Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review.

In recent years, the scientific community has begun tо explore the efficacy оf an integrated neurofeedback + biofeedback approach іn various conditions, both pathological and non-pathological. Although several studies have contributed valuable insights into its potential benefits, this review aims tо further investigate its effectiveness by synthesizing current findings and identifying areas for future research. Our goal іs tо provide a comprehensive overview that may highlight gaps іn the existing literature and propose directions for subsequent studies. The search for articles was conducted on the digital databases PubMed, Scopus, and Web of Science. Studies to have used the integrated neurofeedback + biofeedback approach published between 2014 and 2023 and reviews to have analyzed the efficacy of neurofeedback and biofeedback, separately, related to the same time interval and topics were selected. The search identified five studies compatible with the objectives of the review, related to several conditions: nicotine addiction, sports performance, Autism Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD). The integrated neurofeedback + biofeedback approach has been shown to be effective in improving several aspects of these conditions, such as a reduction in the presence of psychiatric symptoms, anxiety, depression, and withdrawal symptoms and an increase in self-esteem in smokers; improvements in communication, imitation, social/cognitive awareness, and social behavior in ASD subjects; improvements in attention, alertness, and reaction time in sports champions; and improvements in attention and inhibitory control in ADHD subjects. Further research, characterized by greater methodological rigor, is therefore needed to determine the effectiveness of this method and the superiority, if any, of this type of training over the single administration of either. This review іs intended tо serve as a catalyst for future research, signaling promising directions for the advancement оf biofeedback and neurofeedback methodologies.

Improving Mental Skills in Precision Sports by Using Neurofeedback Training: A Narrative Review.

Primary objectives of neurofeedback training (NFT) are to improve concentration, stress and anxiety management, and performance optimisation. This narrative review examines the role of NFT as a tool to improve mental and cognitive skills of target shooting and archery athletes. Current research discusses how neurofeedback training can act on brain waves by influencing specific EEG frequency bands in order to improve cognitive flexibility. This contribution reports studies that have applied neurofeedback protocols in precision disciplines such as archery and shooting. The results of the studies considered showed that neurofeedback can lead to faster reaction times, more sustained attention, and better emotion management, contributing significantly to athletes' performance. Furthermore, it is emphasised that neurofeedback could be combined with other techniques such as motor imagination to maximise effectiveness in precision sports training. This review emphasises the importance of future studies that focus on the integration of neurofeedback with biofeedback in neuromodulation protocols. Current perspectives and limitations of research in this area are also indicated. Neuromodulation by means of neurofeedback represents a promising strategy to improve the overall mental and cognitive abilities of target shooting and archery athletes with an interesting potential for high-level performance. Future research should focus on integrated approaches and customised protocols to optimise the use of neurofeedback in a precision sports context.

Impact of social isolation caused by the COVID-19 pandemic on the mood profile of active and sedentary older adults: physical activity as a protective factor.

Background: The COVID-19 pandemic has changed our habits and lifestyle due to social isolation and mobility restrictions. This new scenario, together with the fear of contracting the coronavirus, influenced mental health, especially among older adults, who presented reductions in social contact and physical activity (PA). Thus, the objective of the study was to analyze the impact caused by social isolation during the COVID-19 pandemic on the mood states of active and sedentary older adults. Methods: This is an observational study conducted during the COVID-19 pandemic. Older adults aged over 60 years, who were registered in the database of the Secretariat for the Promotion of Citizenship from a city in southern Brazil, participated in the research. An online questionnaire was applied with questions about sociodemographic characteristics, level of PA, confinement, and mood states in two periods: May 2020 and June 2021. The Mann-Whitney U test was used to compare the mood states of active and inactive individuals during the pandemic. Results: One hundred and fifty participants answered the questionnaire, of which 80 (53.3%) reported practicing PA. More active older adults suffered fewer changes in mood when compared to inactive older adults, with lower levels of confusion (p = 0.035), depression (p = 0.002), and fatigue (p = 0.000). Older adults confined for more than 50 days were more likely to develop depression. In addition, the mood state correlated with the variable fear of contracting the coronavirus; the greater the fear, the greater the mental confusion, depression, fatigue, and tension, and the lower the vigor in the older adults. The practice of PA is also correlated with the mood state; the greater the number of hours dedicated to PA, the lower the confusion, depression, fatigue, and tension of the older adults. Conclusion: The practice of PA positively influenced the mental health of older adults during periods of isolation and social restrictions. PA has a protective factor for the development of mental health problems and improves mood states, with greater time performing PA leading to more benefits.

