title: Ready, set, relax: biofeedback-assisted relaxation training (BART) in a pediatric psychiatry consultation service.
abstract: BACKGROUND
  Biofeedback-assisted relaxation training (BART) can treat several common pediatric presentations, including chronic pain and anxiety. Its effectiveness, applicability to a variety of conditions, and equipment portability make it an ideal treatment approach for use in an inpatient pediatric consultation-liaison service.
  
  
  OBJECTIVE
  Since there is a paucity of published research on the utility of BART in this setting, we studied pediatric patients (≥8y), medically-admitted to Boston Children's Hospital, and referred to the Psychiatry Consultation Service for assistance in managing pain, anxiety or both.
  
  
  METHODS
  The patients received at least 1 session of BART. In addition to heart rate variability and skin temperature data collection, participants completed the Wong-Baker FACES Pain Rating Scale and a brief mood/affective state rating scale (Youth Feelings Scale) before and after the BART sessions.
  
  
  RESULTS
  A total of 152 sessions were conducted with 66 patients across 11 referring services. BART was successfully used 61% of the time on the medical floor with common barriers involving patient unavailability or refusal. The patients completed an average of 1.57 sessions per admission. The post-BART session pain and mood ratings significantly improved over the presession ratings. Patients with both pain and anxiety reported the greatest changes across sessions in comparison with those with only pain or anxiety. Higher heart rate variability was observed in the "pain-only" group.
  
  
  CONCLUSIONS
  The use of BART in a consultation-liaison setting demonstrates promising utility in working with patients with pain, anxiety, or a combination of symptoms. BART was well-received by patients with subjective reports of benefit across sessions.
authors.affiliation: Psychiatry Consultation Service, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: kristine.mckenna@childrens.harvard.edu.
authors.forename: Kristine
authors.initials: K
authors.lastname: McKenna
authors.affiliation: Psychiatry Consultation Service, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Katherine A S
authors.initials: KA
authors.lastname: Gallagher
authors.affiliation: Psychiatry Consultation Service, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Forbes
authors.affiliation: Psychiatry Consultation Service, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ibeziako
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D001676:Biofeedback, Psychology / Q000379:methods*; D001900:Boston; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D012017:Referral and Consultation; D012064:Relaxation Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult