SOCIAL DISTANCING AND MENTAL HEALTH: PERCEPTION

OFATRADITIONAL VEGETATIVE BIOFEEDBACK THERAPY

ONLINEPROGRAM

Jorge Manuel de Sousa Magalhães Rodrigues1, Ana Sofia de Sousa Cruz2,

Joana Isabel Moura de Oliveira3, Renato Lino Ribeiro4, José Luís Ferreira de Oliveira5,

Andreia Sofia Pinto da Silva Zenha6, Jorge Pereira Machado7, Cristina Maria Leite Queirós8

PSIQUE • EISSN 21834806 • VOLUME XXI • ISSUE FASCÍCULO 2

1ST JULY JULHO  31ST DECEMBER DEZEMBRO 2025 • PP. 5275

DOI: https://doi.org/10.26619/2183-4806.XXI.2.4

Submited on 12/05/2025 Submetido a 12/05/2025

Accepted on 17/11/2025 Aceite a 17/11/2025

Abstract

The demands of today’s fast-paced society, intensified by the impacts of the COVID-19

pandemic, often overwhelm our coping mechanisms and negatively affect mental and overall

well-being. This study aimed to investigate the impact of a distance program that included tra-

ditional vegetative biofeedback techniques on the mental health of participants during the first

year of isolation and social distancing measures related to the COVID-19 pandemic. Additionally,

the study aimed to identify the advantages and disadvantages of this type of distance program.

Semi-structured interviews were conducted with nine email-recruited participants.

1 ORCiD, Porto – Portugal - dep.investig-iptc@outlook.pt

FPCEUP – Faculty of Psychology and Education Sciences of the University of Porto, Portugal.

IPTC – Research Department in Complementary Therapies, Portuguese Institute of Taiji and Qigong, Portugal.

ICBAS – School of Medicine and Biomedical Sciences of the University of Porto, Portugal.

CBSin—Center of BioSciences in Integrative Health, Porto, Portugal

2 ORCiD, Porto – Portugal - anasofia_cruz@outlook.pt

FPCEUP – Faculty of Psychology and Education Sciences of the University of Porto, Portugal.

3 ORCiD, Porto – Portugal – joana.m.oliveira95@gmail.com

IPTC – Research Department in Complementary Therapies, Portuguese Institute of Taiji and Qigong, Portugal.

4 Porto – Portugal - renatolinoribeiro@gmail.com

IPTC – Research Department in Complementary Therapies, Portuguese Institute of Taiji and Qigong, Portugal.

5 Porto – Portugal - jose.oliveira.10523@abs.pt

IPTC – Research Department in Complementary Therapies, Portuguese Institute of Taiji and Qigong, Portugal.

6 ORCiD, Porto – Portugal - andreiazenha@yahoo.co.uk

IPTC – Research Department in Complementary Therapies, Portuguese Institute of Taiji and Qigong, Portugal.

7 ORCiD, Porto – Portugal - jmachado@icbas.up.pt

ICBAS – School of Medicine and Biomedical Sciences of the University of Porto, Portugal.

CBSin—Center of BioSciences in Integrative Health, Porto, Portugal

8 ORCiD, Porto – Portugal - cqueiros@fpce.up.pt

FPCEUP – Faculty of Psychology and Education Sciences of the University of Porto, Portugal.

Corresponding Author: dep.investig-iptc@outlook.pt IPTC – Research Department in Complementary Therapies, Portuguese

Institute of Taiji and Qigong, Rua E n.102, 4470-765, Maia, Porto, Portugal.

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

Results revealed that the pandemic negatively impacted participants’ personal, occupa-

tional, and family lives. However, the program appeared to have provided mental management

tools that helped combat anxiety and stress and improve emotional management. The program

also seemed to have benefited physical and mental stability, helping participants deal with the

pressures of the pandemic. The program offered accessibility, autonomy, low-cost, and applica-

bility in the post-pandemic era.

The study suggests that this program can be a useful intervention in pandemic and non-pan-

demic situations where conventional interventions are not accessible. Nonetheless, the study

suggests that the interaction between the instructor and participants and among participants

themselves could be improved to maximize the program’s effectiveness.

Keywords: Mental health, Distance program, Vegetative Biofeedback, Tajiquan, Qigong.

1. Introduction

The adaptation of human beings to the frenetic pace of current society involves an enormous

physical, mental and social effort, and the strategies to overcome the demands of modern society

are often insufficient. According to OECD data (2020), in 2018, the average prevalence of psycho-

logical stress symptoms in adults in the European Union was 11%, reaching over 20% in countries

such as Croatia and Portugal.

Regarding stress, as a complex phenomenon, Selye (1946), considered the “father” of stress,

defines it as a nonspecific response of the body to any demand, whether caused by or resulting

in, favourable or unfavourable conditions. Its complexity starts exactly in its definition, since it

is seen as a non-specific response of the body, and this non-specificity in its expression shows,

from the outset, the difficulty in identifying it correctly.

In fact, neurophysiological mechanisms are varied and complexly interconnected. A stress-

ful situation alters the organism’s homeostasis, leading to a need for an adaptive response to

recover balance (Pereira & Queirós, 2021). Also, in response to the stressor stimulus, various bio-

logical systems are activated, including the sympathetic nervous system and the hypothalam-

ic-pituitary-adrenal axis (Ulrich-Lai & Herman, 2009). The latter is related to the neuroendocrine

response of regulating “stress hormones,” including cortisol. In an exaggerated or prolonged

response to stress, imbalanced levels of cortisol, epinephrine, dopamine, and norepinephrine,

among others, will have negative consequences on homeostasis (Sousa et al., 2015). Thus, it is

necessary to emphasize that stress can be seen as a response of the organism, characterized by

the involvement of numerous biological systems.

