Heart Rate Variability Biofeedback Reduces Food Cravings in High Food Cravers

Volitionally Regulated Breathing with Prolonged Expiration Influences Food Craving and Impulsivity

INTRODUCTION

Previously, an intervention involving volitional slow breathing reduced trait food craving with protective effects on cardiac vagal activity (CVA). Breathing with a low inspiration-to-expiration (i/e) ratio also increases CVA. High CVA was separately associated with low unregulated eating and lesser impulsivity. Hence, the present study assessed breathing with a low i/e for effects on state food craving, hunger and satiety, state impulsivity, and heart rate variability (HRV) in healthy obese persons.

METHODS

Forty obese persons were randomized to two groups. The intervention group (mean age ± SD, 41.15 ± 12.63, M:F, 10:10) practiced metronome-regulated breathing with low i/e at 12 breaths per minute (expiration 72% of total breath duration) and attained expiration 55.8% of total breath duration, while the active control group (mean age ± SD, 44.45 ± 11.06, M:F, 13:07) sat motionless and directed their gaze and awareness to the stationary metronome without modifying their breath consciously. The HRV was recorded before, during, and after breathing intervention (or control) (standard limb lead I, acquisition at 2,000 Hz, with an LF filter = 0.5 Hz and HF filter = 50 Hz). Time-domain and frequency-domain HRV parameters were obtained with Kubios software. State food craving, and hunger and satiety were recorded before and after the intervention/control.

RESULTS

The intervention group decreased total state food craving scores and the sub-domains (i.e., desire to eat, positive reinforcement, lack of control and hunger), increased current satisfaction with food, decreased total state impulsivity (repeated measures ANOVA, p < 0.05 in all cases), increased HF-HRV and RMSSD (linear mixed model analyses with age and gender as fixed factors; p < 0.05 in all cases) during the intervention compared to the preceding baseline. The intervention group also showed an increase in positive mood and a decrease in aroused and negative mood states.

CONCLUSION

Changes in state food craving and impulsivity could be related to an increase in HRV or to changes in subjective relaxation and positive mood or to both.

A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?

Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.

Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines

Heart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported.

Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report

OBJECTIVE

Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin.

METHOD

We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points.

RESULTS

We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain.

DISCUSSION

Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings.

PUBLIC SIGNIFICANCE

Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.

Discordance between assessments of food cue responsiveness: Implications for assessment in youth with overweight/obesity

Food cue responsiveness (FCR), broadly defined as behavioral, cognitive, emotional and/or physiological responses to external appetitive cues outside of physiological need, contributes to overeating and obesity among youth and adults. A variety of measures purportedly assess this construct, ranging from youth- or parent-report surveys to objective eating tasks. However, little research has assessed their convergence. It is especially important to evaluate this in children with overweight/obesity (OW/OB), as reliable and valid assessments of FCR are essential to better understand the role of this critical mechanism in behavioral interventions. The present study examined the relationship between five measures of FCR in a sample of 111 children with OW/OB (mean age = 10.6, mean BMI percentile = 96.4; 70% female; 68% white; 23% Latinx). Assessments included: objectively measured eating in the absence of hunger (EAH), parasympathetic activity when exposed to food, parent reported food responsiveness subscale from the Child Eating Behavior Questionnaire (CEBQ-FR), child self-reported Power of Food total score (C-PFS), and child self-reported Food Cravings Questionnaire total score (FCQ-T). Statistically significant spearman correlations were found between EAH and CEBQ-FR (ρ = 0.19, p < 0.05) and parasympathetic reactivity to food cues with both C-PFS (ρ = -0.32, p = 0.002) and FCQ-T (ρ = -0.34, p < 0.001). No other associations were statistically significant. These relationships remained significant in subsequent linear regression models controlling for child age and gender. The lack of concordance between measures assessing highly conceptually related constructs is of concern. Future studies should seek to elucidate a clear operationalization of FCR, examine the associations between FCR assessments in children and adolescents with a range of weight statuses, and evaluate how to best revise these measures to accurately reflect the latent construct being assessed.

Development and validation of the food cue responsivity scale

Food cues are ubiquitous in today's environment; however, there is heterogeneity as to the extent to which these cues impact eating behavior among individuals. This study examines the validity and reliability of the Food Cue Responsivity Scale (FCRS) to assess responsivity to distinct types of food cues. Items gathered from existing measures were combined in the FCRS to reflect two subdomains, uncontrolled eating behavior and cognitive rumination. The criterion validity of the FCRS was established using a paradigm that assesses psychophysiological responsivity to a craved food among adults with overweight or obesity. Higher overall FCRS scores were associated with greater physiological responsivity to food exposures. These findings may help identify specific phenotypes of individuals with overweight or obesity with high responsivity to food cues, which could be used to understand overeating and response to weight-loss programs.

