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Thoen A, Alaerts K, Prinsen J, Steyaert J, Van Damme T. The Physiological and Clinical-Behavioral Effects of Heart Rate Variability Biofeedback in Adolescents with Autism: A Pilot Randomized Controlled Trial. Appl Psychophysiol Biofeedback 2024; 49:419-438. [PMID: 38491260 DOI: 10.1007/s10484-024-09638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
Adolescents with autism present lower levels of cardiac vagal modulation. It was hypothesized that Heart Rate Variability Biofeedback (HRVB) increases cardiac vagal modulation in adolescents with autism, resulting in positive effects on physiological and psychosocial parameters. It was also hypothesized that home-based HRVB training is feasible. In a single-blind, randomized sham-controlled pilot trial, adolescents with autism performed supervised HRVB (n = 24) or sham training (n = 20). Subsequently, half of the adolescents received HRVB training at home, whereas the other subset did not practice. Physiological, cortisol and behavioral data were collected during stress-provoking assessments before and after each training period. Supervised HRVB resulted in a late increase in cardiac vagal modulation in adolescents with autism. Heart rate increased and cortisol decreased significantly immediately after supervised HRVB, but none of these effects remained after follow-up. Following supervised HRVB, no significant change in psychosocial functioning was found. Home-based HRVB was feasible, adolescents reported lower symptoms of stress, but a significant decrease in compliance rate was found. HRVB is feasible and effective in adolescents with autism given the late-emerging increases in cardiac vagal modulation and decrease in stress symptoms. Replicating this study with a larger sample and further exploration of the working mechanisms of HRVB are recommended. ClinicalTrials.gov , NCT04628715.
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Affiliation(s)
- Anoushka Thoen
- Department of Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation, KU Leuven, Herestraat 49 - box 1510, Leuven, 3000, Belgium.
- Leuven Autism Research (LAuRes), KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
| | - Kaat Alaerts
- Leuven Autism Research (LAuRes), KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, KU Leuven, Tervuursevest 101 - box 1501, Leuven, 3001, Belgium
| | - Jellina Prinsen
- Leuven Autism Research (LAuRes), KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, KU Leuven, Tervuursevest 101 - box 1501, Leuven, 3001, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Child Psychiatry, UPC KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Neurosciences, Research Group of Developmental Psychiatry, KU Leuven, Kapucijnenvoer 7h - box 7001, Leuven, 3000, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation, KU Leuven, Herestraat 49 - box 1510, Leuven, 3000, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Child Psychiatry, UPC KU Leuven, Herestraat 49, Leuven, 3000, Belgium
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2
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Wang YL, Wu WX, Yang CC, Huang SM, Chang CC, Li CR, Chiang SL, Chen YJ. Heart rate variability biofeedback enhances cognitive, motor, psychological, and autonomic functions in post-stroke rehabilitation. Int J Psychophysiol 2024; 203:112411. [PMID: 39116804 DOI: 10.1016/j.ijpsycho.2024.112411] [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: 05/24/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024]
Abstract
Post-stroke patients often experience psychological distress and autonomic nervous system (ANS) dysregulation, impacting their well-being. This study evaluated the effectiveness of heart rate variability (HRV) biofeedback on cognitive, motor, psychological, and ANS functions in sixty-two ischemic stroke patients (43 males, mean age = 60.1) at a Medical Center in southern Taiwan. To prevent interaction, we allocated patients to the HRV biofeedback or control (usual care) group based on their assigned rehabilitation days, with 31 patients in each group. Assessments conducted at baseline, three, and six months included the Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment for Upper Extremities (FMA-UE), Perceived Stress Scale, Hospital Anxiety and Depression Scales (HADS), and HRV indices. Mixed-effect models were used to analyze Group by Time interactions. The results revealed significant interactions across all functions. At 3 months, significant improvements in the HRV biofeedback group were observed only in MoCA, FMA-UE, and HADS-depression scores compared to the control group. By 6 months, all measured outcomes demonstrated significant improvements in the biofeedback group relative to the control group. These results suggest that HRV biofeedback may be an effective complementary intervention in post-stroke rehabilitation, warranting further validation.
