Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study

A Synthesized Model for Applying Stress Management and Biofeedback Interventions in Research Utilization: A Systematic Review and Meta-analysis

Background

Stress management and biofeedback interventions have been shown to be effective in improving mental and physical health outcomes. However, previous research studies and synthesized models for applying these interventions in research utilization are insufficient.

Objective

This study aimed to synthesize a model for applying stress management and biofeedback interventions in research utilization.

Methods

A systematic review and meta-analysis were conducted according to the PRISMA guidelines.Multiple studies were used to assess the effectiveness of applying stress management and biofeedback interventions published from 2017 to 2023. The process included identifying the research questions, conducting a comprehensive literature search, assessing study quality, extracting data, synthesizing the data, analyzing and interpreting the findings, drawing conclusions, and making recommendations.

Results

The results indicated a significant mean effect size without evidence of publication bias. The effect sizes of the subgroups among the study variables were not significantly different [Q = 4.02, p = .26]. However, there were significant differences regarding the mean effect sizes among the studies [Q = 63.59, p < .001] and also in terms of the test of subgroups among the participants [Q = 8.49, p = .04].

Conclusion

The results emphasize the importance of evidence-based practice and highlight the need for ongoing evaluation and refinement of interventions. The proposed model was supported by related theories and research studies in order to ensure the robustness and reliability to guide practice and future research in the field of biofeedback interventions. By following this model, researchers and practitioners can ensure that stress management and biofeedback interventions are evidence-based and are effective in improving mental and physical health outcomes.

User-centered development of an mHealth app for cardiovascular prevention

Background

Mobile health (mHealth) apps can be used for cardiovascular disease (CVD) prevention. User-centered design, evidence-based content and user testing can be applied to ensure a high level of usability and adequate app access.

Objective

To develop and evaluate an mHealth app (HerzFit) for CVD prevention.

Methods

HerzFit´s development included a user-centered design approach and guideline-based content creation based on the identified requirements of the target group. Beta testing and a preliminary usability evaluation of the HerzFit prototype were performed. For evaluation, German versions of the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (GER-MAUQ) as well as free text feedback were applied.

Results

User-centered design thinking led to the definition of four personas. Based on their requirements, HerzFit enables users to individually assess, monitor, and optimize their cardiovascular risk profile. Users are also provided with a variety of evidence-based information on CVD and their risk factors. The user interface and system design followed the identified functional requirements. Beta-testers provided feedback on the structure and functionality and rated the usability of HerzFit´s prototype as slightly above average both in SUS and GER-MAUQ rating. Participants positively noted the variety of functions and information presented in HerzFit, while negative feedback mostly concerned wearable synchronization.

Conclusions

The present study demonstrates the user-centered development of a guideline-based mHealth app for CVD prevention. Beta-testing and a preliminary usability study were used to further improve the HerzFit app until its official release.

The interplay of self-critical rumination and resting heart rate variability on subjective well-being and somatic symptom distress: A prospective study

OBJECTIVE

The aim of this prospective study was to investigate the association of self-critical rumination, autonomic function (indexed by a time domain metric of resting heart rate variability-RMSSD), subjective well-being and somatic symptom distress.

METHOD

84 healthy participants (73 females; mean age = 23.56, SD = 3.35 years) completed the Somatic Symptom Severity Scale of the Patient Health Questionnaire and Mental Health Continuum Short Form at two timepoints (at baseline and six months later). Resting heart rate variability (HRV) was assessed at baseline, along with content specific rumination using the Self-Critical Rumination Scale. Four moderation analyses were performed to test these associations.

RESULTS

The interaction between resting HRV and self-critical rumination significantly explained somatic symptom distress at baseline. For those participants who had high resting HRV, somatic symptom distress was basically independent from the level of self-critical rumination. At the same time, lower resting HRV was associated with higher somatic symptom distress, especially in the presence of more ruminative thoughts. Prospectively, however, the interaction between rumination and resting HRV was not a significant predictor of somatic symptom distress. The association between resting HRV and self-critical rumination did not explain the variance on subjective well-being, but subjective well-being was negatively related to self-critical rumination.

CONCLUSION

Our findings potentially indicate that self-critical rumination could have a long-term negative impact on psychological functioning, even in a non-clinical sample, and highlight that a lower level of parasympathetic activation, assessed with RMSSD, might be an important factor in the relationship of self-critical rumination and somatic symptom distress.

Relationship between the proficiency level and anxiety-reducing effect in a one-time heart rate variability biofeedback: A randomized controlled trial

INTRODUCTION

Previous studies have reported that the proficiency level of heart rate variability biofeedback (HRVBF) contributes significantly to the anxiety-reducing effects in continuous HRVBF interventions. Meanwhile, anxiety-reducing effects have been confirmed in one-time HRVBF interventions as well as continuous HRVBF; however, no study has analyzed the relationship between the proficiency level of a one-time HRVBF and its anxiety-reducing effects. To pursuit the effectiveness of a one-time HRVBF intervention, it is necessary to clarify whether the proficiency level is an important predictor of anxiety-reducing effects from a dose-response relationship between these 2 variables. The purpose of this study was to examine the dose-response relationship between the proficiency level and anxiety-reducing effects of a one-time HRVBF.