Meta-Analysis and Systematic Review of Resting-State High-Frequency Heart Rate Variability in Binge-Eating Disorder

Abstract. Binge-eating disorder (BED) is associated with a greater risk for cardiac problems and co-occurring health conditions. Resting-state measures of high-frequency heart rate variability (HF-HRV), which is a physiological proxy of self-regulatory neural functioning, may aid understanding of health risks. We systematically reviewed and meta-analyzed the literature on HF-HRV in individuals with BED and without BED. Six studies were reviewed in the qualitative synthesis, and five studies assessing HRV in individuals with BED ( n = 153) and without BED ( n = 124) were included in the meta-analysis. A non-significant effect size (Hedges’ g = .08, SE = 0.36, 95% CI [−0.62, 0.78]; z = 0.23, p = .82) was found, suggesting no difference in HF-HRV between groups. Age, BMI, and BMI-matched control status were not significant covariates. Synthesizing the five studies with available data, we found no difference in resting-state HF-HRV between individuals with and without BED. There was high heterogeneity in the sample, suggesting potential moderators. We discuss potential mechanisms, methodological and demographic confounds, and future directions for study.

A Pilot Randomized Control Study on Effect Brief Heart Rate Variability Biofeedback as a Complementary Treatment in Men with Methamphetamine Use Disorder

The aims of this study were to investigate the efficacy of heart rate variability biofeedback (HRVBFB) intervention in terms of reducing craving, severity of dependence, and rate of positive methamphetamine urine testing in men taking part in a methamphetamine use disorder outpatient treatment program. Sixty-one adult men received either HRVBFB treatment plus treatment as usual (TAU) over four weeks or TAU only. Men receiving HRVBFB showed significantly greater reductions in craving, dependence severity, and the rate of positive methamphetamine urine testing at the end of the intervention and four weeks of follow-up. The analyses further showed that the levels of craving and dependence severity at treatment entry were predictive of changes in craving and dependence severity at the end of treatment and follow-up, respectively. The baseline status of a positive methamphetamine urine test only predicted a positive methamphetamine urine test at the end of treatment, not at the end of the follow-up period. Our results showed HRVBFB intervention has merits as an adjunct treatment to ameliorate cravings and reduce the severity of dependence experienced by persons with methamphetamine use disorder. An added value of HRVBFB intervention is the fact that it can be easily and affordably implemented in everyday life.

Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis

We performed a systematic and meta analytic review of heart rate variability biofeedback (HRVB) for various symptoms and human functioning. We analyzed all problems addressed by HRVB and all outcome measures in all studies, whether or not relevant to the studied population, among randomly controlled studies. Targets included various biological and psychological problems and issues with athletic, cognitive, and artistic performance. Our initial review yielded 1868 papers, from which 58 met inclusion criteria. A significant small to moderate effect size was found favoring HRVB, which does not differ from that of other effective treatments. With a small number of studies for each, HRVB has the largest effect sizes for anxiety, depression, anger and athletic/artistic performance and the smallest effect sizes on PTSD, sleep and quality of life. We found no significant differences for number of treatment sessions or weeks between pretest and post-test, whether the outcome measure was targeted to the population, or year of publication. Effect sizes are larger in comparison to inactive than active control conditions although significant for both. HRVB improves symptoms and functioning in many areas, both in the normal and pathological ranges. It appears useful as a complementary treatment. Further research is needed to confirm its efficacy for particular applications.

Resonance frequency is not always stable over time and could be related to the inter-beat interval

Heart Rate Variability Biofeedback (HRVB) is based on breathing at an optimal rate (or resonance frequency, RF) corresponding to the respiratory sinus arrhythmia (RSA). Our aim is to check whether the RF is a stable factor and analyse the HRV parameters individually per each breathing rate, comparing it with free slow breathing. A sample of 21 participants were trained in a test–retest HRVB protocol. The results indicated that RF changed between Test and Retest sessions in 66.7% of participants. This instability could be related to the average of interbeat interval (IBI). HRV time domain parameters (SDNN and RMSSD) were significantly higher for RF than for other breathing rates, including 6 breath/min and free slow breathing. Free slow breathing showed a lower heart rate averages than RF and other slow breathing rates. Overall, our study suggests the relevance of assessing RF individually and before each HRVB session, because the maximum cardiovascular benefits in terms of increasing HRV were found only at RF. Thus, breathing at the individualized and momentary frequency of resonance increases cardiac variability.

Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an "ideal range"

Heart rate variability (HRV), a measure of the variability in intervals between subsequent heart beats, is now widely considered an index of emotion regulatory capacity and the ability to adapt flexibly to changing environmental demands. Abnormalities in HRV are implicated in a host of psychopathologies, making it a potentially powerful transdiagnostic biobehavioral change mechanism in treatment interventions. While most mental illnesses are associated with low HRV, eating disorders have been linked to elevated HRV. We examined 62 research articles on HRV in psychopathology to test the hypothesis that there is an "ideal range" of HRV that predicts optimal functioning. Relationships between symptom severity and parameters that quantify HRV were examined graphically. More extreme time-domain HRV measures, both high and low, were associated with psychopathology, whereas healthy controls displayed mid-range values. Findings preliminarily support the hypothesis that there is an "ideal range" of HRV that could be targeted in biofeedback interventions.

