An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation

Biofeedback has shown to be a promising tool for the treatment of anxiety however several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health we argue that this is an ideal time to launch a new wave of biofeedback training. In this review we reflect on the current state of biofeedback training including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques and changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as: growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centred approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful. (JMIR Preprints 06/06/2019:14958) DOI: https://doi.org/10.2196/preprints.14958 Preprint Settings 1) Would you like to publish your submitted manuscript as preprint? Please make my preprint PDF available to anyone at any time (recommended). Please make my preprint PDF available only to logged-in users; I understand that my title and abstract will remain visible to all users. Only make the preprint title and abstract visible. No, I do not wish to publish my submitted manuscript as a preprint. 2) If accepted for publication in a JMIR journal, would you like the PDF to be visible to the public? Yes, please make my accepted manuscript PDF available to anyone at any time (Recommended). Yes, but please make my accepted manuscript PDF available only to logged-in users; I understand that the title and abstract will remain visible to all users (see Important note, above). I also understand that if I later pay to participate in <a href="https://jmir.zendesk. com/hc/en-us/articles/360008899632-What-is-the-PubMed-Now-ahead-of-print-option-when-I-pay-the-APF-" target="_blank">JMIR’s PubMed Now! service</a> service, my accepted manuscript PDF will automatically be made openly available. Yes, but only make the title and abstract visible (see Important note, above). I understand that if I later pay to participate in <a href="https://jmir.zendesk. com/hc/en-us/articles/360008899632-What-is-the-PubMed-Now-ahead-of-print-option-when-I-pay-the-APF-" target="_blank">JMIR’s PubMed Now! service</a> service, my accepted manuscript PDF will automatically be made openly available. https://preprints.jmir. org/preprint/14958 [unpublished, non-peer-reviewed preprint] JMIR Preprints Weerdmeester et al