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Moon SJE, Schlenk EA, Lee H. Heart Rate Variability in Adults With Substance Use Disorder: A Comprehensive Narrative Review. J Am Psychiatr Nurses Assoc 2024; 30:240-251. [PMID: 36856156 DOI: 10.1177/10783903221145142] [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: 03/02/2023]
Abstract
BACKGROUND Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use. AIM The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse. METHODS A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances. RESULTS A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility. CONCLUSION HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.
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Affiliation(s)
| | - Elizabeth A Schlenk
- Elizabeth A. Schlenk, PhD, RN, CNL, FAAN, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, University of Pittsburgh, Pittsburgh, PA, USA
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Nyamathi AM, Salem BE, Gelberg L, Garfin DR, Wolitsky-Taylor K, Shin SS, Yu Z, Hudson A, Yadav K, Clarke R, Alikhani M, van Cise E, Lee D. Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness. Stress Health 2023. [PMID: 38146789 DOI: 10.1002/smi.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/27/2023]
Abstract
People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post-traumatic stress disorder as compared with the general population. Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV-BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV-BF or an active HP control group and received eight weekly, 30-min sessions over two months, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8-week session, and/or 2-month follow-up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV-BF and HP interventions showed significant increases in HRV from baseline to 2-month follow-up, with no significant difference between the intervention groups. The HRV-BF programme revealed a somewhat greater, although non-significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV-BF and HP intervention.
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Affiliation(s)
- Adeline M Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, California, USA
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Dana Rose Garfin
- Community Health Sciences/Fielding School of Public Health, Los Angeles, California, USA
| | - Kate Wolitsky-Taylor
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Zhaoxia Yu
- Department of Statistics, School of Information and Computer Sciences, University of California, Irvine, California, USA
| | | | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Richard Clarke
- Office of Research, University of California, Irvine, California, USA
| | - Mitra Alikhani
- School of Nursing, University of California, Los Angeles, California, USA
| | | | - Darlene Lee
- Susan Samueli Integrative Health Institute, University of California, Irvine, California, USA
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3
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Park SJ, Roth M. Heart Rate Variability Biofeedback as Adjunctive Treatment of Generalized Anxiety Disorder: A Case Report. Integr Med (Encinitas) 2023; 22:42-47. [PMID: 37752932 PMCID: PMC10519238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Introduction Generalized anxiety disorder (GAD) is a common psychiatric disorder that can cause significant functional impairment to a patient's life. Mind body therapies (MBT) have increasingly been used as an intervention to manage symptoms of anxiety. Heart rate variability (HRV) biofeedback is a specific MBT that utilizes real-time feedback on autonomic functioning to train the physiological stress response through diaphragmatic breathing. Case Presentation A 39-year-old female was referred for a seven-week HRV biofeedback training protocol at Bastyr University Clinic for adjunctive treatment of GAD and depression. She had been taking citalopram for approximately four months prior to the first visit. Discussion/Conclusion After completing the seven-week protocol, the patient's anxiety improved from severe to mild, and her depression improved from mild to minimal. This improvement was maintained at a four-week follow-up, and eight weeks after the final visit she reported that her anxiety was no longer a concern to her. HRV biofeedback demonstrated to be an effective adjunctive treatment for GAD in this patient's case; however further research is needed to elucidate the effects of HRV biofeedback in patients with GAD.
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Affiliation(s)
| | - Maya Roth
- Assistant Professor, Bastyr University, San Diego, California
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Demir B, Ozsoy F, Buyuk A, Altindag A. The effects of methamphetamine on electrocardiographic parameters in male patients. Int J Psychiatry Clin Pract 2022; 26:381-386. [PMID: 35225724 DOI: 10.1080/13651501.2022.2041671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to compare the electrocardiographic parameters in patients with methamphetamine use to healthy controls. METHODS The study is a cross-sectional case-control study. Sixty-eight patients diagnosed with methamphetamine use disorder (MUD) according to DSM-5 criteria and 65 subjects in healthy control group who can match the patient group with demographic data were included in the study. Heart rate, P wave dispersion, QT dispersion, QTc and Tp-e/QTc ratios were calculated in the ECGs of all participants. RESULTS The mean age of the patients was 25.60 ± 5.70 and of the control group was 27.43 ± 6.10 (p = 0.076). There was no statistically significant difference between the blood pressure, body mass index, HDL-LDL-total cholesterol and triglyceride values of the participants (p > 0.05). Although QT dispersion was 13.68 ± 9.12 in patients with methamphetamine use disorder, it was calculated as 9.08 ± 7.85 in the control group (p = 0.002). Finally, the Tp-e/QTc ratio of the patients was higher than the healthy controls (p = 0.014). CONCLUSION In our study, we found a significant deterioration in QT dispersion and Tp-e/QTc ratio in the MUD group. Therefore, it should be kept in mind that there is a risk of malignant arrhythmia in this patient group and care should be taken in terms of arrhythmic events during follow-up in this patient group.Key pointsPatients with methamphetamine use showed significant deterioration in QTd and Tp-e/QTcMethamphetamine users have prolonged Tp-e/QTc ratio and QTdCaution should be exercised in terms of arrhythmic events in methamphetamine users.