The Influence of Physiological and Psychological Learning Mechanisms in Neurofeedback vs. Mental Imagery Against Binge Eating

In biofeedback research, the debate on physiological versus psychological learning has a long tradition and is still relevant today, regarding new developments of biofeedback for behavior modification. Analyzing the role of these learning mechanisms may help improving the protocols and answer the question, whether feedback of physiological functions is necessary to modify a target behavior. We explored the presence and impact of physiological (EEG changes) versus psychological learning (changes in somatic self-efficacy) in a recently developed EEG neurofeedback protocol for binge eating. The protocol targets a reduction of food-cue induced cortical arousal through regulation of EEG high beta activity. In an experimental study accompanying a randomized controlled trial, pre and post treatment EEG measurements were analyzed in a neurofeedback group (n = 18) and an active mental imagery control group without physiological feedback (n = 18). Physiological learning in terms of EEG high beta reduction only occurred in the neurofeedback group. Post treatment, participants with successfully reduced binge eating episodes (≥ 50% reduction) showed lower EEG high beta activity than unsuccessful participants (p = .02) after neurofeedback, but not after mental imagery. Further, lower EEG high beta activity at post-treatment predicted fewer binge eating episodes in neurofeedback only. In mental imagery, somatic self-efficacy predicted treatment success instead of EEG activity. Altogether, the results indicate that physiological changes serve as a specific treatment mechanism in neurofeedback against binge eating. Reducing cortical arousal may improve eating behaviors and corresponding neurofeedback techniques should therefore be considered in future treatments.

Heart rate variability as a biomarker for anorexia nervosa: A review

OBJECTIVE

Anorexia nervosa (AN) typically begins in early adolescence and other than weight status has few reliable biomarkers. Early diagnosis is a critical prognostic factor, but this can be clinically challenging. Heart rate variability (HRV), the beat-by-beat variance in heart rate (HR), may provide a unique assessment for the presence of AN because it has clinical utility as a biomarker of cardiac autonomic control in various populations (e.g., athletes, the aged, those with cardiovascular diseases, etc.). We present a review of the literature examining HRV in those with AN.

METHOD

Relevant publications were selected from PubMed using the search terms 'anorexia nervosa AND (HR OR HRV)'. Twenty papers were selected and reviewed.

RESULTS

The majority of studies suggest that those with AN have markedly and consistently elevated HRV compared to controls, even greater than among young athletes. However, no studies have explored HRV as a biomarker for AN.

DISCUSSION

Future studies on HRV should elucidate its role as a diagnostic biomarker for AN as well as its responsiveness with serial measurement to track response rates and predict relapse.

Cardiac vagal imbalance to the isometric sustained weight test in adolescents with emotional eating behavior

PURPOSE

To assess the relationship between emotional eating behavior and heart rate variability in Spanish adolescents during an isometric exercise test.

METHODS

Participants included 52 adolescents aged between 13 and 18 years old. Heart rate was continuously recorded at rest (2 minutes) and during the sustained weight test (2 minutes). Linear and nonlinear methods of heart rate variability were assessed and related to the emotional eating behavior divided in two clusters.

RESULTS

Statistically significant differences were observed in linear and non-linear parameters of heart rate variability comparing rest and sustained weight test. An increase in the value of emotional eating in overweight adolescents was founded. During the sustained weight test, there were differences between the two emotional eating clusters regarding the variables peak high frequency power, normalized low frequency power, normalized high frequency power, low frequency/high frequency ratio, and sample entropy. A positive correlation between the emotional eating behavior and the peak high frequency power was observed, though the prediction capacity of the high frequency waves is low it is observed that there is a good fit to the regression line.

CONCLUSION

Results of this study shows that there was a relationship between vagal tone and emotional eating behavior in adolescents during an isometric exercise, with excessive parasympathetic predominance and sympathetic withdrawal during a physical effort.

Psychosocial Functioning, BMI, and Nutritional Behaviors in Women at Cardiovascular Risk

Psychosocial factors such as depression, anxiety, and stress are associated with increased cardiovascular risk. Health behaviors may play a role in this relationship, as individuals experiencing elevated levels of anxiety, stress, and/or depression may be less likely to engage in risk-reducing behaviors such as diet and exercise. Some evidence suggests that this relationship is particularly relevant for women. This study explored the relationship between levels of anxiety, depression, stress, and specific nutritional behaviors in a sample of 187 women at cardiovascular risk. BMI was explored as a possible moderator of these relationships. Higher levels of depression in patients with high BMI was associated with increased fruit consumption, whereas this was not seen in highly depressed patients with normal BMI. The reverse pattern was seen for consumption of sweet drinks. Anxiety was found to have a complex relationship with consumption of sweetened drinks and white bread, with higher consumption at moderately elevated levels of anxiety and reduced consumption at the highest levels. Possible interpretations of these findings, as well as their implications for lifestyle interventions with this population are discussed. These findings suggest a number of questions for further research.

Resting state heart rate variability in clinical and subthreshold disordered eating: A meta-analysis

OBJECTIVE

Research has demonstrated mixed results regarding the direction of the association between vagal activation and disordered eating. The current meta-analysis examined studies testing the link between resting-state heart rate variability indices of vagal activation (vmHRV), and both clinical and subthreshold disordered eating.

METHOD

A systematic search of the literature resulted in the inclusion of studies that were correlational (associations between HRV and disordered eating symptoms) and that examined group differences (e.g., control group vs. disordered eating group), for a total of 36 samples.

