Effects of Ten Biofeedback Sessions on Athletes’ Physiological,Psychological,and Cognitive Functioning: A Randomized Controlled Trial with International Tennis Players
Restricted accessResearch articleFirst published online October, 2024
Effects of Ten Biofeedback Sessions on Athletes’ Physiological,Psychological,and Cognitive Functioning: A Randomized Controlled Trial with International Tennis Players
Our aim in this study was to test the effect of 10 sessions of biofeedback (BFB) on physiological, psychological, and cognitive functioning of international tennis players. In this randomized controlled trial, we recruited 16 international tennis players (11 male, 5 female; Mage = 17.31, SD = 0.87 years), who were randomly assigned to either an intervention group (IG; n = 8) or a control group (CG; n = 8). Those in the IG received 10 multimodal BFB sessions over four weeks, while those in the CG received no intervention. We assessed physiological, psychological, and cognitive parameters before and after the intervention and found a positive effect for skin temperature, state anxiety, and cognitive performance in the IG versus the CG. We provide preliminary data that 10 sessions of multimodal BFB improved cognitive functions and reduced anxiety symptoms in international tennis players. Future investigators should consider increasing sample size, incorporating an active CG, and studying these effects across diverse athletic disciplines.
Ayuso-MorenoR.Fuentes-GarcíaJ. P.Collado-MateoD.VillafainaS. (2020). Heart rate variability and pre-competitive anxiety according to the demanding level of the match in female soccer athletes. Physiology & Behavior, 222, Article 112926. https://doi.org/10.1016/j.physbeh.2020.112926
2.
BlancaM. J.AlarcónR.ArnauJ.BonoR.BendayanR. (2017). Non-normal data: Is ANOVA still a valid option?Psicothema, 29(4), 552–557. https://doi.org/10.7334/psicothema2016.383
3.
BrennerJ. S.LaBotzM.SugimotoD.StraccioliniA. (2019). The psychosocial implications of sport specialization in pediatric athletes. Journal of Athletic Training, 54(10), 1021–1029. https://doi.org/10.4085/1062-6050-394-18
4.
BrickenkampR.OosterveldP. (2012). D2 aandachts-en concentratie test: Handleiding (d2 test of attention: User manual). Hogrefe.
5.
CarlstedtR. A. (2018). Psychologically mediated heart rate variability during official competition. In CarlstedtR.BalconiM. (Eds.), Handbook of sport neuroscience and psychophysiology. Routledge.
6.
CooperJ. J.JohnsonM.RadcliffeJ.FisherJ. (2021). Optimal emotional profiles for peak performance in strength and conditioning. The Journal of Strength & Conditioning Research, 35(3), 833–840. https://doi.org/10.1519/JSC.0000000000002832
7.
de BruinE. I.van der ZwanJ. E.BögelsS. M. (2016). A RCT comparing daily mindfulness meditations, biofeedback exercises, and daily physical exercise on attention control, executive functioning, mindful awareness, self-compassion, and worrying in stressed young adults. Mindfulness, 7(5), 1182–1192. https://doi.org/10.1007/s12671-016-0561-5
8.
Deschodt-ArsacV.LalanneR.SpiluttiniB.BertinC.ArsacL. M. (2018). Effects of heart rate variability biofeedback training in athletes exposed to stress of university examinations. PLoS One, 13(7), Article e0201388. https://doi.org/10.1371/journal.pone.0201388
9.
DessyE.Van PuyveldeM.MairesseO.NeytX.PattynN. (2018). Cognitive performance enhancement: Do biofeedback and neurofeedback work?Journal of Cognitive Enhancement, 2(1), 12–42. https://doi.org/10.1007/s41465-017-0039-y
10.