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Affiliation(s)
- Bahadir Demir
- Faculty of Medicine, Department of Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Filiz Ozsoy
- Faculty of Medicine, Department of Psychiatry, Gaziosmanpasa University, Tokat, Turkey
| | - Ahmet Buyuk
- M.D. - 25 December State Hospital, Clinic of Cardiology, Gaziantep, Turkey
| | - Abdurrahman Altindag
- Faculty of Medicine, Department of Psychiatry, Gaziantep University, Gaziantep, Turkey
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5
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Huang WL, Ko LC, Liao SC. The association between heart rate variability and skin conductance: a correlation analysis in healthy individuals and patients with somatic symptom disorder comorbid with depression and anxiety. J Int Med Res 2022; 50:3000605221127104. [PMID: 36177841 PMCID: PMC9528031 DOI: 10.1177/03000605221127104] [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] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the correlations between heart rate variability (HRV) and skin conductance (SC) in two populations under three different situations. Methods This cross-sectional study enrolled patients with somatic symptom disorder comorbid with depression and anxiety and healthy individuals without a psychiatric history. The biological signals were measured under three conditions: resting state, during a cognitive task and during paced breathing. Pearson’s correlation analysis and the generalized estimating equation were used to examine the correlations between SC and HRV in the two populations under the three situations. Results The study enrolled 97 patients with somatic symptom disorder comorbid with depression and anxiety and 96 healthy individuals. In healthy individuals, the ratio of low-frequency power to high frequency power (LF/HF) and normalized LF (LF%) were significantly correlated with SC in the resting state and during a cognitive task, but the correlation coefficients were low level. In patients with somatic symptom disorder comorbid with depression and anxiety, LF/HF and LF% did not show significant correlations with SC under any situation. Conclusions The two different populations and three situations might have affected the significance of the LF/HF-SC and LF%-SC correlations. The generally low correlations indicate that LF/HF and LF% cannot fully reflect the sympathetic cholinergic activity represented by SC.
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Affiliation(s)
- Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
| | - Li-Chin Ko
- Department of Neurology, National Taiwan University Hospital, Taipei
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu Hospital, Hsin-Chu City
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Clemente-Suárez VJ, Ruisoto P, Isorna-Folgar M, Cancelo-Martínez J, Beltrán-Velasco AI, Tornero-Aguilera JF. Psychophysiological and Psychosocial Profile of Patients Attending Drug Addiction Centers. Appl Psychophysiol Biofeedback 2021; 47:77-84. [PMID: 34958443 PMCID: PMC9098533 DOI: 10.1007/s10484-021-09531-1] [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] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/01/2022]
Abstract
Drug treatment centres provide the highest level of rehab services for patients diagnosed with drug addictions. Most inpatient drug rehab programs focus on medical detox and mental health interventions. However, how to optimize the later remains a challenge. The aim of this study was to examine the psychophysiological and psychosocial profile of patients attending drug addiction centres in comparation with the general population. A total of 105 inpatient drug rehab patients and 50 participants from the general population were compared based on standardized psychophysiological and psychosocial measures. Results of this study suggest that patients attending drug addiction centers differ from general population in several different psychophysiological and psychosocial factors. Patients reported significantly lower levels of physical activity and increased sympathetic responsiveness, and significantly higher levels in loneliness, psychologically inflexibility and neuroticism. The results of this study highlight the importance of address healthy lifestyle behaviors such as sport practice and psychological variables such as loneliness, psychological (in)flexibility and neuroticism to improve current programs aim to prevent or reduce problematic drug consumptions.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, Villaviciosa de Odón, 28670, Madrid, Spain. .,Studies Centre in Applied Combat (CESCA), Toledo, Spain. .,Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla, Colombia.