RESULTS

Findings indicated a small but reliable association of vmHRV with disordered eating, r = 0.12, indicating greater vagal activation in individuals with disordered eating compared to those with little or no disordered eating behavior. Moderation analyses identified predictors of the vmHRV/disordered eating association. Bulimia nervosa was found to have a large, positive effect size with vmHRV, r = 0.60, which was significantly greater than all other types of disordered eating, Q _T = 10.74, p = .047. Compared to subthreshold disordered eating, clinical eating disorders demonstrated significant, persistent increased vagal activation with a medium, reliable effect size, r = 25, Q_T = 3.94, p = .045.

CONCLUSION

These insights contribute to an improved understanding of the pathophysiology in disordered eating.

Laboratory-based interventions targeting food craving: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to quantify the effects of laboratory-based interventions targeting specific mechanisms of food craving, to identify moderators of effects, and to qualitatively summarize findings. The study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-nine studies were included in the quantitative synthesis, and separate meta-analyses were conducted for the outcomes self-reported craving and objective food intake. Results show small to medium positive effects across specific craving interventions on both outcomes. Effect sizes were partly moderated by intervention type. The most effective intervention regarding food intake was in sensu cue exposure. For subjective craving, the most robust evidence was found for beneficial effects of cognitive regulation strategies (ie, reappraisal, suppression, and distraction). Results further indicate that training inhibitory control through behavioral inhibition might be more effective than approach-avoidance training when considering its effect on subjective craving and food intake. People with external eating habits, overeating, or loss-of-control eating might benefit from these types of specific craving interventions. Future research should focus on long-term effects, transferability, and effectiveness in clinical samples.

Twenty Years of the Food Cravings Questionnaires: a Comprehensive Review

Purpose of Review

The Food Cravings Questionnaires (FCQs; Cepeda-Benito, Gleaves, Williams, & Erath, 2000) are among the most widely used instruments for measuring food cravings. In addition to the Food Cravings Questionnaire–Trait (FCQ–T) and the Food Cravings Questionnaire–State (FCQ–S), several modified versions have been developed as well. For their 20th anniversary, this article provides a comprehensive description of the FCQs and reviews studies on their psychometric properties and correlates.

Recent Findings

The FCQs and their modified versions have excellent internal reliability. Expectedly, the FCQ–T (and its derivatives) has higher retest-reliability than the FCQ–S as the FCQ–S is sensitive to situational changes such as food deprivation and food intake. However, while the FCQ–T is largely unaffected by such momentary states, it is also sensitive to change during weight-loss treatments and other interventions. Factor structure of the FCQ–T and FCQ–S has only partially been replicated. Construct validity of the FCQs is supported by experimental and longitudinal studies that measured food craving and food consumption in the laboratory and with ecological momentary assessment.

Summary

Numerous studies support reliability and validity of the FCQs and their modified versions, yet findings about their factor structures are inconsistent. Thus, using total scores or the short versions of the FCQs may be preferable.

Stress and craving reduction under treatment with heart rate variability biofeedback and the Phramongkutklao model among patients with alcohol use disorder

Background and objective

Stress is an environmental cue, which may lead to increased alcohol craving, and vulnerability to relapse. Heart rate variability (HRV) biofeedback, a supplement standard for inpatient rehabilitation, has been applied for treatment and has been shown to effectively reduce craving and anxiety, increase HRV, and improve vasomotor function, among patients who have alcohol dependence problems. Therefore, the purpose of this study was to investigate the impact of HRV biofeedback and the Phramongkutklao model (PMK model) as an intensive inpatient rehabilitation program concerning stress and craving reduction of inpatients with alcohol use disorder. The findings could benefit treatment design to increase the effectiveness regarding stress and craving reduction among patients with alcohol use disorder and may also reduce rehabilitation costs.

Methods

We conducted this study as a randomized controlled intervention trial, which was also performed single blinded. In all, 35 patients with alcohol use disorder were recruited and randomly assigned in two groups. Patients in the intervention group (n=17) were treated under the PMK model and underwent 16 sessions of the HRV biofeedback program, which included 30 minute long sessions, 4 days per week, for 4 weeks continuously. Patients in the control group (n=18) received PMK model treatment only. Participants were asked to complete a Stress Test (ST-5) and the Penn Alcohol-Craving Scale at baseline, after completing treatment, and at one month afterward (follow-up).

Results

The study showed decreased stress and craving in the intervention group immediately after treatment and at one-month follow-up, whereas the control group had reduced stress and craving only immediately after treatment. Furthermore, we found a significant effect concerning stress and craving between baseline and at one-month follow-up that showed the intervention group exhibited higher difference of scores than the control group.

Conclusion

The study results showed that applying HRV biofeedback may be considered beneficial for standard rehabilitation inpatients to reduce stress and craving for patients with alcohol use disorder.