Due to this complex involvement, the World Health Report (WHO, 2001) highlights the

importance of the need to consider health according to an evidence-based integrated model. This

integrated model should include emotions and patterns of thought, in the sense that a distressed

or depressed affective state (for example) initiates a cascade of harmful changes at the endocrine

and immune levels, leaving the individual more prone to developing various diseases. As Glaser

et al. (1999) point out, there is a relationship between stress and slower healing, or as Cohen et

al. (1991) note, there is a relationship between stress and the development of the common cold,

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

in addition to being associated with many other issues, including depression and anxiety (Heim

et al., 2000; Nolte et al., 2011).

Now, the work world is fertile in stressful events, and work can cause suffering (Areosa,

2018), making it pertinent to investigate occupational stress or work stress since this facilitates

the development of various mental disorders (Notaras & van den Buuse, 2020), and in the occupa-

tional context, it can lead to burnout (Farnaz et al., 2010; Kim et al., 2010; Wang et al., 2015; Wu et

al., 2007). Thus, in the occupational/work context, stress is experienced as a function of a stressor

stimulus associated with the task in the occupation. Sutherland and Cooper (1990) refer to the

existence of three major conceptual aspects of occupational stress: potential causes of stress,

moderators of the stress response, and manifestations of stress. The causes of stress may or may

not exist in the work environment (such as organizational causes) or in-home/work interactions

(such as extra-organizational causes), and, together with individual characteristics (moderators

of the response), may eventually lead to symptoms and diseases associated with stress (manifes-

tations).

Burnout is a process that occurs over time, as a way of coping with chronic occupational

stress, culminating in a state from which it is difficult to recover. Freudenberger (1974) indicates

that burnout is referenced in professions that involve working with people, while Maslach et al.

(2001) state that chronic work stress leads to the depletion of resources and a feeling of incapac-

ity to act as intended. Thus, burnout can arise mid-career, due to involvement in emotionally

draining situations. They also state that anyone can experience stress, but burnout is only expe-

rienced by those who enter their career with high ideals, motivation, and personal investment,

and who then feel disappointed in their goals. Currently, the most accepted model in the litera-

ture is Maslach’s, which suggests three dimensions of burnout: emotional exhaustion, deperson-

alization or cynicism, and lack of personal/professional accomplishment or professional ineffi-

cacy (Maslach & Jackson, 1981; Maslach & Leiter, 2008). However, even other theoretical models,

such as those by Buunk and Schaufeli (2018), Cherniss (1980), Leiter (1991), Meier (2016), or Pines

(1993), reinforce the idea that the origin of burnout lies in the organization and characteristics of

the job, rather than the worker’s inability to cope with stress at work.

In recent decades, numerous studies have been conducted on burnout, and we can summa-

rize its consequences at the individual and organizational levels (Queirós et al., 2014). For exam-

ple, Maslach and Leiter (2008) have stated that burnout has serious and prolonged consequences,

leading to the erosion of values, dignity, spirit, and loss of faith in helping tasks and one’s capac-

ity as a professional, affecting professional performance and the quality of services provided. In

turn, Schaufeli and Enzmann (1998) also identify individual consequences, such as depression,

anxiety, aggression, irritability, suicide risk, and organizational consequences, such as errors in

tasks and performance, and decreased quality of services/products. However, in recent years,

there has been a debate about the overlap between burnout and depression (Bianchi et al., 2015;

Bianchi et al., 2021). While highlighting the individual consequences, Koutsimani et al. (2019)

state in their systematic review and meta-analysis that people who suffer from burnout have

similar behaviours to those with depression, and several symptoms can be shared by both condi-

tions, although they are different concepts. The authors also suggest that occupational stress may

be a risk factor for anxiety symptoms, as extrinsic effort and excessive commitment are linked

to high levels of anxiety, with a strong association between anxiety and emotional exhaustion.

The study also concludes that burnout is a construct closely related to work, while depression is

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

a context-free concept, and although there are correlations between burnout and depression and

burnout and anxiety, their strength is not sufficient to suggest that they are the same construct.

Currently, it is assumed that living and working in the context of the COVID-19 pandemic

has harmed mental health (Eurofound, 2021, 2022; OCDE, 2021; WHO, 2022). Due to its unpredict-

ability, global scope, and sudden and rapid onset, the impact of this pandemic is incomparable

to recent outbreaks, causing extreme psychological stress on the world’s population, as well as

uncertainty, anxiety, and stress (De Girolamo et al., 2020). Therefore, as a means of containing the

spread of the virus, isolation and confinement measures were implemented worldwide, which

were essential in protecting physical health by reducing the probability of contagion.

However, prolonged isolation has implications for mental health (Reynolds et al., 2008), trig-

gering various psychopathological symptoms, such as anxiety, stress, fear, depressed mood, irri-

tability, anger, and insomnia (Brooks et al., 2020), as well as long-term consequences expressed

in an increased risk of alcohol abuse, symptoms of post-traumatic stress disorder, and depression

(Panchal et al., 2023; Wu et al., 2008). Moreover, these measures have brought sudden changes to

the work environment, notably with the teleworking and remote learning models, whose conse-

quences on mental health have been under study (EU-OSHA, 2021; Eurofound, 2021). Eitherway,

concerns about mental health are still elevated three years after the onset of the pandemic, now

considered to have developed into a mental health crisis (Bilu et al., 2023; Lopes et al., 2022;

Panchal et al., 2023).