De WitteN. A.BuyckI.Van DaeleT. (2019). Combining biofeedback with stress management interventions: A systematic review of physiological and psychological effects. Applied Psychophysiology and Biofeedback, 44(2), 71–82. https://doi.org/10.1007/s10484-018-09427-7
DziembowskaI.IzdebskiP.RasmusA.BrudnyJ.GrzelczakM.CysewskiP. (2016). Effects of heart rate variability biofeedback on EEG alpha asymmetry and anxiety symptoms in male athletes: A pilot study. Applied Psychophysiology and Biofeedback, 41(2), 141–150. https://doi.org/10.1007/s10484-015-9319-4
13.
Fernandez-FernandezJ.Sanz-RivasD.Sanchez-MuñozC.PluimB. M.TiemessenI.Mendez-VillanuevaA. (2009). A comparison of the activity profile and physiological demands between advanced and recreational veteran tennis players. The Journal of Strength & Conditioning Research, 23(2), 604–610. https://doi.org/10.1519/JSC.0b013e318194208a
14.
FinchH. (2005). Comparison of the performance of nonparametric and parametric MANOVA test statistics when assumptions are violated. Methodology, 1(1), 27–38. https://doi.org/10.1027/1614-1881.1.1.27
15.
FisherC. J.MoravecC. S.KhorshidL. (2018). The “how and why” of group biofeedback for chronic disease management. Applied Psychophysiology and Biofeedback, 43(4), 333–340. https://doi.org/10.1007/s10484-018-9411-7
16.
FriedmanN. P.MiyakeA. (2017). Unity and diversity of executive functions: Individual differences as a window on cognitive structure. Cortex, 86(117), 186–204. https://doi.org/10.1016/j.cortex.2016.04.023
17.
Fuentes-GarcíaJ. P.VillafainaS.Martínez-GallegoR.CrespoM. (2022). Pre-and post-competitive anxiety and match outcome in elite international junior tennis players. International Journal of Sports Science & Coaching, 18(6), 2108. https://doi.org/10.1177/17479541221122396
18.
García-GonzálezL.MorenoA.GilA.MorenoM. P.VillarF. D. (2014). Effects of decision training on decision making and performance in young tennis players: An applied research. Journal of Applied Sport Psychology, 26(4), 426–440. https://doi.org/10.1080/10413200.2014.917441
19.
GaumeA.VialatteA.Mora-SánchezA.RamdaniC.VialatteF. B. (2016). A psychoengineering paradigm for the neurocognitive mechanisms of biofeedback and neurofeedback. Neuroscience & Biobehavioral Reviews, 68, 891–910. https://doi.org/10.1016/j.neubiorev.2016.06.012
20.
Gholami TahsiniZ.Makvand HosseiniS.KianersiF.RashnS.MajdaraE. (2017). Biofeedback-aided relaxation training helps emotional disturbances in undergraduate students before examination. Applied Psychophysiology and Biofeedback, 42(4), 299–307. https://doi.org/10.1007/s10484-017-9375-z
21.
HaganJ. E.Jr.PollmannD.SchackT. (2017). Elite athletes’ in-event competitive anxiety responses and psychological skills usage under differing conditions. Frontiers in Psychology, 8, 2280. https://doi.org/10.3389/fpsyg.2017.02280
JanelleC. M. (2002). Anxiety, arousal and visual attention: A mechanistic account of performance variability. Journal of Sports Sciences, 20(3), 237–251. https://doi.org/10.1080/026404102317284790
24.
Jimenez MorganS.Molina MoraJ. A. (2017). Effect of heart rate variability biofeedback on sport performance, a systematic review. Applied Psychophysiology and Biofeedback, 42(3), 235–245. https://doi.org/10.1007/s10484-017-9364-2
25.
KalénA.BisagnoE.MusculusL.RaabM.Pérez-FerreirósA.WilliamsA. M.AraújoD.LindwallM.IvarssonA. (2021). The role of domain-specific and domain-general cognitive functions and skills in sports performance: A meta-analysis. Psychological Bulletin, 147(12), 1290–1308. https://doi.org/10.1037/bul0000355
26.
