring of patients’ physiological parameters. This approach enables the modulation of physiological responses during gradual exposure to anxiety-provoking stimuli, enhancing the effectiveness of the treatment.

The combined approach stands out for its ability to reduce improvement times compared with traditional methods, thanks to the possibility of targeted, intensive, and personalized interventions. VR provides a safe environment for exposure, and biofeedback allows for the evaluation and direct intervention for physiological reactions, maximizing therapeutic benefits. Two clinical cases will be presented to demonstrate the effectiveness of this approach: a patient with needle phobia and another with social phobia. These concrete examples will illustrate how the integration of VR and biofeedback has accelerated the therapeutic process, leading to significant improvements in symptoms and the quality of life of the patients.

The presentation will conclude with a reflection on the impact of this integrated methodology in the clinical landscape, highlighting its potential to transform the management of psychological disorders and the enhancement of wellness and performance through a faster, more personalized, and technologically advanced approach.

Correspondence: Elena Barel, Centro Italiano di Biofeedback e Neurofeedback CINB, elena.barel02@gmail.com

Annalia Delle Rose, Gabriele Ciccarese, Giorgia Cucurachi, Aurora D’Autilia, Marco Caiulo, Paola Graziano, Ilenia Carangelo, Silvia Rosafio

Over the past few years, biofeedback has become a cornerstone in the comprehension and treatment of psychological and physiological disorders. This study aims to explore the correlation between psychophysiological patterns (skin conductance, heart rate variability, surface electromyography, skin temperature, and respiratory patterns) and clinical psychometric scales (Personality Assessment Inventory, Symptom Checklist 90, Difficulties in Emotion Regulation Scale, Toronto Alexithymia Scale, SCOFF Questionnaire, and Adult ADHD Self-Report Scale) on a clinical sample.

The main objective is to identify potentially recurrent psychophysiological patterns associated with specific clinical frameworks, including Axis I and II disorders. The research integrates an in-depth bibliographical review of the scientific literature with the experimental evidence gathered through a rigorous methodology of biofeedback and psychometric testing. The data were collected during specific phases of a structured stress assessment, and the patient’s psychophysiological responses were analyzed during varying conditions of emotional activation.

The preliminary outcome indicates the existence of a significant correlation between physiological parameters and psychometric scales, suggesting the possibility of identifying psychophysiological markers helpful for diagnosis and tailored treatment.

This approach, through the combination of experimental and bibliographical research, provides an innovative perspective on the usage of biofeedback as a clinical and diagnostic tool, therefore contributing to the advancement of scientific knowledge in psychology and neuroscience. This research exemplifies how integrating existing literature and new clinical evidence could facilitate the development of new methodologies based on data to support clinical practice.

Correspondence: Annalia Delle Rose, Centro Nova Mentis, d.ricerca@centronovamentis.it

Jente Depoorter, Rudi De Raedt, Kristof Hoorelbeke

Individual resonance frequency breathing is a technique during which a person breathes at their resonance frequency, the optimal rate for maximizing heart rate variability (HRV). This frequency is crucial in HRV biofeedback (HRVB) and can improve emotional well-being, performance, and quality of life. However, key questions remain unanswered: (a) whether the individual resonance frequency is stable over time and (b) whether individuals can spontaneously achieve this frequency during slow breathing without explicit guidance.

This study was conducted to investigate the stability of resonance frequency over time and compare it to the breathing rate achieved during spontaneous slow breathing. Interindividual differences, such as emotion regulation and resilience, that may influence one’s ability to reduce HRV were also explored. The study involves two lab visits, 1 week apart, where participants’ resonance frequency is measured and participants complete questionnaires and a slow breathing exercise.

Results will shed light on the consistency of resonance frequency and the potential barriers individuals face when trying to improve their HRV through breathing. These findings may provide insights for refining HRVB protocols and exploring the relationship between individual traits and respiratory interventions. Data collection concluded in January 2025, and results will be available by March.

Correspondence: Jente Depoorter, Ghent University, jente.depoorter@ugent.be

Elena Franco, Chiara Buizza

Vertigo is a condition that significantly affects the lives of those who suffer from it. Most treatments available to patients are pharmacological. This study was conducted to evaluate the therapeutic effectiveness of a brief biofeedback training program combined with breathing exercises and muscle relaxation as part of a medical center’s routine care for treating vestibular disorders. The study was focused on analyzing the differences in self-perceived disability reduction between patients with short-term disease duration (symptom onset within 1 year) and long-term duration (more than 1 year).

A total of 134 outpatients participated in the study: 60 with short-term disease and 74 with long-term disease. The average age was 57.8 years. Patients underwent a brief biofeedback training program using the Procomp Infiniti system with an eight-channel computer-operated encoder (Thought Technology, Ltd., Montreal, QC, Canada) integrated with breathing and relaxation exercises. Self-perceived disability reduction was assessed in terms of emotional, functional, and physical aspects of daily living using the Dizziness Handicap Inventory (DHI) questionnaire at a 3-month follow-up study. At the follow-up, all patients had a significant reduction in their DHI scores, both in the total score and across the three subscales. No differences were found between the two subgroups (short versus long disease duration).

This study suggests that brief biofeedback training is effective even for patients with a long duration of illness, helping to reduce the impact of vertigo on their daily lives. The benefits are likely due to the patients’ ability to regulate physiological parameters such as respiratory rate, heart rate, and muscle tension.

Correspondence: Elena Franco, San Francesco Centre, elena.franco@poliambulatoriosanfrancesco.it

Marialuisa Guglielmo, Valentina Nicolardi, Serena Tagliente, Cinzia Palmirotta, Stefania De Trane, Gianvito Lagravinese

Neurofeedback (NFB) is gaining recognition as a nonpharmacological approach for managing multiple sclerosis (MS) symptoms. Emerging research highlight the potential for NFB to enhance cognitive functions, including memory and executive skills, while alleviating fatigue, pain, and depression. Despite the limited and heterogeneous evidence, NFB shows promise as part of a comprehensive neurorehabilitation strategy.

This discussion includes the latest findings on NFB and MS and showcases a clinical case highlighting the potential of this treatment within integrated care rehabilitation. A 52-year-old woman with secondary progressive MS (SPMS) underwent a 15-day intensive rehabilitation program. This multidisciplinary protocol included daily physiokinesitherapy and NFB training, addressing both visible symptoms (e.g., spasticity and neuropathy) and invisible symptoms (e.g., cognitive deficits, fatigue, and chronic pain).

Posttreatment evaluations revealed significant improvements, including reduced slow-wave EEG patterns; decreased disability, pain, and spasticity; and enhanced cognitive and psychological functions. These changes resulted in a notable improvement in the patient’s quality of life and will be discussed in detail. This case underscores the efficacy of combining advanced therapies such as NFB with standard rehabilitation approaches to tackle the multifaceted challenges of SPMS. The observed neurophysiological, motor, and neuropsychological improvements emphasize the potential of this integrative approach to enhance patient outcomes. Further research is essential to refine and expand the role of NFB in MS rehabilitation.

Correspondence: Marialuisa Guglielmo, Laboratory of Neuropsychology of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, marialuisa.guglielmo@hotmail.it

Sara Guidotti, Carlo Pruneti

Work-related stress is a public health problem and can have a series of repercussions on mental and physical health. Various objective external factors can increase perceived stress in healthcare workers. For example, being part of a category of healthcare workers can represent a risk factor for burnout. Therefore, it becomes essential to highlight individual factors that can represent protective factors for mental health.

