# Motivation and emotion/Book/2024/Biofeedback and motivation

* Multimedia presentation (3 min)

## Overview

* Scenario
* Figure 1. Women running with smart watches
* Sophia is a competitive runner preparing for an upcoming competition. Despite her rigorous training and experience in racing, she experiences pre-race anxiety which affects both her motivation and performance. Sophia's coach decides to introduce biofeedback training to help manage her stress and enhance her focus - thus increasing motivation. Sophia begins to use a biofeedback tool (a smart watch) to track her heart rate, heart rate variability (HRV), respiration rate, and muscle tension. Through analysing these results and using a variety of techniques such as deep breathing, muscle relaxation, she is able to learn how to control these physiological responses to stress. During her training, Sophia uses this biofeedback to help maintain an optimal heart rate, and optimal level of arousal. This feedback helps her to identify which state correlates with her peak performance. Being able to track these tangible improvements has helped boost Sophia's confidence which has now led to an increase in her intrinsic motivation!
Biofeedback is a technique that brings together a persons[grammar?] mind and body through the use of sensors and other technologies (Browne, 2023). Some examples are the monitoring of heart rate, skin temperature, and brain activity. Providing someone with the ability to monitor these bodily functions is now thought to be able to influence their motivation, and as a result, their performance. Motivation can be defined as the process that energises, directs, and sustains behaviour. It also takes into account an individual's needs, cognitions and emotions (Reeve, 2024). It is a crucial aspect of everyday life for individuals as it is a key factor in setting and pursuing goals, and giving people a sense of purpose. Without motivation, people would have no desire to get out of bed in the morning, no desire to learn and to grow and to better themselves and the community (Cook & Artino, 2016). Understanding how biofeedback influences motivation will allow individuals to implement techniques that increase their motivation, benefitting not only themselves, but society as a whole. The impact of biofeedback on motivation is a relatively new area of study. Their influence on each other [explain?] is still a subject for debate, with more research in this area needed to help further our understanding, and clarify the magnitude of this interaction. Despite this, there have been numerous successes with biofeedback being used to increase motivation, and as a result, an individual's performance.
* Focus questions:
* What is biofeedback?
* What is the relationship between biofeedback and motivation?
* How can the relationship between biofeedback and motivation be used to improve performance?

## What is biofeedback?

Use of the biofeedback technique began in the late 1950s in the United States of America. It was further developed through a series of other disciplines including psychophysiology, biomedical engineering, behaviour therapy, behavioural medicine, and stress management research (Schwartz & Andrasik, 2016). In combining several components of these disciplines, biofeedback was born. In very simple terms, biofeedback attempts to bring together the mind and the body. It uses technology to make information about the body more easily available to the mind through visualisation or auditory cues. By doing this, people are provided with the information that is needed to help control previously involuntary physical processes (West, 2009). If a patient can see something happening on a screen before they can feel it, they can use that information to attempt to further affect the result (Schwartz & Andrisak, 2016). Use of the biofeedback technique to exert greater control over physiological processes can be used in conjunction with other psychological treatments to provide the best chance of success for the patient. For example, it is often used with Cognitive Behavioural Therapy as well as with dietary considerations and improvements (Schwartz & Andrasik, 2016).