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Affiliation(s)
- Yu-Lin Wang
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Xuan Wu
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Department and Graduate Institute of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.
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3
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Saito R, Yoshida K, Sawamura D, Watanabe A, Tokikuni Y, Sakai S. Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09650-5. [PMID: 38888656 DOI: 10.1007/s10484-024-09650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
Heart rate variability biofeedback (HRVBF) is a promising anxiety-reducing intervention that increases vagally-mediated heart rate variability (vmHRV) through slow-paced breathing and feedback of heart rhythm. Several studies have reported the anxiety-reducing effects of HRVBF; however, some studies have reported such training as ineffective. Furthermore, the effects of training and underlying brain activity changes remain unclear. This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active control group, and measuring anxiety-related attentional bias using the emotional Stroop task and electroencephalography (EEG). Fifty-five healthy students with anxiety were randomly assigned to the HRVBF or control groups, and 21 in the HRVBF group and 19 in the control group were included in the analysis. Both groups performed 10 training sessions of 20 min each within 3 weeks. They were assessed using resting vmHRV, event-related potential (ERP), time-frequency EEG, attentional bias, and the State-Trait Anxiety Inventory-JYZ (STAI-JYZ) before and after training. The results demonstrated increased resting vmHRV in the HRVBF group compared to the control group after training. However, no differences were observed in ERP, time-frequency EEG, attentional bias, and STAI-JYZ. Participants with higher pre-training resting vmHRV achieved higher heart rhythm coherence in HRVBF training and had reduced attentional bias. This study suggests that individuals with higher resting vmHRV are more likely to be proficient in HRVBF training and benefit from its anxiety-reducing effects. The findings contribute to participant selection to benefit from HRVBF training and modification of the training protocols for non-responders.Clinical trial registrationOrganization: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), JapanRegistration number: UMIN000047096Registration date: March 6, 2022.
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Affiliation(s)
- Ryuji Saito
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kazuki Yoshida
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Daisuke Sawamura
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Akihiro Watanabe
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yukina Tokikuni
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shinya Sakai
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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4
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Galin S, Keren H. The Predictive Potential of Heart Rate Variability for Depression. Neuroscience 2024; 546:88-103. [PMID: 38513761 DOI: 10.1016/j.neuroscience.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
Heart rate variability (HRV),a measure of the fluctuations in the intervals between consecutive heartbeats, is an indicator of changes in the autonomic nervous system. A chronic reduction in HRV has been repeatedly linked to clinical depression. However, the chronological and mechanistic aspects of this relationship, between the neural, physiological, and psychopathological levels, remain unclear. In this review we present evidence by which changes in HRV might precede the onset of depression. We describe several pathways that can facilitate this relationship. First, we examine a theoretical model of the impact of autonomic imbalance on HRV and its role in contributing to mood dysregulation and depression. We then highlight brain regions that are regulating both HRV and emotion, suggesting these neural regions, and the Insula in particular, as potential mediators of this relationship. We also present additional possible mediating mechanisms involving the immune system and inflammation processes. Lastly, we support this model by showing evidence that modification of HRV with biofeedback leads to an improvement in some symptoms of depression. The possibility that changes in HRV precede the onset of depression is critical to put to the test, not only because it could provide insights into the mechanisms of the illness but also because it may offer a predictive anddiagnosticphysiological marker for depression. Importantly, it could also help to develop new effective clinical interventions for treating depression.