A group of 20 healthcare workers (doctors, nurses, health technicians, etc.) (16 women and 4 men, age: M = 49.33, SD = 13.06), employees of the San Giacomo Physical Medicine and Rehabilitation Hospital in Ponte dell’Olio (Piacenza, Italy), underwent 10 sessions of cardiac coherence training (CCT) using the emWave Pro Plus software (HeartMath Institute, Boulder Creek, CA). After a pre-post comparison of psychological symptoms (through the Symptom Checklist-90-Revised) and resting values, reactivity and recovery of psychophysiological parameters (through the Psychophysiological Stress Profile), the correlations between the personality traits (measured through the 16 Personality Factors [16PF] questionnaire) described at Time 0 (T0) and the cardiac coherence (coherence index [CI]) and the related cumulative score (achievement score [AS]) achieved at the end of the intervention (T1) were investigated.

The CI obtained at T1 was positively correlated with the poststress recovery values of skin conductance and the ego strength of the personality structure measured at T0. However, the same factors were also the predictors of AS at T1 and with the trait of conscientiousness and perseverance of the 16PF at T0. The analysis of the predictive factors of the effectiveness of CCT could highlight those personality characteristics that can facilitate the learning of stress management techniques as well as those patients who need greater support from the operator or the modification of cognitive patterns or maladaptive behaviors.

Correspondence: Sara Guidotti, University of Parma, sara.guidotti@unipr.it

Eszter Horváth, László Tóth

Enhancement of the mental state of athletes is crucial for optimizing their performance. The aim of the present study was to examine the effects of a single application of heart rate variability biofeedback (HRVB) and bilateral stimulation (BLS) on athletes’ competition anxiety, affectivity, and response inhibition ability.

The study involved 34 professional team athletes, with participants assigned to either the HRVB group (n = 16) or the BLS group (n = 18). Participants’ HRV, competition anxiety (Competitive State Anxiety Inventory-2), affectivity (Positive and Negative Affect Schedule), and response inhibition ability (Stroop test) were measured before and after the intervention. The results indicated a significant improvement in competition anxiety and response inhibition in the HRVB group, whereas no such changes were observed in the BLS group. Although changes in negative affectivity were observed in both groups, these changes were not statistically significant.

Our findings suggest that even a single application of HRVB can effectively reduce competition anxiety and improve cognitive control, whereas the efficacy of BLS for enhancing athletic performance warrants further investigation.

Correspondence: Eszter Horváth, Hungarian Biofeedback and Neurofeedback Academy Scientific Association, Hungarian University of Physical Education and Sport Sciences, Doctoral School of Sport Sciences, Department of Psychology and Sport Psychology, eszter.horvath28@gmail.com

Gianvito Lagravinese, Marialuisa Guglielmo, Valentina Nicolardi, Simona Aresta, Serena Tagliente, Cinzia Palmirotta, Fabiana Montenegro, Renata Minichelli, Emilia Picciola, Ernesto Losavio, Petronilla Battista, Stefania De Trane, Brendan Parsons

Neurofeedback (NFB) is a biofeedback technique that leverages brain wave detection and real-time feedback to help individuals self-regulate brain activity. Although NFB has been effective for improving cognitive and psychosocial functions in conditions such as epilepsy, migraines, and anxiety disorders, its application for addressing cognitive impairments after brain tumor surgery remains underexplored. This gap in the literature highlights an opportunity to investigate the therapeutic potential of NFB for this specific patient group. This presentation will describe the latest findings on NFB for the treatment of cognitive deficits in patients recovering from brain tumor resection and provide insights from a clinical case series that illustrates the potential uses of NFB in rehabilitation.

Seven patients who underwent brain tumor surgery were assessed pre- and posttreatment with quantitative electroencephalographic recordings and a battery of neuropsychological tests. The NFB training consisted of 5–15 sessions and was tailored to target specific brain regions based on each tumor’s location. The results suggest that enhancing alpha wave activity and lowering the delta:alpha ratio may play key roles in improving cognitive function in brain tumor survivors. These changes were associated with meaningful improvements in symptoms that significantly affect daily life.

The results of this study shed light on the potential of NFB as a therapeutic approach for cognitive impairments following brain tumor surgery. The findings highlight a promising avenue for neurorehabilitation, although further research with larger patient cohorts is needed to fully establish the feasibility and effectiveness of NFB protocols in this population.

Correspondence: Gianvito Lagravinese, Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute, gianvito.lagravinese@icsmaugeri.it

Lew Lim

Photobiomodulation (PBM) has emerged as a promising nonpharmacological intervention for cognitive decline and neurodegenerative diseases in aging people. This presentation examines PBM’s effects on the aging brain, integrating it with EEG feedback. We synthesized near-infrared wavelengths collected during preclinical and clinical studies in aging individuals and those with dementia and neurodegenerative diseases and evaluated the effects of PBM on EEG waveforms and potential synergies with neurofeedback techniques.

PBM improved memory in animal models and healthy older adults and reduced amyloid-beta accumulation and inflammation in patients with neurodegeneration, enhancing cognition. PBM had neuroprotective effects, improved mitochondrial function, and increased cerebral blood flow and showed potential for modulating EEG presentations related to various brain states, suggesting a promising interface with EEG neurofeedback.

PBM’s primary mechanism involves cytochrome c oxidase absorption, increasing ATP production, releasing vasodilating nitric oxide, and modifying protein activities. These triggers reduce oxidative stress, modulate inflammatory pathways, and enhance neuroplasticity. Transcranial and intranasal PBM approaches show potential for treating neurodegenerative conditions. Novel findings include pulse frequency effects on EEG waveforms, presenting opportunities for combined PBM-neurofeedback interventions to optimize brain function in aging individuals and those with neurodegenerative disorders. The wearability of the PBM devices enhances their practical appeal. PBM holds significant potential for addressing age-related cognitive decline and neurodegenerative diseases. Its multifaceted effects and wearability warrant consideration for widespread adoption. Future research should focus on optimizing treatment parameters and exploring synergies with neurofeedback to enhance outcomes and to personalize interventions for aging individuals and those with neurodegenerative conditions.

Correspondence: Lew Lim, Vie Light, Inc., lewlim@vielight.com

Luciana Lorenzon, Emanuela Russo, Luigi Maffei, Valentina Iadanza, Nicole Brugnera

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that often requires multimodal approaches to address its diverse manifestations. This discussion includes the outcomes of an innovative intensive neuromodulation protocol conducted over 1 week in a preliminary sample of children with ASD who were treated with a combination of advanced therapeutic interventions guided by quantitative EEG. The interventions included bioneurofeedback with passive infrared hemoencephalography, brainwave entrainment, rehabilitation using virtual and augmented reality, transcranial magnetic stimulation, transcranial direct current stimulation, and autonomic and stress oxidative regulation therapy. Treatments were tailored to individual needs and implemented in an integrated manner to maximize therapeutic outcomes.

This work underscores the potential of intensive, multimodal neuromodulation protocols for addressing the multifaceted challenges of ASD and highlights the importance of integrating advanced technologies and personalized strategies for effective intervention.

Correspondence: Luciana Lorenzon Centro Italiano di Biofeedback e Neurofeedback CINB, luci.gn@libero.it

Rabeea Maqsood, Susie Schofield, Alexander N. Bennett, Ahmed Khattab, Anthony M. J. Bull, Nicola T. Fear, Paul Cullinan, Christopher J. Boos, for the ADVANCE Study

Combat-related traumatic injury (CRTI) adversely affects cardiovascular functions. However, the association between CRTI and heart rate variability (HRV) as a measure of autonomic function has not been investigated in a contemporary military cohort.

We examined the association between CRTI and short-term HRV using the first follow-up data from the Armed Services Trauma Rehabilitation Outcome (ADVANCE) prospective cohort study. Participants were 469 injured servicemen (who sustained serious physical CRTI during deployment) and 506 uninjured servicemen (who were uninjured and frequency matched to the injured individuals based on age, sex (male), rank, and deployment (Afghanistan, 2003–2014) at recruitment. Resting HRV was measured (5-minute electrocardiogram) in the supine position. The root mean square of successive differences (RMSSD) and the sympathetic nervous system (SNS) index were calculated using Kubios as measures of parasympathetic and sympathetic activity, respectively. Multivariate regression was used to model the association between CRTI and HRV, adjusting for age, rank, and ethnicity.