### Types of biofeedback

There are a significant number of techniques and technologies that can be used to record different kinds of biofeedback. The most common kind of biofeedback is heart rate. Most smart watches will record people's heart rate and some even give warnings if heart rate becomes too high or too low. Another way to record heart rate is through an electrocardiogram. This is more accurate than a smart watch, and as a result, provides a clearer picture of a person's heart activity. Another common form of biofeedback is respiration rate. Whilst it is possible for a person to record this themselves by counting breaths per minute, it is more accurate to use a spirometer or sensor bands that go around your stomach and chest. In order to record skin temperature, a simple temperature sensor or thermometer can be held between the fore finger and thumb, otherwise pads that measure blood flow can be attached to the individual's hands and feet. Another method of biofeedback measures muscle tension. This is often recorded by an electromyograph. Brain activity can also be used to provide biofeedback and is measured through an electroencephalograph (EEG).
Table 1. The type of biofeedback being recorded, how it is recorded, and with what technology.
Types of biofeedback :
| Type of biofeedback | Metric | Technology used |
| Heart Rate and heart rate variability | beats per minute | Electrocardiogram (ECG) |
| Respiration rate | breaths per minute | Spirometer or sensor bands on stomach and chest |
| Thermal biofeedback | skin temperature | Temperature Sensors or pads attached to fingers and feet measure blood flow |
| Electromyography | muscle tension | Electromyograph |
| Electroencephalography / neurofeedback | brain activity | Electroencephalograph (EEG) (uses scalp pads to measure brain waves) |
Note: Nowadays, smart watches are also being used to track a number of these types of biofeedback.

### What is biofeedback used for?

Biofeedback is often used as a non-invasive treatment for various psychiatric disorders. This includes anxiety, depression, eating disorders, autism spectrum disorders, and schizophrenia, with anxiety being the most commonly treated in this fashion (Schoenberg & David, 2014). It has also been shown to help minimise the effects of physical disorders such as asthma, IBS, headaches, epilepsy, high blood pressure, nausea and vomiting associated with chemotherapy, and incontinence (West, 2009). When treating psychological issues, anxiety in particular, biofeedback is used as a relaxation and mindfulness tool. Learning to control breathing, heart rate, and muscle tension can all help to reduce the effects of anxiety (Fehring, 1983). It can also be used to treat headaches and migraines caused by muscle tension (Bussone et al., 1998). Biofeedback can also be used to help treat other issues such as chronic fatigue, chronic pain, insomnia, high-blood pressure, constipation, epilepsy etc. (Gilbert & Moss, 2003).
* Case study (West, 2009)
* Figure 3. Woman listening to music to try and relax.
* A 45 year old women finds herself experiencing a high amount of stress and anxiety. She started using biofeedback as a relaxation tool to help reduce the feelings of stress and anxiety. She has a sensor strapped to her chest that records her breathing and translates the different speeds to different types of music. She can therefore tell when she is not breathing deeply enough and can adapt. Deep-breathing has been shown to significantly reduce anxiety (Chen et al., 2017). Allowing the individual to see (or in this case hear) the changes and levels of their breathing, gives them more power to make the change that they need in order to better themselves.

### Biofeedback training

Biofeedback training is a non-invasive technique and can be done at home. As long as you have access to some form of monitoring technology and information about what to do, you could do this training yourself! Because it is non-invasive and relatively easily accessible, people may be more receptive or open to the idea of this type of training. The training itself uses operant conditioning principles and feedback learning, utilising consequences as a means to modify behaviour (Schoenberg & David, 2014).
* At-home exercise
* If you have a smart watch you can give this a go at home! Most smart watches have a feature that records your heart rate. Close your eyes and get a friend to record how long it takes you to lower your heart rate by 5 beats per minute. Then open your eyes and try again whilst looking at the data. Was it faster when you could see what was happening? Did you feel a change in motivation when you could visualise the data? Now maybe try the other way and see if you can increase your heart rate.
Biofeedback training has shown to be more effective when multiple modes of biofeedback are used (Schoenberg & David, 2014). For example, combining heart-rate monitoring with ECG or respiration rate would be more effective in training that just using heart-rate monitoring on its own.
A more personal or individualised version of biofeedback training is psychophysiological psychotherapy (Gilbert & Moss, 2003). This however needs to be administered by a health professional and requires a psychophysiological assessment.

### Quiz
## Biofeedback and motivation: theoretical frameworks

Biofeedback and motivation, whilst not new theories or techniques, are not often linked directly to each other. Biofeedback is often seen as only a treatment for stress, and motivation seen only as a symptom (e.g. lack of motivation). Further study is required to fully understand and quantify the relationship between the two.

