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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 222-227

A study on safe driving performance using biofeedback therapy among drivers in Delhi


1 Senior Principal Scientist, Former Head Traffic Engineering and Safety Divisions, Central Road Research Institute, New Delhi, India
2 Assistant Professor, Prasanna School of Public Health, Manipal Academy of Higher Education, New Delhi, India
3 Central Road Research Institute, New Delhi, India

Date of Web Publication25-Sep-2018

Correspondence Address:
Dr. Kumar Sumit
2nd Floor, Old Tapmi Building, MAHE, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_42_18

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  Abstract 


INTRODUCTION: Biofeedback therapy is essential for releasing the stress, gain awareness, and to control over psychophysiological processes. The current study deals with the impact of biofeedback therapy on drivers by comparing the performances of drivers on “Decision Time” (DT) test before and after the use of biofeedback therapy.
METHODOLOGY: For this study, as a special case 40 drivers from special protection group were selected for administering the decision time (DT) from “Vienna Test System” before and after applying biofeedback therapy with respiratory training.
RESULTS: The results of this study reveal the beneficial effects of biofeedback in reducing negative effects, thereby enhancing the behavioral performance of the drivers.
CONCLUSIONS: Results obtained in this study recommend that biofeedback therapy training may be used as an adjunct to existing behavior modification and stress management programs of drivers adopted by the driver training institutes for enhancing driver's physical and psychological health.

Keywords: Biofeedback, driver training, psychological health, stress management


How to cite this article:
Chakrabarty N, Sumit K, Gupta K. A study on safe driving performance using biofeedback therapy among drivers in Delhi. Indian J Health Sci Biomed Res 2018;11:222-7

How to cite this URL:
Chakrabarty N, Sumit K, Gupta K. A study on safe driving performance using biofeedback therapy among drivers in Delhi. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 15];11:222-7. Available from: http://www.ijournalhs.org/text.asp?2018/11/3/222/242048




  Introduction Top


Biofeedback is a therapy for releasing stress, gain awareness, and to control over psychophysiological processes.[1],[2],[3] Reviews from the related research show that biofeedback is an effective treatment for several psychological disorders ranging from a headache to hypertension and to attentional disorders. Biofeedback instruments are used to evaluate numerous activities such as muscle activities, skin temperature, electrodermal activity, respiration, heart rate, blood pressure, brain electrical activity, and brain blood flow. Biofeedback therapies facilitate the learning of voluntary control over the body and mind and to take a more active role in maintaining personal health and a higher level of the mind–body wellness. Many neurological and medical disorders are accompanied by abnormal patterns of the cortical activity. Clinical training with feedback electroencephalogram (EEG) enables the individual to modify those disorders, normalizing or optimizing brain activity.[4]

Biofeedback is an ideal approach to seek out therapies which: (1) give the individual a more active role in his or her healthcare, (2) involve a holistic emphasis on body, mind, and spirit, (3) are noninvasive, and (4) elicit the body's own healing response.[5],[6] There are biofeedback protocols to address many of the disorders, including anxiety, depression, and chronic pain, for which the public is using CAM therapies in high numbers (Burke, 2003).[7],[8]

Biofeedback provides the kind of evidence-based practice, which is a process of using the best evidence, preferably research findings, to guide the delivery of health services.[9],[10]

Several different relaxation exercises are used in biofeedback therapy, like deep breathing, progressive muscle relaxation – alternately tightening and then relaxing different muscle groups, guided imagery – concentrating on a specific image (such as the colour and texture of an orange) to focus your mind and make you feel more relaxed, mindfulness meditation – focusing your thoughts and letting go of negative emotions.[11],[12]

The main objective of the current study is to observe the impact of biofeedback therapy (i.e., relaxation from stress) on drivers by comparing the performances of drivers by administering decision time (DT) test before and after the use of biofeedback therapy.

Aim and objectives

The main objective of the study was to observe the impact of biofeedback therapy (i.e., relaxation from stress) on drivers by comparing the performances of drivers by administering decision time (DT) test before and after the use of biofeedback therapy.


  Methodology Top


Sample size

The convenient sampling method was used to select 40 drivers from special protection group were selected for administering the decision time (DT) from “Vienna Test System (VTS)” (The VTS is a test system for computerized psychological assessments. The system includes not only classical questionnaires but also tests that can only be administered precisely using a computer) before and after applying biofeedback therapy with respiratory training. All the participants were male and approximate same age group and economic status. The training about the biofeedback was given to the respondents by the experts from the institute. Verbal informed consent was obtained by the participants before recruiting them for the study.

