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Le Saux O, Canada B, Debarnot U, Haouhache NEH, Lehot JJ, Binay M, Cortet M, Rimmelé T, Duclos A, Rode G, Lilot M, Schlatter S. Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:784-793. [PMID: 38534105 DOI: 10.1097/acm.0000000000005714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students. METHOD A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models. RESULTS Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness ( β = 10.27 [95% confidence interval {CI}, 7.40-13.13; P < .001] and β = 3.42 [95% CI, 0.98-5.85; P = .006], respectively) and lower openness ( β = -4.95; 95% CI, -7.40 to -2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological ( P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological ( β = -5.66; 95% CI, -10.83 to -0.50; P = .03) and physiological stress reduction ( β = -0.002; 95% CI, -0.003 to -0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction ( β = -7.87; 95% CI, -13.05 to -2.68; P = .003). CONCLUSIONS Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.
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Turner W, Brühl A, Böker H, Schulze B, Marschall K, La Marca R, Pfaff M, Russmann T, Schmidt-Trucksäss A. Heart rate vARiability and physical activity in inpatient treatMent of burnOut and DepressIon (HARMODI): protocol of a cross-sectional study with up to 8-week follow up. BMJ Open 2024; 14:e081299. [PMID: 38925684 PMCID: PMC11202726 DOI: 10.1136/bmjopen-2023-081299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Chronic stress can cause an imbalance within the autonomic nervous system, thereby affecting cardiovascular and mental health. Physical activity (PA) may have a positive effect on the autonomic nervous system and stress-related disorders, such as depression and burnout. Heart rate variability (HRV) is a non-invasive marker of the autonomic nervous system. However, limited and inconsistent data exist on the exact relationship between HRV, PA and depression and burnout symptoms. The HARMODI study aims to explore whether HRV is a feasible marker of depression and burnout symptoms and aims to evaluate the role of PA in the treatment of stress-related disorders. METHODS AND ANALYSES This is an observational study with a cross-sectional up to 8 week follow-up study design. A total of 153 patients, undergoing psychiatric inpatient treatment with burnout syndrome (Z73) and depressive episode (F32 or F33) or adjustment disorder (F43.2), will be recruited. Data on depression and burnout symptoms, HRV recordings (24-hour, supine, standing and exercise stress test), cognitive function, cardiorespiratory fitness, cardiovascular health, balance and strength will be collected at baseline (T1) and after up to 8 weeks (T2). Continuous data on PA and Ecological Momentary Assessments of exhaustion, mood and tension will be monitored daily throughout inpatient treatment. Multiple regression models, adjusted for potential confounders, will assess the association between HRV as the primary outcome, PA and depression and burnout severity score. ETHICS AND DISSEMINATION The protocol has been approved by Swiss Ethics Committee, Cantonal Ethics Committee Zürich. Results of HARMODI will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05874856.
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Affiliation(s)
- Wiebke Turner
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Clinica Holistica Engiadina SA, Susch, Switzerland
| | - Annette Brühl
- Department of Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Heinz Böker
- Department of Psychiatric Research, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Coulter HL, Donnelly MP, Yakkundi A, McAneney H, Barr OG, Kernohan WG. Heart rate variability biofeedback to reduce anxiety in autism spectrum disorder - a mini review. Front Psychiatry 2024; 15:1409173. [PMID: 38938467 PMCID: PMC11208699 DOI: 10.3389/fpsyt.2024.1409173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
There is a reported high prevalence of anxiety in people with autism spectrum disorder. This mini review appraises existing research investigating heart rate variability biofeedback to help manage symptoms of anxiety in people with autism spectrum disorder. A thorough search of electronic databases was conducted to find relevant literature. Consultation with experts and a librarian helped develop search terms following the PICO framework. Five databases were searched, and screening was undertaken using Covidence software, with the process outlined in a PRISMA flowchart. The latest review showed positive short-term effects but there is a need for long-term follow-up. Future investigations should consider device type, training settings, and control interventions. Accurate heart rate variability assessment independent of biofeedback devices is crucial. Additional measures like cortisol assessment and user feedback are recommended for comprehensive evaluation. The findings highlight progress in the evidence base and offer insight to future directions.
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Affiliation(s)
- Helen L. Coulter
- Doctoral College, Ulster University, Belfast, United Kingdom
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
| | - Mark P. Donnelly
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, Belfast, United Kingdom
| | - Anita Yakkundi
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- Northern Ireland Public Health Research Network, Belfast, United Kingdom
| | - Helen McAneney
- Northern Ireland Public Health Research Network, Belfast, United Kingdom
- School of Medicine, Faculty of Life and Health Sciences, University of Ulster, Belfast, United Kingdom
| | - Owen G. Barr
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
| | - W. George Kernohan
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
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Böttcher E, Schreiber LS, Wozniak D, Scheller E, Schmidt FM, Pelz JO. Impaired Modulation of the Autonomic Nervous System in Adult Patients with Major Depressive Disorder. Biomedicines 2024; 12:1268. [PMID: 38927475 PMCID: PMC11201748 DOI: 10.3390/biomedicines12061268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Patients with major depressive disorder (MDD) have an increased risk for cardiac events. This is partly attributed to a disbalance of the autonomic nervous system (ANS) indicated by a reduced vagal tone and a (relative) sympathetic hyperactivity. However, in most studies, heart rate variability (HRV) was only examined while resting. So far, it remains unclear whether the dysbalance of the ANS in patients with MDD is restricted to resting or whether it is also evident during sympathetic and parasympathetic activation. The aim of this study was to compare the responses of the ANS to challenges that stimulated the sympathetic and, respectively, the parasympathetic nervous systems in patients with MDD. Forty-six patients with MDD (female 27 (58.7%), mean age 44 ± 17 years) and 46 healthy controls (female 26 (56.5%), mean age 44 ± 20 years) underwent measurement of time- and frequency-dependent domains of HRV at rest, while standing (sympathetic challenge), and during slow-paced breathing (SPB, vagal, i.e., parasympathetic challenge). Patients with MDD showed a higher heart rate, a reduced HRV, and a diminished vagal tone during resting, standing, and SPB compared to controls. Patients with MDD and controls responded similarly to sympathetic and vagal activation. However, the extent of modulation of the ANS was impaired in patients with MDD, who showed a reduced decrease in the vagal tone but also a reduced increase in sympathetic activity when switching from resting to standing. Assessing changes in the ANS during sympathetic and vagal activation via respective challenges might serve as a future biomarker and help to allocate patients with MDD to therapies like HRV biofeedback and psychotherapy that were recently found to modulate the vagal tone.
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Affiliation(s)
- Elise Böttcher
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Lisa Sofie Schreiber
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - David Wozniak
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Erik Scheller
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Frank M. Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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Wu Q, Miao X, Cao Y, Chi A, Xiao T. Heart rate variability status at rest in adult depressed patients: a systematic review and meta-analysis. Front Public Health 2023; 11:1243213. [PMID: 38169979 PMCID: PMC10760642 DOI: 10.3389/fpubh.2023.1243213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Purposes A meta-analysis was conducted to examine the differences in heart rate variability (HRV) between depressed patients and healthy individuals, with the purpose of providing a theoretical basis for the diagnosis of depression and the prevention of cardiovascular diseases. Methods To search China National Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Web of Science, Science Direct, and Cochrane Library databases to collect case-control studies on HRV in depressed patients, the retrieval date is from the establishment of the database to December 2022. Effective Public Health Practice Project (EPHPP) scale was used to evaluate literature quality, and Stata14.0 software was used for meta-analysis. Results This study comprised of 43 papers, 22 written in Chinese and 21 in English, that included 2,359 subjects in the depression group and 3,547 in the healthy control group. Meta-analysis results showed that compared with the healthy control group, patients with depression had lower SDNN [Hedges' g = -0.87, 95% CI (-1.14, -0.60), Z = -6.254, p < 0.01], RMSSD [Hedges' g = -0.51, 95% CI (-0.69,-0.33), Z = -5.525, p < 0.01], PNN50 [Hedges' g = -0.43, 95% CI (-0.59, -0.27), Z = -5.245, p < 0.01], LF [Hedges' g = -0.34, 95% CI (-0.55, - 0.13), Z = -3.104, p < 0.01], and HF [Hedges' g = -0.51, 95% CI (-0.69, -0.33), Z = -5.669 p < 0.01], and LF/HF [Hedges' g = -0.05, 95% CI (-0.27, 0.18), Z = -0.410, p = 0.682] showed no significant difference. Conclusion This research revealed that HRV measures of depressed individuals were lower than those of the healthy population, except for LF/HF, suggesting that people with depression may be more at risk of cardiovascular diseases than the healthy population.