| | - Pablo Ruisoto
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain
| | - Manuel Isorna-Folgar
- Facultad Ciencias Educación y Trabajo Social, Universidad de Vigo, Ourense, Spain
| | | | | | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, Villaviciosa de Odón, 28670, Madrid, Spain.,Studies Centre in Applied Combat (CESCA), Toledo, Spain
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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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8
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Blase K, Vermetten E, Lehrer P, Gevirtz R. Neurophysiological Approach by Self-Control of Your Stress-Related Autonomic Nervous System with Depression, Stress and Anxiety Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073329. [PMID: 33804817 PMCID: PMC8036915 DOI: 10.3390/ijerph18073329] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Heart Rate Variability Biofeedback (HRVB) is a treatment in which patients learn self-regulation of a physiological dysregulated vagal nerve function. While the therapeutic approach of HRVB is promising for a variety of disorders, it has not yet been regularly offered in a mental health treatment setting. AIM To provide a systematic review about the efficacy of HRV-Biofeedback in treatment of anxiety, depression, and stress related disorders. METHOD Systematic review in PubMed and Web of Science in 2020 with terms HRV, biofeedback, Post-Traumatic Stress Disorder (PTSD), depression, panic disorder, and anxiety disorder. Selection, critical appraisal, and description of the Random Controlled Trials (RCT) studies. Combined with recent meta-analyses. RESULTS The search resulted in a total of 881 studies. After critical appraisal, nine RCTs have been selected as well as two other relevant studies. The RCTs with control groups treatment as usual, muscle relaxation training and a "placebo"-biofeedback instrument revealed significant clinical efficacy and better results compared with control conditions, mostly significant. In the depression studies average reduction at the Beck Depression Inventory (BDI) scale was 64% (HRVB plus Treatment as Usual (TAU) versus 25% (control group with TAU) and 30% reduction (HRVB) at the PSQ scale versus 7% (control group with TAU). In the PTSD studies average reduction at the BDI-scale was 53% (HRV plus TAU) versus 24% (control group with TAU) and 22% (HRVB) versus 10% (TAU) with the PTSD Checklist (PCL). In other systematic reviews significant effects have been shown for HRV-Biofeedback in treatment of asthma, coronary artery disease, sleeping disorders, postpartum depression and stress and anxiety. CONCLUSION This systematic review shows significant improvement of the non-invasive HRVB training in stress related disorders like PTSD, depression, and panic disorder, in particular when combined with cognitive behavioral therapy or different TAU. Effects were visible after four weeks of training, but clinical practice in a longer daily self-treatment of eight weeks is more promising. More research to integrate HRVB in treatment of stress related disorders in psychiatry is warranted, as well as research focused on the neurophysiological mechanisms.
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Affiliation(s)
- Kees Blase
- National Centre Stress Management, Innovational and Educational Centre HartFocus, 1231 NC78 Loosdrecht, The Netherlands
- Correspondence:
| | - Eric Vermetten
- Department Psychiatry, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Paul Lehrer
- Rutgers Medical School, Rutgers University, Monmouth Junction, NJ 08852, USA;
| | - Richard Gevirtz
- California School of Professional Psychology, Alliant International University, San Diego, CA 92131, USA;
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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10
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You M, Laborde S, Salvotti C, Zammit N, Mosley E, Dosseville F. Influence of a Single Slow-Paced Breathing Session on Cardiac Vagal Activity in Athletes. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00467-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Demir B, Ozsoy F, Buyuk A, Altindag A. ECG changes in patients with opioid use disorder; P-QT wave dispersion: a retrospective study. J Addict Dis 2020; 39:234-240. [PMID: 33215556 DOI: 10.1080/10550887.2020.1848257] [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: 10/23/2022]
Abstract
OBJECTIVE We aimed to examine the electrocardiographic arrhythmia risk predictors in patients with opioid use disorder by P wave dispersion, QT dispersion, and by comparing Tp-e/QTc ratio with healthy controls. METHODS One hundred seventeen patients who were diagnosed with opioid use disorder according to DSM-5 criteria and who were hospitalized in 25 Aralık Gaziantep State Hospital AMATEM (Alcohol and substance addiction treatment center) service and a healthy control group consisting of 168 subjects were included in the study. Electrocardiography (ECG) scans of all participants were performed in the supine position and at rest. P wave dispersion, QT dispersion, and Tp-e/QTc ratio were calculated. RESULTS Of all the participants, 12 were women (4.21%), 273 (95.78%) were men. The mean age of all participants was 30.42 ± 9.36 years. No difference was found between the gender, mean age, marital status, educational level, and smoking status of the participants (p > 0.05). The entire patient group was using heroin. Heart rate of the patient group was calculated as 68.14 ± 13.26 beats per minute, being lower than healthy controls (p < 0.05). Although QT dispersion value was lower than healthy controls (p < 0.05); P wave dispersion did not differ between groups (p > 0.05). CONCLUSION It is thought that the patients with opioid use disorder are at risk for cardiac arrhythmia based on our findings. Therefore, physicians should be careful about cardiac rhythm and conduction problems while organizing any treatment of these patients.