The Use of Voice Assistant for Psychological Assessment Elicits Empathy and Engagement While Maintaining Good Psychometric Properties.

This study aimed to use the Alexa vocal assistant as an administerer of psychometric tests, assessing the efficiency and validity of this measurement. A total of 300 participants were administered the Interpersonal Reactivity Index (IRI). After a week, the administration was repeated, but the participants were randomly divided into groups of 100 participants each. In the first, the test was administered by means of a paper version; in the second, the questionnaire was read to the participants in person, and the operator contemporaneously recorded the answers declared by the participants; in the third group, the questionnaire was directly administered by the Alexa voice device, after specific reprogramming. The third group was also administered, as a post-session survey, the Engagement and Perceptions of the Bot Scale (EPVS), a short version of the Communication Styles Inventory (CSI), the Marlowe-Crowne Social Desirability Scale (MCSDS), and an additional six items to measure degrees of concentration, ease, and perceived pressure at the beginning and at the end of the administration. The results confirmed that the IRI did keep measurement invariance within the three conditions. The administration through vocal assistant showed an empathic activation effect significantly superior to the conditions of pencil-paper and operator-in-presence. The results indicated an engagement and positive evaluation of the interactive experience, with reported perceptions of closeness, warmth, competence, and human-likeness associated with higher values of empathetic activation and lower values of personal discomfort.

Effects of Cognitive Appraisals on Perceived Self-Efficacy and Distress during the COVID-19 Lockdown: An Empirical Analysis Based on Structural Equation Modeling.

During the COVID-19 lockdown, individuals and households had to responsibly manage the difficulties and problems caused by the restrictions on their mobility, such as the interruptions to work schedules, insecure food supplies, and the procurement of services and health care. The perceptions of risk as well as the fear of disease were strongly linked to worry, defined as a sequence of thoughts that evoke negative emotions and elevated levels of anxiety and distress. This study evaluated how different cognitive appraisals of an individual's sources of worry could influence their perceived self-efficacy and directly or indirectly moderate their perceived general distress. A sample of 544 participants completed a survey that included questions based on the generalized self-efficacy scale, the sources of concern during the epidemic, the cognitive appraisal scale in emergency, and perceived discomfort. Subsequently, a structural-equation-modeling (SEM) analysis was performed to test the moderating role of cognitive appraisals and perceived self-efficacy on participants' overall distress during a lockdown. Overall, the model reported acceptable fit values and confirmed the hypotheses of the study. An individual's worries activated either a dysfunctional threat appraisal, which prompted a fear-and-closure response that then increased their overall state of distress; or two other functional appraisals (i.e., adaptive or supportive) that contributed to significantly improving the individual's self-efficacy. Higher self-efficacy was shown to be associated with lower levels of perceived distress. For the purposes of prevention and distress containment, it would be appropriate to promote psycho-educational interventions that promote the adoption of appraisal strategies that are functional and beneficial for perceived self-efficacy.

Assessing Decentering Capacity in Athletes: A Moderated Mediation Model.