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Affiliation(s)
- Shir Galin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; Gonda Interdisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Hanna Keren
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; Gonda Interdisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
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5
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Min J, Koenig J, Nashiro K, Yoo HJ, Cho C, Thayer JF, Mather M. Resting heart rate variability is associated with neural adaptation when repeatedly exposed to emotional stimuli. Neuropsychologia 2024; 196:108819. [PMID: 38360391 PMCID: PMC11293881 DOI: 10.1016/j.neuropsychologia.2024.108819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Higher heart rate variability (HRV) at rest is associated with better emotion regulation ability. While the neurovisceral integration model explains this by postulating that HRV can index how the brain adaptively modulates responses to emotional stimuli, neuroimaging studies directly supporting this idea are scarce. We examined the neural correlates of regulating negative and positive emotion in relation to resting HRV based on the neuroimaging and heart rate data of one hundred young adults. The results showed that those with higher HRV better recruit the medial prefrontal cortex while intensifying positive compared to negative emotion. We also examined how individual differences in resting HRV are associated with adjusting brain activity to repeated emotional stimuli. During repeated viewing of emotional images, subjects with higher resting HRV better reduced activity in the medial prefrontal cortex, posterior cingulate gyrus, and angular gyrus, most of which overlapped with the default mode network. This HRV-DMN association was observed during passively viewing emotional images rather than during actively regulating emotion. While the regulating trials can better detect task-induced changes, the viewing trials might approximate resting state, better revealing individual differences. These findings suggest two possibilities: people with higher resting HRV might have a tendency to spontaneously engage with emotion regulation or possess a trait helping emotional arousal fade away.
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Affiliation(s)
- Jungwon Min
- University of Southern California, Irvine, CA, United States.
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany
| | - Kaoru Nashiro
- University of Southern California, Irvine, CA, United States
| | - Hyun Joo Yoo
- University of Southern California, Irvine, CA, United States
| | - Christine Cho
- University of Southern California, Irvine, CA, United States
| | | | - Mara Mather
- University of Southern California, Irvine, CA, United States
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6
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Nashiro K, Yoo HJ, Cho C, Kim AJ, Nasseri P, Min J, Dahl MJ, Mercer N, Choupan J, Choi P, Lee HRJ, Choi D, Alemu K, Herrera AY, Ng NF, Thayer JF, Mather M. Heart rate and breathing effects on attention and memory (HeartBEAM): study protocol for a randomized controlled trial in older adults. Trials 2024; 25:190. [PMID: 38491546 PMCID: PMC10941428 DOI: 10.1186/s13063-024-07943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/18/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In healthy people, the "fight-or-flight" sympathetic system is counterbalanced by the "rest-and-digest" parasympathetic system. As we grow older, the parasympathetic system declines as the sympathetic system becomes hyperactive. In our prior heart rate variability biofeedback and emotion regulation (HRV-ER) clinical trial, we found that increasing parasympathetic activity through daily practice of slow-paced breathing significantly decreased plasma amyloid-β (Aβ) in healthy younger and older adults. In healthy adults, higher plasma Aβ is associated with greater risk of Alzheimer's disease (AD). Our primary goal of this trial is to reproduce and extend our initial findings regarding effects of slow-paced breathing on Aβ. Our secondary objectives are to examine the effects of daily slow-paced breathing on brain structure and the rate of learning. METHODS Adults aged 50-70 have been randomized to practice one of two breathing protocols twice daily for 9 weeks: (1) "slow-paced breathing condition" involving daily cognitive training followed by slow-paced breathing designed to maximize heart rate oscillations or (2) "random-paced breathing condition" involving daily cognitive training followed by random-paced breathing to avoid increasing heart rate oscillations. The primary outcomes are plasma Aβ40 and Aβ42 levels and plasma Aβ42/40 ratio. The secondary outcomes are brain perivascular space volume, hippocampal volume, and learning rates measured by cognitive training performance. Other pre-registered outcomes include plasma pTau-181/tTau ratio and urine Aβ42. Recruitment began in January 2023. Interventions are ongoing and will be completed by the end of 2023. DISCUSSION Our HRV-ER trial was groundbreaking in demonstrating that a behavioral intervention can reduce plasma Aβ levels relative to a randomized control group. We aim to reproduce these findings while testing effects on brain clearance pathways and cognition. TRIAL REGISTRATION ClinicalTrials.gov NCT05602220. Registered on January 12, 2023.