KayacanY.MakaracıY.UcarC.AmonetteW. E.YıldızS. (2023). Heart rate variability and cortisol levels before and after a brief anaerobic exercise in handball players. The Journal of Strength & Conditioning Research, 37(7), 1479–1485. https://doi.org/10.1519/JSC.0000000000004411
27.
KennedyL.ParkerS. H. (2019). Biofeedback as a stress management tool: A systematic review. Cognition, Technology & Work, 21(2), 161–190. https://doi.org/10.1007/s10111-018-0487-x
28.
LautenbachF.LabordeS. (2016). The influence of hormonal stress on performance. In Performance psychology (pp. 315–328). Academic Press.
29.
LautenbachF.LabordeS.MesagnoC.LobingerB. H.AchtzehnS.ArimondF. (2015). Nonautomated pre-performance routine in tennis: An intervention study. Journal of Applied Sport Psychology, 27(2), 123–131. https://doi.org/10.1080/10413200.2014.957364
30.
LautenbachF.LabordeS. J. P.PutmanP.AngelidisA.RaabM. (2016). Attentional distraction by negative sports words in athletes under low-and high-pressure conditions: Evidence from the sport emotional Stroop task. Sport, Exercise, and Performance Psychology, 5(4), 296–307. https://doi.org/10.1037/spy0000073
31.
LehrerP. (2007a). Principles and practice of stress management: Advances in the field. Biofeedback, 35(3), 83.
32.
LehrerP. M. (2007b). Biofeedback training to increase heart rate variability. Principles and Practice of Stress Management, 3(3), 227–248.
33.
LehrerP.KaurK.SharmaA.ShahK.HusebyR.BhavsarJ.SgobbaP.ZhangY. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z
34.
LevyJ. J.BaldwinD. R. (2019). Psychophysiology and biofeedback of sport performance. In AnshelM. H.PetrieT. A.SteinfeldtJ. A. (Eds.), APA handbook of sport and exercise psychology: Sport psychology (pp. 745–758). American Psychological Association.
35.
MakaracıY.MakaracıM.ZorbaE.LautenbachF. (2023). A pilot study of the biofeedback training to reduce salivary cortisol level and improve mental health in highly-trained female athletes. Applied Psychophysiology and Biofeedback, 48(3), 357–367. https://doi.org/10.1007/s10484-023-09589-z
36.
MartensR.VealeyR. S.BurtonD. (1990). Competitive anxiety in sport. Human Kinetics.
37.
McKayA. K.StellingwerffT.SmithE. S.MartinD. T.MujikaI.Goosey-TolfreyV. L.SheppardJ.BurkeL. M. (2021). Defining training and performance caliber: A participant classification framework. International Journal of Sports Physiology and Performance, 17(2), 317–331. https://doi.org/10.1123/ijspp.2021-0451
38.
MelnikovM. Y. (2021). The current evidence levels for biofeedback and neurofeedback interventions in treating depression: A narrative review. Neural Plasticity, 2021, Article 8878857. https://doi.org/10.1155/2021/8878857
39.
Mercader-RubioI.Gutiérrez ÁngelN.SilvaS.MoisãoA.Brito-CostaS. (2023). Relationships between somatic anxiety, cognitive anxiety, self-efficacy, and emotional intelligence levels in university physical education students. Frontiers in Psychology, 13, Article 1059432. https://doi.org/10.3389/fpsyg.2022.1059432
40.
MinklerT. O.GlassC. R.HutM. (2021). Mindfulness training for a college team: Feasibility, acceptability, and effectiveness from within an athletic department. Journal of Applied Sport Psychology, 33(6), 609–626. https://doi.org/10.1080/10413200.2020.1739169
41.
MosleyE.LabordeS. (2022). A scoping review of heart rate variability in sport and exercise psychology. International Review of Sport and Exercise Psychology, 1–75. https://doi.org/10.1080/1750984x.2022.2092884
42.