Decentering has received more attention in sports literature as a self-regulating skill capable of significantly limiting episodes of mental block in competitive situations. This contribution depicts a comparative study conducted with 375 Italian national and international athletes. The objective was to evaluate athletes' decentralization skills across different sports and levels of competition and test a mediation model of decentering in sports with coping and emotional balance variables. Pearson bivariate correlations, linear hierarchical regression, and simple mediation analysis were conducted for all main measures (The Decentering Sport Scale, The Emotion Regulation Questionnaire, and The Coping Orientations to Problems Experienced). Outputs reported significant associations with emotional regulation and coping styles. Mediation analysis confirmed the central mediating role of decentering capacity which has indirect effects on both the coping ability of problem solving (z-value = 2.986; p = 0.003) and cognitive reappraisal (z-value = 2.779; p = 0.005). Decentering acts as a mediator between an athlete's positive attitude, problem-orientation ability, and management of emotions in competition through cognitive reappraisal. The study highlights the significance of evaluating and enhancing decentralization skills in order to establish specific action mechanisms, which are crucial for both peak performance and the athlete's health.

Perceived Pain in Athletes: A Comparison between Endurance Runners and Powerlifters through a Cold Experimental Stimulation and Two Sessions of Various Physical Activation.

Few studies in the literature have illustrated cold hypoalgesia induced by strength training. Objectives of this contribution were to compare the ratings of perceived pain in endurance running (n = 22) and powerlifting (n = 22) male athletes and controls (n = 22) at baseline and after two bouts of 40 min aerobic/strength training respectively, using the Cold Pressor Test (CPT) and simultaneously monitoring changes in blood pressure (BP), heart rate (HR), and body temperature. A two-way repeated measures ANOVA was conducted to examine the effects of training sessions in endurance runners vs. powerlifting athletes vs. controls on the intensity of perceived pain at CPT. A statistically significant two-way interaction between the group and training resulted in p < 0.001, ηp2 = 0.513. A simple main effects analysis showed that as the participants went through the strength training session, pain perception at CPT was significantly lower in powerlifters compared to runners and controls. Considering the physiological parameters, powerlifters reported significantly higher values of BP and HR. This difference was present at baseline but after training as well, and before and after CPT, despite a slight hypotensive effect. The differences reported after CPT at baseline, but very significantly after the strength activation session in the powerlifters, provide interesting insights into the hypoalgesic effect of high-intensity strength training.

Internet addiction in young adults: The role of impulsivity and codependency.

Excessive Internet use has demonstrated comorbidity with other psychological symptoms and psychiatric disorders, as well as impairments in the management of daily life, relationships and emotional stability. Recent findings in the literature have consistently supported the relationship between impulsivity and Internet addiction. The present study hypothesized that, in addition to impulsivity, a further predictor of Internet addiction might be relational co-dependency, which is also associated in the literature with addiction phenomena, but mainly substance addiction. This paper investigates the role and predictive weight of impulsivity and codependency on Internet addiction on a sample of young adult university students (n = 481) by using a hierarchical regression analysis. The participants were administered the UADI-2, the BIS-11 and the SFCDS. In terms of percentage distribution, 38 % of the participants were in the dependency range, while 37.7 % demonstrated Internet abuse behavior. The results confirmed the role of impulsiveness (ß = 0.312) and added to the literature by showing the significant role of relational codependency (ß = 0.275), gender (ß = 0.174) and age (ß = 0.196). Thus, male participants were more dependent, more impulsive and more co-dependent, with increasing age in the given range (18-30). The present study shed light to the presence of this issue among young adults and that, as a preventive and restraining measure, there is a need not only for targeted awareness-raising programmes but also for interventions to promote greater emotional control and a more balanced management of personal relationships.

Impulsivity and Depressive Brooding in Internet Addiction: A Study With a Sample of Italian Adolescents During COVID-19 Lockdown.