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Affiliation(s)
- Qianqian Wu
- School of Physical Education, Shaanxi Normal University, Xi’an, China
| | | | - Yingying Cao
- School of Physical Education, Shaanxi Normal University, Xi’an, China
| | - Aiping Chi
- School of Physical Education, Shaanxi Normal University, Xi’an, China
| | - Tao Xiao
- School of Physical Education, Shaanxi Normal University, Xi’an, China
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Steffen PR. Using the Research Domain Criteria as a framework to integrate psychophysiological findings into stress management and psychotherapy interventions. FRONTIERS IN NEUROERGONOMICS 2023; 4:1245946. [PMID: 38234487 PMCID: PMC10790878 DOI: 10.3389/fnrgo.2023.1245946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/11/2023] [Indexed: 01/19/2024]
Abstract
Research on the psychophysiology of stress is expanding rapidly, but the field lacks a clear integrative framework to help translate research findings into empirically supported stress interventions. The Research Domain Criteria (RDoC) is an excellent candidate to explore as a framework to integrate stress research. The RDoC framework is a dimensional, multi-modal approach to psychopathology proposed as an alternative to categorical approaches used by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). The goal of this paper is to explore the RDoC as a framework to integrate psychophysiology research into therapeutic interventions for stress. The RDoC consists of six domains: negative valence systems, positive valence systems, cognitive systems, social processes systems, arousal/regulatory systems, and sensorimotor systems, and provides an excellent structure for integrating information from multiple levels of functioning including physiology, behavior, and self-report, as well as genes, molecules, cells, and brain circuits. Integrating psychophysiological research on stress using the RDoC framework can direct and amplify stress management and psychotherapeutic interventions. First, the RDoC provides a clear foundation for conceptualizing the stress response in terms of important concepts such as allostasis and adaptation. In this perspective, the terms "allostatic response" or "adaptation response" are more descriptive terms than "stress response" in understanding bodily responses to life threats and challenges. Second, psychophysiological approaches can be used in the context of modalities such as biofeedback and mindfulness to both collect psychophysiological data and then integrate that data into a broader therapeutic framework. Heart rate variability (HRV) biofeedback is being used more frequently as part of a therapeutic intervention package with stress management and psychotherapy, and HRV data is also used to provide outcome evidence on the efficacy of treatment. Mindfulness practices are commonly used in combination with stress management and psychotherapy, and psychophysiological data (HRV, EEG, blood pressure, etc.) is often collected to explore and understand mind/body relationships. In conclusion, the lack of a clear framework to assess and understand mind/body functioning limits current stress research and interventions. The RDoC provides a strong framework to assess and integrate physiological and psychological data and improve stress interventions.
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Affiliation(s)
- Patrick R. Steffen
- Department of Psychology, Brigham Young University, Provo, UT, United States
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Lalanza JF, Lorente S, Bullich R, García C, Losilla JM, Capdevila L. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback 2023; 48:275-297. [PMID: 36917418 PMCID: PMC10412682 DOI: 10.1007/s10484-023-09582-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
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.
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Affiliation(s)
- Jaume F Lalanza
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sonia Lorente
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Area, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Raimon Bullich
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carlos García
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lluis Capdevila
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Departament of Basic Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
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Euteneuer F, Neuert M, Salzmann S, Fischer S, Ehlert U, Rief W. Does psychological treatment of major depression reduce cardiac risk biomarkers? An exploratory randomized controlled trial. Psychol Med 2023; 53:3735-3749. [PMID: 35232509 PMCID: PMC10277774 DOI: 10.1017/s0033291722000447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/31/2021] [Accepted: 02/07/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Depression is associated with an increased risk for cardiovascular disease (CVD). Biological cardiac risk factors are already elevated in depressed patients without existing CVD. The purpose of this exploratory trial was to examine whether treating Major Depression (MD) with cognitive behavioral therapy (CBT) is associated with improvements in cardiac risk biomarkers and whether depressive symptom severity at baseline moderates treatment effects. METHODS Eighty antidepressant-free patients with MD were randomly assigned to CBT or waiting list (WL). Biological outcomes included long-term recordings (24-h, daytime, nighttime) of heart rate, heart rate variability (HRV), and blood pressure, as well as inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MD at study entry. RESULTS Compared to WL, CBT was associated with a significant increase in overall HRV, as indexed by the 24-h and daytime HRV triangular index, as well as trend improvements in 24-h low-frequency HRV and daytime systolic blood pressure. Self-rated depressive symptom severity moderated (or tended to moderate) improvements in CBT for 24-h and daytime heart rate and several indices of HRV (especially daytime measures). Inflammatory treatment effects were not observed. CONCLUSIONS CBT increased overall HRV in patients with MD. Initially more depressed patients showed the most pronounced cardiovascular improvements through CBT. These exploratory findings may provide new insights into the biological effects of psychological treatment against depression and must be confirmed through future research.
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Affiliation(s)
- Frank Euteneuer
- Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Berlin, Berlin, Germany
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Marie Neuert
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
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Cuneo A, Yang R, Zhou H, Wang K, Goh S, Wang Y, Raiti J, Krashin D, Murinova N. The Utility of a Novel, Combined Biofeedback-Virtual Reality Device as Add-on Treatment for Chronic Migraine: A Randomized Pilot Study. Clin J Pain 2023; 39:286-296. [PMID: 37026763 DOI: 10.1097/ajp.0000000000001114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES To determine if the frequent use of a combined biofeedback-virtual reality device improves headache-related outcomes in chronic migraine. MATERIALS AND METHODS In this randomized, controlled pilot study, 50 adults with chronic migraine were randomized to the experimental group (frequent use of a heart rate variability biofeedback-virtual reality device plus standard medical care; n=25) or wait-list control group (standard medical care alone; n=25). The primary outcome was a reduction in mean monthly headache days between groups at 12 weeks. Secondary outcomes included mean change in acute analgesic use frequency, depression, migraine-related disability, stress, insomnia, and catastrophizing between groups at 12 weeks. Tertiary outcomes included change in heart rate variability and device-related user experience measures. RESULTS A statistically significant reduction in mean monthly headache days between groups was not demonstrated at 12 weeks. However, statistically significant decreases in the mean frequency of total acute analgesic use per month (65% decrease in the experimental group versus 35% decrease in the control group, P <0.01) and depression score (35% decrease in the experimental group versus 0.5% increase in the control group; P <0.05) were shown at 12 weeks. At study completion, more than 50% of participants reported device satisfaction on a 5-level Likert scale. DISCUSSION Frequent use of a portable biofeedback-virtual reality device was associated with decreases in the frequency of acute analgesic use and in depression in individuals with chronic migraine. This platform holds promise as an add-on treatment for chronic migraine, especially for individuals aiming to decrease acute analgesic use or interested in nonmedication approaches.
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Siddi S, Bailon R, Giné-Vázquez I, Matcham F, Lamers F, Kontaxis S, Laporta E, Garcia E, Lombardini F, Annas P, Hotopf M, Penninx BWJH, Ivan A, White KM, Difrancesco S, Locatelli P, Aguiló J, Peñarrubia-Maria MT, Narayan VA, Folarin A, Leightley D, Cummins N, Vairavan S, Ranjan Y, Rintala A, de Girolamo G, Simblett SK, Wykes T, Myin-Germeys I, Dobson R, Haro JM. The usability of daytime and night-time heart rate dynamics as digital biomarkers of depression severity. Psychol Med 2023; 53:3249-3260. [PMID: 37184076 DOI: 10.1017/s0033291723001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Alterations in heart rate (HR) may provide new information about physiological signatures of depression severity. This 2-year study in individuals with a history of recurrent major depressive disorder (MDD) explored the intra-individual variations in HR parameters and their relationship with depression severity. METHODS Data from 510 participants (Number of observations of the HR parameters = 6666) were collected from three centres in the Netherlands, Spain, and the UK, as a part of the remote assessment of disease and relapse-MDD study. We analysed the relationship between depression severity, assessed every 2 weeks with the Patient Health Questionnaire-8, with HR parameters in the week before the assessment, such as HR features during all day, resting periods during the day and at night, and activity periods during the day evaluated with a wrist-worn Fitbit device. Linear mixed models were used with random intercepts for participants and countries. Covariates included in the models were age, sex, BMI, smoking and alcohol consumption, antidepressant use and co-morbidities with other medical health conditions. RESULTS Decreases in HR variation during resting periods during the day were related with an increased severity of depression both in univariate and multivariate analyses. Mean HR during resting at night was higher in participants with more severe depressive symptoms. CONCLUSIONS Our findings demonstrate that alterations in resting HR during all day and night are associated with depression severity. These findings may provide an early warning of worsening depression symptoms which could allow clinicians to take responsive treatment measures promptly.
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Affiliation(s)
- S Siddi
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - R Bailon
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Centros de investigación biomédica en red en el área de bioingeniería, biomateriales y nanomedicina (CIBER-BBN), Madrid, Spain
| | - I Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - F Matcham
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- School of Psychology, University of Sussex, Falmer, UK
| | - F Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - S Kontaxis
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Centros de investigación biomédica en red en el área de bioingeniería, biomateriales y nanomedicina (CIBER-BBN), Madrid, Spain
| | - E Laporta
- Centros de investigación biomédica en red en el área de bioingeniería, biomateriales y nanomedicina (CIBER-BBN), Madrid, Spain
| | - E Garcia
- Centros de investigación biomédica en red en el área de bioingeniería, biomateriales y nanomedicina (CIBER-BBN), Madrid, Spain
- Microelectrónica y Sistemas Electrónicos, Universidad Autónoma de Barcelona, CIBERBBN, Barcelona, Spain
| | - F Lombardini
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - P Annas
- H. Lundbeck A/S, Valby, Denmark
| | - M Hotopf
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - A Ivan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - K M White
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Difrancesco
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - P Locatelli
- Department of Engineering and Applied Science, University of Bergamo, Bergamo, Italy
| | - J Aguiló
- Centros de investigación biomédica en red en el área de bioingeniería, biomateriales y nanomedicina (CIBER-BBN), Madrid, Spain
- Microelectrónica y Sistemas Electrónicos, Universidad Autónoma de Barcelona, CIBERBBN, Barcelona, Spain
| | - M T Peñarrubia-Maria
- Catalan Institute of Health, Primary Care Research Institute (IDIAP Jordi Gol), CIBERESP, Barcelona, Spain
| | - V A Narayan
- Research and Development Information Technology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - A Folarin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - D Leightley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - N Cummins
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Vairavan
- Research and Development Information Technology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Y Ranjan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A Rintala
- Department for Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - G de Girolamo
- IRCCS Instituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - S K Simblett
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - T Wykes
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - I Myin-Germeys
- Department for Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Dobson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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11
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Valenza G. Depression as a cardiovascular disorder: central-autonomic network, brain-heart axis, and vagal perspectives of low mood. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1125495. [PMID: 37260560 PMCID: PMC10228690 DOI: 10.3389/fnetp.2023.1125495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
If depressive symptoms are not caused by the physiological effects of a substance or other medical or neurological conditions, they are generally classified as mental disorders that target the central nervous system. However, recent evidence suggests that peripheral neural dynamics on cardiovascular control play a causal role in regulating and processing emotions. In this perspective, we explore the dynamics of the Central-Autonomic Network (CAN) and related brain-heart interplay (BHI), highlighting their psychophysiological correlates and clinical symptoms of depression. Thus, we suggest that depression may arise from dysregulated cardiac vagal and sympathovagal dynamics that lead to CAN and BHI dysfunctions. Therefore, treatments for depression should target the nervous system as a whole, with particular emphasis on regulating vagal and BHI dynamics.