Cardiac dysautonomia in depression - heart rate variability biofeedback as a potential add-on therapy

Depressive disorders are among the most important health problems and are predicted to constitute the leading cause of disease burden by the year 2030. Aside significant impact on quality of life, psychosocial well-being and socioeconomic status of affected patients, depression is associated with impaired cardiovascular health and increased mortality. The link between affective and cardiovascular disease has largely been attributed to dysregulation of the autonomic nervous system resulting in a chronic shift toward increased sympathetic and decreased parasympathetic activity and, consecutively, cardiac dysautonomia. Among proposed surrogate parameters to capture and quantitatively analyze this shift, heart rate variability (HRV) and baroreflex sensitivity have emerged as reliable tools. Attenuation of these parameters is frequently seen in patients suffering from depression and is closely linked to cardiovascular morbidity and mortality. Therefore, diagnostic and therapeutic strategies were designed to assess and counteract cardiac dysautonomia. While psychopharmacological treatment can effectively improve affective symptoms of depression, its effect on cardiac dysautonomia is limited. HRV biofeedback is a non-invasive technique which is based on a metronomic breathing technique to increase parasympathetic tone. While some small studies observed beneficial effects of HRV biofeedback on dysautonomia in patients with depressive disorders, larger confirmatory trials are lacking. We reviewed the current literature on cardiac dysautonomia in patients suffering from depression with a focus on the underlying pathophysiology as well as diagnostic workup and treatment.

A unifying conceptual framework of factors associated to cardiac vagal control

Cardiac vagal control (CVC) reflects the activity of the vagus nerve regulating cardiac functioning. CVC can be inferred via heart rate variability measurement, and it has been positively associated to a broad range of cognitive, emotional, social, and health outcomes. It could then be considered as an indicator for effective self-regulation, and given this role, one should understand the factors increasing and decreasing CVC. The aim of this paper is to review the broad range of factors influencing CVC, and to provide a unifying conceptual framework to integrate comprehensively those factors. The structure of the unifying conceptual framework is based on the theory of ecological rationality, while its functional aspects are based on the neurovisceral integration model. The structure of this framework distinguishes two broad areas of associations: person and environment, as this reflects adequately the role played by CVC regarding adaptation. The added value of this framework lies at different levels: theoretically, it allows integrating findings from a variety of scientific disciplines and refining the predictions of the neurovisceral integration model; methodologically, it helps identifying factors that increase and decrease CVC; and lastly at the applied level, it can play an important role for society regarding health policies and for the individual to empower one's flourishing.

Feedback-Based Treatments for Eating Disorders and Related Symptoms: A Systematic Review of the Literature

The effectiveness of biofeedback and neurofeedback has been investigated in a range of psychiatric disorders. However, to date, there are few studies on the clinical usefulness of feedback-based techniques for eating disorders (EDs) and EDs-related symptoms (e.g., food craving). A systematic search of PubMed, Scopus and PsychINFO identified 162 articles. Among these, thirteen studies exploring the therapeutic use of biofeedback and neurofeedback in EDs or EDs-related symptoms were included. Biofeedback and neurofeedback were implemented respectively in five and eight of all reviewed articles. No studies incorporated different feedback modalities or both biofeedback and neurofeedback. The considered studies provide preliminary data of the usefulness of feedback-based techniques in the treatment of several dysfunctional eating behaviors (e.g., food craving, rumination). Although no significant effect has been reported for other important EDs-related symptoms (i.e., body image disturbance), feedback-based techniques are also associated with significant modifications of both sympathetic reaction to food-related stimuli and brain activity in several regions of the reward system (e.g., insula). Taken together the results of the present review suggest that feedback-based treatments may be useful in the treatment of several dysfunctional eating behaviors operating both on top-down and bottom-up individual coping strategies. Methodological and clinical issues are also discussed.

The Vagus Nerve Can Predict and Possibly Modulate Non-Communicable Chronic Diseases: Introducing a Neuroimmunological Paradigm to Public Health

Global burden of diseases (GBD) includes non-communicable conditions such as cardiovascular diseases, cancer and chronic obstructive pulmonary disease. These share important behavioral risk factors (e.g., smoking, diet) and pathophysiological contributing factors (oxidative stress, inflammation and excessive sympathetic activity). This article wishes to introduce to medicine and public health a new paradigm to predict, understand, prevent and possibly treat such diseases based on the science of neuro-immunology and specifically by focusing on vagal neuro-modulation. Vagal nerve activity is related to frontal brain activity which regulates unhealthy lifestyle behaviors. Epidemiologically, high vagal activity, indexed by greater heart rate variability (HRV), independently predicts reduced risk of GBD and better prognosis in GBD. Biologically, the vagus nerve inhibits oxidative stress, inflammation and sympathetic activity (and associated hypoxia). Finally, current non-invasive methods exist to activate this nerve for neuro-modulation, and have promising clinical effects. Indeed, preliminary evidence exists for the beneficial effects of vagal nerve activation in diabetes, stroke, myocardial infarction and possibly cancer. Thus, we propose to routinely implement measurement of HRV to predict such GBD in populations, and to test in randomized controlled trials effects of non-invasive vagal nerve activation on prevention and treatment of GBD, reflecting possible neuro-modulation of health.

Current Evidence on Heart Rate Variability Biofeedback as a Complementary Anticraving Intervention

BACKGROUND

The limited success of conventional anticraving interventions encourages research into new treatment strategies. Heart rate variability biofeedback (HRVB), which is based on slowed breathing, was shown to improve symptom severity in various disorders. HRVB, and certain rates of controlled breathing (CB), may offer therapeutic potential as a complementary drug-free treatment option to help control substance craving.

METHODS

This review evaluated current evidence on the effectiveness of HRVB and CB training as a complementary anticraving intervention, based on guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies that assessed a cardiorespiratory feedback or CB intervention with substance craving as an outcome were selected. Effect sizes were calculated for each study. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to evaluate the quality of each study reviewed.