Therefore, it is necessary to overcome the lack of action and underestimation of the burden

of morbidity by governments and global health funders, in order to mitigate human, social, and

economic costs (Trautmann et al., 2016; Vigo et al., 2016). Additionally, it is urgent to educate the

population as traditional beliefs and attitudes about mental illness in modern society lead to

stigma, compromising the demand, adherence, and quality of psychological treatment (Chat-

mon, 2020; Crowe & Kim, 2020; Devendorf et al., 2020).

In this sense, it is important to educate about mental illness and deepen understanding of

new ways to complement primary care, unveiling how certain therapeutic techniques work and

their effects on mental health, particularly on the signs and symptoms of the most prevalent

disorders such as anxiety and depression, but also on precursors such as stress, or in specific

contexts such as the workplace, occupational stress or burnout in the long run.

Chinese medicine is guided by a unique theoretical paradigm with key concepts and theories

such as Yin/Yang, the “Five Elements”, elemental substances Qi, Xue, and Jin Ye, as well as a dif-

ferential diagnosis approach to syndromes. Treatment methodology may include techniques such

as acupuncture, moxibustion, Chinese pharmacotherapy, Chinese manual therapy, traditional

Chinese psychotherapy, and even Qigong and Taijiquan as traditional vegetative biofeedback

therapies (Consentino et al., 2018; Greten, 2015; Matos et al., 2015). Currently, scientific aspects of

traditional Chinese medicine understand it as a traditional model of vegetative system biology

with a systemic therapeutic approach (Greten, 2011a, 2011b; Greten, 2013; Serteletal.,2010).

Specifically, Qigong was developed and perfected as a series of exercises to improve phys-

ical and mental health and proactively prevent disease (Chinese Health Qigong Association,

2012). According to Windridge and Xiaochun (1994), Qigong is a system of meditative exercises

intended to cultivate mental and physical health to strengthen the body to resist disease, adapt

to the environment, and restore proper internal functioning. It combines static positions and

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

slow and gentle movements with control of breathing and a specific state of mental “awareness”

(Matos et al., 2015; Rodrigues et al., 2019).

Taijiquan originally emerged as a martial art, but its evolution alongside the principles of

Chinese medicine (particularly Taoist roots) brought it closer to the therapeutic perspective for

which it is so well-known today (Rodrigues & Mestre, 2017). It consists of a system of continuous,

slow, and gentle movements intended to promote mental and emotional awareness, as well as

physical health by correcting energy imbalances in the body. The traditional view is that the

combination of breathing, meditative visualization of Qi (vital energy), and specific stretching of

certain body segments will allow for the energetic harmonization of organs and their respective

energy channels, thus balancing the individual as a whole.

From a more scientific perspective, these techniques are understood as a traditional biofeed-

back therapy aimed at improving and strengthening the general state of autonomic regulation,

namely homeostasis (Cheung et al., 2005; Greten, 2013; Lee et al., 2007; Lee, Jang, et al., 2003; San-

cier & Holman, 2004; Xin et al., 2007). Furthermore, specifically in mental health, there appears

to be some evidence suggesting that Taijiquan and Qigong may have a positive effect on the

prevention and reduction of depressive symptoms and other mood disorders, such as stress and

anxiety (Abbott & Lavretsky, 2013; Chan et al., 2013; Chan et al., 2014; Johansson et al., 2011; Kjos

& Etnier, 2006; Oh et al., 2013; Rodrigues, Lopes, et al., 2021; Rodrigues, Matos, et al., 2021; Rodri-

gues et al., 2023; Wang et al., 2014; Webster et al., 2016; Yeung et al., 2018). These techniques have

been shown to promote relaxation and decrease sympathetic system output (Irwin et al., 2008;

Motivala et al., 2006), activate the parasympathetic nervous system (So et al., 2019), resulting in

decreased levels of adrenaline, noradrenaline, and cortisol (Chow et al., 2012; Lee, Lee, et al.,

2003; Skoglund & Jansson, 2007; Tsang & Fung, 2008), and also observing an increase in endor-

phin levels (Ryu et al., 1996).

The objectives of this study are to understand the impact of a distance program composed

of traditional vegetative biofeedback techniques on the mental health of participants during the

first year of social isolation/distancing measures related to the COVID-19 pandemic, as well as to

understand the advantages and disadvantages of this type of distance program.

2. Methods

2.1. Participants

Participants were selected from a convenience sample. Inclusion criteria required partic-

ipants to be enrolled in an online programme consisting of traditional vegetative biofeedback

therapies. Participants had to be participants in the online distance programme between March

2020 and May 2021 (date of data collection). Participants who used the face-to-face method in the

meantime were excluded.

The sample consisted of nine participants aged between 26 and 57 years (M=46.56; SD =11.37),

67% (n=6) were female and 33% (n=3) were male.

All participants were employed and practising their respective professions during the period

this study analysed. Two participants (22%) continued their on-site professional roles, two (22%)

switched to remote work, and five (56%) adopted a mixed model of remote and on-site work.

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

In terms of educational background, one (11%) had a PhD, two (22%) had a Master’s degree,

five (56%) had a Bachelor’s degree, and one (11%) had a high school diploma.

The marital status of the participants was 33% (n=3) single, 33% (n=3) married and 33% (n=3)

divorced.

In addition, 56% (n=5) were already practising these techniques frequently before the inter-

vention period.

The study design conforms to the ethical principles for medical research involving human

subjects according to the Declaration of Helsinki. This research was conducted as a further inves-

tigation of a previous study (anonimized) and the project was reviewed and approved by the

Ethics Committee of the University Hospital of Porto (CHUP)/School of Medicine and Biomedical

Sciences (ICBAS) under reference 2020/ CE /P012(P324/ CETI /ICBAS).