Participants’ median age at follow-up assessment was 37.5 years. The time from CRTI or deployment was approximately 11 years. Median RMSSD was significantly lower in the injured (37.7 ms; interquartile range [IQR]: 25.3, 55.9) versus uninjured (41.9 ms; IQR: 27.7, 62.2) (p = .01). After confounder adjustment, CRTI was significantly associated with lower RMSSD (geometric mean ratio: 0.92; 95% confidence interval [CI]: 0.85, 0.99) and relatively higher SNS index (0.19; 95% CI: 0.05, 0.34) in the injured versus uninjured. Blast injury and traumatic amputation were also associated with significantly lower RMSSD and higher SNS activity.

CRTI is associated with relatively poor autonomic balance. The findings of this study highlight the need to promote HRV elevating interventions, e.g., HRV biofeedback, in this population for postinjury rehabilitation.

Correspondence: Rabeea Maqsood, Department of Medical Sciences and Public Health, Faculty of Health & Social Sciences, Bournemouth University, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, rabeeamaqsood18@gmail.com

Janell L. Mensinger, Alexandria Johnston, Arjena Valls Palacios Reese, Nicholas Johnston

Eating disorders (EDs) have dramatically increased in prevalence since the COVID-19 pandemic. Recent U.S. data (N = 1,294) indicate that more than one of every four adults suffer from clinically significant disordered eating. Methods for preventing subthreshold problems from becoming full-blown EDs are needed.

An 8-week, single-arm feasibility study of a mobile heart rate variability biofeedback (mHRVB) app supported strong acceptability and preliminary efficacy of mHRVB for reducing eating pathology. The present study was conducted to investigate potential mechanisms of the changes from pre- to postintervention. We enrolled 25 healthcare workers scoring in the clinically significant range on a validated measure of loss of control eating (88% women; 84% non-Hispanic White; age [years]: M = 43, SD = 11.7, range = 26–64). Measurements included the eight subscales of the Multidimensional Assessment of Interoceptive Awareness-v2 (MAIA-2) for interoceptive sensibility, the Eating Disorder Examination-Questionnaire 7-item Short (EDE-Q7), and the Loss of Control Eating Scale-Brief (LOCES) for disordered eating. Individual mediation analyses for each MAIA-2 subscale and disordered eating outcome were conducted using the MEMORE macro designed for repeated measures. Indirect effects were evaluated using 95% bias-corrected Monte Carlo bootstrapped confidence intervals.

Results demonstrated significant indirect effects on EDE-Q7 scores for MAIA-2 factors of Noticing, Attention-Regulation, Emotional-Awareness, Self-Regulation, and Body-Listening. The MAIA-2 factors of Not-Worrying, Not-Distracting, and Trusting did not significantly mediate changes in EDE-Q7 scores. Significant indirect effects were evident for changes in loss of control eating via the MAIA-2 Trusting factor. This study provides promising preliminary evidence of the critical role HRVB may play for enhancing interoceptive skills in people struggling with eating and body image distress.

Correspondence: Janell L. Mensinger, Nova Southeastern University, jmensing@nova.edu

Barbara Minton

Songs were composed to elicit various brain states, from delta through low beta. Pre-post surface and sorted weighted low-resolution electromagnetic tomography maps were generated for 20 participants. This presentation focuses on how this music affects various Brodmann areas and networks related to disorders of interest such as anxiety, depression, and attention deficit hyperactivity disorder. Suggestions are given on how to use music to augment and increase the power of existing neurofeedback and biofeedback techniques.

Correspondence: Barbara Minton, Private Practice, drbminton@gmail.com

Donald Moss

Chronic conditions aggravated by lifestyle present increasing burdens economically, medically, and in pain and suffering. Biofeedback therapies, especially heart rate variability biofeedback, have many applications for chronic conditions. However, unless the individual also makes lasting health-supporting lifestyle changes, the symptoms moderated by biofeedback therapy are likely to recur and progress to greater severity over time.

Angele McGrady and Donald Moss developed the Pathways Model to organize lifestyle-oriented interventions in a stepwise fashion and integrate these interventions with biofeedback, neurofeedback, and other mind-body therapies. This presentation will introduce the Pathways Model, the Pathways assessment, and the integration of self-care practices, life-style changes, and professionally delivered treatments to address chronic illness and enhance long-term wellness and resilience. Case narratives will be utilized to illustrate the application of the Pathways Model.

Correspondence: Donald Moss, Saybrook University, dmoss@saybrook.edu

Erik Peper, Richard Harvey, Singing Chen, Nicholas Heinz

In today’s fast-paced world, university students experience unprecedented levels of stress, which significantly impact their mental, emotional, and physical well-being. Many report symptoms such as anxiety, depression, gastrointestinal distress, chronic pain, allergies, and other stress-related disorders.

Over the past 45 years, we have taught an upper-division university course integrating holistic health and stress management strategies. By the end of the semester, more than 80% of students report a significant reduction in symptoms.

Based on these findings, we advocate for the integration of a whole-person self-care approach within educational curricula to equip students with essential skills for preventing and managing stress. Additionally, we recommend that therapists introduce these self-care practices in conjunction with biofeedback or neurofeedback interventions. This presentation outlines holistic self-care strategies that can be effectively incorporated into both educational settings and clinical practice.

Correspondence: Erik Peper, Institute for Holistic Health, San Francisco State University, epeper@sfsu.edu

Giuseppe Sacco, Cordellieri Pierluigi, Pasquale Giaccone

This study includes the preliminary results of a pilot study with 40 participants for whom the following parameters were measured: heart rate variability, respiratory rate, and skin conductance for the autonomic nervous system (ANS) and alpha and beta brain waves and sensorimotor rhythm for the central nervous system (CNS). The measurements were made during five phases: Baseline, Video Administration 1 (activating), Rest 1, Video Administration 2 (fun), Rest 2. The first results provide an indication of the importance of the integration between the observed ANS and CNS parameters and the need to further deepen the study. Some first application hypotheses in the clinical field are proposed through the introduction of specific combined bioneurofeedback protocols.

Correspondence: Giuseppe Sacco, Libra Associazione Scientifica, saccogiuseppe@libero.it

Erik Peper, Angelika Sadar

In today’s fast-paced world, college students and young adults often struggle with various health issues. From anxiety and depression to attention deficit hyperactivity disorder and epilepsy, these challenges can significantly impact their daily lives. But what if the solution to many of these problems lies in something as simple as Grandmother Therapy?

What is Grandmother Therapy? Grandmother Therapy is all about going back to basics and establishing healthy lifestyle habits. It’s the common-sense approach that our grandmothers might have suggested: regular sleep patterns, balanced nutrition, increased social connections, and regular physical activity.

This presentation will review the basics that help support and may be necessary to get the most out of the other therapeutic interventions recommended. Although these behaviors are things our grandmothers did because they made sense, in today’s world, there are many obstacles to implementing a common sense approach. The research that supports Grandmother Therapy and how to apply this therapy with today’s children and teens will be discussed.

Correspondence: Angelika Sadar, Sadar Psychological and Sports Center, angelika@sadarpsych.com

Mark Smith

To reduce the inherent uncertainty in a changing environment, the brain evolved as a complex adaptive system. It functions as a predictive machine that aids in finding safety and satiation. When neither can be found, the brain seeks information in the internal and external environment to update its predictions. To optimally adapt to changing environments, the brain predicts what the next situation will be based on its intention and the context. It attempts to verify the accuracy of the prediction by using various senses. When no new information can be gained by the senses, the brain will resort to memory. Failure to update our predictive capacity may result in the overreliance on memory to deal with life’s challenges. This approach often results in psychopathology, especially when memories distort current functioning. One such distortion is idiopathic chronic pain.