### Psychological theories of motivation

There are a number of psychological theories of motivation. The Tripartite Theory is one of the original theories of motivation, originally outlined by Plato. The Self-determination Theory and the Expectancy Value Theory are two of the key contemporary theories of motivation.

##### Tripartite theory

The Tripartite theory of the soul, outlined by Plato, divides the human psyche into three components: reason, spirit and appetite, with each component corresponding to a form of motivation. Reason (the rational component) seeks truth and wisdom, spirit drives actions motivated by honour, pride and social standing, and appetite which controls instincts associated with basic needs such as appetite, safety and sexual urges (Carbonneau et al, 2012).
With regards to biofeedback and its influence on motivation, the tripartite theory could relate the ‘reason’ component to 'appetite' by measuring applicable physiological states and allowing an individual to rationalise their behaviour. Individuals could have their brain waves, heart rate or volume of oxygen measured which could indicate their stress or anxiety levels in response to various stimuli. Individuals could then use this biofeedback to assist in recognising physiological cues in response to stress and manage their emotions more effectively.

##### Self-determination theory

Self-determination theory was developed by Edward Deci and Richard Ryan to explain motivation by providing individuals with three main psychological needs that need fulfilling for optimal functioning (Deci & Ryan, 2012). These three areas are:
* Autonomy - the need for control over your own actions
* Competence - the need for effective interactions with your environment
* Relatedness - the need for meaningful connections with others
There is a valuable interaction between biofeedback and self-determination theory as biofeedback can apply to every aspect of the theory.

##### Expectancy value theory

Expectancy value theory was developed by Martin Fishbein and Icek Azjen and details how an individual’s behaviour is driven by expectancy and value. Expectancy relates the belief one’s effort will lead to an ideal outcome, whereas value relates to the perceived importance of an ideal outcome (Wigfield & Cambria, 2010).
The expectancy value theory can be applied practically to many aspects of biofeedback, including chronic pain management. For individuals utilising biofeedback to manage their chronic pain, the high value placed on reducing the pain can drive motivation. As an individual learns to control their pain (whether through controlling breathing or muscle relaxation), they experience increases in expectancy for managing pain. Overall contributing to greater adherence to biofeedback strategies.

### Interaction between biofeedback and motivation

The biofeedback technique provides individuals with a greater understanding of the control they have over their bodies. People often underestimate the impact that their thoughts have on their bodies and can often become unmotivated as a result. If they are able to visualise this impact, it is likely that their motivation and/or self-efficacy will increase (Peper et al., 2015).
Biofeedback allows people to see what is happening with their body and understand how they can change it. This may lead to an individual being more motivated to make a specific change. For example, if someone learns that they have high blood-pressure and knows that this is not good for their health, they may be motivated to do something to try and change this (Peper et al., 2015).
The relationship between biofeedback and motivation also works in reverse. Motivation can have an impact on biofeedback performance. A study found that people that were more motivated to decrease their blood pressure were better able to affect this change, and those that struggled to motivate themselves were less likely to decrease it (Kleinman, 1981). Another study found that if people were motivated with money to increase their skin temperature, their ability to do so increased (Bregman & McAllister, 1982).
Another way that biofeedback may improve motivation is through its use in relaxation and mindfulness. Using biofeedback to slow down breathing, decrease muscle tension, and lower heart rate, can lead to reduced stress which may increase energy and focus, thus indirectly increasing motivation (Dobrovolná & Winkler, 2014).