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Affiliation(s)
- Kaoru Nashiro
- University of Southern California, Los Angeles, USA.
| | - Hyun Joo Yoo
- University of Southern California, Los Angeles, USA
| | | | | | | | - Jungwon Min
- University of Southern California, Los Angeles, USA
| | - Martin J Dahl
- University of Southern California, Los Angeles, USA
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Noah Mercer
- University of Southern California, Los Angeles, USA
| | - Jeiran Choupan
- University of Southern California, Los Angeles, USA
- NeuroScope Inc., New York, USA
| | - Paul Choi
- University of Southern California, Los Angeles, USA
| | | | - David Choi
- University of Southern California, Los Angeles, USA
| | | | | | | | | | - Mara Mather
- University of Southern California, Los Angeles, USA
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7
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Yoo HJ, Nashiro K, Dutt S, Min J, Cho C, Thayer JF, Lehrer P, Chang C, Mather M. Daily biofeedback to modulate heart rate oscillations affects structural volume in hippocampal subregions targeted by the locus coeruleus in older adults but not younger adults. Neurobiol Aging 2023; 132:85-99. [PMID: 37769491 PMCID: PMC10840698 DOI: 10.1016/j.neurobiolaging.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
Using data from a clinical trial, we tested the hypothesis that daily sessions modulating heart rate oscillations affect older adults' volume of a region-of-interest (ROI) comprised of adjacent hippocampal subregions with relatively strong locus coeruleus (LC) noradrenergic input. Younger and older adults were randomly assigned to one of two daily biofeedback practices for 5 weeks: (1) engage in slow-paced breathing to increase the amplitude of oscillations in heart rate at their breathing frequency (Osc+); (2) engage in self-selected strategies to decrease heart rate oscillations (Osc-). The interventions did not significantly affect younger adults' hippocampal volume. Among older adults, the two conditions affected volume in the LC-targeted hippocampal ROI differentially as reflected in a significant condition × time-point interaction on ROI volume. These condition differences were driven by opposing changes in the two conditions (increased volume in Osc+ and decreased volume in Osc-) and were mediated by the degree of heart rate oscillation during training sessions.
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Affiliation(s)
- Hyun Joo Yoo
- University of Southern California, Los Angeles, CA 90089, USA
| | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA 90089, USA
| | - Shubir Dutt
- University of Southern California, Los Angeles, CA 90089, USA
| | - Jungwon Min
- University of Southern California, Los Angeles, CA 90089, USA
| | - Christine Cho
- University of Southern California, Los Angeles, CA 90089, USA
| | | | - Paul Lehrer
- Rutgers University, New Brunswick, NJ 08852, USA
| | - Catie Chang
- Vanderbilt University, Nashville, TN 37235, USA
| | - Mara Mather
- University of Southern California, Los Angeles, CA 90089, USA.
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8
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Bachman SL, Cole S, Yoo HJ, Nashiro K, Min J, Mercer N, Nasseri P, Thayer JF, Lehrer P, Mather M. Daily heart rate variability biofeedback training decreases locus coeruleus MRI contrast in younger adults in a randomized clinical trial. Int J Psychophysiol 2023; 193:112241. [PMID: 37647944 PMCID: PMC10591988 DOI: 10.1016/j.ijpsycho.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
As an arousal hub region in the brain, the locus coeruleus (LC) has bidirectional connections with the autonomic nervous system. Magnetic resonance imaging (MRI)-based measures of LC structural integrity have been linked to cognition and arousal, but less is known about factors that influence LC structure and function across time. Here, we tested the effects of heart rate variability (HRV) biofeedback, an intervention targeting the autonomic nervous system, on LC MRI contrast and sympathetic activity. Younger and older participants completed daily HRV biofeedback training for five weeks. Those assigned to an experimental condition performed biofeedback involving slow, paced breathing designed to increase heart rate oscillations, whereas those assigned to a control condition performed biofeedback to decrease heart rate oscillations. At the pre- and post-training timepoints, LC contrast was assessed using turbo spin echo MRI scans, and RNA sequencing was used to assess cAMP-responsive element binding protein (CREB)-regulated gene expression in circulating blood cells, an index of sympathetic nervous system signaling. We found that left LC contrast decreased in younger participants in the experimental group, and across younger participants, decreases in left LC contrast were related to the extent to which participants increased their heart rate oscillations during training. Furthermore, decreases in left LC contrast were associated with decreased expression of CREB-associated gene transcripts. On the contrary, there were no effects of biofeedback on LC contrast among older participants in the experimental group. These findings provide novel evidence that in younger adults, HRV biofeedback involving slow, paced breathing can decrease both LC contrast and sympathetic nervous system signaling.