Any internal or external stimulus that deviates from homeostasis evokes a physiological response, as a nonspecific general adaptive response, mediated via the sympathetic and parasympathetic nervous systems. It has been proposed that neuropsychological issues are caused by deviant interactions between the central autonomic network and the large behavioral networks of the triple network model that result in maladaptive Bayesian predictions. Put simply, many forms of pain, especially chronic pain and more general suffering, are the result of the failure of this predictive mechanism. Current research on infraslow standardized low-resolution electromagnetic tomographic analysis neurofeedback and pain suggests validation of these concepts.

Correspondence: Mark Smith, Neurofeedback Therapy Services of New York, mark@neurofeedbackservicesny.com

Patrick Steffen

To learn and benefit from heart rate variability (HRV) biofeedback, regular practice is required. However, not all people learning HRV biofeedback put in the same amount of time and effort. To improve the amount and quality of practice, we explored using motivational interviewing techniques in combination with Lehrer’s brief HRV protocol to teach HRV biofeedback. Motivational interviewing is a collaborative, goal-oriented approach to interaction and communication with an emphasis on behavior change and the primary goal of increasing personal motivation and commitment.

A motivational interviewing approach was developed within the context of HRV biofeedback to increase motivation to engage in regular home practice. Participants came to the lab for six sessions, with each session emphasizing the benefits of regular practice and identifying potential roadblocks to practice and discovery of how to overcome challenges. HRV biofeedback was practiced in the lab using a NEXUS 10 biofeedback device, and participants were sent home with a HeartMath ear sensor Bluetooth device that allowed participants the opportunity to practice at home and researchers to carefully examine the quantity and quality of their practice. Results indicate that motivational interviewing improved practice.

Motivational interviewing shows promise as an approach to improve the implementation of HRV biofeedback.

Correspondence: Patrick Steffen, Brigham Young University, steffen@byu.edu

Mari Swingle, Niki Triantafyllopoulou, Davide Del Vento

This presentation will deliver the results of a 100-person clinical trial involving the application of combined harmonic and heart rate variability (HRV) training on the EEG. The presenters will share the effects found with multiple mechanisms of action, both the hypothesized targeted results (involving expected changes) in the EEG associated with desired brain quieting and unexpected secondary findings in the EEG that turned out to be main effects. Findings include EEG markers of mental efficiency improving in tandem with quieting, fueling further hypotheses regarding the power of an intervention that can quiet without sedative effects.

The discussion also includes how psychotherapeutic theory can combine with empirical movement in the EEG and how combining traditional therapeutic techniques with technological tools can offer more rapid solutions as the intervention acts on both the central and autonomic nervous systems.

The presentation will cover and differentiate universal effects versus relative subeffects of gender, condition or ailment, environment, and age. Both empirical and subjective data will be included (subjective reporting of participants and statistical findings). Therapeutic considerations, limitations, and cautions will also be presented, including challenges with equipment and delivery system fidelity.

Correspondence: Mari Swingle, Swingle Clinic, mari@drmariswingle.com

Porzia Talluri

The initial assessment with bioneurofeedback integrates technical data with insight obtained through a structural interview based on the protocol developed by Sebern Fisher. Additional information related to the gastrointestinal system was included as a part of the evaluation. Technical data were collected through bioneurofeedback tools and categorized as follows.

Physiological data showed activation of participants inside and outside the window of tolerance for skin conductance measured bilaterally to assess activation levels; blood volume pulse evaluated using a photoplethysmograph, and diaphragmatic breathing: monitored to assess respiratory function. Metabolic data were collected using hemoencephalography with three passive infrared (pIR) sensors to detect fluctuations in blood flow and metabolic waste. Sensors were positioned at frontopolar locations enabling separate readings for the right, left, and central frontal areas. Cortical (EEG) signals were recorded at Cz during eyes-open and eyes-closed conditions. Baseline values included EEG at Cz analyzed in 1-Hz increments and mean values for skin conductance, respiration, heart rate variability, and pIR fluctuations (right, left, and central). Participants then performed a stress-response protocol and were asked to imagine and relive emotional experiences (anger, fear, joy, and sadness), with recovery phases measured for each condition.

This comprehensive assessment framework combines physiological, metabolic, and cortical indices to provide a robust foundation for individualized bioneurofeedback interventions. The integration of these multidimensional data sets offers a novel insight into brain-body interactions and their modulation under emotional stress.

Correspondence: Porzia Talluri, talluri.porzia@gmail.com

Lynda Thompson

Neurofeedback alone can be an effective intervention for many conditions, as exemplified by a positive response rate of around 80% for attention deficit hyperactivity disorder. Clinicians can do even better—they can increase the odds of success by combining modalities. At the ADD Centre in Toronto (ON, Canada), we have combined neurofeedback with biofeedback and metacognitive strategies for over 30 years. The neurofeedback is highly effective for self-regulation of attention, and biofeedback is highly effective for self-regulation of emotions. Learning to learn through coaching in strategies gives added value because the client has techniques they can apply starting with their first session, whereas the neuro- and biofeedback take longer to yield results.

This combined approach has served us well, but neuroscience research moves quickly, and as new modalities have been developed we have added to our tool kit some that are research based. These interventions include transcranial direct current stimulation, photobiomodulation, and listening interventions (Stephen Porges’s Safe and Sound Protocol). This presentation will describe these newer techniques and explain how to combine interventions during each training session. The core interventions remain neurofeedback and biofeedback, but there is added value when you use multiple interventions. Case examples will illustrate the favorable outcomes achieved with some challenging cases and show how taking a multimodal approach helps clinicians reach the goal of success with every client.

Correspondence: Lynda Thompson, ADD Centre & Biofeedback Institute of Toronto, lyndathom@gmail.com

Mehmet Fatih Varli

The main aim of this study was to investigate the effects of an EEG biofeedback method on the memory performances of gifted and talented children. The subsidiary aim was to investigate and compare the effects of the EEG biofeedback method and a memory exercise program on memory performances of these children.

Thirty-four gifted and talented fifth and sixth grade students enrolled in Istanbul Science and Art Center were included in this study. Öktem Verbal Memory Process Test (T1), Visual Aural Digit Span Test (T2), and Visual Memory Test (T3) were applied as preliminary tests. These 34 students were grouped according to their preliminary memory test scores into three groups; score means and standard deviations were not significantly different. Experimental Group (EG) 1 included 6 students; EG2 included 14 students; and the Control Group (CG) included 14 students. EEG biofeedback training was applied in DGl, and a memory exercise program was applied in DG2. At the end of the application, T1, T2, and T3 were administered to each of the three groups as a final test. The nonparametric Kruskal-Wallis test, Wilcoxon signed rank test, and Mann-Whitney U test were used for analysis of the data.

In this study, the final test total average scores of both DGl and DG2 were significantly higher than the preliminary test total average scores. For the experimental groups, which were the focus of this study, the final test total average scores of DGl were significantly higher than those of DG2. The results indicate that the EEG biofeedback training and memory exercise program both improved the memory performances of these gifted and talented children, but the EEG biofeedback was more effective.

Correspondence: Mehmet Fatih Varli, Istanbul Topkapı University, mehmetfatihvarli@topkapi.edu.tr

Stoyan Vezenkov, Violeta Manolova, Boryana Ruseva, Pencho Tonchev, Iliya Mihaylov, Lazar Trenchev, Yuliyan Radoyski

Cognitive performance in aviation relies on neural synchronization across brain regions essential for attention, decision making, and motor control. This study was conducted to investigate coherence differences between military pilot instructors and students during closed- and open-eyes conditions, focusing on delta, theta, alpha, and beta frequency bands.