Informed consent was obtained from all participants.

2.2. Materials

In this descriptive, transversal and exploratory study, we applied a qualitative methodology.

Due to the exploratory nature of the study and the specificity of the information to be collected,

the authors decided to create an interview script to increase knowledge about the phenomenon

under study. This script meets the suitability criteria to interpret and infer the subjective percep-

tions of the interviewees concerning the different issues raised by the topic; be accepted by the

interviewees; and be useful for our research (Ribeiro, 1999).

The semi-structured interview method was chosen because its flexibility allows structured

questions to be asked, but without preventing relevant aspects that emerge spontaneously dur-

ing the interviewee’s speech from being addressed and explored (Lune & Berg, 2017).

The script consisted of a first part in which the aim of the study was formally mentioned and

explained to the participants, as well as some general instructions ensuring the confidentiality

of the information and the anonymity of the respondents. The second part concerns informed

consent and questions about contextualisation and demographic characterisation. The third part

consists of several questions that address the topics the authors intended to explore, namely try-

ing to understand the general and specific psychological effects (symptoms of anxiety, depres-

sion and occupational stress) resulting from the constraints and limitations related to the COVID-

19 pandemic, the contribution of the programme to the mental health of the participants, the

advantages and disadvantages of the distance programme and its format (frequency and dura-

tion of sessions), and understanding what could contribute to improving this type of programme.

2.3. Procedures

2.3.1. Data collection

To proceed with the recruitment of participants, direct contact was made by email to all

participants in the Taijiquan and Qigong distance programme developed at the Portuguese Insti-

tute of Taichi and Chikung from March 2020 until the time of contact in May 2021. The contact

aimed to inform about the purpose of the study and to request cooperation, taking into account

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

the inclusion criteria, namely participation in the online programme during the first year of the

COVID-19 pandemic.

The traditional vegetative biofeedback techniques used during the programme varied

between therapeutic Taijiquan and Qigong techniques according to the Shao Yin system of

Applied Traditional Psychophysiological Feedback Techniques developed and adapted by the

Portuguese Institute of Taichi and Chikung and studied in the last decade (Rodrigues et al., 2019;

Rodrigues, 2022; Rodrigues, Lopes, et al., 2021; Rodrigues, Matos, et al., 2021; Rodrigues et al.,

2022).

Data collection took place between 15 and 31 May 2021 using video communication software

ZOOM (Zoom Video Communications Inc., California, USA) to avoid limitations and difficulties

arising from the pandemic context.

2.3.2. Data analysis

Data analysis was conducted using Bardin’s content analysis (Bardin, 2006), in which each

response was analysed by forming broad categories defined by two researchers (JMR and CQ)

until a consensus was reached. These categories were defined after reading all the interviews

and taking into account the objectives of the study. They were then defined as themes and sub-

themes in the tables at the following point.

3. Results and Analysis

thus, given the objectives of the study, the psychological impact of the pandemic and the con-

straints and limitations were defined as the main themes, which also included sub-themes, with

some illustrative extracts shown in Table 1. Table 2 shows the contributions of the distance pro-

gramme to psychological well-being during the pandemic, while Table 3 focuses on the advan-

tages, drawbacks, adequacy and suggestions for improvement of the distance programme. The

detailed results for each of these themes are presented below, and their interpretation/discussion

is done in light of other studies and theoretical foundations.

3.1. Psychological impact of the pandemic

The content analysis carried out resulted in Table 1, which is commented on below. Thus,

under the topic “Psychological impact of the pandemic”, three main themes were identified,

relating to the impact of the pandemic on (1) personal, (2) professional and (3) family life.

In the first, all participants reported having had an impact on their personal lives, and two

main causes were identified. The first cause relates to the pandemic in general, identified by

seven participants, and it was generally observed that “anxiety ended up being something

always present” (participant #4), which would have implied great uncertainty about the future

and a great fear of social contact. As previously discussed, the pandemic has increased the prev-

alence of anxiety (Collaborators, 2021; Schafer et al., 2022), and therefore, the results of this study

are consistent with this notion. Less referred to by participants but also important to note, the

pandemic had caused feelings of loneliness and emotional exhaustion, something that studies

such as those by Ray (2021) and Ray and Shebib (2022) also observed. Regarding the second cause,

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

identified in the discourse of 5 participants, the impact on personal life also occurred through

lockdown and distancing measures, which, as studied, have implications for the mental health

of the population (Silva et al., 2022; Venkatesh & Edirappuli, 2020). As stated, “it was totally new,

we suddenly became deprived of our freedom, our routines” (participant #2), which led to uncer-

tainty, fear, concern, and even a feeling of helplessness and uselessness mentioned in the speech

of one of the participants.

Regarding the second identified theme, it was observed that almost all participants (eight

out of nine) referred to the impact that the pandemic had on the occupational sphere. Although

the majority of studies focus on healthcare professionals (Levi & Moss, 2022; Riedel et al., 2022;

Smallwood et al., 2022; Wynter et al., 2022), most other professions or occupations were also

affected by the pandemic (Deguchi et al., 2022; Keeney et al., 2022; Minihan et al., 2022; Mobar-

aka et al., 2022). Of this impact, five participants mentioned that teleworking and layoff were the

most destabilizing factors because “there was not enough preparation, neither technically nor

in terms of socio-professional relationship” and “therefore, everything was lacking, and there

was great instability, and professional work itself was always accompanied by great stress” (par-

ticipant #4). In the participants’ speech, this difficulty in interaction led to a feeling of lack of

effectiveness and productivity, frustration, and exhaustion since “the work sequence is not what

we want, but we have to submit to a discipline that is not ours (...) work is not as fluid, we do

not progress as we want (...) efficiency, effectiveness is completely lost” (participant #4). In fact,

pandemic-related stress related to telework seems to have been an emerging problem during the

pandemic (Gualano et al., 2023), negatively affecting job satisfaction and productivity (Martin et

al., 2022). Almost without representation, one participant mentioned that telework also harmed

their social life, as it limited social contact with colleagues, something that has already been

mentioned by Evans et al. (2021) and Larson et al. (2020).