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Affiliation(s)
- Shelby L Bachman
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Steve Cole
- University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Hyun Joo Yoo
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Jungwon Min
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Noah Mercer
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Padideh Nasseri
- University of Southern California, Los Angeles, CA 90089, United States of America
| | - Julian F Thayer
- University of California Irvine, Irvine, CA 92697, United States of America
| | - Paul Lehrer
- Rutgers University, Piscataway, NJ 08852, United States of America
| | - Mara Mather
- University of Southern California, Los Angeles, CA 90089, United States of America.
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9
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Stange JP, Li J, Xu EP, Ye Z, Zapetis SL, Phanord CS, Wu J, Sellery P, Keefe K, Forbes E, Mermelstein RJ, Trull TJ, Langenecker SA. Autonomic complexity dynamically indexes affect regulation in everyday life. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:847-866. [PMID: 37410429 PMCID: PMC10592626 DOI: 10.1037/abn0000849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Affect regulation often is disrupted in depression. Understanding biomarkers of affect regulation in ecologically valid contexts is critical for identifying moments when interventions can be delivered to improve regulation and may have utility for identifying which individuals are vulnerable to psychopathology. Autonomic complexity, which includes linear and nonlinear indices of heart rate variability, has been proposed as a novel marker of neurovisceral integration. However, it is not clear how autonomic complexity tracks with regulation in everyday life, and whether low complexity serves as a marker of related psychopathology. To measure regulation phenotypes with diminished influence of current symptoms, 37 young adults with remitted major depressive disorder (rMDD) and 28 healthy comparisons (HCs) completed ambulatory assessments of autonomic complexity and affect regulation across one week in everyday life. Multilevel models indicated that in HCs, but not rMDD, autonomic complexity fluctuated in response to regulation cues, increasing in response to reappraisal and distraction and decreasing in response to negative affect. Higher complexity across the week predicted greater everyday regulation success, whereas greater variability of complexity predicted lower (and less variable) negative affect, rumination, and mind-wandering. Results suggest that ambulatory assessment of autonomic complexity can passively index dynamic aspects of real-world affect and regulation, and that dynamic physiological reactivity to regulation is restricted in rMDD. These results demonstrate how intensive sampling of dynamic, nonlinear regulatory processes can advance our understanding of potential mechanisms underlying psychopathology. Such measurements might inform how to test interventions to enhance neurovisceral complexity and affect regulation success in real time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jonathan P. Stange
- Department of Psychology, University of Southern California
- Department of Psychiatry and Behavioral Sciences, University of Southern California
| | - Jiani Li
- Department of Psychology, University of Southern California
| | - Ellie P. Xu
- Department of Psychology, University of Southern California
| | - Zihua Ye
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | | | - Jenny Wu
- Department of Psychology, University of Massachusetts Boston
| | - Pia Sellery
- Department of Psychology, University of Colorado at Boulder
| | - Kaley Keefe
- Department of Psychology, University of Southern California
| | - Erika Forbes
- Department of Psychiatry, University of Pittsburgh
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10
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Yoo HJ, Nashiro K, Dutt S, Min J, Cho C, Thayer JF, Lehrer P, Chang C, Mather M. Daily biofeedback to modulate heart rate oscillations affects structural volume in hippocampal subregions targeted by the locus coeruleus in older adults but not younger adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.02.23286715. [PMID: 37745356 PMCID: PMC10516053 DOI: 10.1101/2023.03.02.23286715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Using data from a clinical trial, we tested the hypothesis that daily sessions modulating heart rate oscillations affect older adults' volume of a region-of-interest (ROI) comprised of adjacent hippocampal subregions with relatively strong locus coeruleus (LC) noradrenergic input. Younger and older adults were randomly assigned to one of two daily biofeedback practices for 5 weeks: 1) engage in slow-paced breathing to increase the amplitude of oscillations in heart rate at their breathing frequency (Osc+); 2) engage in self-selected strategies to decrease heart rate oscillations (Osc-). The interventions did not significantly affect younger adults' hippocampal volume. Among older adults, the two conditions affected volume in the LC-targeted hippocampal ROI differentially as reflected in a significant condition x time-point interaction on ROI volume. These condition differences were driven by opposing changes in the two conditions (increased volume in Osc+ and decreased volume in Osc-) and were mediated by the degree of heart rate oscillation during training sessions.