EEG coherence was measured in military pilot instructors (n = 4) and students (n = 9). Independent t tests revealed significant coherence differences at p ≤ .05, .025, and .01. Coherence patterns were analyzed both intrahemispherically and interhemispherically to map functional connectivity variations between the groups.

Instructors demonstrated significantly higher coherence in frontotemporal and interhemispheric regions across all frequency bands, with the most pronounced differences in alpha and beta bands. These findings suggest enhanced neural synchronization supporting visual-spatial processing, decision making, and motor control. Conversely, students had lower coherence, particularly in central and temporal regions, reflecting developing neural integration. Differences in lower frequency bands (delta and theta) indicate variability in baseline attentional and memory processes, whereas higher frequency differences (alpha and beta) emphasize advanced cognitive control in instructors.

Experience-driven neural optimization in military pilots enhances functional connectivity in brain regions critical for aviation tasks. EEG coherence emerges as a promising biomarker for cognitive readiness, with potential applications in designing neuro-training interventions. Targeted coherence-based training for novice pilots could accelerate skill acquisition, enhance cognitive performance, and improve the overall efficiency and safety of aviation training programs.

Correspondence: Stoyan Vezenkov, Medical University, Pleven; Bulgarian Airforce Academy Georgi Benkovski, Center for Applied Neuroscience Vezenkov, info@vezenkov.com

Meinte Vollema

In addition to earlier effect studies on hemoencephalography (HEG) neurofeedback, we focused in this HEG neurofeedback effect study on three aspects of sustained attention in children with neurodevelopmental disorders. This approach may give rise to interesting theoretical and practical implications.

Eight children were included in the study (ages 10–17 years), five with autism spectrum disorder (ASD) and comorbid attention deficit hyperactivity disorder (ADHD) (inattentive type), one with ASD, and two with ADHD (inattentive type). HEG neurofeedback was given once each week for 3 months using a two-channel HEG sensor and Biograph Infiniti software. The Bourdon-Vostest (BV) cancellation task was administered before the first HEG neurofeedback session and immediately after the last session 3 months later. The BV generates scores on three variables: speed of information processing, variation of speed, and accuracy.

For all participants, we calculated reliable change indexes based on the differences between pre- and posttraining scores for two of the BV variables: speed and accuracy. With regard to variation of speed, we could not calculate reliable change indexes and thus present raw data. After the HEG neurofeedback sessions, six of the eight participants had a higher speed of information processing, and six participants reached higher levels of accuracy (significant reduction of omissions).

Keeping limitations in mind, we conclude that HEG neurofeedback seems to have positive effects on attentional functions in children with neurodevelopmental disorders and presents as a promising treatment option.

Correspondence: Meinte Vollema, meinte@debinnenkijk.nl

Marco Caiulo, Annalia Delle Rose, Aurora D’Autilia, Paola Graziano, Giorgia Cucurachi, Ilenia Carangelo, Silvia Rosafio, Gabriele Ciccarese

Anxiety is closely linked to physiological parameters regulated by the autonomic nervous system (ANS), including heart rate variability (HRV), skin conductance (SC), and surface electromyography (sEMG). SC is a sensitive indicator of sympathetic activation; however, it is not always directly correlated with high levels of anxiety or physiological arousal. SC also reflects the system’s ability to implement emotional regulation strategies. This work proposes an analysis that integrates SC, HRV, and sEMG to better understand the relationship between anxiety and physiological regulation.

A biofeedback-based stress assessment was conducted with a clinical sample of 200 participants and was structured into baseline, cognitive stress, two emotional stress phases, and recovery periods. Physiological parameters of HRV metrics, SC, sEMG, respiratory parameters, and temperature were analyzed in relation to psychological data collected through a validated tool. Some preliminary findings have revealed that participants with high anxiety scores have a significant reduction in HRV metrics during the first emotional stress phase and recovery difficulties. SC did not emerge as a mere indicator of arousal but rather as a measure of emotional regulation capacity. Furthermore, increased frontal muscle tension, as measured by sEMG, was associated with recovery difficulties.

These findings highlight that SC interpretation should be considered within a broader context of emotional regulation rather than as a direct marker of anxiety levels. By integrating SC, HRV, and sEMG, biofeedback may represent an innovative and personalized intervention for assessing and managing anxiety and related disorders, opening new perspectives for diagnosis and treatment based on physiological markers.

Correspondence: Marco Caiulo, Centro Nova Mentis, marco.caiulo.mc@gmail.com

Isaac Compton, Frederic Shaffer

Heart rate variability (HRV) reflects the fluctuation in time intervals between consecutive heartbeats, influenced by autonomic nervous system dynamics. Prior research has demonstrated that slow-paced breathing (SPB) and slow-paced muscle contraction (SPC), particularly at rates near 6 cycles/minute (bpm/cpm), can enhance HRV by stimulating arterial and vascular tone baroreflexes. This study was conducted to investigate whether combining SPB and SPC produces greater HRV improvements than does SPB alone.

A within-participants design was used to compare HRV metrics across three conditions: resting baseline (BL), SPB, and SPB combined with SPC. Data from 28 undergraduate participants 19–22 years of age who consistently adhered to the 6-bpm breathing protocol were analyzed. HRV metrics of HR maximum minus minimum (Max−Min), root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and low-frequency (LF) power were evaluated using a repeated-measures analysis of variance.

Results revealed that both SPB and the combined condition significantly improved HR Max−Min, SDNN, and LF power compared with BL. However, the combined condition had a modest advantage over SPB alone, significantly increasing HR Max−Min (p = .004, partial η² = .34) but no other metrics. RMSSD improvements in the combined condition were near the significance threshold (p = .046, η² = .18).

These findings suggest that although SPB and SPC individually enhance HRV, combining them yields only marginal additional benefits. Because of its simplicity and similar effectiveness, SPB may remain preferable for HRV biofeedback training. Future studies should explore these effects in clinical populations to enhance generalizability. Limitations included participant adherence challenges, underscoring the need for pretraining in paced breathing techniques.

Correspondence: Isaac Compton, Truman State University, icompton044@gmail.com

Elisabetta Cremonese, Vanessa Ruggiero, Elisabetta Patron, Eleonora Volpato

Functional gastrointestinal disorders (FGIDs) are characterized by chronic gastrointestinal symptoms without evidence of organic pathology. These disorders are frequently associated with psychosocial factors and exhibit a strong link with anxiety. Altered autonomic modulation, reflected by reduced heart rate variability (HRV), is implicated in both anxiety and FGID pathophysiology. This study was conducted to investigate the potential of HRV biofeedback training to mitigate FGID symptoms and anxiety in university students by enhancing autonomic balance.

University students exhibiting elevated FGID symptoms (assessed through the Irritable Bowel Syndrome Severity Scoring System) and high anxiety levels (Depression, Anxiety, and Stress Scale-21) were enrolled in the study. The intervention lasted 2 weeks and consisted of five sessions of HRV biofeedback training designed to enhance HRV and promote parasympathetic activity.

Preliminary data indicated that at baseline, more severe FGID symptoms were significantly associated with lower HRV and reduced parasympathetic activity. After a short period of HRV biofeedback training, participants had a significant reduction in FGID symptom severity and perceived stress.

This pilot study provides evidence for the effectiveness of HRV biofeedback as a nonpharmacological intervention for the management of FGID symptoms in university students. By targeting the underlying autonomic imbalance associated with stress and anxiety, this approach may offer a valuable strategy for improving the well-being of this vulnerable population.