With references from only two participants, the occupational impact, according to the gen-

eral picture, led to a certain uncertainty and fear of losing their job and to a greater workload

leading to stress and exhaustion, as referenced by participant #1 when stating that “our produc-

tions decreased, and they talked a lot about layoffs (...) we had a lot of stress. With a smaller team,

the work increases a lot, and I was getting exhausted. Psychologically exhausted.” The pressure

that professionals were under during the pandemic was real, as, according to the study by Ang

and Dong (2021), restrictions and lockdowns are related to higher levels of unemployment.

Only mentioned by one participant, social distancing measures would also have a negative

impact on the work environment as they harmed “the social interaction between colleagues

and... even between teachers and students (...) all these things end up not allowing social inter-

action in the work context to be as light as it used to be,” and furthermore, “all these procedures,

we have to do our work plus these extra procedures and then we have these concerns... they are

all procedures of concern, see if everyone is doing well, if the distance is being maintained, if

we air the rooms, if we did this and that” (participant #2) leading to a certain degree of mental

exhaustion.

Finally, the third theme, with references from three participants, concerns the impact that

the pandemic had on the family sphere. In general, the pandemic created fear, uncertainty, and

anxiety within the family, and various sources of concern could influence each specific case.

In the case of participant #3, there was a “fear of how things were going to happen, right? If

people were going to abandon people in nursing homes, as heard in other countries (...) how

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

they isolated themselves inside ... it became impossible to follow day-to-day... how things were

going to unfold inside (...) it is normal that I worry more about her (mother).” In fact, regarding

the restrictions applied in nursing homes, family members not only bear the emotional burden

of the relative being institutionalized but also suffer from situations of stress due to the fall of the

economy, instability typically related to disasters, increased exposure to abusive relationships,

and reduced options for support and monitoring (Paananen et al., 2021; Yeh et al., 2020).

On the other hand, an impact on the family level specifically due to lockdown was identified

in two participants, due to the incompatibility between family members and lack of space, as

stated by participant #9 when stated that “it was a concentration of 4 people in the same physical

space and this was a bit difficult to manage. Because each one has their own habits and rhythms

(...) this so far, despite everything, is still a bit difficult (...) because we are really confined in the

space, in an apartment and not a house ... and so it was a bit difficult”. Regarding this last point,

studies also point out that family relationships deteriorated during the pandemic, especially dur-

ing the lockdown (Cassinat et al., 2021; Feinberg et al., 2022).

TABLE1

Themes, sub-themes and illustrative excerpts on the psychological impact of the pandemic, restrictions,

and lockdowns.

Themes Subthemes Illustrative excerpt

Impact on personal life Due to the pandemic “Somewhat anxious, rst because everything was new. The TV news

ended up bringing some novelty because it is the unknown. Being

unknown, the person does not know how long it would last, what

attitude to take, if it would worsen. In other words, anxiety ended up

being something always present” Participant #4.

Due to lockdown and

distancing measures

“Initially (…) it seemed like everything was a kind of dream, a nightmare,

we still didn’t understand very well what the implications would be for

our lives, of this new reality (…) it was totally new, we were suddenly

deprived of our freedom, our routines. So it was a bit of fear of the

unknown.” Participant #2”

Occupational impact Due to telework and layo “There was not enough preparation, neither in technical nor in socio-

professional terms. Therefore, everything was lacking, and there

was great instability, and the professional exercise itself was always

accompanied by great stress (...) the work sequence is not what we

want, but we have to submit to a discipline that is not ours (...) the

work is not as uid, we do not make progress as we want (...) eciency,

eectiveness is completely lost.” Participant #4

General picture “… our productions decreased, and they talk a lot about layos (…) we

had a lot of stress. With a smaller team, the workload increases a lot

and it was not possible... I was becoming exhausted. Psychologically

exhausted.” Participant #1”

Due to distancing measures “…and then also the work routines themselves, right? Like, interaction

among colleagues and...even among teachers and students (...) all

those things end up not allowing social interaction in the work context

to be as easygoing as it used to be (...) All those procedures, we have

to do our work plus these extra procedures, and then we have those

concerns...they are procedures of concern, checking if everyone is

doing well, if the distance is being maintained, if we are ventilating

the rooms, if we did this and that, right. The correct procedures”

Participant#2

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Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

Themes Subthemes Illustrative excerpt

Family life impact Due to the pandemic “And for a while, I was even afraid of how things were going to go,

right? If people were going to abandon people in nursing homes, as

we heard in other countries (...) how they isolated themselves inside...

we stopped being able to keep up with the day-to-day... how things

were going to unfold in there (...) it’s normal that I worry more about her

(mother).” Participant #3

Due to connement “There were four people concentrated in the same physical space

and this was a bit dicult to manage. Because each one has their

own habits and rhythms (…) up until now, despite everything, it is still

a bit dicult (…) because we are really conned in the space, in an

apartment and not in a house… and that’s why it was a bit dicult.”

Participant #9

3.2. Contributions of remote therapeutic sessions to psychological well-being during the

pandemic.

Through the content analysis carried out, Table 2 was constructed, which is then discussed.