NagaiY.JonesC. I.SenA. (2019). Galvanic skin response (gsr)/electrodermal/skin conductance biofeedback on epilepsy: A systematic review and meta-analysis. Frontiers in Neurology, 10, 377. https://doi.org/10.3389/fneur.2019.00377
43.
NashiroK.YooH. J.ChoC.MinJ.FengT.NasseriP.BachmanS. L.LehrerP.ThayerJ. F.MatherM.MatherM. (2023). Effects of a randomised trial of 5-week heart rate variability biofeedback ıntervention on cognitive function: Possible benefits for inhibitory control. Applied Psychophysiology and Biofeedback, 48(1), 35–48. https://doi.org/10.1007/s10484-022-09558-y
44.
PagaduanJ. C.ChenY. S.FellJ. W.WuS. S. X. (2020). Can heart rate variability biofeedback improve athletic performance? A systematic review. Journal of Human Kinetics, 73, 103–114. https://doi.org/10.2478/hukin-2020-0004
45.
Perez-GaidoM.LalanzaJ. F.ParradoE.CapdevilaL. (2021). Can HRV biofeedback improve short-term effort recovery? Implications for intermittent load sports. Applied Psychophysiology and Biofeedback, 46(2), 215–226. https://doi.org/10.1007/s10484-020-09495-8
46.
PratoC. A.YuchaC. B. (2013). Biofeedback-assisted relaxation training to decrease test anxiety in nursing students. Nursing Education Perspectives, 34(2), 76–81. https://doi.org/10.5480/1536-5026-34.2.76
47.
PrinslooG. E.DermanW. E.LambertM. I.Laurie RauchH. G. (2013). The effect of a single session of short duration biofeedback-induced deep breathing on measures of heart rate variability during laboratory-induced cognitive stress: A pilot study. Applied Psychophysiology and Biofeedback, 38(2), 81–90. https://doi.org/10.1007/s10484-013-9210-0
48.
PrinslooG. E.RauchH. G. L.LambertM. I.MuenchF.NoakesT. D.DermanW. E. (2011). The effect of short duration heart rate variability (HRV) biofeedback on cognitive performance during laboratory induced cognitive stress. Applied Cognitive Psychology, 25(5), 792–801. https://doi.org/10.1002/acp.1750
49.
PrończukM.TrybekG.TerbalyanA.MarkowskiJ.PilchJ.KrzysztofikM.KostrzewaM.MostowikA.MaszczykA. (2023). The effects of EEG biofeedback training on visual reaction time in Judo athletes. Journal of Human Kinetics, 89, 247–258. https://doi.org/10.5114/jhk/174272
50.
PusenjakN.GradA.TusakM.LeskovsekM.SchwarzlinR. (2015). Can biofeedback training on psychophysiological responses enhance athletes’ sports performance? A practitioner’s perspective. The Physician and Sportsmedicine, 43(3), 287–289. https://doi.org/10.1080/00913847.2015.1069169
51.
RichardsonJ. T. (2011). Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review, 6(2), 135–147. https://doi.org/10.1016/j.edurev.2010.12.001
52.
RijkenN. H.SoerR.de MaarE.PrinsH.TeeuwW. B.PeuscherJ.OosterveldF. G. (2016). Increasing performance of professional soccer players and elite track and field athletes with peak performance training and biofeedback: A pilot study. Applied Psychophysiology and Biofeedback, 41(4), 421–430. https://doi.org/10.1007/s10484-016-9344-y
53.
RöthlinP.BirrerD.HorvathS.Grosse HoltforthM. (2016). Psychological skills training and a mindfulness-based intervention to enhance functional athletic performance: Design of a randomized controlled trial using ambulatory assessment. BMC Psychology, 4, 39. https://doi.org/10.1186/s40359-016-0147-y
54.