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12
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Kremer S, Blue T. Biofeedback as an Adjunct or Alternative Intervention to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:85-93. [PMID: 36764789 DOI: 10.1016/j.jsmc.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Insomnia is highly prevalent and comorbid with many disorders. However, insomnia is underdiagnosed and undertreated in many populations. Cognitive behavioral therapy for insomnia (CBT-I) is not appropriate or sufficient for some individuals. Biofeedback has demonstrated efficacy in a range of disorders, including insomnia. The authors discuss the history and rationale for the use of biofeedback in the treatment of insomnia and other comorbid disorders. The article also presents current research on biofeedback for insomnia and comorbid disorders with recommendations for using biofeedback as an adjunct or alternative intervention to CBT-I.
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Affiliation(s)
- Stephanie Kremer
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, 300 Medical Plaza, Suite 3200A, Los Angeles, CA 90095, USA.
| | - Tanecia Blue
- VA Pacific Islands Healthcare System, 459 Patterson Road, Honolulu, HI 96819, USA
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13
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Wang Y, Li X, Yan H, Zhang Q, Ou Y, Wu W, Shangguan W, Chen W, Yu Y, Liang J, Wu W, Liao H, Liu Z, Mai X, Xie G, Guo W. Multiple examinations indicated associations between abnormal regional homogeneity and cognitive dysfunction in major depressive disorder. Front Psychol 2023; 13:1090181. [PMID: 36778176 PMCID: PMC9909210 DOI: 10.3389/fpsyg.2022.1090181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background This study aimed to investigate the relationships between regional neural activity and multiple related indicators in patients with major depressive disorder (MDD). Methods Forty-two patients and 42 healthy controls (HCs) were enrolled. Pearson/Spearman correlation analyses were applied to examine the associations between abnormal regional homogeneity (ReHo) and different indicators in the patients. Results Compared with HCs, patients with MDD had increased ReHo in the left inferior temporal gyrus (ITG) and decreased ReHo values in the left putamen, anterior cingulate cortex (ACC), and precentral gyrus. The ReHo of the left putamen was positively correlated with the PR interval, Repeatable Battery for the Assessment of Neuropsychological Status 4A, and Discriminant analysis (D), and negatively correlated with Ae (block) and Ae (total) in the patients. The ReHo value of the left ACC was positively correlated with the severity of depression, Stroop Color Word Test of C - 2B + 100 in reaction time, and negatively correlated with Ce (Missay) and Perseverative Responses in the patients. The ReHo of the left ITG was positively correlated with the Neuroticism scores and negatively correlated with the Lie scores in the patients. Conclusion These results suggested that the decreased ReHo of the salience network might be the underpinning of cognitive impairments in patients with MDD.
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Affiliation(s)
- Yun Wang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Xiaoling Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qinqin Zhang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Yangpan Ou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weibin Wu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Webo Shangguan
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Wensheng Chen
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Yang Yu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiaquan Liang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Wanting Wu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Hairong Liao
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Zishan Liu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Xiancong Mai
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China,*Correspondence: Guojun Xie, ✉
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Wenbin Guo, ✉
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14
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Steffen PR. In Honor of Evgeny Vaschillo: His Impact on My Research and Career. Appl Psychophysiol Biofeedback 2022; 47:341-343. [PMID: 35556191 DOI: 10.1007/s10484-022-09545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Tabor A, Bateman S, Scheme EJ, schraefel M. Comparing heart rate variability biofeedback and simple paced breathing to inform the design of guided breathing technologies. FRONTIERS IN COMPUTER SCIENCE 2022. [DOI: 10.3389/fcomp.2022.926649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IntroductionA goal of inbodied interaction is to explore how tools can be designed to provide external interactions that support our internal processes. One process that often suffers from our external interactions with modern computing technology is our breathing. Because of the ergonomics and low-grade-but-frequent stress associated with computer work, many people adopt a short, shallow breathing pattern that is known to have a negative effect on other parts of our physiology. Breathing guides are tools that help people match their breathing patterns to an external (most often visual) cue to practice healthy breathing exercises.However, there are two leading protocols for how breathing cues are offered by breathing guides used in non-clinical settings: simple paced breathing (SPB) and Heart Rate Variability Biofeedback (HRV-b). Although these protocols have separately been demonstrated to be effective, they differ substantially in their complexity and design. Paced breathing is a simpler protocol where a user is asked to match their breathing pattern with a cue paced at a predetermined rate and is simple enough to be completed as a secondary task during other activities. HRV-b, on the other hand, provides adaptive, real-time guidance derived from heart rate variability, a physiological signal that can be sensed through a wearable device. Although the benefits of these two protocols have been well established in clinical contexts, designers of guided breathing technology have little information about whether one is better than the other for non-clinical use.MethodsTo address this important gap in knowledge, we conducted the first comparative study of these two leading protocols in the context of end-user applications. In our N=28 between-subject design, participants were trained in either SPB or HRV-b and then completed a 10-minute session following their training protocol. Breathing rates and heart rate variability scores were recorded and compared between groups.Results and discussionOur findings indicate that the exercises did not significantly differ in their immediate outcomes – both resulted in significantly slower breathing rates than their baseline and both provided similar relative increases in HRV. Therefore, there were no observed differences in the acute physiological effects when using either SPB or HRV-b. Our paper contributes new findings suggesting that simple paced breathing – a straightforward, intuitive, and easy-to-design breathing exercise – provides the same immediate benefits as HRV-b, but without its added design complexities.
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16
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Heart Rate Variability: A Measure of Cardiovascular Health and Possible Therapeutic Target in Dysautonomic Mental and Neurological Disorders. Appl Psychophysiol Biofeedback 2022; 47:273-287. [DOI: 10.1007/s10484-022-09572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
AbstractMental illness such as depression and anxiety as well as cerebrovascular disease are linked to impairment of neurocardiac function mediated by changes to the autonomic nervous system with increased sympathetic and decreased parasympathetic activity. Autonomic neurocardiac function can be evaluated by computing heart rate variability (HRV). Over the past decades, research has demonstrated the diagnostic value of HRV as independent predictor of cardiovascular mortality and as disease marker in progressive autonomic nervous system disorders such as Parkinson’s disease. Here we summarize our studies on HRV and its therapeutic modulation in the context of psychopharmacology as well as psychiatric and neurological disorders to honor the life of Professor Evgeny Vaschillo, the true pioneer of HRV research who sadly passed away on November 21st, 2020.
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17
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Chen S, Wang H, Yue J, Guan N, Wang X. Intervention methods for improving reduced heart rate variability in patients with major depressive disorder: A systematic review and meta-analysis. Compr Psychiatry 2022; 119:152347. [PMID: 36183449 DOI: 10.1016/j.comppsych.2022.152347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/27/2022] [Accepted: 09/22/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Several studies have demonstrated that patients with major depressive disorder (MDD) commonly show reductions in heart rate variability (HRV) parameters. Thus, interventions for the improvement of low HRV may be advantageous in treating MDD. This systematic review and meta-analysis aimed to explore the improvement effects of current clinical treatments on low HRV in patients with MDD. METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, EMBASE, PsycINFO, and CNKI databases were searched for relevant literature. Interventional studies of patients with confirmed MDD, which included baseline and post-intervention data and at least one HRV parameter as an outcome indicator, were included for meta-analysis. RESULTS Twenty-one studies were included in the review. Several studies affirmed the role of psychotherapy in improving low HRV in patients with MDD showing a significant increase in high-frequency and low-frequency power after psychotherapy in the meta-analysis. However, both pharmacotherapy studies and physiotherapy studies included in the meta-analysis showed significant heterogeneity. LIMITATIONS The main limitation of this study was the relatively small samples for the meta-analysis, and more high-quality randomized controlled trials in this field are wanted. CONCLUSIONS Psychotherapy was effective for improving low HRV in patients with MDD. However, the effect of pharmacotherapy or physical therapy on low HRV in MDD remains unclear. Regarding research methods, it is necessary to formulate and standardize operational guidelines for future HRV measurements.
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Affiliation(s)
- Shurui Chen
- Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, China
| | - Hong Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China
| | - Jihui Yue
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China
| | - Nianhong Guan
- Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, China
| | - Xianglan Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China.