Thus, according to the superordinate theme “contributions of distance therapeutic sessions to

psychological well-being during the pandemic”, two main themes were identified concerning

the application of techniques as (1) a mental management tool and (2) the ability to promote a

sense of normality and create a routine.

As an aid tool, all participants referred to the ability of these techniques to promote mental

management in various contexts. Four participants referred to it as an anxiety control tool, and

as stated by participant #4, it “lowers anxiety levels because I try to concentrate, therefore, make

a cut with reality. Try to abstract myself from reality”. The ability of these techniques to improve

anxiety symptoms has been studied in recent years (Chan et al., 2014; Johansson et al., 2011; Rod-

rigues, Matos, et al., 2021), with the study by Yu-Xuan et al. (2020) already applied in the COVID-

19 era, and even the preliminary study of this online program (Rodrigues et al., 2022), which

concluded that there were significant benefits in the anxiety levels of participants compared to

a control group. These results appear to be related to the modulation of cortisol levels (Chow et

al., 2012; Rodrigues, Matos, et al., 2021; Tsang & Fung, 2008), which also corroborates the results

of this study for the use of Taijiquan and Qigong as a stress management tool, referred to by two

participants. Following this line of thought, two participants also referred that these techniques

taught at a distance promote the ability of emotional management, with participant #8 referring

that “I think I use some things and it helped me to come to some conclusions, kind of related to

emotions or ways of processing emotions, it was a way to stop a bit, reflect and well...process

emotions a bit (…). I had those discussions and those episodes, and on those days of more stress, I

did Taichi, and on those days, I channelled that and tried to incorporate those negative emotions,

and well, it helped me”. In this way, these techniques can also be used early in a preventive way

(van Dam, 2020), something that may be related to the ability to improve the positive affect of

practitioners, also observed in the preliminary study of this program (Rodrigues et al., 2022).

Similarly, four participants referred to the program’s benefits in helping to combat occupa-

tional stress caused by the pandemic. Participant #3 refers, “I think they contributed a lot (to

dealing with professional stress) (…) it was an hour that I was relaxed and I liked what I was

doing, right? And then that effect clearly prolongs for some time,” noting the prolonged effect

of practice. This effect may be related to these techniques acting as vegetative biofeedback

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

techniques, due to their long-term autonomic regulation of mind-body physiological effects

(Matos et al., 2015).

Even though only mentioned by two participants, it is important to emphasize the possibility

of this program assisting in family stress management. As previously discussed, family stress

has increased during the pandemic, and this program seems to promote some benefits, espe-

cially during confinement, as participant #9 states that “everyone improved their mood (...) and

managed to stay calm, suddenly everyone was in a good mood, we were playing (...) so it was

something that managed to bring the whole family together and it was much easier to manage

that tension. (...) Everyone tries hard and it’s fun (laughs) for everyone. It’s in this sense that a kind

of good humour was created, which was very difficult to find at that time.” An improvement in

mood, cohesion, and family well-being is observed. Regarding this topic, and according to the

participants’ discourse, this online program seems to have benefited various spheres of life dur-

ing the COVID-19 era, promoting calm, relaxation, and tranquillity in general and being a pleas-

urable practice that promotes mental presence and abstraction from reality. In this sense, Robles

et al. (2021) also showed that a Taijiquan and Qigong intervention remotely during the pandemic

could benefit participants’ psychological well-being.

In the second theme, six participants mentioned that the program promoted a sense of

normality and created a routine. These same six participants pointed out the resulting mental

stability, for example, the sessions “contributed greatly to having a routine, a moment dedi-

cated to me, to my own physical and mental stability (...) it continues to help me compensate for

this overload of new concerns and new stresses” (participant #2), also referring to the issue of

physical stability, as did two other participants. In this context, the holistic aspect of the prac-

tice is important, which, as participant #7 states, through the promotion of physical health, we

obtain mental benefits: “Tai Chi, which is a light thing, you immediately feel it in the muscles.

Which for me is very positive (...) Because if a person is going to feel stiffness in the mus-

cles, they will feel it, and psychologically they will be affected...the psychological will affect

the organs again” (participant #7). From this perspective, there is already an extensive notion

about the body-mind interaction in psychophysiology. It is precisely in this sense that these

techniques can be considered applied psychophysiological feedback techniques (Rodrigues,

Matos, et al., 2021) because they integrate movement, meditation, and breathing techniques to

manipulate the processes of the body and mind. Oh et al.’s (2021) study, also conducted during

the pandemic, suggests that an online Taijiquan program can improve participants’ overall

satisfaction and quality of life.

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

TABLE2

Themes, sub-themes, and illustrative excerpts of the contributions of the distance program to psychological

well-being during the pandemic.

Themes Sub-themes Illustrative excerpt

Mental management tool Anxiety control “Lowering those anxiety levels, because I tried to concentrate, so

making a cut with reality. Trying to abstract myself from reality (…) ‘Ok,

now it’s a moment where I’m not going to think about anything else.

The world may end. This could all be an earthquake, but now this.’

And I tried not to think about anything else. I turned o my phone...

everything.” Participant #4.

Occupational stress

management

“I think they contributed a lot (to dealing with professional stress) (...)

it was a time when I was relaxed and enjoying what I was doing, right?

And then that eect clearly lasted for some time. I even did many

sessions alone and tried to practice the movements without class

because I really felt good doing it, it was very good.” Participant #3

Emotional management “I think I use some things and it helped me to come to some

conclusions, like related to emotions or ways of processing emotions,

it was a way of stopping a bit, reecting and processing emotions a bit

(...) I had those discussions and those episodes, and on those days of

more stress, I did Taichi and on those days, I channelled a bit of that

and tried to incorporate those negative emotions, and it helped me ...”