Correspondence: Elisabetta Cremonese, Department of General Psychology, University of Padua, elisabetta.cremonese@unipd.it

Aurora D’Autilia, Annalia Delle Rose, Gabriele Ciccarese, Marco Caiulo, Paola Graziano, Giorgia Cucurachi, Ilenia Carangelo, Silvia Rosafio

Emotional dysregulation, interpersonal difficulties, depressive mood, and heightened sensitivity to rejection are hallmarks of borderline personality disorder, vulnerable narcissistic personality disorder, histrionic personality disorder, and conversion disorder. These conditions present significant clinical challenges. The integration of metacognitive interpersonal therapy (MIT) and biofeedback may provide an effective approach to addressing the complex dynamics underlying these disorders. This case study was conducted to evaluate the efficacy of such a treatment for improving metacognitive functions, including monitoring, differentiation, integration, decentering, and mastery.

The patient, a 25-year-old woman, underwent a combined treatment consisting of MIT provided by the Third Centre for Cognitive Psychotherapy and 12 biofeedback sessions aimed at enhancing emotional regulation and physiological awareness. In these sessions, heart rate variability (HRV), skin conductance (SC), and surface electromyography (sEMG) were measured. Pre- and posttreatment assessments included a comprehensive psychological battery to examine emotional dysregulation, interpersonal difficulties, anxiety, depression, and functional impairment. A structured stress assessment was used to monitor physiological patterns during baseline, cognitive stress, emotional stress (avoidant and ambivalent stimuli), and recovery phases.

Initial findings indicated reduced HRV during emotional stress, particularly with ambivalent stimuli, elevated SC with poor recovery in stress phases, and persistent muscle tension indicative of ineffective regulation. Posttreatment, the patient exhibited significant improvements, including enhanced emotional regulation, reduced hyperreactivity, improved HRV, greater metacognitive functioning, reduced anxiety, reduced depressive symptoms, and improved interpersonal abilities.

This case demonstrates the potential of integrating MIT and biofeedback to treat complex personality disorders, highlighting its utility for fostering personalized interventions and improving self-regulation.

Correspondence: Aurora D’Autilia, Centro Nova Mentis, a.dautilia@centronovamentis.it

Alice Fiduccia, Sara Guidotti, Costantino Gozzi, Nadia Felisa, Martina Saccani, Roberto Bardini, Carlo Pruneti

In Italy, the assessment of work-related stress is legally required (Legislative Decree 81/2008). However, a standardized protocol does not yet exist, although burnout affects 8 of 10 workers and represents a public health issue because of the psychophysical impact of chronic stress. Interventions based on heart rate variability biofeedback (HRVB) combined with a multidimensional stress assessment (work-environment risk factors, psychopathological symptoms, personality traits, and psychophysiological evaluation) were effective in various occupational settings. Based on these assumptions and in alignment with European Union (EU) objectives for industrial innovation and digitalization, we worked to develop the STRESS LESS app for a digital multidimensional work-related stress assessment and a psychophysiological intervention based on HRVB.

One hundred employees from Trancerie Emiliane, a leading metalworking company, will be recruited. Participants will complete the digital versions of the Italian National Institute for Insurance Against Accidents at Work-Checklist, Symptom Checklist-90-Revised (SCL-90-R), 16 Personality Factor, and P Stress Questionnaire at baseline (T0) in addition to HRV assessment. After 10 sessions of HRVB (T1), psychopathological symptoms (SCL-90-R) and HRV will be reassessed (T2).

We expect to improve psychopathological symptoms and autonomic dysregulation and elucidate the role of personality traits in modulating psychological and psychophysiological distress, contributing to the research field of work-related stress psychophysiology. Further shared objectives include return of aggregated data to the company; compliance with Legislative Decree 81/2008 and SA8000 ethical/social certification; and development of an inclusive, environmentally sustainable startup company aligned with EU industrial innovation goals.

Correspondence: Alice Fiduccia, Department of Medicine and Surgery, University of Parma, alice.fiduccia@live.it

Marco Gonella, Carola Grimaldi, Maria Domenica Sauta, Luciana Lorenzon, Serena Villa, Alice D’Ambra, Mariangela Coia, Martina Guglielmino, Angelo Valenti, Monica Agnesone, Barbara Vinassa, Antonella Granieri, Isabella Giulia Franzoi

Patients affected by medically unexplained symptoms (MUS) and patients who suffer from panic attacks can benefit from psychophysiological assessment and training. The use of biofeedback can support psychophysiological and emotional regulation, promoting emotion symbolization and mentalization and possible symptom relief. Biofeedback also can sustain the detection of individual frailties and resources and improve multidisciplinary collaboration with medical professionals. Patients affected by MUS and panic attacks can have alexithymia and affective dysregulation, as indicated by a deficit in perceiving and regulating psychophysiological states, symbolizing emotions, and mentalizing their own affective states and those of others. These patients may benefit from brief interventions including biofeedback training.

A protocol integrating biofeedback and psychoanalytical psychology was given to patients affected by MUS and panic attacks thanks to a collaboration between the Psychology Department of Azienda Sanitaria Locale Città di Torino, general practitioners in the city of Turin, and the Psychology Department of the University of Turin. T tests were performed to compare psychometric and psychophysiological measures before (T0) and after (T1) biofeedback intervention (n = 8). The Depression, Anxiety, and Stress Scale-21 Anxiety subscale (t = 3.431; p = .009), Body Perception Questionnaire Body Awareness subscale (t = 2.305; p = .05), and subdiaphragmatic symptoms (t = 2.507; p = .04) were reduced from T0 to T1, and Working Alliance Inventory agreement on treatment tasks increased (t = −2.414; p = .04).

Biofeedback training given to patients suffering from MUS and panic attacks can promote a first stabilization of symptoms, which opens the way to emotion representation.

Correspondence: Marco Gonella, S.C. Psicologia Aziendale; Dipartimento di Psicologia Università degli Studi di Torino, dott.marcogonella@gmail.com

Paola Graziano, Annalia Delle Rose, Marco Caiulo, Aurora D’Autilia, Giorgia Cucurachi, Ilenia Carangelo, Silvia Rosafio, Gabriele Ciccarese

Borderline personality disorder (BPD) is characterized by emotional dysregulation, interpersonal instability, and impulsivity. Physiological markers such as heart rate variability (HRV), skin conductance (SC), and surface electromyography (sEMG) are useful for investigating autonomic nervous system (ANS) dysregulation in BPD patients. This study was conducted to explore the correlations between physiological patterns, which were measured with biofeedback tools, and the dimensions of BPD, which were assessed through the Personality Assessment Inventory-Borderline Scale (PAI-BOR) and its subscales (Affective Instability, Identity Problems, Negative Relationships, and Self-Harm), offering insights into the diagnosis and treatment of the disorder.

This poster presents preliminary results from an investigation with 200 patients who completed a stress assessment protocol including baseline, cognitive stress, two emotional stressors (with different attachment-related stimuli), and recovery phases. Data on HRV, SC, sEMG, respiratory parameters, and temperature were analyzed in relation to PAI-BOR scores.

Significant correlations were found between high PAI-BOR scores and dysregulated physiological responses during stress and recovery, with HRV, sEMG, and SC serving as key markers of emotional and autonomic imbalances. The Negative Relationships subscale of PAI-BOR is associated with parasympathetic hyperactivity, detectable through increases in root mean square of successive differences during cognitive stress and in heart failure during emotional stress. Elevated frontal muscle tension was observed during recovery from all stress phases. The Identity Problems subscale score is correlated with higher baseline temperature, whereas the Self-Harm subscale is linked to increased SC and temperature variability during emotional stress.

These findings underscore the diagnostic and therapeutic potential of physiological markers in BPD treatment. Biofeedback-based interventions may offer an innovative strategy for improving emotional and autonomic regulation.

