Date of Award

Summer 2017

Document Type


Degree Name

Doctor of Philosophy (PhD)


Counselor Education and Counseling Psychology


Counseling Psychology

First Advisor

Melchert, Timothy

Second Advisor

Bloom, Margaret

Third Advisor

Anderson, Rebecca


Millions of Americans suffer from chronic pain. Treatment costs are in the billions and some patients still do not find relief. Current effectiveness research shows positive results for biofeedback training as an intervention for headache and other types of chronic pain. The present retrospective, archival study used patient information (N=72) collected during a heart rate variability biofeedback training program to assess treatment effectiveness among patients who experience chronic pain. More specifically, the study was designed to examine six research questions focused on patient-reported levels of pain and distress, as well as catastrophizing, depression, anxiety, and somatization. It was hypothesized that after three sessions of biofeedback, the patient scores on these six variables would decrease. A significant reduction in self-reported pain and distress was found immediately after the biofeedback session, however, pain and distress scores generally returned to the pre-session baseline by the beginning of the next biofeedback session and the reductions in pain and distress were not maintained between sessions revealing a “sawtooth” pattern. On average, patients reported a decrease of more than one point on a numeric (0 to 10) rating scale when rating their pain after the biofeedback training intervention (1.21 for Session 1; 1.63 Session 2; and 1.50 for Session 3). There was a slightly greater reduction in distress ratings than pain ratings after each session of biofeedback (i.e., distress ratings decreased an average of 1.75 after Session 1, 1.67 after Session 2, and 1.74 after Session 3). Of the four symptom measures (catastrophizing, depression, anxiety, and somatization), a statistically significant reduction was found only in the case of catastrophizing scores. When comparing Session 1 and Session 3 catastrophizing, the scores decreased 3.14 points on average (SD = 7.63), t(69) = 3.45, p = .001. Catastrophizing influences one’s beliefs about his or her ability to cope with pain and how much it interferes with his or her life. This finding strengthens the existing research literature that highlights the importance of targeting physical and psychological symptoms when developing a comprehensive pain management plan.