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Pallich G, Fischer S, La Marca R, Grosse Holtforth M, Hochstrasser B. Post-awakening salivary alpha-amylase as modulator of treatment response in patients with burnout and major depression. J Psychiatr Res 2022; 154:175-180. [PMID: 35944379 DOI: 10.1016/j.jpsychires.2022.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
Around 50% of patients with major depression do not respond to standard first-line treatments, such as psychotherapy and pharmacotherapy. At the same time, a subgroup exhibits altered functioning of stress-responsive bodily systems, such as the central locus coeruleus/sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Given that these systems impact arousal and cognition, it is possible that this subgroup contributes to the high rates of non-responders. Our aim was to investigate whether sympathetic and HPA axis activity modulate treatment outcomes in patients with stress-related major depression. A total of N = 74 inpatients (median age: 50, 62% male) with signs of burnout who fulfilled diagnostic criteria for major depression were recruited. Saliva samples were collected at awakening as well as 30 and 45 min later. Alpha-amylase activity and cortisol concentrations were determined before patients underwent evidence-based multimodal treatment. Non-responders were defined as patients exhibiting a <50% decrease in depression on the Beck Depression Inventory. Non-responders had significantly higher post-awakening alpha-amylase activity than responders (p = .025). In addition, alpha-amylase activity increased significantly over the course of treatment (p = .004), irrespective of responder status. Post-awakening cortisol was neither a predictor nor an indicator of treatment response. If future research confirms alpha-amylase activity as a modulator of treatment response, this may indicate a subgroup of patients with major depression which may benefit from augmentative treatments, such as heart rate variability biofeedback and/or cognitive interventions targeting high arousal.
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Affiliation(s)
- Gianandrea Pallich
- University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland; Private Hospital Meiringen, Center for Psychiatry and Psychotherapy, Meiringen, Switzerland.
| | - Susanne Fischer
- University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
| | - Roberto La Marca
- University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland; Clinica Holistica Engiadina SA, Centre for Stress-Related Disorders, Susch, Switzerland
| | - Martin Grosse Holtforth
- University of Berne, Clinical Psychology and Psychotherapy, Berne, Switzerland; University Hospital Inselspital, Psychosomatic Competence Center, Berne, Switzerland
| | - Barbara Hochstrasser
- Private Hospital Meiringen, Center for Psychiatry and Psychotherapy, Meiringen, Switzerland
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Coulter H, Donnelly M, Mallett J, Kernohan WG. Heart Rate Variability Biofeedback to Treat Anxiety in Young People With Autism Spectrum Disorder: Findings From a Home-Based Pilot Study. JMIR Form Res 2022; 6:e37994. [PMID: 36018712 PMCID: PMC9463620 DOI: 10.2196/37994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings. Objective This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population. Methods We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device. Results Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t6=2.55; P=.04; Cohen d=0.99) as well as adults (t7=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD. Conclusions HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD. Trial Registration ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093
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Affiliation(s)
- Helen Coulter
- South Eastern Health and Social Care Trust, County Down, United Kingdom
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Schumann A, Helbing N, Rieger K, Suttkus S, Bär KJ. Depressive rumination and heart rate variability: A pilot study on the effect of biofeedback on rumination and its physiological concomitants. Front Psychiatry 2022; 13:961294. [PMID: 36090366 PMCID: PMC9452722 DOI: 10.3389/fpsyt.2022.961294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Recent studies suggest that lower resting heart rate variability (HRV) is associated with elevated vulnerability to depressive rumination. In this study, we tested whether increases in HRV after HRV-biofeedback training are accompanied by reductions in rumination levels. Materials and methods Sixteen patients suffering from depression completed a 6-week HRV-biofeedback training and fourteen patients completed a control condition in which there was no intervention (waitlist). The training included five sessions per week at home using a smartphone application and an ECG belt. Depressive symptoms and autonomic function at rest and during induced rumination were assessed before and after each of the two conditions. We used a well-established rumination induction task to provoke a state of pervasive rumination while recording various physiological signals simultaneously. Changes in HRV, respiration rate, skin conductance, and pupil diameter were compared between conditions and time points. Results A significant correlation was found between resting HRV and rumination levels, both assessed at the first laboratory session (r = -0.43, p < 0.05). Induction of rumination led to an acceleration of heart rate and skin conductance increases. After biofeedback training, resting vagal HRV was increased (p < 0.01) and self-ratings of state anxiety (p < 0.05), rumination (p < 0.05), perceived stress (p < 0.05), and depressive symptoms (QIDS, BDI; both p < 0.05) were decreased. In the control condition, there were no changes in autonomic indices or depressive symptomatology. A significant interaction effect group x time on HRV was observed. Conclusion Our results indicate that a smartphone-based HRV-biofeedback intervention can be applied to improve cardiovagal function and to reduce depressive symptoms including self-rated rumination tendencies.
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Affiliation(s)
- Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Nadin Helbing
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Katrin Rieger
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stefanie Suttkus
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
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Ketelhut S, Wehlan E, Bayer G, Ketelhut RG. Influence of Initial Severity of Depression on the Effectiveness of a Multimodal Therapy on Depressive Score, Heart Rate Variability, and Hemodynamic Parameters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9836. [PMID: 36011470 PMCID: PMC9407770 DOI: 10.3390/ijerph19169836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Depression is a major cause of disability among populations worldwide. Apart from primary symptoms, depressed patients often have a higher cardiovascular risk profile. Multimodal therapy concepts, including exercise, have emerged as promising approaches that not only improve depressive symptoms but also have a positive impact on cardiovascular risk profile. However, controversies have arisen concerning the influence of baseline severity on the effects of therapy concepts for this demographic. This study assessed whether pretreatment severity moderates psychological and physiological treatment outcomes of a multimodal therapy. A total of 16 patients diagnosed with mild depression (MD) and 14 patients diagnosed with severe depression (SD) took part in a 3-month outpatient multimodal treatment therapy. Before and after the treatment, depression score (Beck Depression Inventory (BDI)), peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), heart rate (HR), and parasympathetic parameters of heart rate variability (RMSSD) were assessed. Significant time effects were detected for BDI (−20.0 ± 11.6, p > 0.001, η2 = 0.871), pSBP (−4.7 ± 6.8 mmHg, p < 0.001, η2 = 0.322), pDBP (−3.5 ± 6.9 mmHg, p = 0.01, η2 = 0.209), cSBP (−4.8 ± 6.5 mmHg, p < 0.001, η2 = 0.355), cDBP (−3.6 ± 6.8 mmHg, p = 0.008, η2 = 0.226), PWV (−0.13 ± 0.23 m/s, p = 0.008, η2 = 0.229), HR (4.3 ± 8.8 min−1, p = 0.015, η2 = 0.193), RMSSD (−12.2 ± 23.9 ms, p = 0.017, η2 = 0.251), and and SDNN (10.5 ± 17.8 ms, p = 0.005, η2 = 0.330). Significant time × group interaction could be revealed for BDI (p < 0.001, η2 = 0.543), with patients suffering from SD showing stronger reductions. Pretreatment severity of depression has an impact on the effectiveness of a multimodal therapy regarding psychological but not physiological outcomes.
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Affiliation(s)
- Sascha Ketelhut
- Institute of Sport Science, University of Bern, 3012 Bern, Switzerland
- Cardiology and Sports Medicine, Medical Center Berlin (MCB), 10559 Berlin, Germany
| | - Emanuel Wehlan
- Cardiology and Sports Medicine, Medical Center Berlin (MCB), 10559 Berlin, Germany
- Institute of Sport Science, Humboldt University of Berlin, 10115 Berlin, Germany
| | - Gerhart Bayer
- Institute of Sport Science, Humboldt University of Berlin, 10115 Berlin, Germany
| | - Reinhard G. Ketelhut
- Cardiology and Sports Medicine, Medical Center Berlin (MCB), 10559 Berlin, Germany
- Institute of Sport Science, Humboldt University of Berlin, 10115 Berlin, Germany
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Balint EM, Daniele V, Langgartner D, Reber SO, Rothermund E, Gündel H, Von Wietersheim J, Buckley T, Jarczok MN. Heart rate variability predicts outcome of short-term psychotherapy at the workplace. Psychophysiology 2022; 60:e14150. [PMID: 35867961 DOI: 10.1111/psyp.14150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 12/18/2022]
Abstract
The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.
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Affiliation(s)
- Elisabeth Maria Balint
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Viktorija Daniele
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Dominik Langgartner
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Stefan O Reber
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Jörn Von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Thomas Buckley
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marc N Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
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Examining the Autonomic Nervous System in the Relationship among Heart Rate Variability, Stress Coping, and Cognitive Ability in Individuals with Psychiatric Disorders. J Clin Med 2022; 11:jcm11123277. [PMID: 35743347 PMCID: PMC9225621 DOI: 10.3390/jcm11123277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
Depression is one of the most severe psychiatric disorders and affects patients on emotional, physical, and cognitive levels. Comorbid somatic conditions, such as cardiovascular diseases, are frequent and affect the quality of life, as well as mortality. Underlying maladaptive autonomic nervous system regulation influences emotional and cognitive processes. This study, thus, aimed to investigate the relationship among heart rate variability (HRV), self-reported coping strategies, executive function, and inhibition in individuals with psychiatric disorders. Data of 97 patients treated in a multi-professional psychiatric rehabilitation center for 6 weeks were analyzed. Subjects underwent psychological tests (Stress Coping Style Questionnaire, Emotional Competence Questionnaire, and Becks Depression Inventory-II), a cognitive test (Color-Word Interference Test), and a 24 h electrocardiogram to record HRV. Patients with higher depression scores had significantly lower HRVs and decreased self-reported abilities for stress coping. Depression severity did not affect cognitive inhibitory abilities. HRV was related to neither coping strategies nor cognitive inhibition abilities. However, lower HRV was related to higher values of Negative Stress Coping (β = −0.21, p < 0.05). This relationship was fully mediated by depression severity (−4.79, 95% CI: −8.72, −0.72). HRV is not related to quantitative cognitive inhibition, but to the self-reported ability to cope with negative emotions in individuals with psychiatric disorders.