Correspondence: Paola Graziano, Centro Nova Mentis, paola.graziano198@gmail.com

Aida Ivan, Delia Barbu

This case study was conducted to explore the impact of whole brain training neurofeedback on a 23-year-old woman diagnosed with moderate to severe depression. Neurofeedback, a noninvasive technique aimed at regulating brainwave activity, has been increasingly utilized as an alternative treatment for mood disorders.

The participant in this study underwent a structured whole brain training neurofeedback program over the course of 10 weeks, involving 20 sessions targeting emotional regulation and cognitive functioning (four cycles of five sessions each). Pre- and postintervention assessments using standardized depression scales and neurocognitive tests were conducted to measure changes in symptom severity, brainwave patterns, and overall mental health.

Results indicate significant improvement in mood, reduction in depressive symptoms, and enhanced cognitive flexibility. The findings suggest that whole brain training neurofeedback can be a promising adjunctive therapy for individuals suffering from depression, contributing to a more personalized and integrative approach to mental health treatment.

Correspondence: Aida Ivan, aidaivan40@gmail.com

Gabija Jarašiūnaitė-Fedosejeva, Viktorija Stankevičienė

Mothers with attention deficit hyperactivity disorder (ADHD) face unique challenges, such as difficulties with organization, emotional regulation, and maintaining focus. These challenges not only disrupt their daily lives but also complicate the demanding responsibilities of parenting. Elevated parenting stress can strain parent-child relationships, hinder effective parenting practices, and adversely affect the child’s emotional and behavioral development. Addressing this stress effectively is crucial for fostering healthier family dynamics and supporting maternal well-being.

Neurofeedback, a widely used approach to treat ADHD, directly targets neurological dysregulation and may address the underlying causes of parenting stress. Heart rate variability biofeedback, which is primarily designed to enhance stress management and emotional resilience by improving physiological self-regulation, has also shown promise not only in reducing stress but also in alleviating ADHD symptoms. Despite their potential, the comparative efficacy of these two interventions in reducing parenting stress among mothers with ADHD remains unexplored.

Reducing parenting stress could empower mothers with ADHD to better manage their parenting responsibilities, enhance self-confidence, and improve overall quality of life. Having evidence-based data on the effectiveness of these interventions would help mothers make more informed and cost-effective decisions about treatment options. This research is valuable for advancing our understanding of how biofeedback-based interventions can address the dual challenges of ADHD symptoms and parenting stress, providing important insights for both clinical practice and future research.

This presentation will introduce the research protocol designed to compare the efficacy of neurofeedback and HRV biofeedback for reducing parenting stress and ADHD symptoms in mothers.

Correspondence: Gabija Jarašiūnaitė-Fedosejeva, Vytautas Magnus University, gabija.jarasiunaite-fedosejeva@vdu.lt

Ilona Bidzan-Bluma, Magdalena Jochimek, Małgorzata Lipowska

The brains of children 10–12 years of age undergo intensive changes, and children in this age group are less frequently studied than are adults and very young children. The concept of opened and closed skilled exercise is often used in research in sports psychology and neuropsychology of sport for examination of the cognitive functioning of people practicing various sports. The aim of the study was to compare the bioelectrical activity of the brain of children practicing football and gymnastics and of children who exercise regularly but do not practice sports.

The study involved 176 preadolescent children (age in years: M = 11.06, SD = 0.77). The individual groups were comparable in terms of the number and proportion of girls and boys. The study involved research tools to assess individual explored areas: the International Physical Activity Questionnaire in a modified version for children and a proprietary questionnaire, the part concerning sports activity and analysis of the student’s sports history. EEG biofeedback was also used. Electrodes were placed centrally (Cz) to measure fast brain waves (alpha, beta1, and beta2) and slow brain waves (delta and theta). The study was conducted using a closed script. The following spectral coefficients were analyzed: theta/beta (4–8 Hz/16–20 Hz) (Lubar coefficient) and theta/SMR (Monastery coefficient).

The results of the study indicate that in terms of indicators of bioelectrical brain activity measured at point Cz, differences were obtained between the gymnast group and the control group. Children undertaking physical activity more often than five times each week were characterized by a higher theta/SMR coefficient.

Correspondence: Magdalena Jochimek, Faculty of Psychology in Sopot, SWPS University, mjochimek@swps.edu.pl

Mattia Nese, Greta Riboli, Gianni Brighetti, Rosita Borlimi

Resonant breathing, characterized by an optimal breathing frequency (usually between 6.5 and 4.5 breaths per minute), promotes synchronization between cardiovascular and respiratory rhythms, yielding benefits such as stress reduction, improved emotional regulation, and enhanced heart rate variability (HRV). However, integration of this breathing technique into clinical practice remains limited because of barriers such as insufficient practitioner training and the need for advanced tools such as biofeedback systems. Development of accessible and effective methods for teaching resonant breathing could facilitate its broader application.

This study was conducted to examine whether the effects of resonant breathing, learned in a single session, differ depending on the instructional method. Two approaches were compared: a biofeedback-based session and a video tutorial. Twenty-four university students were randomly assigned to one of two groups. The biofeedback group participated in a 25-minute session with real-time feedback on physiological parameters, and the video group watched a 25-minute tutorial demonstrating slow diaphragmatic breathing. Subsequently, participants wore a portable ECG device (BioNomadix, BIOPAC Systems Inc.) programmed to prompt three practice sessions, during which the participants performed resonant breathing for 2 minutes per prompt. ECG data were analyzed to extract HRV parameters linked to respiratory sinus arrhythmia (standard deviation of normal-to-normal intervals, root mean square of successive differences, and percentage of consecutive normal-to-normal intervals that differ by more than 50 ms), comparing breathing sessions with baseline measurements (previous 2-minute windows).

No significant differences in the main HRV indices were found between groups. However, individual profiles revealed high variability in the effects of resonant breathing. Video instructions may be as effective as biofeedback for some individuals but could have iatrogenic effects for others. Personalized interventions should be guided by a preliminary psychophysiological assessment.

Correspondence: Mattia Nese, Department of Psychology, Sigmund Freud University Milano, m.nese@milano-sfu.it

Elisabetta Pappalardi, D. Mongelli, R. Falcone, G. Lagravinese, P. Fiore, I. Battel

This pilot study was conducted to examine whether surface electromyography (sEMG) biofeedback improves swallowing function more effectively than conventional therapy in poststroke dysphagia rehabilitation. sEMG biofeedback provides a real-time, objective approach for neuromuscular retraining, potentially enhancing patient outcomes.

Although biofeedback is well established as contributing to poststroke motor recovery, its role in dysphagia treatment remains underexplored. Research indicates that sEMG biofeedback significantly enhances swallowing function, reduces aspiration pneumonia risk, and improves quality of life. However, most studies emphasize general swallowing ability rather than performance across food consistencies. sEMG biofeedback is considered safe and clinically accepted, although further large-scale studies are needed to confirm its long-term efficacy.

This prospective study involved 10 poststroke patients: 5 received sEMG biofeedback, and 5 underwent conventional therapy. Both groups completed 20 treatment sessions over 4 weeks. Objective assessment tools included the Dysphagia Outcome Severity Scale, Functional Oral Intake Scale, Penetration-Aspiration Scale, and Yale Pharyngeal Residue Severity Rating Scale measured during fiberoptic endoscopic evaluation of swallowing. Subjective assessments covered swallowing competence across food consistencies.

Preliminary findings indicate superior swallowing improvements in the experimental group, suggesting that sEMG biofeedback has potential advantages over conventional therapy. These results support sEMG biofeedback as a promising rehabilitation strategy, emphasizing the need for larger scale studies to optimize protocols and validate long-term outcomes.