This contribution presents a study conducted on a sample of Italian adolescents (n = 411) in the period of the first COVID-19 lockdown. The study investigated the role and predictive weight of the impulsivity and depressive brooding variables on Internet addiction, using a hierarchical regression analysis. The participants were administered the Uso-Abuso e Dipendenza da Internet [Internet Use-Abuse and Addiction] (UADI-2), the Barratt Impulsiveness Scale-11 (BIS-11), and the Ruminative Response Scale (RRS). In terms of percentage distribution, 28% of the participants were in the full dependency range, while 34.7% demonstrated Internet abuse behavior. The results highlighted not only the predictive value of impulsiveness (ß = 0.323) and ruminative thinking (ß = 0.258), but also the role of gender (ß = -0.205) on Internet addiction. Thus, male participants showed higher levels of Internet addiction, with higher scores on impulsiveness and brooding way of thinking. The study shows that the issue in question is significantly present among adolescents; in addition, not only targeted awareness programmes but also psycho-educational and clinical interventions to promote greater emotional and cognitive control would be necessary as a preventive and mitigating measure. Psychological interventions can help increase self-awareness, develop emotional regulation and impulse control, and correct maladaptive cognitions which in adolescents are mostly driven by a ruminative cognitive style.

A Psychoeducational Intervention in Prenatal Classes: Positive Effects on Anxiety, Self-Efficacy, and Temporal Focus in Birth Attendants.

BACKGROUND: Previous studies have reported associations between high maternal anxiety, temporal perceptions during pregnancy, and a poor sense of self-efficacy. One type of anxiety expecting mothers experience is associated with childbirth, which previous studies have shown can be reduced by antenatal training. Recent contributions have pointed out that current prenatal courses, while providing important and useful knowledge, do not devote sufficient content to the mental health of the parturient and to the psychological issues that can arise before and after the birth. METHODS: In total, 80 pregnant women were provided with a special prepartum course in which ample space was devoted to topics such as maternal mental health, parenting skills and couple relationship, relaxation techniques, and assertiveness. Perception of threat, state anxiety, temporal focus, needs and expectations, and self-efficacy were assessed by comparing this psychoeducational intervention group with a traditional antenatal course group (n = 80), and a control group (n = 80). Two-way mixed ANOVAS (3 × 2) were performed for each dependent variable considered, including the time variable (pre-course-post-course) as a factor within the participants and the group variable as a factor between the subjects. RESULTS: The psychoeducational intervention actually induced significant and positive changes primarily on four dimensions: state anxiety, perceived self-efficacy, the need for information, and reassurance of the pregnant women who participated in this trial. CONCLUSIONS: The study suggests improving the quality of prenatal classes by paying particular attention to the content and communication used within the group, in order to gratify at the highest level, the need for information, reassurance, and sharing that characterize the parturient's request for support. The evidence collected recommends further replicating the intervention protocol described in order to improve the psychophysical well-being of women in a delicate moment such as pregnancy and preparation for childbirth, but especially in terms of the prevention and containment of the risks of psychological distress that currently affect a significant number of women after childbirth.

Motivations and Personal Traits Can Predict Self-Efficacy of the Clown Therapist: A Descriptive Study.

The individual and collective perception of self-efficacy in clown therapists is fundamental in order to be able to be active, restrained, energetic and defocused, if necessary, without being overwhelmed by any problems patients might have. The present study evaluated both the incidence of motivational and dispositional functions on the level of perceived self-efficacy with a sample of 259 Italian clown therapists who were administered The Volunteer Self-Efficacy Scale, the Volunteer Process Model and the Italy Personality Inventory. The significance of a hierarchical linear regression model of perceived self-efficacy was tested. The results showed that the value orientation of the operators mainly influenced the level of perceived self-efficacy, that is, the search for actions with a high social meaning, rather than the orientation towards situations and experiences that allow one to expand one's knowledge and promote one's own person. Profiles with higher perceived self-efficacy were associated with the trait of dynamism and conscientiousness, while a person's vulnerability was found to be a significant negative predictor of self-efficacy. An additional significant predictor was the experience of the clown therapist. The results of the study also showed a positive and functional role of the synergy conferred by teamwork. The group mitigates the emotional difficulties of the individual and supports him/her by orienting him/her technically and compensating for any inexperience in the field of animation in sensitive contexts, such as hospital wards with serious and vulnerable patients, such as children.

Intention to Screen for Hepatitis C Among University Students: Influence of Different Communicative Scenarios.

