Abstract
BACKGROUND: Biofeedback (BFB) is widely used to manage stress and anxiety in competitive athletes; however, its effects on cognitive domains such as attention remain underexplored. This study aimed to evaluate the impact of a multimodal BFB intervention on autonomic function and sustained attention in female volleyball players. METHODS: Twelve national-level female volleyball players were recruited and randomly assigned to either a BFB group (n = 6; M(age): 17.83 ± 0.75 years) or a control group (CG, n = 6; M(age): 17.67 ± 0.52 years) in this randomized pilot trial. The BFB group completed 15 sessions of multimodal BFB training over five weeks, while the CG received no intervention. Autonomic parameters, including galvanic skin response (GSR) and peripheral temperature (PT), were measured before and after the intervention using a BFB device. Sustained attention was assessed using the d2 attention test. RESULTS: ANCOVA results revealed significant improvements in PT (p = 0.020, η² = 0.673) and error percentage on the d2 attention test (p = 0.045, η² = 0.346) for the BFB group compared to the CG. Significant changes were observed in GSR, PT, and d2 attention test parameters from pre- to post- intervention following 15 sessions of BFB training in the BFB group (p < 0.05). No significant changes were observed in the CG (p > 0.05). CONCLUSION: These preliminary results suggest that a 5-week multimodal BFB (GSR and PT focused) intervention may improve autonomic functions and cognitive performance in competitive female athletes. Further research with larger samples and diverse athletic populations is warranted to support or refute these findings and assess their generalizability. TRIAL REGISTRATION NUMBER: The study protocol was retrospectively registered at ClinicalTrials.gov (Registration No: NCT07061834) on 01/07/2025. Ethical approval was obtained from the Clinical Research Ethics Committee of Karamanoğlu Mehmetbey University prior to study initiation (Approval No: 02-2024/26; Date: 23/01/2024).