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Zafeiri E, Dedes V, Tzirogiannis K, Kandylaki A, Polikandrioti M, Panidis D, Panoutsopoulos GI. Managing anxiety disorders with the neuro-biofeedback method of Brain Boy Universal Professional. Health Psychol Res 2022; 10:35644. [PMID: 35774902 PMCID: PMC9239376 DOI: 10.52965/001c.35644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/05/2022] [Indexed: 09/07/2024] Open
Abstract
Background Biofeedback is a non-invasive therapeutic method used independently or as an adjunct alongside other methods. Objective This study evaluated the efficacy of biofeedback in the treatment of anxiety disorders. Methods The sample consisted of 85 individuals with anxiety symptoms who underwent neuro-biofeedback therapy using Brain Boy Universal Professional. Anxiety was assessed by both the Hamilton Rating Scale for Anxiety (HAM-A) and Zung Anxiety Self-Assessment Scale (SAS) before the initiation and after completing ten sessions with biofeedback. Results Before biofeedback and based on the HAM-A scale, 27.0% of the individuals showed mild to moderate anxiety, 16.5% medium anxiety, and 56.5% severe anxiety. After the completion of biofeedback, 90.6% of the individuals experienced mild to moderate anxiety, 5.9% medium anxiety, and 3.5% severe anxiety. Based on the SAS scale, before biofeedback, 42.4% of the individuals showed minimal to moderate anxiety, 21.2% marked severe anxiety and 36.5% most extreme anxiety. After the biofeedback, 68.2% of the individuals were within a normal range, 27.1% had minimal to moderate anxiety, 4.7% marked severe anxiety, and none in most extreme anxiety. Conclusion Both HAMA-A and SAS scales showed statistically reduced anxiety levels after biofeedback therapy. Thus, the primary symptom of anxiety can be addressed by the biofeedback method.
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25
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La Marca R, Pallich G, Holtforth MG, Hochstrasser B. Higher Resting Cardiovagal Activity Predicts Larger Decrease of Depressive Symptoms in Inpatients Treated for Stress-Related Depression. J PSYCHOPHYSIOL 2022. [DOI: 10.1027/0269-8803/a000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Depression is one of the most prevalent mental disorders, with treatment outcomes generally being unsatisfactory. The identification of outcome predictors could contribute to improving diagnosis, treatment, and outcome. Heart rate variability (HRV), an index of cardiovagal activity, has been proposed as a potential correlate of depression as well as a predictor of treatment effectiveness. The aim of the present study was to examine if HRV at baseline could predict the outcome of inpatient treatment for stress-related depressive disorder (SRDD). Depressive symptoms of n = 57 inpatients with an SRDD, who were treated in a specialized burnout ward, were assessed using the Beck Depression Inventory (BDI) at the beginning, the end of treatment, and at 3-month follow-up. HRV (i.e., RMSSD, the root mean square of successive RR interval differences) was determined from a five-minute measurement in the supine position. RMSSD was not significantly associated with the BDI score at the beginning, end, and follow-up. Higher RMSSD was revealed to be a significant predictor of a stronger decrease in depressive severity from the beginning to the end of the treatment. Thereby, the regression model explained 7.6% of the total variance in the BDI decrease. The results revealed initial HRV to predict a larger decrease in depressive severity. Therefore, resting HRV represents a physiological resource and index of successful neurovisceral interaction, which supports inpatients in benefitting from specialized treatment.
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Affiliation(s)
- Roberto La Marca
- Centre for Stress-Related Disorders, Clinica Holistica Engiadina SA, Susch, Switzerland
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
| | - Gianandrea Pallich
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
- Clinical Psychology and Psychotherapy, University of Bern, Switzerland
- Private Hospital Meiringen, Switzerland
| | - Martin grosse Holtforth
- Clinical Psychology and Psychotherapy, University of Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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26
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Klewinghaus L, Martin A. Presentation and Evaluation of a Manual for Heart Rate Variability Biofeedback in Somatic Symptom Disorder. VERHALTENSTHERAPIE 2022. [DOI: 10.1159/000522419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Background:</i></b> There is initial evidence for the efficacy of heart rate variability biofeedback (HRV-BF) in depression, anxiety disorders, and functional somatic syndromes. In somatic symptom disorder (SSD), evidence is lacking. The aim of this study was to describe a newly developed HRV-BF brief intervention and to analyze HRV changes, and to examine the applicability and acceptance in SSD. <b><i>Methods:</i></b> We analyzed the data of the subsample of a pilot randomized controlled trial (22 subjects with SSD) who received HRV-BF over 4 sessions. We assessed HRV (SDNN: standard deviation of the NN interval, RMSSD: root mean square of successive differences between NN interval, LF: low frequency) and the subjective evaluation and acceptance of the intervention. <b><i>Results:</i></b> HRV analyses within therapy sessions showed that individuals learned to increase their HRV significantly during biofeedback sessions and were able to maintain it during self-regulation periods without feedback (SDNN, RMSSD, LF: 5.7 ≤ <i>F</i><sub><i>t</i></sub> ≤ 11.1). Moreover, HRV improved across sessions (SDNN). The majority of participants rated the intervention very positively (e.g., satisfaction, improvement in mood and physical well-being). <b><i>Conclusions:</i></b> HRV-BF can be learned within 4 sessions and shows positive effects in patients with SSD. Adding HRV-BF to existing treatments, e.g., psychotherapy, seems promising.
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Orendáčová M, Kvašňák E. Possible Mechanisms Underlying Neurological Post-COVID Symptoms and Neurofeedback as a Potential Therapy. Front Hum Neurosci 2022; 16:837972. [PMID: 35431842 PMCID: PMC9010738 DOI: 10.3389/fnhum.2022.837972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
Theoretical considerations related to neurological post-COVID complications have become a serious issue in the COVID pandemic. We propose 3 theoretical hypotheses related to neurological post-COVID complications. First, pathophysiological processes responsible for long-term neurological complications caused by COVID-19 might have 2 phases: (1) Phase of acute Sars-CoV-2 infection linked with the pathogenesis responsible for the onset of COVID-19-related neurological complications and (2) the phase of post-acute Sars-CoV-2 infection linked with the pathogenesis responsible for long-lasting persistence of post-COVID neurological problems and/or exacerbation of another neurological pathologies. Second, post-COVID symptoms can be described and investigated from the perspective of dynamical system theory exploiting its fundamental concepts such as system parameters, attractors and criticality. Thirdly, neurofeedback may represent a promising therapy for neurological post-COVID complications. Based on the current knowledge related to neurofeedback and what is already known about neurological complications linked to acute COVID-19 and post-acute COVID-19 conditions, we propose that neurofeedback modalities, such as functional magnetic resonance-based neurofeedback, quantitative EEG-based neurofeedback, Othmer's method of rewarding individual optimal EEG frequency and heart rate variability-based biofeedback, represent a potential therapy for improvement of post-COVID symptoms.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Eugen Kvašňák
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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28
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Cui X, Cao J, Rafanelli C, Zhu B, Gostoli S. Efficacy of group biofeedback treatment on hyperemesis gravidarum with psychosomatic symptoms diagnosed with the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R): study protocol for a randomised controlled trial. BMJ Open 2022; 12:e051295. [PMID: 35361636 PMCID: PMC8971773 DOI: 10.1136/bmjopen-2021-051295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hyperemesis gravidarum (HG) is a condition characterised by dehydration, electrolyte imbalance, lack of nutrition and at least 5% loss in body weight, occurring in the first half of pregnancy. The aim of this trial is to examine the efficacy of group biofeedback treatment on patients with HG with psychosomatic symptoms, which will be evaluated through the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R). METHODS AND ANALYSIS In this single-blinded randomised controlled clinical trial, 68 patients with HG diagnosed with at least one psychosomatic syndrome according to DCPR-R and aged 18-40 years, will be recruited in a Chinese Maternal and Child Health Hospital. The sample will be randomised (1:1) into two arms: experimental group, which will undergo group biofeedback treatment, psycho-education and treatment as usual (TAU); and control group, which will undergo psycho-education and TAU only. The primary outcomes will be reduction of the frequency of psychosomatic syndromes, severity of nausea/vomiting, quality of life and heart rate variability. The secondary outcomes will include days of hospitalisation, repeated hospitalisation and laboratory investigations. ETHICS AND DISSEMINATION This study has received ethical approval from the Nanjing Medical University (No. 2019/491, granted 22 February 2019). All participants will be required to provide written informed consent. Study outcomes will be disseminated through peer-reviewed publications and academic conferences, and used to confirm a tailored biofeedback intervention for patients with HG with psychosomatic symptoms. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2000028754).
