Computerised biofeedback games: a new method for teaching stress management and its use in irritable bowel syndrome

Objectives: To develop and test a computer biofeedback game designed to tea ch deep relaxation to patients with a stress related disorder and to assess whether relaxation can improve symptomatic episodes. Study design and setting An open, prospective, single centre study. Departm ent of Gastroenterology, Royal Free Hospital, London. Subjects: Forty patients with irritable bowel syndrome refractory to conven tional medical treatment, Main outcome measures: Development of a computer aided biofeedback apparatu s directed at the gut for teaching relaxation to patients with irritable bo wel syndrome. The patients' ability to complete a computer game involving b iofeedback modulated by a physiological loop that related changes in stress (monitored by electrodermal activity) to animated computer graphics. The d egree to which deep relaxation was achieved was measured numerically by a p rogressive reduction in the sensitivity level of the biofeedback loop. The success of relaxation in ameliorating physical symptoms of irritable bowel syndrome was assessed by daily diaries in which global and weighted bower s ymptom scores were entered. Results: A computer biofeedback game based on animated gut imagery was succ essfully developed. Most patients learned to achieve progressively deeper l evels of relaxation after four 30 minute biofeedback sessions (mean differe nce in sensitivity level 2.0 (95% confidence interval 0.96 to 2.93), p<0.00 1). Use of 'dosed' relaxation when bowel symptoms were troublesome was help ful in 50% of patients. It reduced the global symptom score (mean differenc e 0.5 (0.02 to 0.32), p<0.04) and the bowel symptom score (mean difference 0.8 (0.04 to 1.58), p<0.04). At long term follow up, 64% of patients who ha d been helped by dosed relaxation continued to use the technique, although they had had no further contact with the hospital. Conclusions: This computer biofeedback game taught deep relaxation rapidly and effectively. Half the patients with refractory irritable bowel syndrome found the technique helpful on most occasions an which it was used. Comput er biofeedback games may offer a simple, inexpensive strategy for managing other stress related medical disorders.