OBJECTIVE: Access to care has become a priority for the Veterans Administration 
(VA) health care system as a significant number of veterans enrolled in the VA 
health care system reside in rural areas. The feasibility and effects of a novel 
clinical intervention that combined group therapy and biofeedback training was 
evaluated on women veterans living in rural areas.
METHODS: The study was conducted at selected community-based outpatient clinics 
(CBOCs) in Texas. Thirty four women veterans with chronic pain and comorbid 
depression and/or posttraumatic stress disorder (PTSD) were recruited. Five 
sessions of education/therapy were delivered via telemedicine in combination 
with daily home practice of a portable biofeedback device (Stress Eraser®, 
Helicor, New York, NY, USA). Participants responded to self-report 
questionnaires at baseline, at posttreatment, and at 6-week follow-up. Daily 
practice logs were also maintained by participants.
RESULTS: The clinical protocol was acceptable, easy to administer, and 
associated with statistically significant decreases in self-reported pain 
unpleasantness, pain interference, depressive symptoms, PTSD symptoms, and sleep 
disturbance at posttreatment. Improvements were maintained at 6-week follow-up. 
Qualitative analyses indicated that many participants 1) wished to continue to 
meet as a support group in their respective CBOCs and 2) felt less isolated and 
more empowered to cope with their problems of daily living as a result of the 
treatment.
CONCLUSIONS: It is feasible to provide treatment to women veterans living in 
rural areas by utilizing video-teleconferencing technology between larger VA 
medical centers and facilities at CBOCs in more rural settings. A controlled 
trial of the intervention is warranted.