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Affiliation(s)
- Xuelian Cui
- Department of Healthcare, Changzhou Maternity and Child Healthcare Hospital, Changzhou, China
| | - Jianxin Cao
- Department of Gastroenterology, Third Affiliated Hospital of Soochow University, Changzhou, China
- Soochow University Psychosomatic Gastroenterology Institute, Changzhou, People's Republic of China
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Boheng Zhu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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Pots W, Chakhssi F. Psilocybin-Assisted Compassion Focused Therapy for Depression. Front Psychol 2022; 13:812930. [PMID: 35401294 PMCID: PMC8990799 DOI: 10.3389/fpsyg.2022.812930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Psilocybin-assisted psychotherapy, i.e., psilocybin treatment with psychological support, has demonstrated the efficacy of psilocybin to reduce depressive symptoms. However, in clinical trials, the structure of psilocybin-assisted psychotherapy is primarily based on preparation, navigation (support during dosing sessions), and integration. For psychotherapeutic guidance, the application of this structure is favored over the usage of theoretical models. The applied psychotherapeutic models may be of critical importance if the effects are augmented due to the psychologically insightful experiences during the navigation and integration sessions. One of the important next steps is to provide therapists with guidance on how to provide psilocybin-assisted psychotherapy. We present an integrated protocol for psilocybin-assisted psychotherapy for depression based on the theoretical model and psychotherapeutic framework of Compassion Focused Therapy (CFT). We hypothesize that CFT can provide the theoretical model and compassion practices that will reinforce the experiences during the navigation and follow-up therapy sessions. In this paper, we describe the rationale for selecting CFT, the compatibility of CFT and psilocybin-therapy, an overview of the psilocybin-assisted CFT protocol, the study protocol, and limitations to this approach.
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Affiliation(s)
- Wendy Pots
- Arjuna Labs, Mill Valley, CA, United States
- *Correspondence: Wendy Pots,
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30
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Balint EM, Angerer P, Guendel H, Marten-Mittag B, Jarczok MN. Stress Management Intervention for Leaders Increases Nighttime SDANN: Results from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3841. [PMID: 35409525 PMCID: PMC8997599 DOI: 10.3390/ijerph19073841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
Stress management interventions aim to reduce the disease risk that is heightened by work stress. Possible pathways of risk reduction include improvements in the autonomous nervous system, which is indexed by the measurement of heart rate variability (HRV). A randomized controlled trial on improving stress management skills at work was conducted to investigate the effects of intervention on HRV. A total of 174 lower management employees were randomized into either the waiting list control group (CG) or the intervention group (IG) receiving a 2-day stress management training program and another half-day booster after four and six months. In the trial, 24 h HRV was measured at baseline and after 12 months. Heart rate (HR), root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and standard deviation of the average of normal-to-normal intervals (SDANN) were calculated for 24 h and nighttime periods. Age-adjusted multilevel mixed effects linear regressions with unstructured covariance, time as a random coefficient, and time × group interaction with the according likelihood-ratio tests were calculated. The linear mixed-effect regression models showed neither group effects between IG and CG at baseline nor time effects between baseline and follow-up for SDANN (24 h), SDNN (24 h and nighttime), RMSSD (24 h and nighttime), and HR (24 h and nighttime). Nighttime SDANN significantly improved in the intervention group (z = 2.04, p = 0.041) compared to the control group. The objective stress axis measures (SDANN) showed successful stress reduction due to the training. Nighttime SDANN was strongly associated with minimum HR. Though the effects were small and only visible at night, it is highly remarkable that 3 days of intervention achieved a measurable effect considering that stress is only one of many factors that can influence HR and HRV.
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Affiliation(s)
- Elisabeth Maria Balint
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (E.M.B.); (M.N.J.)
- Burnout Section, Privatklinik Meiringen, 3860 Meiringen, Switzerland
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, 40204 Düsseldorf, Germany;
| | - Harald Guendel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (E.M.B.); (M.N.J.)
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität Muenchen, 81675 Munich, Germany;
| | - Marc N. Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (E.M.B.); (M.N.J.)
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31
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Thurner C, Horing B, Zipfel S, Stengel A, Mazurak N. Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort. Front Psychiatry 2022; 13:817778. [PMID: 35990055 PMCID: PMC9385984 DOI: 10.3389/fpsyt.2022.817778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Patients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders. METHODS We examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase. RESULTS We found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR -3.20 ± 1.30 ms, p = 0.026; RMSSD: -3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (-0.04 ± 0.17 μS, p = 0.019) and EDR (-0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001). CONCLUSION Our data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.
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Affiliation(s)
- Carolin Thurner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Bjoern Horing
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany.,Clinic for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
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Fernández-Alvarez J, Grassi M, Colombo D, Botella C, Cipresso P, Perna G, Riva G. Efficacy of bio- and neurofeedback for depression: a meta-analysis. Psychol Med 2022; 52:201-216. [PMID: 34776024 PMCID: PMC8842225 DOI: 10.1017/s0033291721004396] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND For many years, biofeedback and neurofeedback have been implemented in the treatment of depression. However, the effectiveness of these techniques on depressive symptomatology is still controversial. Hence, we conducted a meta-analysis of studies extracted from PubMed, Scopus, Web of Science and Embase. METHODS Two different strings were considered for each of the two objectives of the study: A first group comprising studies patients with major depressive disorder (MDD) and a second group including studies targeting depressive symptomatology reduction in other mental or medical conditions. RESULTS In the first group of studies including patients with MDD, the within-group analyses yielded an effect size of Hedges' g = 0.717, while the between-group analysis an effect size of Hedges' g = 1.050. Moderator analyses indicate that treatment efficacy is only significant when accounting for experimental design, in favor of randomized controlled trials (RCTs) in comparison to non RCTs, whereas the type of neurofeedback, trial design, year of publication, number of sessions, age, sex and quality of study did not influence treatment efficacy. In the second group of studies, a small but significant effect between groups was found (Hedges' g = 0.303) in favor of bio- and neurofeedback against control groups. Moderator analyses revealed that treatment efficacy was not moderated by any of the sociodemographic and clinical variables. CONCLUSIONS Heart rate variability (HRV) biofeedback and neurofeedback are associated with a reduction in self-reported depression. Despite the fact that the field has still a large room for improvement in terms of research quality, the results presented in this study suggests that both modalities may become relevant complementary strategies for the treatment of MDD and depressive symptomatology in the coming years.
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Affiliation(s)
- J. Fernández-Alvarez
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - M. Grassi
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - D. Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - C. Botella
- Ciber Fisiopatología Obesidad y Nutrición, CB06/03 Instituto Salud Carlos III, Madrid, Spain
| | - P. Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - G. Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands
| | - G. Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Dormal V, Vermeulen N, Mejias S. Is heart rate variability biofeedback useful in children and adolescents? A systematic review. J Child Psychol Psychiatry 2021; 62:1379-1390. [PMID: 34155631 DOI: 10.1111/jcpp.13463] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is considered as an index of both physical and emotional health, and biofeedback aiming to increase the level of HRV has demonstrated extensive beneficial effects. Although HRV biofeedback is commonly and reliably applied in adults, the use of this technique, alone or in addition to other treatments, in children and adolescents has not been widely explored to date. METHODS This systematic review following PRISMA guidelines covers all human studies using HRV biofeedback in children and adolescents. A literature search was conducted in PsycINFO, PubMed and Scopus, and a standardized methodological quality assessment was performed. RESULTS Results showed the efficiency of HRV biofeedback sessions with children and adolescents to reduce physical and mental health-related symptoms and enhance well-being. CONCLUSIONS These findings underline the therapeutic value of using HRV biofeedback as a complement to more conventional behavioural and cognitive interventions to help children to manage stress and/or pain. Capitalizing on the identified strengths and shortcomings of available results, we propose research avenues as well as evidence-based clinical guidelines for using HRV biofeedback in clinical paediatric settings.
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Affiliation(s)
- Valérie Dormal
- Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nicolas Vermeulen
- Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sandrine Mejias
- UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Univ. Lille, CNRS, Lille, France
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Moon E, Yang M, Seon Q, Linnaranta O. Relevance of Objective Measures in Psychiatric Disorders-Rest-Activity Rhythm and Psychophysiological Measures. Curr Psychiatry Rep 2021; 23:85. [PMID: 34714422 PMCID: PMC8556205 DOI: 10.1007/s11920-021-01291-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW We present a review of recent methods of objective measurement in psychiatry and psychology with a focus on home monitoring and its utility in guiding treatment. RECENT FINDINGS For individualized diagnostics and treatment of insomnia, actigraphy can generate clinically useful graphical presentations of sleep timing and patterns. Psychophysiological measures may complement psychometrics by tracking parallel changes in physiological responses and emotional functioning, especially during therapy for trauma symptoms and emotion regulation. It seems that rather than defining universal cut-offs, an individualised range of variability could characterize treatment response. Wearable actigraphy and psychophysiological sensors are promising devices to provide biofeedback and guide treatment. Use of feasible and reliable technology during experimental and clinical procedures may necessitate defining healthy and abnormal responses in different populations and pathological states. We present a "call for action" towards further collaborative work to enable large scale use of objective measures.