Tools

Following tools were used for the present study

The decision time from the Vienna test system

This test is administered and scored by computer as part of the VTS. This is described as a “Complex multiple stimuli reaction” test which provides measurement of reactive stress tolerance, attention deficits, and reaction speed in the presence of rapidly changing and continuous optical and acoustic stimuli. During the test, the driver is presented with a variety of colour and acoustic stimuli to which he has to respond by pressing coloured buttons (on a specially provided keyboard) or by pressing foot pedals according to a set of predetermined rules [Figure 1].
Figure 1: DT test being administered on drivers

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Biofeedback therapy

Biofeedback therapy is a nondrug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate. During a biofeedback session, electrodes keep attached to the skin. Finger sensors are also being used. These electrodes/sensors send signals to a monitor, which displays a sound, flash of light, or image that represents the heart and breathing rate, blood pressure, skin temperature, sweating, or muscle activity. When the driver is under stress, these functions changed the graph pattern changes. The driver can view the stress responses as they happen on the monitor, and then get immediate feedback as he tries to control them through therapy and training. Deep breathing related relaxation exercises followed by muscle relaxation were used in the present study during biofeedback therapy. Biofeedback therapy was given on an average for 20 min [Figure 2].
Figure 2: Biofeedback therapeutic session

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Procedure

On selected sample, the decision time (DT) from the VTS (Schuhfried) were administered. The performance data of each subject were collected before and after the use of biofeedback therapy for the following response conditions: average reaction time for each test condition, number of on-time correct reactions, number of omitted reactions, and number of delayed reactions, number of correct reactions and number of incorrect reactions [Figure 3].
Figure 3: Subjects are taking part in the DT test

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  Results Top


The findings of the study highlight that drivers responded more to the stimuli during DT test administration before biofeedback therapy, but they have shown detrimental effects on performance as the number of correct responses were less as compared to the second session, i.e., after biofeedback therapy. The reason behind such activities is that individual information-processing abilities may become overwhelmed (Boucsein and Backs, 2009)[13] and this can impair responding activities which also affect adversely driving safety, especially under high temporal constraints [Figure 4] and [Figure 5].
Figure 4: Total number of correct responses before and after biofeedback therapy

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Figure 5: Total number of correct response before and after biofeedback therapy

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The observance of the data revealed that drivers attempted more correct responses after the biotherapy session, they were relaxed and completely looking fresh (as observed by the administrator and also their video recordings were taken about their experience after the biofeedback therapy). Their number of correct responses were more overall 83% as compared to the before therapy session, i.e., 73%.


  Discussion Top


The findings from related review suggest that participants attempt more responses during stress and anxiety conditions, but the responses are more inaccurate as stress and strain both contribute to increase mental load [Table 1]. This in turn associated with attentional deficits and increasing feeling of difficulty in performing the task. This interaction can lead to overloaded situations and have detrimental effects on performance, particularly on reaction time (RT), response accuracy or both.[14] Accordingly, attentional resources required to process information are mediated by both task difficulty and its subjective perception (Kantowitz, 1987).
Table 1: Number of correct reactions before and after biofeedback therapy in subjects who underwent decision time test including a calculated percentage of correct responses

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The skin conductance levels (SCLs) of the 40 selected participants have been shown in the [Table 2]. The performance parameters from the table highlight that SCL which should be between 2 and 8 μS reduced significantly after the therapy session. T-test for two-independent means among SCLs of the drivers before and after biofeedback therapy was applied. The t value is 3.6899, the P = 0.000207 which is statistically significant at P < 0.01.
Table 2: Biofeedback responses for skin conductance levels-brain fingerprinting parameter measured in reference value of the session

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Similarly, skin temperature should be 30°C–35°C, increased which is a good sign of relaxation. T-test for two independent means among temperature difference levels of the drivers before and after biofeedback therapy were applied, the t value is −3.45842, and P = 0.000442 which is statistically significant at P < 0.01.

Pulse rate in beat per minutes should be 60–80 in frequency, which also reduced after the therapeutic session, which is a good sign of relaxation, the t-test for two-independent means among pulse values BPM difference levels of the drivers before and after biofeedback therapy were applied, the t value is 7.27364 and P < 0.00001 which is statistically significant at P < 0.01.


  Summary Top


Present study highlights

  1. SCL which should be between 2 and 8 μS reduced significantly after the therapy session
  2. Skin temperature should be 30°C–35°C, increased which is a good sign of relaxation
  3. Pulse rate in beat per minutes should be 60–80 in frequency, which also reduced after the therapeutic session, which is a good sign of relaxation
  4. The observance of the data revealed that drivers attempted more correct responses after the biotherapy session, they were relaxed and completely looking fresh (as observed by the administrator and also there video recordings were taken about their experience after the biofeedback therapy). Their number of correct responses were more overall 83% as compared to the before therapy session, i.e., 73%.