Correspondence: Elisabetta Pappalardi. Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute; Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Bari Institute, elisabetta.pappalardi@icsmaugeri.it

Evgenii Pashnin, Simone Cutini

Breath holding (BH) is widely used in psychophysiology as a test for distress tolerance (DT) and as a component of breathwork practices. However, methodological inconsistencies and limited integration into neuroscience frameworks reduce its applicability. Emerging evidence, particularly on CO₂ sensitivity as a transdiagnostic marker for anxiety and mental health disorders, suggests untapped potential for BH to enhance DT understanding and biofeedback applications. A systematic analysis of BH research can identify gaps, demonstrate its feedback-rich utility, and highlight its role in interventions targeting CO₂ and interoceptive sensitivity.

Research shows that BH duration is influenced by physiological and psychological factors, but inconsistent protocols undermine its reliability. Despite its quantifiable parameters (e.g., duration and CO₂ retention), BH remains underexplored in breathwork. Insights from free diving reveal that CO₂ tolerance is highly trainable, offering potential for reducing anxiety and panic sensitivity.

This ongoing systematic review was conducted to evaluate studies on BH as a DT test and in breathwork practices. Studies are categorized by their focus on BH as a test or therapeutic intervention. Preliminary findings reveal substantial methodological gaps, including inconsistent lung volume control, limited attention to repeated trials and BH’s biphasic nature, and insufficient exploration of CO₂ sensitivity and fear regulation. BH’s role in breathwork remains poorly defined, with no studies isolating it as a stand-alone practice.

Standardized BH protocols and interdisciplinary research integrating CO₂ sensitivity are needed to unlock its potential as a biofeedback tool. These findings aim to guide future clinical applications for anxiety and stress resilience.

Correspondence: Evgenii Pashnin, University of Padua, Department of Developmental Psychology and Socialisation, evgenii.pashnin@phd.unipd.it

Via Nicole Calderon, Maggie Hellberg, Erik Peper, Richard Harvey

Mental and physical symptoms among college students have risen significantly over the past two decades. Course-based programs offer an effective way to address diverse needs in a cost-efficient manner. One such course, Holistic Health: Western Perspectives, has been taught for years at San Francisco State University, focusing on stress management and personalized health improvement. Assignments include creating individualized plans to address issues such as diet, exercise, and symptoms of physical or mental illness. The curriculum includes daily self-practices that include dynamic relaxation, positive internal dialogue, self-healing imagery, and diaphragmatic breathing and are based on the book Make Health Happen. Students undertake a self-healing journey, collecting data throughout the semester to observe how self-regulation skills affect symptom reduction.

Over 80% of participants reported significant symptom relief after implementing their projects for 5 weeks. The benefits are illustrated by three students who reduced their symptoms. A 21-year-old female student eliminated her essential hypertension, as measured by her average daily blood pressure, reducing it from 148/79 to 119/74 mmHg through stress management and breathing techniques. A 59-year-old female student reduced her diabetes, as measured by her A1C, from 13.5 to 8.0 by changing her eating habits and managing stress, and her mood improved on a self-rating scale from 4 to 9 (on a 0–10 scale). A 26-year-old female student reduced her chronic urticaria (hives) by 57% and noticed a decrease in acne and eczema by reducing gluten intake, managing emotional stress, and practicing breathing and self-healing imagery when becoming aware of skin sensations.

These results demonstrate the transformative impact of holistic health education that includes skill mastery and regular self-practice throughout the semester. We suggest that universities incorporate such courses into their curricula to equip students with lifelong self-healing skills.

Correspondence: Erik Peper, San Francisco State University, epeper@sfsu.edu

Karolina Zofia Poczopko, Agnieszka Kułak-Bejda, Napoleon Waszkiewicz

Posttraumatic stress disorder (PTSD) is a complex condition often accompanied by autonomic dysregulation, including emotional numbing, which manifests by a weakened parasympathetic nervous system and an overactive sympathetic nervous system. Although some evidence supports the efficacy of HRV biofeedback and the combination of prolonged exposure (PE) with propranolol, which blocks β-adrenergic receptors, in PTSD treatment, the integration of HRV biofeedback with PE in PTSD treatment has not yet been investigated.

This single case study was conducted to examine a novel therapeutic approach combining PE with HRV biofeedback in a 40-year-old woman hospitalized for PTSD and depression at a psychiatry clinic. The patient underwent 10 sessions of diaphragmatic breathing training (twice daily over 5 days) followed by seven PE sessions integrated with HRV biofeedback. During PE-HRV sessions, she listened to an audio recording of a trauma script. Neurophysiological assessments, including HRV parameters, were conducted at baseline and pre- and postintervention during trauma recall.

Treatment led to significant reductions in dissociative symptoms, including sudden sleepiness, and overall PTSD severity, with decreased emotional numbness and avoidance behaviors. At the pretest, the metrics suggested dorsal vagal shutdown. HRV metrics improved over the course of treatment, indicating better autonomic regulation. As PTSD symptoms decreased, the patient experienced transient mood worsening, attributed to emotional processing of previously avoided content. This response is aligned with better heart rate reactivity. These results highlight the potential efficacy of combining PE with HRV biofeedback for PTSD treatment, particularly for patients with dissociative symptoms.

Correspondence: Karolina Zofia Poczopko, Department of Psychiatry University Clinic Hospital Bialystok, karolina.zofia.poczopko@gmail.com

Rosanna Sanseverino, Sara Guidotti, Daniele Chirco, Alice Fiduccia, Emma Carli, Carlo Pruneti

In clinical psychophysiology studies, a link between some physiological parameters in eating disorders has been documented. This work was conducted to investigate the association between increased basal sympathetic arousal and binge eating, a typical behavior in individuals who regulate emotions through food intake. We also explored the possible relationship between binge eating and body mass index (BMI).

This cross-sectional research involved 63 university students, ages 18–49 years, from some of the healthcare courses of the University of Parma. All participants were assessed. The Psychophysiological Stress Profile (PSP) and the Eating Disorder Inventory-3 (EDI-3) were administered, and their BMIs were calculated.

A path analysis revealed that overcontrol fully mediated the relationship between autonomic arousal (i.e., baseline skin conductance) and binge eating (Z = −2.18; p < .05), which in turn significantly predicted BMI (β = .34; p < .001).

These results confirmed that alterations in eating behavior might originate from autonomic imbalance and favor an increase in BMI. Further studies are needed to determine the causality between autonomic arousal, overcontrol, emotional dysregulation associated with binge eating, and BMI.

Correspondence: Rosanna Sanseverino, Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Laboratory, Department of Medicine and Surgery, University of Parma, rosanna.sanseverino@studenti.unipr.it

Agnieszka Trawicka

This poster provides an overview of an innovative approach to integrating biofeedback techniques with eye movement desensitization and reprocessing (EMDR) therapy, offering new perspectives for working with individuals with trauma and other psychological disorders. The topic of trauma is a particularly important and growing issue in today’s world. EMDR therapy, recognized as an effective method for processing traumatic memories, is enhanced by combining it with biofeedback, which enables monitoring and regulation of psychophysiological parameters such as heart rate variability and muscle tension. Previous research on biofeedback has demonstrated its effectiveness for improving emotion regulation and reducing symptoms of posttraumatic stress. Integrating these two approaches opens new possibilities for improving the therapeutic process.

This poster emphasizes the particular role of biofeedback in preparing the patient for EMDR sessions, supporting them in developing self-regulation skills, and increasing tolerance to emotional arousal during the processing of difficult memories. Thanks to this approach, therapists can better tailor interventions to the individual needs of patients while increasing the effectiveness and safety of treatment. The novelty of integrating biofeedback and EMDR lies in the synergistic use of psychophysiological techniques and cognitive processing, which opens new directions for research and practical opportunities for specialists in the field of psychotherapy.

Correspondence: Agnieszka Trawicka, University SWPS, atrawicka@swps.edu.pl