RESULTS

A total of eight articles remained for final review, including controlled studies with or without randomization, as well as noncontrolled trials. Most studies showed positive results with a variety of methodological quality levels and effect size. Current HRVB studies rated moderately on methodological rigor and showed inconsistent magnitudes of calculated effect size (0.074-0.727) across populations. The largest effect size was found in a nonclinical college population of high food cravers utilizing the most intensive HRVB training time of 240 min.

CONCLUSIONS

Despite the limitations of this review, there is beginning evidence that HRVB and CB training can be of significant therapeutic potential. Larger clinical trials are needed with methodological improvements such as longer treatment duration, adequate control conditions, measures of adherence and compliance, longitudinal examination of craving changes, and more comprehensive methods of craving measurement.

Altered Heart Rate Variability During Gaming in Internet Gaming Disorder

Internet gaming disorder (IGD) is characterized by addiction to online gaming and reduced executive control, particularly when individuals are exposed to gaming-related cues. Executive control can be measured as vagally mediated heart rate variability (HRV), which corresponds to variability in the time interval between heart beats. In this study, we investigated whether individuals with IGD have altered HRV while playing online games. We hypothesized that while gaming, individuals with IGD would exhibit phasic suppression of vagally mediated HRV, which would reflect executive control dysfunction during game play. To test this, we measured the changes of HRV when young males with IGD were engaged in real-time online gaming. The changes of HRV were associated with the severity of IGD assessed by self-reports and prefrontal gray matter volume (GMV) calculated by voxel-based morphometry. We included 23 IGD subjects and 18 controls in our analyses. Changes in HRV were not statistically different between IGD subjects and controls. Within the IGD group, however, subjects showed significant decreases in high-frequency (HF) HRV during gaming. Furthermore, the degree of decrease correlated with IGD severity and prefrontal GMV. Importantly, this phasic suppression of HF-HRV in response to gaming did not occur in control subjects. In conclusion, young males with IGD showed an altered HRV response while playing an online game, reflecting their difficulties in executive control over gaming. The dynamics between executive control and reward seeking may be out of balance during game play in IGD.

A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving

Heart rate variability biofeedback (HRV-BF) involves slow paced breathing (approximately six breaths per minute), thereby maximizing low-frequent heart rate oscillations and baroreflex gain. Mounting evidence suggests that HRV-BF promotes symptom reductions in a variety of physical and mental disorders. It may also positively affect eating behavior by reducing food cravings. The aim of the current study was to investigate if slow paced breathing can be useful for attenuating momentary food craving. Female students performed paced breathing either at six breaths per minute (n = 32) or at nine breaths per minute (n = 33) while watching their favorite food on the computer screen. Current food craving decreased during a first resting period, increased during paced breathing, and decreased during a second resting period in both conditions. Although current hunger increased in both conditions during paced breathing as well, it remained elevated after the second resting period in the nine breaths condition only. Thus, breathing rate did not influence specific food craving, but slow paced breathing appeared to have a delayed influence on state hunger. Future avenues are suggested for the study of HRV-BF in the context of eating behavior.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety.

Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected.

Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI.

Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.

Incorporation of a Stress Reducing Mobile App in the Care of Patients With Type 2 Diabetes: A Prospective Study

Background

Severe and sustained emotional stress creates a physiological burden through increased sympathetic activity and higher energy demand. This may lead to increased oxidative stress and development of the metabolic syndrome. Emotional stress has been shown to contribute to the onset, progression, and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach.

Objective

The aim of this study was to assess the effect of using a mobile app of biofeedback-assisted relaxation on weight, blood pressure (BP), and glycemic measures of patients with T2D.

Methods

Adult patients with T2D and inadequate glycemic control (hemoglobin A1c [HbA1c]>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, BP, HbA1c, fasting plasma glucose (FPG), triglycerides (TG), and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing biofeedback mobile app and instructed to use it 3 times a day. The mobile app—Serenita—is an interactive relaxation app based on acquiring a photoplethysmography signal from the mobile phone’s camera lens, where the user places his finger. The app collects information regarding the user’s blood flow, heart rate, and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks.

Results

Seven patients completed 8 weeks of the study and 4 completed 16 weeks. At week 8, weight dropped by an average of 4.0 Kg (SD 4.3), systolic BP by 8.6 mmHg (SD 18.6), HbA1c by 1.3% (SD 1.6), FPG by 4.3 mmol/l (4.2), and serum TG were unchanged.

Conclusions

Stress reduction using a mobile app based on biofeedback may improve glycemic control, weight, and BP.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety. Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected. Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI. Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.

[CORRECTION OF HEART RATE VARIABILITY USING DIAPHRAGMATIC BREATHING MODE BIOFEEDBACK IN HEALTHY PEOPLE.]