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Affiliation(s)
- Hyun Joo Yoo
- University of Southern California, Los Angeles, CA 90089
| | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA 90089
| | - Shubir Dutt
- University of Southern California, Los Angeles, CA 90089
| | - Jungwon Min
- University of Southern California, Los Angeles, CA 90089
| | - Christine Cho
- University of Southern California, Los Angeles, CA 90089
| | | | | | | | - Mara Mather
- University of Southern California, Los Angeles, CA 90089
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11
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Yoo HJ, Nashiro K, Min J, Cho C, Mercer N, Bachman SL, Nasseri P, Dutt S, Porat S, Choi P, Zhang Y, Grigoryan V, Feng T, Thayer JF, Lehrer P, Chang C, Stanley JA, Head E, Rouanet J, Marmarelis VZ, Narayanan S, Wisnowski J, Nation DA, Mather M. Multimodal neuroimaging data from a 5-week heart rate variability biofeedback randomized clinical trial. Sci Data 2023; 10:503. [PMID: 37516756 PMCID: PMC10387077 DOI: 10.1038/s41597-023-02396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/17/2023] [Indexed: 07/31/2023] Open
Abstract
We present data from the Heart Rate Variability and Emotion Regulation (HRV-ER) randomized clinical trial testing effects of HRV biofeedback. Younger (N = 121) and older (N = 72) participants completed baseline magnetic resonance imaging (MRI) including T1-weighted, resting and emotion regulation task functional MRI (fMRI), pulsed continuous arterial spin labeling (PCASL), and proton magnetic resonance spectroscopy (1H MRS). During fMRI scans, physiological measures (blood pressure, pulse, respiration, and end-tidal CO2) were continuously acquired. Participants were randomized to either increase heart rate oscillations or decrease heart rate oscillations during daily sessions. After 5 weeks of HRV biofeedback, they repeated the baseline measurements in addition to new measures (ultimatum game fMRI, training mimicking during blood oxygen level dependent (BOLD) and PCASL fMRI). Participants also wore a wristband sensor to estimate sleep time. Psychological assessment comprised three cognitive tests and ten questionnaires related to emotional well-being. A subset (N = 104) provided plasma samples pre- and post-intervention that were assayed for amyloid and tau. Data is publicly available via the OpenNeuro data sharing platform.
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Affiliation(s)
- Hyun Joo Yoo
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Jungwon Min
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Christine Cho
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Noah Mercer
- University of Southern California, Los Angeles, CA, 90007, USA
| | | | - Padideh Nasseri
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Shubir Dutt
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Shai Porat
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Paul Choi
- University of Southern California, Los Angeles, CA, 90007, USA
| | - Yong Zhang
- University of Southern California, Los Angeles, CA, 90007, USA
| | | | - Tiantian Feng
- University of Southern California, Los Angeles, CA, 90007, USA
| | | | - Paul Lehrer
- Rutgers University, New Brunswick-Piscataway, USA
| | | | | | | | | | | | | | | | | | - Mara Mather
- University of Southern California, Los Angeles, CA, 90007, USA.