This study aimed to evaluate the influence of different narrative scenarios regarding students' intentions to undergo diagnostic screening for hepatitis C, and whether gender identification with the characters of the scenario could influence the students' intentions to undergo a medical test. A sample of 600 participants was administered three narrative scenarios with different frames (positive, negative, and ambivalent), including two gender options (male and female) for the main character of the story. A statistically significant three-way interaction between scenario, gender identification, and time resulted. There were significant simple main effects on the intention to have a diagnostic test for hepatitis C for the scenarios with the protagonist of the same gender as the participant and after the administration of the negative scenario. The use of a negative scenario with the same gender character was always more effective than the use of a positive framed scenario, even though there was a high level of knowledge regarding the disease. Personal diagnostic testing was not directly associated with knowledge regarding the infection. The findings of this study can ultimately help policymakers develop communication campaigns adapted to target populations such as college students, in order to raise awareness of the risk, promote prevention and behavioral change, and encourage medical screening.

Both Gender and Agonistic Experience Affect Perceived Pain during the Cold Pressor Test.

BACKGROUND: Differences in pain perception in athletes have recently been highlighted in the literature. OBJECTIVES: To compare gender ratings of perceived pain in athletes with low and high agonistic experiences (N = 200) using the Cold Pressor Test (CPT). METHODS: A three-way repeated measures ANOVA to assess both the effects of the athletes' gender and lower vs. higher agonistic experiences in the intensity of perceived pain at the beginning of the cold box hand immersion (L0) and after a 90 s interval (L1). RESULTS: There was a statistically significant interaction effect between the level of the agonistic experience and gender in the two moments: p < 0.001; ηp2 = 0.266; F(1,49) = 9.771. Simple main effects analysis showed a significative difference for females at L0: F(1,99) = 93.567, p < 0.025, partial η2 = 0.302) and for males at L1: F(1,99) = 173.420, p < 0.025, partial η2 = 0.666. At the initial moment of CPT, the female athletes showed significantly higher perceived intensity than males, regardless of their experience level. After a 90 s interval, a significantly lower pain perception effect associated with the increased competitive experience of male athletes was observed. Female athletes did not appear to benefit from the experience effect on their pain tolerance. CONCLUSIONS: The study confirmed a significant difference in pain perception associated with the athletes' gender and agonistic experience. Separate explanations related to the pattern of pain inhibition and the acquired reduction in pain sensitivity are reported.

A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity.

Introduction: The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context. Methods: A large sample of participants was recruited (n = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed. Results: The three factors structure of the 13-item version of the questionnaire was confirmed (χ2 = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions. Discussion: The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.

Influence of Cognitive Orientation and Attentional Focus on Pain Perception.

BACKGROUND: Recently, a growing interest has emerged in the role of attention and hypervigilance in the experience of pain. Shifting attention away from pain seems likely to reduce the perception of pain itself. OBJECTIVES: The present study has been designed to test the following overall hypotheses: (1) disposition to catastrophize, self-efficacy perceived in pain resistance (task self-efficacy), previous experiences concerning the tolerance of physical pain, and degree of impulsiveness are significant predictors of the decision to abandon a painful test such as the cold pressor test (CPT); (2) the manipulation of the attentive focus (internal or external) can influence the level of perceived pain. METHODS: Effects of the manipulation of attentional focus (internal and external) on pain perception and response of trial abandonment were evaluated in a sample of university students (n = 246) subjected to the cold pressor test. RESULTS: A significant effect (p < 0.05) was found through a test-retest comparison on the final level of perceived pain among subjects who had received instruction to externalize the focus of their attention (mixed factorial analysis of variance), but no significance was observed with respect to the decision to abandon the experiment. A general explanatory model of the abandonment behavior demonstrating overall good fit measurements was tested too. CONCLUSION: The abandonment of tests has been shown to be predicted mainly by catastrophic attitude. Attentive impulsiveness showed a further positive effect on catastrophic attitude. Perceived self-efficacy in the tolerance of pain limited learned helplessness, which in turn positively influenced catastrophizing.