Participant #8

Stress management “It has to do with health, it has to do with psychological feeling. It’s a

very dierent thing. Then it’s that situation of a certain relaxation (...)

and basically, it’s about relieving stress. It’s about being able to have a

certain relaxation, really.” - Participant #5

Family stress management “Everyone improved their mood (...) to be able to stay calm, and

suddenly everyone was in a good mood, we were joking (...) so it was

something that managed to bring the whole family together and it

was much easier to manage the tension. (...) Everyone tries to make an

eort and this is fun (laughs) for everyone. It is in this sense that a kind

of good humour was created, which was very dicult to nd at that

time.” Participant #9

Providing routine and a

sense of normalcy

Mental stability “...they contributed a lot to having a routine, a moment dedicated to

me, to my own physical and mental stability (...) it continues to help me

compensate for this overload of new concerns and new stresses…”

Participant #2

Physical stability “...the Taichi, which is a light thing, the person immediately feels it in

their muscles. Which for me is very positive (...) Because if a person is

going to feel muscle stiness, they will feel it and psychologically it will

aect them ... the psychological aspect will then aect the organs and

so on.” Participant #7

3.3. Advantages, disadvantages, suitability, and suggestions for improving the distance

program.

Through the content analysis carried out, Table 3 was constructed, which is then discussed.

Thus, to evaluate and understand the strengths and weaknesses of this program, the partici-

pants’ experience was explored. From the analysis of the interviews, two major advantages were

identified. All participants agreed that access to sessions was significantly benefited by being

online. Participant #4 stated that “being an online session, geographic distance doesn’t matter,

so we can enjoy the sessions wherever we are, as long as there is internet, we can minimize the

effect of not being present.” In addition to the main advantage being the lack of travel (mentioned

by five participants), this advantage in access allowed for greater regularity in participation,

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

participation in a more comfortable setting (home), and cost reduction. It is important to note

that, in a non-pandemic context, this type of program allows access to segments of the popula-

tion who may be inhibited from accessing conventional treatments or interventions for various

reasons.

The other point that proved advantageous for the success of the program was the way the

session was conducted, namely the detailed manner in which it was guided, allowing for evo-

lution in the applied techniques and providing participants with autonomy in their execution.

Thus, according to participant #2, “it was easy to understand the step-by-step instructions as

they were transmitted so that they could be done at home without feeling the need for in-person

supervision.” This advantage was mentioned by four participants and coincides with the study

by Li et al. (2022), which found that, in addition to the benefits, an online Taijiquan intervention

is feasible, well-accepted, and safe.

However, despite these advantages, the online context brought some disadvantages. Although

there was attention to the detail of the execution by the therapist-instructor, four participants

pointed to the lack of feedback given by them. At this point, and despite the remote benefits of

participation, remote practice implies a reduction in the ability of the therapist-instructor to ana-

lyze and observe the execution of the participants. It is suggested, therefore, that the use of video

conferencing software instead of just video transmission may benefit this interaction.

Poor social interaction was another disadvantage observed in the discourse of four partici-

pants. As participant #3 said, “I think it’s more interesting to do it with other people, you feel the

spirit of the group, and that is lost online (...) That interaction is missing.” Similar to the previous

point, changing software may promote more interaction, and it is suggested to have an informal

moment before and after the session dedicated to interaction among participants.

Four participants pointed to the disadvantage that technological limitations can bring, and

that “of course, these are things we do not control. It is to have an internet (laughs) with excel-

lent performance, so that a person can enjoy everything without major alterations, to hear the

instructions, the voice, the music, which is part of a whole” (participant #4). In contrast to possible

solutions to the aforementioned disadvantages, the use of more demanding software that allows

input and output of video will harm the participation conditions of those with these limitations.

Thus, in these types of programs, it is necessary to evaluate the risk of loss of participation condi-

tions due to the change from a simple video transmission system to a video conferencing system,

taking into account this specific dilemma.

Finally, there was also a limitation of space for the practice of sessions. Although mentioned

by only two participants, there is a possibility of constraints in the physical home conditions of

the participants. To not aggravate this topic, it is suggested to maintain the techniques applied in

this program since they focus on a group of practices that require very little space.

Regarding the frequency and duration of sessions, participants generally found them appro-

priate. It is important to note that the sessions were more frequent weekly during the first phase

of the pandemic, with that frequency decreasing after that critical initial period. This change

seemed to accompany the participants’ needs. The duration of the session, as mentioned by

participant #2, “was quite appropriate, even considering the effects that were noticeable after-

wards.”

Suggestions for improving this program were also requested. Overall, the suggestions provided

by the participants were scarce. However, we can mention the need for greater diversification of

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

the techniques, as indicated by participant #2 who stated that it would be beneficial to “include

new exercises from time to time, to increase the diversity of exercises and the functions associ-

ated with each exercise”. For this suggestion, it is recommended that efforts be made to keep par-

ticipants motivated, while always taking into account the issue of the physical space limitations

of the participants. Some more advanced techniques, such as Taijiquan, require a larger space for

their practice, so this diversification should focus on Qigong techniques.

Another suggestion mentioned by one of the participants was to improve the interaction

among the group of participants to promote socialization: “Perhaps have some classes together

with the cameras (...) spend some more time with colleagues. Because it’s important in these

classes too. I don’t know them, but it’s very good. As if it takes us back to school time” (partici-

pant #1). Regarding this topic, we again refer to the possibility of software modification and the

promotion of specific moments to promote socialization, always considering the potential con-

straints regarding the technological conditions of some participants.