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12
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Sible IJ, Yoo HJ, Min J, Nashiro K, Chang C, Nation DA, Mather M. Short-term blood pressure variability is inversely related to regional amplitude of low frequency fluctuations in older and younger adults. AGING BRAIN 2023; 4:100085. [PMID: 37485296 PMCID: PMC10362312 DOI: 10.1016/j.nbas.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Blood pressure variability (BPV), independent of mean blood pressure levels, is associated with cerebrovascular disease burden on MRI and postmortem evaluation. However, less is known about relationships with markers of cerebrovascular dysfunction, such as diminished spontaneous brain activity as measured by the amplitude of low frequency fluctuations (ALFF), especially in brain regions with vascular and neuronal vulnerability in aging. We investigated the relationship between short-term BPV and concurrent regional ALFF from resting state fMRI in a sample of community-dwelling older adults (n = 44) and healthy younger adults (n = 49). In older adults, elevated systolic BPV was associated with lower ALFF in widespread medial temporal regions and the anterior cingulate cortex. Higher systolic BPV in younger adults was also related to lower ALFF in the medial temporal lobe, albeit in fewer subregions, and the amygdala. There were no significant associations between systolic BPV and ALFF across the right/left whole brain or in the insular cortex in either group. Findings suggest a possible regional vulnerability to cerebrovascular dysfunction and short-term fluctuations in blood pressure. BPV may be an understudied risk factor for cerebrovascular changes in aging.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Hyun Joo Yoo
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jungwon Min
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Kaoru Nashiro
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Catie Chang
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Daniel A. Nation
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Mara Mather
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
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13
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Ali MK, Liu L, Hussain A, Zheng D, Alam M, Chen JH, Huizinga JD. Root mean square of successive differences is not a valid measure of parasympathetic reactivity during slow deep breathing. Am J Physiol Regul Integr Comp Physiol 2023; 324:R446-R456. [PMID: 36717167 DOI: 10.1152/ajpregu.00272.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Deep breathing exercises are the second most used complementary health approach in the United States. Two heart rate variability (HRV) parameters, the root mean square of successive differences (RMSSD) and the respiratory sinus arrhythmia (RSA), are used to assess parasympathetic reactivity to deep breathing, but they are often not in agreement. Our purpose was to determine the cause of the disagreement. We investigated HRV parameters in 38 subjects during baseline, deep breathing, and recovery. Here we show that RMSSD as a measure of parasympathetic reactivity is unreliable; it does not reflect the increase in HRV during deep breathing as determined by RSA. We observed a decrease in RMSSD values despite a marked increase in HRV as determined by RSA and the standard deviation of normal heartbeat interval (SDNN) in healthy subjects and patients with functional bowel disorders. We show that RSA captures all aspects of HRV, whereas successive differences in heart rate intervals are only a small part of HRV, with decreasing variability during deep breathing in most subjects. We present a new measure of calculating RSA during deep breathing that may become an essential tool for researchers and clinicians. We also provide a unique visualization of the increased heart rate variability during deep breathing. Hence, RMSSD cannot be used to assess parasympathetic reactivity during deep breathing; using RSA is recommended. The use of RMSSD in previous influential studies may have led to erroneous conclusions about parasympathetic reactivity during deep breathing. Its continued use may undervalue the effects of the autonomic nervous system in slow deep breathing.
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Affiliation(s)
- M Khawar Ali
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Department of Engineering, McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Lijun Liu
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Amer Hussain
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Difei Zheng
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Honours Biology Pharmacology Co-Op Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marzia Alam
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ji-Hong Chen
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan D Huizinga
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Department of Engineering, McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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14
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Min J, Rouanet J, Martini AC, Nashiro K, Yoo HJ, Porat S, Cho C, Wan J, Cole SW, Head E, Nation DA, Thayer JF, Mather M. Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults. Sci Rep 2023; 13:3967. [PMID: 36894565 PMCID: PMC9998394 DOI: 10.1038/s41598-023-30167-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Slow paced breathing via heart rate variability (HRV) biofeedback stimulates vagus-nerve pathways that counter noradrenergic stress and arousal pathways that can influence production and clearance of Alzheimer's disease (AD)-related proteins. Thus, we examined whether HRV biofeedback intervention affects plasma Αβ40, Αβ42, total tau (tTau), and phosphorylated tau-181 (pTau-181) levels. We randomized healthy adults (N = 108) to use slow-paced breathing with HRV biofeedback to increase heart rate oscillations (Osc+) or to use personalized strategies with HRV biofeedback to decrease heart rate oscillations (Osc-). They practiced 20-40 min daily. Four weeks of practicing the Osc+ and Osc- conditions produced large effect size differences in change in plasma Aβ40 and Aβ42 levels. The Osc+ condition decreased plasma Αβ while the Osc- condition increased Αβ. Decreases in Αβ were associated with decreases in gene transcription indicators of β-adrenergic signaling, linking effects to the noradrenergic system. There were also opposing effects of the Osc+ and Osc- interventions on tTau for younger adults and pTau-181 for older adults. These results provide novel data supporting a causal role of autonomic activity in modulating plasma AD-related biomarkers.Trial registration: NCT03458910 (ClinicalTrials.gov); first posted on 03/08/2018.