The research is an attempt to explain the use of portable computer devices aiming to correct heart rate variability (HRV) of healthy young men. According to the data, used deep diaphragmatic breathing in mode of biofeedback harmonizes breathing and blood circulation which positively affects the body's adaptive potential. However, developers present the portable instruments of biofeedback primarily as a means of psychological relaxation. The aim of this study is to determine whether such devices are able to significantly affect heart rate variability and how long this effect lasts. There were 30 males aged 18 to 20 years that participated in this study. They were randomly divided into three equal groups with up to 10 people in each of them. Members of the first group were doing breathing exercises using a portable biofeedback StressEraser device, the second group used Em-Wave2, and the third one used hardware and software system MyCalmBeat. Each session lasted from 10 to 15 minutes. There were 10 sessions held daily in the morning. HRV was recorded by remote heart rate monitor Polar RS800CX and software Polar ProTrainer5. 5-minutes' stationary segments of the curve chest electrocardiogram removal were used in order to calculate the HRV indexes. It was found that 15 minutes deep breathing in mode of biofeedback significantly affects the heart rate variability of healthy young people. In particular, it increases the overall heart rate variability according to the statistical and spectral analysis. It was established that in all 3 groups of experiment participants the spectral curve low-range "Low frequency" (LF) suffered the major shifts. These shifts reflect the activity level of the sympathetic autonomic nervous system (ANS) as well as vascular-motor center according to the conventional interpretation. It was found that all three groups suffered a specific weight decrease of Very Low Frequency (VLF)% respectively 11.8±2.2%;(p <0,01); 6.6 ± 2.8%; (p <0,02) and 6.8 ± 2.4% (p <0,05). This means that activity redistribution between different regulatory components of heart rate occurred in favour of the peripheral ANS parts. Heart rate variability changes of this kind remained valid for at least one month after the experiment. The greatest influence on heart rate variability was observed in the group of people who used the device StressEraser.

Psychometric properties of the English Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

Food cravings have been implicated in the development and maintenance of a range of eating- and weight-related pathology. The rapid and accurate assessment of food cravings is thus critical in clinical and research settings. Existing measures of specific food cravings are often not suitable for capturing the multiple facets of the craving experience. A short version of the Food Cravings Questionnaire-Trait (FCQ-T), the most widely used measure of general food cravings, was recently developed in German and shown to be a one-factorial, internally reliable measure. Other recent studies validated an Italian and Spanish version of the FCQ-T-reduced (FCQ-T-r) and successfully replicated its basic psychometrics. This study sought to examine the psychometric properties of the English version of the FCQ-T-r. Undergraduate students (n=610, 51.0% female, 53.9% white/Caucasian) completed a battery of questionnaires containing the FCQ-T-r and measures of specific food cravings, eating style, eating disorder symptoms, weight dissatisfaction, and impulsivity. Even though results of a confirmatory factor analysis suggested poor fit with a one-factorial model, the FCQ-T-r was found to be a one-factorial measure in both principal component and parallel analysis. The FCQ-T-r demonstrated excellent internal consistency reliability (Cronbach's α=.94), and scores were significantly and positively correlated with measures of specific food cravings, restrained eating, eating disorder symptoms, and impulsivity. More work is needed to confirm the factor structure of the English FCQ-T-r, but preliminary findings suggest that it constitutes a valid and reliable alternative to lengthier measures of general food cravings.

A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders

The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day substance abuse disorder inpatient treatment program. Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over 3 weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a hand-held HRV BFB device. HRV BFB training was well tolerated by participants and supported by treatment staff. Men receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. In addition, an interaction effect was observed in analyses that accounted for baseline craving levels, wherein heart rate variability (HRV) levels at treatment entry were predictive of changes in craving in the TAU group only. Low baseline levels of HRV were associated with increases in craving, whereas higher baseline HRV levels were associated with greater decreases in craving from start to end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Given that alcohol and drug craving often precipitates relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with substance use disorders.

Heart rate variability biofeedback: Theoretical basis, delivery, and its potential for the treatment of substance use disorders

Heart rate variability biofeedback (HRV BFB) is a biobehavioural clinical intervention that is gaining growing empirical support for the treatment of a number of psychological disorders, several of which are highly comorbid with substance use disorders (SUDs). The present article reviews the autonomic nervous system bases of two key processes implicated in the formation and maintenance of addictive pathology-affect dysregulation and craving-and asks if HRV BFB may be an effective intervention to ameliorate autonomic nervous system dysregulation in these processes, and as such, prove to be an effective intervention for SUDs. A detailed description of HRV BFB and its delivery is provided. Preliminary evidence suggests HRV BFB may be an effective addendum to current first-line SUD treatments, though no firm conclusions can be drawn at this time; more research is needed.

Heart rate variability biofeedback in patients with alcohol dependence: a randomized controlled study

BACKGROUND AND OBJECTIVE

In patients with alcohol dependence, ethyl-toxic damage of vasomotor and cardiac autonomic nerve fibers leads to autonomic imbalance with neurovascular and cardiac dysfunction, the latter resulting in reduced heart rate variability (HRV). Autonomic imbalance is linked to increased craving and cardiovascular mortality. In this study, we sought to assess the effects of HRV biofeedback training on HRV, vasomotor function, craving, and anxiety.

METHODS

We conducted a randomized controlled study in 48 patients (14 females, ages 25-59 years) undergoing inpatient rehabilitation treatment. In the treatment group, patients (n=24) attended six sessions of HRV biofeedback over 2 weeks in addition to standard rehabilitative care, whereas, in the control group, subjects received standard care only. Psychometric testing for craving (Obsessive Compulsive Drinking Scale), anxiety (Symptom Checklist-90-Revised), HRV assessment using coefficient of variation of R-R intervals (CVNN) analysis, and vasomotor function assessment using laser Doppler flowmetry were performed at baseline, immediately after completion of treatment or control period, and 3 and 6 weeks afterward (follow-ups 1 and 2).