RoßkopfS.WechslerT. F.TuchaS.MühlbergerA. (2024). Effects of facial biofeedback on hypomimia, emotion recognition, and affect in Parkinson’s disease. Journal of the International Neuropsychological Society, 30(4), 360–369. https://doi.org/10.1017/S1355617723000747
55.
RuscianoA.CorradiniG.StoianovI. (2017). Neuroplus biofeedback improves attention, resilience, and injury prevention in elite soccer players. Psychophysiology, 54(6), 916–926. https://doi.org/10.1111/psyp.12847
ScharfenH. E.MemmertD. (2019). Measurement of cognitive functions in experts and elite athletes: A meta‐analytic review. Applied Cognitive Psychology, 33(5), 843–860. https://doi.org/10.1002/acp.3526
58.
SchmitterM.Kares-VrincianuA.KaresH.MalschC.SchindlerH. J. (2019). Chronic stress and temporalis muscle activity in TMD patients and controls during sleep: A pilot study in females. Clinical Oral Investigations, 23(2), 667–672. https://doi.org/10.1007/s00784-018-2474-2
59.
SchumannA.de la CruzF.KöhlerS.BrotteL.BärK. J. (2021). The influence of heart rate variability biofeedback on cardiac regulation and functional brain connectivity. Frontiers in Neuroscience, 15, Article 691988. https://doi.org/10.3389/fnins.2021.691988
60.
SecadesX. G.MolineroO.SalgueroA.BarquínR. R.de la VegaR.MárquezS. (2016). Relationship between resilience and coping strategies in competitive sport. Perceptual and Motor Skills, 122(1), 336–349. https://doi.org/10.1177/0031512516631056
61.
ShokriA.NosratabadiM. (2021). Comparison of biofeedback and combined interventions on athlete’s performance. Applied Psychophysiology and Biofeedback, 46(3), 227–234. https://doi.org/10.1007/s10484-020-09498-5
62.
TóthR.TurnerM. J.KökényT.TóthL. (2022). “I must be perfect”: The role of irrational beliefs and perfectionism on the competitive anxiety of Hungarian athletes. Frontiers in Psychology, 13, Article 994126. https://doi.org/10.3389/fpsyg.2022.994126
63.
WilsonV.PeperE. (2011). Athletes are different: Factors that differentiate biofeedback/neurofeedback for sport versus clinical practice. Biofeedback, 39(1), 27–30. https://doi.org/10.5298/1081-5937-39.1.01
64.
WuX.ZhengX.YiX.LaiP.LanY. (2021). Electromyographic biofeedback for stress urinary incontinence or pelvic floor dysfunction in women: A systematic review and meta-analysis. Advances in Therapy, 38(8), 4163–4177. https://doi.org/10.1007/s12325-021-01831-6
65.
YipJ. A.SchweitzerM. E.NurmohamedS. (2018). Trash-talking: Competitive incivility motivates rivalry, performance, and unethical behavior. Organizational Behavior and Human Decision Processes, 144, 125–144. https://doi.org/10.1016/j.obhdp.2017.06.002
66.
YoonS.SimJ. K.ChoY. H. (2016). A flexible and wearable human stress monitoring patch. Scientific Reports, 6(1), Article 23468. https://doi.org/10.1038/srep23468
67.
ZaichkowskyL. D.FuchsC. Z. (1988). Biofeedback applications in exercise and athletic performance. Exercise and Sport Sciences Reviews, 16(1), 381–421.
68.
ZaichkowskyL. D.FuchsC. Z. (2021). Biofeedback-assisted self-regulation for stress management in sports. In Anxiety in sports (pp. 235–245). Taylor & Francis.
69.
ZarchenkoP. U.KazinE. M.BlinovaN. G.VarichL. A.VasilchenkoI. L. (2021). Implementation of RSA-BFB therapy in students with various types of autonomic heart rate regulation in the process of adaptation to learning activity. Human Physiology, 46(6), 663–670. https://doi.org/10.1134/s0362119720060134