### Quiz
## Impact of biofeedback on motivation

Biofeedback has been shown to have a significant impact on motivation, whether directly or indirectly. Biofeedback impacts intrinsic motivation more than extrinsic motivation as it highlights the control that an individual has over their physiological processes and allows them to visualise the impact that their thoughts have on these. Giving people the knowledge around how to change their bodily functions tends to increase their sense of self-control and self-efficacy which then impacts motivation (Cherian & Jacob, 2013). It can however also increase extrinsic motivation. For example, if someone were to give you a goal to get your heart-rate down to 60 beats per minute, and offered you a reward for doing so, that would provide extrinsic motivation. With the addition of biofeedback to this scenario, you would be able to determine your progress and evaluate what further action is required.
The biofeedback technique is a very good opportunity to implement goal setting. Goal setting is known to be very effective in increasing motivation (Latham & Locke, 1979). Implementing small, achievable goals to reach different biofeedback milestones would help provide both intrinsic and extrinsic motivation. Going on to achieve these goals will also help to increase self-efficacy and as a result, motivation.
Biofeedback helps individuals to learn to self-regulate not only their physical bodily processes, but often as a result, their emotions. This regulation leads to improved focus and concentration which is crucial in increasing motivation. By learning to manage these physiological processes, individual's also increase their resilience. By doing this, they may then increase their self-efficacy and as a result, their motivation.
* Case study (Brannon et al., 2022)
* Figure 6. Man lying on couch, not motivated to exercise.
* Many cancer survivors do not meet the recommended level of exercise, despite knowing the benefits, as they were not motivated enough to do so. Due to this Brannon et al. [year?] decided to see if biofeedback could be used to change this.
* The patients found that being provided with sensors for biofeedback, in this case Fit-Bits and glucose monitors, increased their motivation to exercise. They felt that they were being held accountable for their actions and that this drove them to participate in more exercise.

## Applications of biofeedback on motivational enhancement

As biofeedback is a great tool for motivational enhancement, there are many different situations in which it can be used. A few great examples are: sports and performance, in clinical settings, in workplaces and in educational environments.

### Sports and performance psychology

Biofeedback is a great tool to use in performance-related activities, especially in sports. It provides valuable insight into the body's physiological processes which can then be used to further performance. Applying heart-rate variability biofeedback training to an athlete's training schedule can help improve their overall performance (Jiménez Morgan & Molina Mora, 2017). This is thought to be through increased concentration and improved reflexes (Paul et al., 2012).

### Clinical settings

Biofeedback is well-known as a tool to help reduce anxiety and depression, and to learn to better manage stress. Being able to control the physical symptoms of stress and anxiety helps people become more resilient in stressful, anxiety provoking situations. It is often used in combination with Cognitive Behavioural Therapy to help people manage the emotions that sometimes come about as a result of the physical symptoms of stress. Decreasing symptoms of anxiety and depression is very effective in increasing motivation. Therefore, giving people the ability to manage their physical symptoms of stress is indirectly increasing their motivation.

### Workplace and education

Improving motivation in the workplace applies the same principles as in the education space. Stress can significantly reduce motivation and performance in the workplace. Having staff or students be less stressed means that they will be more motivated and more inclined to perform well (Wani, 2013). Giving people the knowledge about biofeedback techniques and how they can be implemented in order to destress would be very helpful to increase motivation (Rodriguez et al., 2022). The most common types of biofeedback used in these situations are heart rate, respiration rate, and muscle tension. Heart rate however, is the easiest to monitor as many people have smart watches that do it for them. Using biofeedback techniques to de-stress people in the workplace or school is not only effective in increasing motivation but also life satisfaction and overall wellbeing.

## Conclusion

Biofeedback can play a significant role in the increase of an individual's motivation. Biofeedback helps individuals to improve their self-regulation by providing real-time feedback on their physiological states. This increase in bodily awareness allows individuals to better manages their responses to stimuli, leading to improved motivation and performance. By demonstrating how physiological changes can influence performance and emotional states, biofeedback enhances an individual's sense of self-efficacy. This boost in perceived capability can lead to higher levels of intrinsic motivation and greater levels of commitment to an individual's goals. Biofeedback is applicable in several contexts, including sport, clinical therapy, and everyday life. It allows individuals to train to increase control over their physical and emotional stress responses. This makes it an incredibly valuable tool for enhancing motivation as well as overall well-being.