Brigham Young University BYU ScholarsArchive Theses and Dissertations 2020-06-23 Client Experiences of a Brief Heart Rate Variability Biofeedback Protocol Sheilagh Fox Brigham Young University Follow this and additional works at: https://scholarsarchive.byu.edu/etd Part of the Family, Life Course, and Society Commons BYU ScholarsArchive Citation Fox, Sheilagh, "Client Experiences of a Brief Heart Rate Variability Biofeedback Protocol" (2020). Theses and Dissertations. 8621. https://scholarsarchive.byu.edu/etd/8621 This Dissertation is brought to you for free and open access by BYU ScholarsArchive. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. Client Experiences of a Brief Heart Rate Variability Biofeedback Protocol Sheilagh Fox A dissertation submitted to the faculty of Brigham Young University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Melissa K. Goates-Jones, Chair Patrick Steffen David Erekson Wendy Birmingham Gary Burlingame Department of Psychology Brigham Young University Copyright © 2020 Sheilagh Fox All Rights Reserved ABSTRACT Client Experiences of a Brief Heart Rate Variability Biofeedback Protocol Sheilagh Fox Department of Psychology, BYU Doctor of Philosophy This study investigated the experiences of clients who completed a brief heart rate variability biofeedback protocol. The purposes of this study were to (1) learn about client experiences of biofeedback because almost no previous research has done so and (2) explore the potential role of common factors in biofeedback. Fifteen clients were interviewed and their data analyzed according to the methods of Consensual Qualitative Research (CQR; Hill, 2012). CQR relies on the use of group consensus to construct representations of participant experiences and categorize themes within the data. The results showed that participants generally experienced the HRVB+ protocol as helpful. They typically expressed that the intervention helped them with their anxiety or stress and that it increased their self-efficacy concerning their ability to manage anxiety or stress. Several domains emerged that captured data about the biofeedback therapist. Though more research is undoubtedly needed, the findings of this study provide some preliminary support for the idea that common factors could play a role in biofeedback interventions. Keywords: biofeedback, heart rate variability biofeedback, common factors ACKNOWLEDGMENTS Thank you to Dr. Maureen Rice, Dr. Barbara Morrell, Bango Gancinia, Heidi Vogeler, Megan Wolfe, and Erika Steinwand of Stress Management and Biofeedback Services at BYU Counseling and Psychological Services (CAPS) for letting me interview their biofeedback clients. Special thanks to Barbara and Maureen for their input regarding the study method and their generosity in allowing me to carry out tasks for this study as part of my employment with them. Thank you to Sara Johnson and Sheri Knight for helping me distribute payments to participants and for putting up with my aversion to accounting and administrative procedures. Thank you to Dr. Davey Erekson and everyone else at CAPS who was involved in the decision to fund this study. Thank you to my incredible research assistants Kellsie Giras, Hannah Erickson, Ashlie Thacker, Elizabeth Kenning, Ty Johnson, and Vernie DeMille for their many hours spent analyzing the data. Thank you to my friend and colleague, Eric Ghelfi, for interviewing the participants. Thank you to my committee for their support and feedback. I owe a great deal of gratitude to my dissertation chair, Dr. Melissa Jones. Her expertise regarding consensual qualitative research was essential to my being able to effectively conduct this study. But most of all, I appreciate her dedication to mentoring me and for her enthusiastic support of all my academic activities. Thank you to Dr. Joyce Adams for patiently explaining to me the American way of using quotation marks so many times and for all her encouragement over the years. Lastly, thank you to my friends and family for being in my life. I could not have done it without you. And bonus thanks to Brodrick, Eric, and Lindsay for making graduate school much more fun than it would have been without them. iv TABLE OF CONTENTS ABSTRACT .................................................................................................................................... ii ACKNOWLEDGMENTS ............................................................................................................. iii LIST OF TABLES ......................................................................................................................... ix Client Experiences of a Brief Heart Rate Variability Biofeedback Protocol .................................. 1 Heart Rate Variability Biofeedback ............................................................................................ 2 HRV. ....................................................................................................................................... 2 Physiological mechanisms of action. ...................................................................................... 3 Strengthening the baroreflex. .............................................................................................. 3 Vagal afferent activity independent of the baroreflex. ....................................................... 5 Efficacy of HRVB for Psychological Stress. .......................................................................... 6 Efficacy of HRVB as an adjunct to psychotherapy. ........................................................... 6 Client Experiences of Biofeedback ........................................................................................... 10 Client satisfaction with biofeedback interventions. .............................................................. 12 Common Factors in Biofeedback .............................................................................................. 16 Rationale for Present Study ...................................................................................................... 19 Methods......................................................................................................................................... 20 Clinical Procedure ..................................................................................................................... 21 HRVB+ Protocol. .................................................................................................................. 21 Fidelity check. ....................................................................................................................... 23 Participants ................................................................................................................................ 23 Research Procedure ................................................................................................................... 24 Interview. .............................................................................................................................. 24 v Transcription. ........................................................................................................................ 26 Domains. ............................................................................................................................... 26 Cross-analysis. ...................................................................................................................... 27 Physiological data analysis. .................................................................................................. 28 Disclosure of Information about Research Team Members ..................................................... 28 Interviewer. ........................................................................................................................... 28 Coding team. ......................................................................................................................... 28 Auditing team........................................................................................................................ 29 Transcriber. ........................................................................................................................... 29 Results ........................................................................................................................................... 29 Sample....................................................................................................................................... 29 Descriptive data. ................................................................................................................... 30 Deviations from protocol. ..................................................................................................... 32 List of Domains......................................................................................................................... 33 Domain 1: Reasons for Client Participation ............................................................................. 34 Referral sources. ................................................................................................................... 35 Symptoms. ...........................................................................................................................