SPECIAL ISSUE: Lessons Learned: A Pilot Study on the Feasibility of Using Biofeedback Monitoring in a Remote Setting with Special Forces Veterans in Saipan

In 2019, our team traveled internationally to test the effectiveness of a physiological assessment and heart rate variability (HRV) biofeedback program for a group of highly accomplished Special Forces Wounded Warriors participating in an international rehabilitative adaptive event. The intent was to offer biofeedback in a remote setting for managing and measuring stress while performing highly stressful tasks. The evaluation took place 8,000 miles from the mainland United States on the island of Saipan, the site of a tremendous battle during World War II. To our knowledge, a biofeedback system of this type has never been employed in a remote setting with this population. The transport of biofeedback equipment came with unique challenges as did providing an internet-based biofeedback project in a remote setting. Although HRV and health-related data were collected by study staff, the analysis of the data is not included in this manuscript. The purpose of this article is to provide information on key factors to consider when providing biofeedback in a remote setting, including data collection and storage in a limited internet service area; safe transport of equipment; and tools for successful biofeedback training in an isolated, international setting. We hope the information in this article will guide practitioners who plan to do similar types of biofeedback studies and interventions in the future.