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Affiliation(s)
- Jungwon Min
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Kaoru Nashiro
- University of Southern California, Los Angeles, CA, USA
| | - Hyun Joo Yoo
- University of Southern California, Los Angeles, CA, USA
| | - Shai Porat
- University of Southern California, Los Angeles, CA, USA
| | - Christine Cho
- University of Southern California, Los Angeles, CA, USA
| | - Junxiang Wan
- University of Southern California, Los Angeles, CA, USA
| | - Steve W Cole
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Mara Mather
- University of Southern California, Los Angeles, CA, USA.
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15
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Nashiro K, Yoo HJ, Cho C, Min J, Feng T, Nasseri P, Bachman SL, Lehrer P, Thayer JF, Mather M. Effects of a Randomised Trial of 5-Week Heart Rate Variability Biofeedback Intervention on Cognitive Function: Possible Benefits for Inhibitory Control. Appl Psychophysiol Biofeedback 2023; 48:35-48. [PMID: 36030457 PMCID: PMC9420180 DOI: 10.1007/s10484-022-09558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 12/01/2022]
Abstract
Previous research suggests that higher heart rate variability (HRV) is associated with better cognitive function. However, since most previous findings on the relationship between HRV and cognitive function were correlational in nature, it is unclear whether individual differences in HRV play a causal role in cognitive performance. To investigate whether there are causal relationships, we used a simple breathing manipulation that increases HRV through a 5-week HRV biofeedback intervention and examined whether this manipulation improves cognitive performance in younger and older adults (N = 165). The 5-week HRV biofeedback intervention did not significantly improve inhibitory control, working memory and processing speed across age groups. However, improvement in the Flanker score (a measure of inhibition) was associated with the amplitude of heart rate oscillations during practice sessions in the younger and older intervention groups. Our results suggest that daily practice to increase heart rate oscillations may improve inhibitory control, but future studies using longer intervention periods are warranted to replicate the present finding.
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Affiliation(s)
- Kaoru Nashiro
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA.
| | - Hyun Joo Yoo
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Christine Cho
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Jungwon Min
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Tiantian Feng
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Padideh Nasseri
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Shelby L Bachman
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | | | | | - Mara Mather
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
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16
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Changes in Medial Prefrontal Cortex Mediate Effects of Heart Rate Variability Biofeedback on Positive Emotional Memory Biases. Appl Psychophysiol Biofeedback 2023; 48:135-147. [PMID: 36658380 DOI: 10.1007/s10484-023-09579-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
Previous research suggests that implicit automatic emotion regulation relies on the medial prefrontal cortex (mPFC). However, most of the human studies supporting this hypothesis have been correlational in nature. In the current study, we examine how changes in mPFC-left amygdala functional connectivity relate to emotional memory biases. In a randomized clinical trial examining the effects of heart rate variability (HRV) biofeedback on brain mechanisms of emotion regulation, we randomly assigned participants to increase or decrease heart rate oscillations while receiving biofeedback. After several weeks of daily biofeedback sessions, younger and older participants completed an emotional picture memory task involving encoding, recall, and recognition phases as an additional measure in this clinical trial. Participants assigned to increase HRV (Osc+) (n = 84) showed a relatively higher rate of false alarms for positive than negative images than participants assigned to decrease HRV (Osc-) (n = 81). Osc+ participants also recalled relatively more positive compared with negative items than Osc- participants, but this difference was not significant. However, a summary bias score reflecting positive emotional memory bias across recall and recognition was significantly higher in the Osc+ than Osc- condition. As previously reported, the Osc+ manipulation increased left amygdala-mPFC resting-state functional connectivity significantly more than the Osc- manipulation. This increased functional connectivity significantly mediated the effects of the Osc+ condition on emotional bias. These findings suggest that, by increasing mPFC coordination of emotion-related circuits, daily practice increasing heart rate oscillations can increase implicit emotion regulation.
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