Finally, a participant (participant #2) also stated that “it would be very interesting if people

could know about these exercises and take short breaks throughout their workday to do these

exercises to improve respiratory capacity, focus, relieve mental fatigue (...) I think it’s an excel-

lent tool, so it deserves to be more accessible to a wider audience”. In the eyes of this participant,

the potential of this type of online program goes beyond mere intervention in the context of a

pandemic.

Indeed, the application of this online program can be easily adapted to work contexts, bring-

ing several benefits (as observed in the results of this study), as occupational stress existed before

the pandemic and was only aggravated by it. In fact, three participants mentioned taking the

sessions during breaks while teleworking. It is suggested that, in a post-pandemic context, com-

panies may have the ability to eliminate certain disadvantages of this program by providing

technological conditions and physical space for practice to their workers.

Limitations and suggestions

Although the results seem promising, this study has the limitation of being a cross-sectional

study, and of a reduced number of participants, restricted by the inclusion/exclusion criteria

outlined and by the participants still enrolled in the program at the time of data collection. For

future studies, a larger recruitment, a longitudinal design, and an additional quantitative meth-

odology are suggested to explore in more detail the impact of the program (e.g., stress, anxiety

questionnaires, etc.).

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Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

TABLE3

Themes, sub-themes and illustrative excerpts of advantages, disadvantages, adequacy and improvement

suggestions of the remote program.

Themes Sub-themes Illustrative excerpt

Advantages Access “…being an online session, geographical distance is not an issue, so

we can enjoy the sessions no matter where we are, as long as there is

internet, we can minimize the eect of not being physically present.”

Participant #4

Detailed guidance, progress

and autonomy

“…it was easy to understand the step-by-step instructions as they

were given so that one could do it at home without feeling the need for

physical supervision.” Participant #2

Disadvantages Less feedback “I know that maybe in person I could improve better and the teacher

could correct better, do things dierently.” Participant #8

Less social interaction “I think it’s more interesting to do it with other people, you feel the

group spirit, and that is lost online (...) There is a lack of interaction…”

Participant #3

Technological limitations of

participants

“…of course, these are things that we cannot control. We need to

have excellent internet performance (laughs), so that we can enjoy

everything without major disruptions, to hear the instructions, the

voice, the music, which is part of the whole…” Participant #4

Limitations in space for

practice

“…the disadvantage is not having the space that we might have in (the

participant’s usual practice location).” Participant #5

Appropriateness of

frequency/duration of

sessions

Appropriate session

duration

“…I felt that the duration of the sessions was quite appropriate,

especially considering the eects that were noticeable afterwards.”

Participant #2

Appropriate session

frequency

“Yes, I think so. We had, if I’m not mistaken, three (sessions) per week.”

Participant #5

Suggestions for program

improvement

Greater diversication of

applied techniques

“…being able to include new exercises from time to time. To increase

the diversity of exercises and the functions associated with each

exercise.” Participant #2

Improvement in group

interaction

“Maybe doing some classes more together with cameras (...) also

getting to know each other a little more with colleagues. Because it is

important in these classes as well. I don’t know them, but it’s very good.

It’s like going back to school time” Participant #1

Greater reach of the

program

“…it would be very interesting if people could know about these types

of exercises and could take small breaks during their workday and do

these types of exercises to improve respiratory capacity, focus, relieve

mental fatigue (…) I think it’s an excellent tool, so it deserves to be

more accessible to a wider audience.” Participant #2

4. Conclusions

The results showed that the pandemic had a negative impact on mental health, and on per-

sonal, occupational, and family lives. However, the distance program of traditional techniques of

vegetative biofeedback, according to the 9 participants, was able to provide mental management

tools that allow for greater control of anxiety, emotional and stress management, as well as tools

to help combat occupational and family stress. Physical and mental stability is another benefit of

this program as it allows for a feeling of normalcy and the construction of a routine that helped

to deal with the specific pressures of the pandemic. Thus, the program demonstrated various

advantages, and all participants agreed that remote access brought several benefits. The detailed

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Jorge Manuel de Sousa Magalhães Rodrigues, Ana Sofia de Sousa Cruz, Joana Isabel Moura de Oliveira, Renato Lino Ribeiro,

José Luís Ferreira de Oliveira, Andreia Sofia Pinto da Silva Zenha, Jorge Pereira Machado, Cristina Maria Leite Queirós

conduction also seems to allow for the evolution and autonomy of the therapeutic techniques,

although it is suggested to diversify these techniques a little more, namely Qigong. However,

there are some disadvantages, such as inefficient instructor-participant and participant-partici-

pant interaction, which can be mitigated by changing to a video conferencing system. Although,

this change may harm participants with greater technological limitations.

It is also concluded that the duration and frequency of the sessions seem to be suitable for

this context, and it is possible to adapt the sessions to post-pandemic work contexts. This adap-

tation is possible and can bring physical and mental benefits to workers, especially if organiza-

tions provide technological and physical conditions to their workers. Indeed, the online program

of traditional techniques of vegetative biofeedback applied during the pandemic had physical/

mental benefits for its participants, was practical, easy to access and low-cost, and can be applied

in pandemic and non-pandemic situations where the population does not have access to conven-

tional interventions, and can also be implemented in a work context.

5. Author contributions

(Anonymized)

6. Funding

This research received no external funding.

7. Informed consent statement

Informed consent was obtained from all subjects involved in the study.

8. Acknowledgments

(Anonymized)

9. Conflicts of interest

The authors declare no conflict of interest.

PSIQUE • e-ISSN 2183-4806 • Volume XXI • Issue Fascículo 2 • 1st july julho-31st december dezembro 2025 • pp. 52-75

Social Distancing and Mental Health: Perception ofaTraditional Vegetative Biofeedback Therapy OnlineProgram

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