RESULTS

Psychometric testing showed decreased craving in the biofeedback group immediately postintervention (OCDS scores: 8.6±7.9 post-biofeedback versus 13.7±11.0 baseline [mean ± standard deviation], P<0.05), whereas craving was unchanged at this time point in the control group. Anxiety was reduced at follow-ups 1 and 2 post-biofeedback, but was unchanged in the control group (P<0.05). Following biofeedback, CVNN tended to be increased (10.3%±2.8% post-biofeedback, 10.1%±3.5% follow-up 1, 10.1%±2.9% follow-up 2 versus 9.7%±3.6% baseline; P=not significant). There was no such trend in the control group. Vasomotor function assessed using the mean duration to 50% vasoconstriction of cutaneous vessels after deep inspiration was improved following biofeedback immediately postintervention and was unchanged in the control group (P<0.05).

CONCLUSION

Our data indicate that HRV biofeedback might be useful to decrease anxiety, increase HRV, and improve vasomotor function in patients with alcohol dependence when complementing standard rehabilitative inpatient care.

Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research

Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.

On the differentiation between trait and state food craving: Half-year retest-reliability of the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) and the Food Cravings Questionnaire-State (FCQ-S)

BACKGROUND

Food craving refers to an intense desire to consume a specific food. The Food Cravings Questionnaires (FCQs) assess food cravings on a trait and a state level.

METHOD

The current study examined half-year retest-reliability of the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) and the Food Cravings Questionnaire-State (FCQ-S) and reports associations with current food deprivation in female students.

RESULTS

The FCQ-T-r had higher retest-reliability (r tt = .74) than the FCQ-S (r tt = .39). Although trait food craving was correlated with state food craving, it was unaffected by current food deprivation.

CONCLUSIONS

Although state and trait food craving are interdependent, the FCQs are able to differentiate between the two. As scores of the FCQ-T-r represent a stable trait, but are also sensitive to changes in eating behavior, they may be useful for the investigation of the course of eating disorders and obesity.

Impact of biofeedback on self-efficacy and stress reduction in obesity: a randomized controlled pilot study

Biofeedback application is an evidence-based technique to induce relaxation. A primary mechanism of action is the improvement of self-efficacy, which is needed to facilitate the translation of health behavioral intentions into action. Obesity is often associated with low self-efficacy and dysfunctional eating patterns, including comfort eating as an inexpedient relaxation technique. This is the first study investigating the effects of biofeedback on self-efficacy and relaxation in obesity. In the present experiment, 31 women, mean body mass index 35.5 kg/m², were randomized to a food-specific biofeedback paradigm, a non-specific relaxation biofeedback paradigm, or a waiting list control. Eight sessions of biofeedback of the electrodermal activity were performed while presenting either a challenging food stimulus or a non-specific landscape stimulus. Self-efficacy, stress, ability to relax, eating behavior, and electrodermal activity were assessed before, directly after, and 3 months after the intervention. The food-specific biofeedback predominantly showed effects on food-related self-efficacy and perceived stress. The non-specific relaxation biofeedback showed effects on the ability to relax. Self-reported improvements were confirmed by corresponding decrease in the electrodermal reaction to food stimuli. Biofeedback treatment is effective in improving self-efficacy in individuals with obesity and might therefore be a valuable additional intervention in obesity treatment.

Pilot study employing heart rate variability biofeedback training to decrease anxiety in patients with eating disorders

Heart rate variability (HRV) biofeedback, a technique which encourages slow meditative breathing, was offered to 25 in-patients with various eating disorder diagnoses-anorexia nervosa, bulimia nervosa and binge eating disorder. We found that this modality had no serious side effects, and was subjectively useful to most participants. An enhanced ability to generate highly coherent HRV patterns in patients with recent onset anorexia nervosa was observed.

Protocol for Heart Rate Variability Biofeedback Training

This paper describes a five-visit heart rate variability (HRV) biofeedback protocol we have used both clinically and in research. This protocol was refined in a study of biofeedback therapy for treating asthma. Similar, longer methods have been used for treating various conditions involving pain, anxiety, depression, and other psychophysiological disorders.

Bibliotherapy and food cravings control

The use of self-help manuals or bibliotherapy could be an effective resource to treat obesity, but their effects on the elaborative processes of food cravings remain unclear. The present study examined whether bibliotherapy can effectively reduce food cravings in an overweight and obese adult population. 80 participants were randomly allocated either to the Self-help Manual group or the Intention-control group. They had to apply each resource over a period of 3 months whenever they felt a craving arise. During the baseline period most of the participants reported grazing as the main cause of their weight gain. Compared to baseline, the results of the third month of the follow-up revealed that intentions had paradoxical effects on food thought suppression, preoccupation with food, negative affect and guilty feelings; but the Self-help Manual promoted positive changes on the food cravings trait and its dimensions, food thoughts suppression, emotional and behavioural reactions to intrusions and BMI. These findings suggest that the Self-help Manual could be useful in reducing food cravings.