An Exploratory Pilot Study on Choking Episodes in Archery.

The aim of our study is to test the fit of an explanatory model of the frequency of the phenomenon of choking under pressure in archers, focusing on both the individual components (anxiety, coping styles, and decentralization) and environmental components (perception of coach assistance). 115 competitive athletes including 72 males (62.6%) and 43 females (37.4%) participated in the study, with average age of 39 years (±15.47). Participants reported personal data and completed measures of self-consciousness, anxiety, coping styles, and decentering. The ruminative component of concern was found to be the factor directly influencing the frequency of choking episodes in performance. Two significant mediations of personal coping style were also identified on the effects of anxiety on brooding thinking and on the athlete's ability to decentralize. The latter personal self-regulative component has been shown to be able to strongly limit the frequency of choking under pressure. Finally, among the environmental components, a further facilitating influence for the athlete resulted in the perception of being supported by the coach. The results therefore suggest that the athlete in choking should not face alone the hard upcoming period, but should preferably be supported with an articulated program focused on the cognitive remodeling of disturbing thoughts, on the strengthening of the capacity of decentralization, on the enhancement of the relationship of support and trust with the coach.

Psychometric Properties and Reliability of the Referee Self-Efficacy Scale (REFS) in Volleyball Referees.

BACKGROUND: Volleyball officials require a combination of qualities, e.g., confidence, decisiveness, courage and mental toughness as very important attributes for their performance. Measurement of the self-efficacy of volleyball referees has not been studied with large samples; therefore, the aim of this study was to fill this gap in the research. METHODS: Four-hundred and forty-five international volleyball referees participated in the study fulfilling the referee self-efficacy scale in the English version. RESULTS: The confirmatory analysis verified the four-factor structure of the scale and its reliability in this specific sample of international volleyball referees. ANCOVA revealed a significant effect of the covariate "level of education" for all four dimensions of referees' self-efficacy. CONCLUSIONS: Although English was not the mother tongue for most of the subjects in the sample, the scale was statistically reliable, and the items were easy to understand, thus making the tool very suitable to use for further studies on multilingual referees. The study also suggests enhancing the level of education of the officials because of its significant effect on the perceived self-efficacy during refereeing.

Resilience in the Endurance Runner: The Role of Self-Regulatory Modes and Basic Psychological Needs.

Endurance sports certainly require an important and delicate task of mental and physical reintegration from the impact of the fatigue induced by the exertion of the sport performance. The topic of the resilience of athletes has been the theme of numerous studies, however, there are few specific works on the psychological resilience of runners. Our study aimed to investigate Resilience in Endurance Runner related to the role of Self-Regulation Modes and Basic Psychological Needs. Especially, the aim of our work was presenting a model where the gratification of the Needs of Autonomy and Competence and the level of Locomotion were the predictors of the two main components of Richardson's resilience: Homeostatic and Resilient Reintegration. The present study involved 750 endurance runners, members of the Fidal (Italian Athletics Federation). A SEM analysis was performed combining into one explanatory model the following variables: Autonomy and Competence Satisfaction, Self-Regulatory Locomotion Mode, Homeostatic and Resilient Reintegration. The model showed overall acceptable fit measurements: χ2 = 872.152; CFI = 0.966; TLI = 0.952; RMSEA = 0.058. Results indicated that BPNs and SRMs are predictors of the level of resilience in endurance running athletes. In particular, Resilient Reintegration was mainly affected by Locomotion Mode (ß = 0.379 for p < 0.005), which in turn received a major influence from Autonomy Satisfaction (ß = 0.574 for p < 0.001). Homeostatic Recovery was found to be affected by Competence Satisfaction (ß = 0.489 for p < 0.001). The study pointed out the importance of supporting in endurance runners the gratification of the needs of Autonomy and Competence as key factors capable of enhancing perseverance, timely recovery and psychophysical balance.