Learning receptive awareness via neurofeedback in stressed healthcare providers: a prospective pilot investigation

Abstract

ObjectiveBecause physicians and nurses are commonly stressed, Bispectral Index™ (BIS) neurofeedback, following trainer instructions, was used to learn to lower the electroencephalography-derived BIS value, indicating that a state of receptive awareness (relaxed alertness) had been achieved.ResultsTen physicians/nurses participated in 21 learning days with 9 undergoing ≤ 3 days. The BIS-nadir for the 21 days was decreased (88.7) compared to baseline (97.0; p < 0.01). From 21 wellbeing surveys, moderately-to-extremely rated stress responses were a feeling of irritation 38.1%; nervousness 14.3%; over-reacting 28.6%; tension 66.7%; being overwhelmed 38.1%; being drained 38.1%; and people being too demanding 52.4% (57.1% had ≥ 2 stress indicators). Quite a bit-to-extremely rated positive-affect responses were restful sleep 28.6%; energetic 0%; and alert 47.6% (90.5% had ≥ 2 positive-affect responses rated as slightly-to-moderately). For 1 subject who underwent 4 learning days, mean BIS was lower on day 4 (95.1) than on day 1 (96.8; p < 0.01). The wellbeing score increased 23.3% on day 4 (37) compared to day 1 (30). Changes in BIS values provide evidence that brainwave self-regulation can be learned and may manifest with wellbeing. These findings suggest that stress and impairments in positive-affect are common in physicians/nurses.Trial Registration ClinicalTrials.gov NCT03152331. Registered May 15, 2017Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3756-0) contains supplementary material, which is available to authorized users.

Brainwave Self-Regulation During Bispectral IndexTM Neurofeedback in Trauma Center Nurses and Physicians After Receiving Mindfulness Instructions

“…Because of this evidence, the authors created specific mindfulness instructions (suggestions and prompts) that appeared likely to foster learning brainwave self-regulation in our research. The mindfulness instructions were assessed and found to be efficacious in our previous pilot study (Dunham et al, 2018). That is, there were substantial reductions in NFB BIS values, when compared to baseline, indicating that brainwave self-regulation was occurring following these mindfulness instructions.…”

“…In 2017, a pilot study was formulated by the current authors and conducted to teach nurses and physicians how to enter into a state of relaxed alertness (receptive awareness) using BIS NFB (Dunham et al, 2018). To facilitate learning relaxed alertness, participants were provided with mindfulness instructions that might facilitate alterations in attention (cognitive states) during NFB.…”

Psychometric properties of the St. Elizabeth Youngstown hospital wellbeing inventory and non-burnout inventory for physicians and nurses

“…Evidence indicates that physicians and nurses have substantial problems with wellbeing and burnout [1–5]. Apropos, the current authors, in 2017, initiated a study to assess the role of Bispectral Index™ (BIS)-neurofeedback in physician and nurse wellbeing at St. Elizabeth Youngstown Hospital [6]. A survey tool, consisting of 3 positive affect and 7 negative affect items, was created by selecting components from 5 tools in order to follow changes in subject wellbeing [7–11].…”

“…Our principal intent was to use a wellbeing measure that assessed positive and negative affect constructs in nurses and physicians working in a United States hospital. More specifically, our objective was to assess wellbeing in our BIS neurofeedback study where learning sessions and wellbeing evaluations were occurring weekly for four sessions [6]. That is, the BIS neurofeedback investigation required a concise and focused wellbeing instrument with adequate psychometric performance that would measure wellbeing changes over a relatively short period of time.…”

“…However, some items of the PANAS seemed redundant (“scared” and “afraid” or “guilty” and “ashamed”). Of importance, the authors’ study design [6] required participants to complete a wellbeing survey roughly every 4–7 days – potentially closer intervals than the weekly period measured in PANAS.…”