• Melissa Marotta Houser, Lee Rosen, Martha P Seagrave, Don Grabowski, John D Matthew, and William A P Craig.
• Middlesex Hospital Family Medicine Residency Program, Middletown, CT.
• Fam Med. 2013 Oct 1; 45 (9): 615-21.

Background And ObjectivesRural patients with anxiety often lack access to traditional biofeedback modalities. Exercise heart rate monitors (HRMs) are tools used in the fitness industry to provide athletes with feedback on heart rate and regulatory breathing strategies. HRMs are inexpensive, discrete, and publicly accessible. This randomized controlled pilot study explored whether use of HRMs for biofeedback during guided mindfulness, diaphragmatic breathing, and progressive muscle relaxation techniques could facilitate anxiety reduction as compared to these techniques alone.MethodsFifty-three rural anxiety patients were randomized to HRM or control groups for four weekly 20-minute, scripted sessions with a non-behaviorist wherein they practiced these techniques; the HRM group received feedback on their heart rate response.ResultsThe HRM group had significantly greater improvement in state anxiety (State-Trait Anxiety Inventory) and self-efficacy (General Self Efficacy Scale), and a greater percentage of the group indicated that they "felt in control of their anxiety."ConclusionsThis pilot study demonstrates that this novel, inexpensive, and accessible tool may be a useful clinical intervention for anxiety and can be easily incorporated by both behaviorists and non-behaviorist primary care clinicians into individual or group biofeedback treatment for patients with anxiety. This tool has additional potential for patients to use for anxiety self-management. Further study with a larger sample and blinded design is warranted.

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