METHODS

This study was a single-blinded, randomized, controlled trial with stratification based on trait anxiety of the State-Trait Anxiety Inventory-JYZ. In total, 45 healthy young males aged 20 to 30 years were allocated to the HRVBF or control group with simple breathing at rest. The intervention was performed for 15 minute in each group. The state anxiety score of the State-Trait Anxiety Inventory-JYZ was measured to evaluate the anxiety-reducing effect before and after training.

RESULTS

The results showed no significant linear relationship between the proficiency level and anxiety-reducing effect, and variations in the proficiency level were observed post-intervention in the HRVBF group. A significant anxiety-reducing effect was only observed in the HRVBF group (P = .001, effect size r = 0.62).

CONCLUSIONS

These results suggest that there is no close relationship between the proficiency level and anxiety-reducing effect in one-time HRVBF and that HRVBF is effective in reducing anxiety regardless of individual differences in the proficiency level. Therefore, a one-time HRVBF may be a useful breathing technique for reducing state anxiety without specific education and breathing techniques.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trial Registry (UMIN000041760).

Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study

Background

Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery.

Objective

This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress.

Methods

In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period.

Results

Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups.

Conclusions

Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health.

The Association Between Work-Related Rumination and Executive Function Using the Behavior Rating Inventory of Executive Function

Work-related rumination has been associated with a number of health complaints, however, little is known about the underlying factors associated with rumination. Previous work using proxy measures of executive function showed work-related rumination to be negatively associated with executive function. In this paper, we report two studies that examined the association between work-related rumination and executive function utilizing an ecological valid measure of executive function: the Behavior Rating Inventory of Executive Function (BRIEF-A, Roth et al., 2005). In study 1 (N = 63), high, relative to low work-related ruminators, were found to demonstrate lower executive function skills, in eight of the nine subscales of the BRIEF. The aim of study 2 (N = 237) was to identify, the key executive function subscale/s associated with work-related rumination. Controlling for known factors associated with work-related rumination (fatigue and sleep), regression analysis identified the behavioral regulation subscale “shift” as the key predictor within the model. Shift relates to our ability to switch attention, to think about different solutions, and dealing with and accepting change. It was concluded that these findings lend support for future research to develop interventions for enhancing shift ability, as an aid to reduce work-related ruminative thinking.

Inflexible autonomic responses to sadness predict habitual and real-world rumination: A multi-level, multi-wave study

Inflexibility of the autonomic nervous system is relevant to depression vulnerability, but the downstream behavioral consequences of autonomic inflexibility are not well understood. Rumination, a perseverative thinking style that characterizes depression, is one candidate phenotype relevant to autonomic inflexibility. Undergraduates (N = 134) completed a sadness induction while respiratory sinus arrhythmia was measured, and completed four waves of follow-up over twelve weeks during which rumination, stressful events, and symptoms of depression were measured. Individuals with less autonomic flexibility had higher levels of trait rumination, and were more likely to ruminate in daily life, regardless of stress exposure, whereas individuals with more autonomic flexibility ruminated more only in the context of stress. These findings provide the first evidence that autonomic inflexibility may confer vulnerability to context-insensitive rumination. This work suggests a potential behavioral mechanism by which autonomic inflexibility leads to problems with self-regulation and depression, suggesting multiple avenues for intervention to target these markers of vulnerability.

Using ambulatory assessment to measure dynamic risk processes in affective disorders

BACKGROUND

Rapid advances in the capability and affordability of digital technology have begun to allow for the intensive monitoring of psychological and physiological processes associated with affective disorders in daily life. This technology may enable researchers to overcome some limitations of traditional methods for studying risk in affective disorders, which often (implicitly) assume that risk factors are distal and static - that they do not change over time. In contrast, ambulatory assessment (AA) is particularly suited to measure dynamic "real-world" processes and to detect fluctuations in proximal risk for outcomes of interest.

METHOD

We highlight key questions about proximal and distal risk for affective disorders that AA methods (with multilevel modeling, or fully-idiographic methods) allow researchers to evaluate.

RESULTS

Key questions include between-subject questions to understand who is at risk (e.g., are people with more affective instability at greater risk than others?) and within-subject questions to understand when risk is most acute among those who are at risk (e.g., does suicidal ideation increase when people show more sympathetic activation than usual?). We discuss practical study design and analytic strategy considerations for evaluating questions of risk in context, and the benefits and limitations of self-reported vs. passively-collected AA.

LIMITATIONS

Measurements may only be as accurate as the observation period is representative of individuals' usual life contexts. Active measurement techniques are limited by the ability and willingness to self-report.

CONCLUSIONS

We conclude by discussing how monitoring proximal risk with AA may be leveraged for translation into personalized, real-time interventions to reduce risk.