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Affiliation(s)
- Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Psychiatry and Biomedical Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Michelle Yang
- Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Quinta Seon
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Douglas Centre for Sleep and Biological Rhythms, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
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da Estrela C, McGrath J, Booij L, Gouin JP. Heart Rate Variability, Sleep Quality, and Depression in the Context of Chronic Stress. Ann Behav Med 2021; 55:155-164. [PMID: 32525208 DOI: 10.1093/abm/kaaa039] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Disrupted sleep quality is one of the proposed mechanisms through which chronic stress may lead to depression. However, there exist significant individual differences in sleep reactivity, which is the extent to which one experiences sleep disturbances in response to stress. PURPOSE The aim of the current study was to investigate whether low high-frequency heart rate variability (HRV), as a psychophysiological marker of poor emotional and physiological arousal regulation, predicts stress-related sleep disturbances associated with greater risk of depression symptoms. METHODS Using a chronic caregiving stress model, 125 mothers of adolescents with developmental disorders and 97 mothers of typically developing adolescents had their resting HRV and HRV reactivity recorded and completed a measure of depressive symptoms, as well as a 7 day sleep diary to assess their sleep quality. A moderated mediation model tested whether sleep quality mediated the association between chronic stress exposure and depressive symptoms and whether HRV moderated this mediation. RESULTS After controlling for participant age, body mass index, ethnicity, socioeconomic status, and employment status, poor sleep quality mediated the association between chronic stress and depressive symptoms. Resting HRV moderated this indirect effect such that individuals with lower HRV were more likely to report poorer sleep quality in the context of chronic stressor exposure, which, in turn, was related to greater depressive symptoms. CONCLUSIONS Lower HRV, a potential biomarker of increased sleep reactivity to stress, is associated with greater vulnerability to stress-related sleep disturbances, which, in turn, increases the risk for elevated depressive symptoms in response to chronic stress.
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Affiliation(s)
- Chelsea da Estrela
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada
| | - Jennifer McGrath
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
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Brupbacher G, Zander-Schellenberg T, Straus D, Porschke H, Infanger D, Gerber M, von Känel R, Schmidt-Trucksäss A. The Acute Effects of Aerobic Exercise on Nocturnal and Pre-Sleep Arousal in Patients with Unipolar Depression: Preplanned Secondary Analysis of a Randomized Controlled Trial. J Clin Med 2021; 10:jcm10174028. [PMID: 34501476 PMCID: PMC8432550 DOI: 10.3390/jcm10174028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/03/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
Unipolar depression is associated with insomnia and autonomic arousal. The aim of this study was to quantify the effect of a single bout of aerobic exercise on nocturnal heart rate variability and pre-sleep arousal in patients with depression. This study was designed as a two-arm, parallel-group, randomized, outcome assessor-blinded, controlled, superiority trial. Patients with a primary diagnosis of unipolar depression aged 18-65 years were included. The intervention consisted of a single 30 min moderate-intensity aerobic exercise bout. The control group sat and read for 30 min. The primary outcome of interest was RMSSD during the sleep period assessed with polysomnography. Secondary outcomes were additional heart rate variability outcomes during the sleep and pre-sleep period as well as subjective pre-sleep arousal. A total of 92 patients were randomized to either the exercise (N = 46) or the control (N = 46) group. Intent-to-treat analysis ANCOVA of follow-up sleep period RMSSD, adjusted for baseline levels and minimization factors, did not detect a significant effect of the allocation (β = 0.12, p = 0.94). There was no evidence for significant differences between both groups in any other heart rate variability measure nor in measures of cognitive or somatic pre-sleep arousal. As this is the first trial of its kind in this population, the findings need to be confirmed in further studies. Patients with depression should be encouraged to exercise regularly in order to profit from the known benefits on sleep and depressive symptoms, which are supported by extensive literature.
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
- Correspondence:
| | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, 4055 Basel, Switzerland;
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
| | - Hildburg Porschke
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
| | - Denis Infanger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland;
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
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Schlatter S, Guillot A, Schmidt L, Mura M, Trama R, Di Rienzo F, Lilot M, Debarnot U. Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects. Brain Stimul 2021; 14:1384-1392. [PMID: 34438047 DOI: 10.1016/j.brs.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored. OBJECTIVE The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning. METHODS Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol). RESULTS The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb. CONCLUSIONS Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.
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Affiliation(s)
- Sophie Schlatter
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Aymeric Guillot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Mathilde Mura
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Robin Trama
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Franck Di Rienzo
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, University Claude Bernard Lyon 1, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Ursula Debarnot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Institut Universitaire de France, France.
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Nowak U, Wittkamp MF, Clamor A, Lincoln TM. Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion. Front Psychiatry 2021; 12:626698. [PMID: 34434124 PMCID: PMC8380846 DOI: 10.3389/fpsyt.2021.626698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/22/2021] [Indexed: 01/10/2023] Open
Abstract
Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.
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Szulczewski MT. Transcutaneous Auricular Vagus Nerve Stimulation Combined With Slow Breathing: Speculations on Potential Applications and Technical Considerations. Neuromodulation 2021; 25:380-394. [PMID: 35396070 DOI: 10.1111/ner.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing. MATERIALS AND METHODS A nonsystematic review. RESULTS Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises. CONCLUSIONS Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.
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Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression. Appl Psychophysiol Biofeedback 2021; 45:75-86. [PMID: 32246229 PMCID: PMC7250954 DOI: 10.1007/s10484-020-09458-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A rise in the prevalence of depression underscores the need for accessible and effective interventions. The objectives of this study were to determine if the addition of a treatment component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-B (“enhanced”) intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original (“standard”) intervention. We used a quasi-experimental, non-equivalent (matched) groups design to compare changes in symptoms of depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = 48). Patients in the enhanced group completed a total average of 3.86 h of HRV-B practice across 25.8 sessions, and were more likely to report a clinically significant improvement in depressive symptom score post-intervention than participants in the standard group, even after adjusting for differences in demographics and engagement between groups (adjusted OR 3.44, 95% CI [1.28–9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, remote intervention for depression is feasible and may enhance treatment outcomes.
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Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. Appl Psychophysiol Biofeedback 2021; 45:109-129. [PMID: 32385728 DOI: 10.1007/s10484-020-09466-z] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Fournié C, Chouchou F, Dalleau G, Caderby T, Cabrera Q, Verkindt C. Heart rate variability biofeedback in chronic disease management: A systematic review. Complement Ther Med 2021; 60:102750. [PMID: 34118390 DOI: 10.1016/j.ctim.2021.102750] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention used in the management of chronic diseases. METHOD A systematic search was performed according to eligibility criteria including adult chronic patients, HRVB as main treatment with or without control conditions, and psychophysiological outcomes as dependent variables. RESULTS In total, 29 articles were included. Reported results showed the feasibility of HRVB in chronic patients without adverse effects. Significant positive effects were found in various patient profiles on hypertension and cardiovascular prognosis, inflammatory state, asthma disorders, depression and anxiety, sleep disturbances, cognitive performance and pain, which could be associated with improved quality of life. Improvements in clinical outcomes co-occurred with improvements in heart rate variability, suggesting possible regulatory effect of HRVB on autonomic function. CONCLUSIONS HRVB could be effective in managing patients with chronic diseases. Further investigations are required to confirm these results and recommend the most effective method.
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Affiliation(s)
- Claire Fournié
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Florian Chouchou
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Georges Dalleau
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Teddy Caderby
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Quentin Cabrera
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France.
| | - Chantal Verkindt
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
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Pham T, Lau ZJ, Chen SHA, Makowski D. Heart Rate Variability in Psychology: A Review of HRV Indices and an Analysis Tutorial. SENSORS (BASEL, SWITZERLAND) 2021; 21:3998. [PMID: 34207927 PMCID: PMC8230044 DOI: 10.3390/s21123998] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022]
Abstract
The use of heart rate variability (HRV) in research has been greatly popularized over the past decades due to the ease and affordability of HRV collection, coupled with its clinical relevance and significant relationships with psychophysiological constructs and psychopathological disorders. Despite the wide use of electrocardiograms (ECG) in research and advancements in sensor technology, the analytical approach and steps applied to obtain HRV measures can be seen as complex. Thus, this poses a challenge to users who may not have the adequate background knowledge to obtain the HRV indices reliably. To maximize the impact of HRV-related research and its reproducibility, parallel advances in users' understanding of the indices and the standardization of analysis pipelines in its utility will be crucial. This paper addresses this gap and aims to provide an overview of the most up-to-date and commonly used HRV indices, as well as common research areas in which these indices have proven to be very useful, particularly in psychology. In addition, we also provide a step-by-step guide on how to perform HRV analysis using an integrative neurophysiological toolkit, NeuroKit2.
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Affiliation(s)
- Tam Pham
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
| | - Zen Juen Lau
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
| | - S. H. Annabel Chen
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
- Centre for Research and Development in Learning, Nanyang Technological University, Singapore 637460, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
| | - Dominique Makowski
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
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The use of biofeedback intervention in the improvement of depression levels: a randomised trial. Acta Neuropsychiatr 2021; 33:126-133. [PMID: 33427129 DOI: 10.1017/neu.2020.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the use of biofeedback intervention in the levels of depression. The main hypothesis tested if the use of biofeedback improves depression levels compared to the control group. METHODS A randomised clinical trial. The final sample was composed of 36 participants (18 in the experimental group, receiving 6 training, once a week, with biofeedback; and 18 in the control group, who received conventional treatment in the service).Outcome measures were assessed in two stages: pre-test and post-test. The research used the following instruments: demographic survey data, Mini International Neuropsychiatric Interview 5.0.0 and Beck Depression Inventory (BDI). The factors and variables were presented in terms of descriptive and inferential statistics. Fisher's exact test (p < 0.05) was used to verify the existence of an association between the counting variables. The multinomial logistic regression model was adopted, and the Logit link function was used, as the software RStudio version 3.6.2. RESULTS The factors that remained in the final model were group, sex, partner, atypical antidepressant, benzodiazepines, mood stabiliser, antiepileptic and antihistamine, according to the levels of depression based on the BDI. The group that did not receive biofeedback intervention had 16 times more chances of increasing the depression levels compared to participants in the experimental group. CONCLUSION The use of biofeedback reduces depression, thus, representing a complementary alternative for the treatment of moderate and severe depression, and dysthymia.