  Conclusions Top


The most positive results across the various health outcomes were obtained with the biofeedback therapy. The findings of this study suggest beneficial effects of biofeedback in reducing negative effect, depressive cognitions, and depressive symptoms and enhancing resourceful behaviors of drivers. This program may be a useful adjunct to existing behavior modification and stress management programs of drivers adopted by driver training institutes. This therapy can be effective in enhancing driver's physical and psychological health.

Strength of the study

  1. The current study highlights the impact of biofeedback therapy on drivers by comparing the performances of drivers with the use of biofeedback therapy
  2. It reveals the beneficial effects of biofeedback in reducing negative affect, for example, stress and enhancing resourceful behaviors of drivers
  3. This study can be replicated in various parts of India to evaluate the impact of biofeedback therapy on drivers
  4. The findings of the study can be taken up at a higher level to devise strategies to prevent road traffic accidents.


Weakness of the study

  1. Relatively smaller sample size and absence of a control group
  2. Limited time period.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gilbert C, Moss D. Basic tools: Biofeedback and biological monitoring. In Moss D, McGrady A, Davies T, Wickramaskera I, editors. Handbook of Mind-Body Medicine in Primary Care: Behavioral and Physiological Tools. Thousand Oaks, CA: Sage; 2003. p. 109-22.  Back to cited text no. 1
    
2.
Moss D. Biofeedback. In: Shannon S, editor. Handbook of Complementary and Alternative Therapies in Mental Health. San Diego, CA: Academic Press; 2001. p. 135-58.  Back to cited text no. 2
    
3.
Schwartz M, Andrasik F. Biofeedback: A Practitioner's Guide. 3rd ed. New York: Guilford; 2003. World Medical Association. Available from: http://www.wma.net. [Last accessed on 2017 Nov 18].  Back to cited text no. 3
    
4.
Burke A. Biofeedback and the CAM consumer. Clinical EEG (2000). Biofeedback Mag 2000;31:1-6.   Back to cited text no. 4
    
5.
Jonas WB, Levin JS, editors. Essentials of Complementary and Alternative Medicine. Philadelphia, Baltimore, New York: Lippincott, Williams, and Wilkins; 1999.  Back to cited text no. 5
    
6.
Moss D. Mind/body medicine, evidence-based medicine, clinical psychophysiology, and integrative medicine. In: Moss D, McGrady A, Davies T, Wickramaskera I, editors. Handbook of Mind-Body Medicine in Primary Care: Behavioral and Physiological Tools. Thousand Oaks, CA: Sage; 2003a. p. 3-18.  Back to cited text no. 6
    
7.
Kessler RC, Soukup J, Davis RB, Foster DF, Wilkey SA, Van Rompay MI, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001;158:289-94.  Back to cited text no. 7
    
8.
Bassman LE, Uellendahl G. Complementary/alternative medicine: Ethical, professional, and practical challenges for psychologists. Prof Psychol Res Pract 2003;34:264-70.  Back to cited text no. 8
    
9.
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB, editors. Evidence-Based Medicine: How to Practice and Teach EBM. Edinburgh, New York: Churchill Livingstone; 2000.  Back to cited text no. 9
    
10.
Geyman JP, Deyon RA, Ramsey SD, editors. Evidence-Based Clinical Practice: Concepts and Approach. Boston: Butterworth-Heinemann; 2000.  Back to cited text no. 10
    
11.
Moss D. Existential and spiritual dimensions of primary care: Healing the wounded soul. In: Moss D, McGrady A, Davies T, Wickramaskera I, editors. Handbook of Mind-Body Medicine in Primary Care: Behavioural and Physiological Tools. Thousand Oaks, CA: Sage; 2003b. p. 477-88.  Back to cited text no. 11
    
12.
Sterman MB. Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clin Electroencephalogr 2000;31:45-55.  Back to cited text no. 12
    
13.
Boucsein W, Backs RW. Engineering psychophysiology as a discipline: Historical and theoretical aspects. In: Backs RW, Boucsein W, editors. Engineering Psychophysiology (Issues and Applications). Mahwah, NJ: Lawrence Erlbaum Associates; 2000. p. 3-30.  Back to cited text no. 13
    
14.
Ninio A, Kahneman D. Reaction time in focused and in divided attention. J Exp Psychol 1974;103:394-9.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

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