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KIM DAECHANG, LEE SEUNGBONG, KIM SUNGMIN, JEONG JAEHOON. CONFIRMATION OF THE CLINICAL VALUE AND THE EFFECT OF SOUND BIOFEEDBACK ON THE AUTONOMIC NERVOUS SYSTEM THROUGH HEART RATE VARIABILITY ANALYSIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to suggest sound biofeedback, which is a new technique of early stress relief effect by observing change in the heart rate variability (HRV). The sound biofeedback imitating heart rate of the comfortable and stress state is termed parasympathetic stimulation sound (PSS) and sympathetic stimulation sound (SSS), respectively. Twelve subjects were selected without previous history of cardiovascular diseases and mental illness, such as arrhythmia, myocardial infarction, depression and panic disorder. To confirm the changes in the low-frequency (LF), high-frequency (HF) and LF/HF values of HRV as stress evaluation indicators, the HRV of subjects was measured by photoplethysmogram. Signals were processed using the peak detect algorithm, and fast Fourier transform. Results were obtained using power specific densities. During the PSS stimulation, the LF/HF tended to decrease generally. On the other hand, during the SSS stimulation, LF/HF tended to increase. The LF/HF Mean change value ([Formula: see text]) using the PSS stimulation is similar to the effect of Transcutaneous Vagal Nerve Stimulation (tVNS). In addition, the quantitative effect of sound biofeedback was confirmed by judging changes in the parasympathetic and sympathetic nerves in the autonomic nervous system (ANS) through [Formula: see text]-score normalized data. These experimental results suggest that sound biofeedback has the same stimulation location and clinical applicability as tVNS. As a result, sound biofeedback may be used as a new method for stress reduction.
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Affiliation(s)
- DAECHANG KIM
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus, Gyeonggi-do 10326, Korea
| | - SEUNGBONG LEE
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus, Gyeonggi-do 10326, Korea
| | - SUNGMIN KIM
- Department of Medical Devices Industry, Dongguk University-Seoul, Seoul 04620, Korea
| | - JAEHOON JEONG
- Department of Medical Devices Industry, Dongguk University-Seoul, Seoul 04620, Korea
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Siepmann T, Ohle P, Sedghi A, Simon E, Arndt M, Pallesen LP, Ritschel G, Barlinn J, Reichmann H, Puetz V, Barlinn K. Randomized Sham-Controlled Pilot Study of Neurocardiac Function in Patients With Acute Ischaemic Stroke Undergoing Heart Rate Variability Biofeedback. Front Neurol 2021; 12:669843. [PMID: 34122314 PMCID: PMC8187903 DOI: 10.3389/fneur.2021.669843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Neurocardiac dysfunction worsens clinical outcome and increases mortality in stroke survivors. We hypothesized that heart rate variability (HRV) biofeedback improves neurocardiac function by modulating autonomic nervous system activity after acute ischaemic stroke (AIS). Methods: We randomly allocated (1:1) 48 acute ischaemic stroke patients to receive nine sessions of HRV- or sham biofeedback over 3 days in addition to comprehensive stroke unit care. Before and after the intervention patients were evaluated for HRV via standard deviation of normal-to-normal intervals (SDNN, primary outcome), root mean square of successive differences between normal heartbeats (RMSSD), a predominantly parasympathetic measure, and for sympathetic vasomotor and sudomotor function. Severity of autonomic symptoms was assessed via survey of autonomic symptom scale total impact score (TIS) at baseline and after 3 months. Results: We included 48 patients with acute ischaemic stroke [19 females, ages 65 (4.4), median (interquartile range)]. Treatment with HRV biofeedback increased HRV post intervention [SDNN: 43.5 (79.0) ms vs. 34.1 (45.0) ms baseline, p = 0.015; RMSSD: 46.0 (140.6) ms vs. 29.1 (52.2) ms baseline, p = 0.015] and alleviated autonomic symptoms after 3 months [TIS 3.5 (8.0) vs. 7.5 (7.0) baseline, p = 0.029], which was not seen after sham biofeedback (SDNN: p = 0.63, RMSSD: p = 0.65, TIS: 0.06). There were no changes in sympathetic vasomotor and sudomotor function (p = ns). Conclusions: Adding HRV biofeedback to standard stroke unit care led to improved neurocardiac function and sustained alleviation of autonomic symptoms after acute ischaemic stroke, which was likely mediated by a predominantly parasympathetic mechanism. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03865225.
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Affiliation(s)
- Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Paulin Ohle
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Annahita Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Arndt
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Ritschel
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Dell'Acqua C, Dal Bò E, Messerotti Benvenuti S, Ambrosini E, Vallesi A, Palomba D. Depressed mood, brooding rumination and affective interference: The moderating role of heart rate variability. Int J Psychophysiol 2021; 165:47-55. [PMID: 33838165 DOI: 10.1016/j.ijpsycho.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/21/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
Facilitated processing of negative information might contribute to the etiopathogenesis and maintenance of depressive symptoms. Cardiac vagal tone, indexed by heart rate variability (HRV), is believed to represent a proxy of the functional integrity of the neural networks implicated in brooding rumination, affective interference and depression. The present study examined whether HRV may moderate the relation between brooding rumination, affective interference and depressive symptoms in a sample of healthy individuals (n = 68) with different degrees of depressed mood. Self-report measures of depression and brooding were collected, whereas the emotional Stroop task was employed to measure affective interference. Three-minute resting-state electrocardiogram was recorded to obtain time- and frequency-domain vagally mediated HRV parameters. Stepwise linear regression analyses revealed that HRV was a significant moderator of the positive association between depression and brooding rumination, but not of the association between depression and affective interference. An integrated model is supported, in which vagally mediated HRV appeared to potentiate the positive link between depressive symptoms and brooding rumination. Considering that HRV and brooding rumination were found to have an interacting role in determining the severity of depressive symptoms, they may represent potential clinical targets in the prevention and treatment of depressive symptoms.
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Affiliation(s)
- Carola Dell'Acqua
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy.
| | - Elisa Dal Bò
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy
| | - Simone Messerotti Benvenuti
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy
| | - Ettore Ambrosini
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy; Department of Neuroscience, University of Padua, Via Giustiniani 5, 35128 Padua, Italy
| | - Antonino Vallesi
- Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy; Department of Neuroscience, University of Padua, Via Giustiniani 5, 35128 Padua, Italy; Brain Imaging & Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Daniela Palomba
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy
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48
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Pizzoli SFM, Marzorati C, Gatti D, Monzani D, Mazzocco K, Pravettoni G. A meta-analysis on heart rate variability biofeedback and depressive symptoms. Sci Rep 2021; 11:6650. [PMID: 33758260 PMCID: PMC7988005 DOI: 10.1038/s41598-021-86149-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI = - 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being.
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Affiliation(s)
- Silvia F M Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy.
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Daniele Gatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
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49
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Neyer S, Witthöft M, Cropley M, Pawelzik M, Lugo RG, Sütterlin S. Reduction of depressive symptoms during inpatient treatment is not associated with changes in heart rate variability. PLoS One 2021; 16:e0248686. [PMID: 33755668 PMCID: PMC7987172 DOI: 10.1371/journal.pone.0248686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Vagally mediated heart rate variability (HRV) is a psychophysiological indicator of mental and physical health. Limited research suggests there is reduced vagal activity and resulting lower HRV in patients with Major Depressive Disorder (MDD); however little is actually known about the association between HRV and symptoms of depression and whether the association mirrors symptom improvement following psychotherapy. The aim of this study was to investigate the association between antidepressant therapy, symptom change and HRV in 50 inpatients (68% females; 17–68 years) with a diagnosis of MDD. Severity of depressive symptoms was assessed by self-report (Beck Depression Inventory II) and the Hamilton Rating Scale of Depression. Measures of vagally mediated HRV (root mean square of successive differences and high-frequency) were assessed at multiple measurement points before and after inpatient psychotherapeutic and psychiatric treatment. Results showed an expected negative correlation between HRV and depressive symptoms at intake. Depressive symptoms improved (d = 0.84) without corresponding change in HRV, demonstrating a de-coupling between this psychophysiological indicator and symptom severity. To our knowledge, this study is the first to examine an association between HRV and depressive symptoms before and after psychotherapy. The observed de-coupling of depression and HRV, and its methodological implications for future research are discussed.
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Affiliation(s)
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | | | - Ricardo Gregorio Lugo
- Department for Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Faculty for Health and Welfare Sciences, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty for Health and Welfare Sciences, Østfold University College, Halden, Norway
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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50
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Steffen PR, Bartlett D, Channell RM, Jackman K, Cressman M, Bills J, Pescatello M. Integrating Breathing Techniques Into Psychotherapy to Improve HRV: Which Approach Is Best? Front Psychol 2021; 12:624254. [PMID: 33658964 PMCID: PMC7917055 DOI: 10.3389/fpsyg.2021.624254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction Approaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing. Current Study In this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used as a control group condition. Methods Heart rate variability (HRV) measures were assessed via electrocardiogram (ECG) and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate (HR). A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period. Results Conditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals (SDNN), low frequency HRV (LF HRV), and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV (HF HRV) was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video. Conclusions Although the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed.
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Affiliation(s)
- Patrick R Steffen
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Derek Bartlett
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | | | - Katelyn Jackman
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mikel Cressman
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - John Bills
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Meredith Pescatello
- Department of Psychology, Brigham Young University, Provo, UT, United States
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