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Affiliation(s)
- Bahadir Demir
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Filiz Ozsoy
- Clinic of Psychiatry, Tokat State Hospital, Tokat, Turkey
| | - Ahmet Buyuk
- 25 December State Hospital, Clinic of Cardiology, Gaziantep, Turkey
| | - Abdurrahman Altindag
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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12
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The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082905. [PMID: 32331460 PMCID: PMC7215829 DOI: 10.3390/ijerph17082905] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
Psychiatric ward (PW) nurses are at a higher risk to encounter workplace violence than are other healthcare providers, and many interventions have been developed to improve their mental health. We compared the effectiveness of biofeedback training (BT) and smartphone-delivered BT (SDBT) interventions on occupational stress, depressive symptoms, resilience, heart rate variability, and respiration rate in a sample of abused PW nurses. This was a quasi-experimental study. Structured questionnaires were administered before and six weeks after the intervention. Data were collected from April 2017 to October 2017. A total of 159 abused PW nurses were randomly assigned to BT, SDBT, and control groups, and 135 of them completed all processes of our protocol, with the study consisting of 119 females (88.1%) and 16 males (11.9%) and their age range being from 22 to 59 with the mean age of 35.61 and a standard deviation of 8.16. Compared to the controls, both the BT and the SDBT intervention groups experienced significant improvements in depressive symptoms, resilience, and respiration rate; and the SDBT group experienced significant reductions in occupational stress. Considering the cost, accessibility, restrictions time and space, SDBT be used as an effective intervention in people with resilience or occupational stress.
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13
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Chang WL, Lee JT, Li CR, Davis AHT, Yang CC, Chen YJ. Effects of Heart Rate Variability Biofeedback in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial. Biol Res Nurs 2019; 22:34-44. [PMID: 31635477 DOI: 10.1177/1099800419881210] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autonomic dysfunction, cognitive impairment, and psychological distress are associated with poorer prognosis in patients with acute ischemic stroke (AIS). Heart rate variability (HRV) biofeedback (BF) improves autonomic dysfunction, cognitive impairment, and psychological distress in other patient populations, but its effect in patients with AIS is still unclear. OBJECTIVE This study investigated the effects of an HRVBF intervention on autonomic function, cognitive impairment, and psychological distress in patients with AIS. METHOD In this randomized, controlled, single-blind trial, patients with AIS were randomly assigned to the experimental or control group. The experimental group received four HRVBF training sessions. The control group received usual care. Repeated measures of HRV, mini-mental status examination (MMSE), and Hospital Anxiety and Depression Scales (HADS) were collected prior to and at 1 and 3 months postintervention. RESULTS A total of 35 patients completed the study (19 experimental, 16 control). HRV and HADS significantly improved in the experimental group (p < .001) but not in the control group. Likewise, only the experimental group showed significant improvements in HRV, MMSE, and HADS over time (p < .05). CONCLUSION HRVBF is a promising intervention for improving autonomic function, cognitive impairment, and psychological distress in patients with AIS. More studies of HRVBF interventions are needed to further optimize the effects of HRVBF on autonomic, cognitive, and psychological function in patients with AIS.
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Affiliation(s)
- Wan-Ling Chang
- Department of Nursing, Fu Jen Catholic University Hospital, New Taipei City
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taichung
| | - Amy H T Davis
- College of Health and Society, Hawaii Pacific University, Kaneohe, HI, USA
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei
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Kroll SL, Williams DP, Thoma M, Staib M, Binz TM, Baumgartner MR, Kirschbaum C, Thayer JF, Quednow BB. Non-medical prescription opioid users exhibit dysfunctional physiological stress responses to social rejection. Psychoneuroendocrinology 2019; 100:264-275. [PMID: 30594739 DOI: 10.1016/j.psyneuen.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/16/2022]
Abstract
Non-medical prescription opioid use (NMPOU) recently increased dramatically, especially in the U.S. Although chronic opioid use is commonly accompanied by deficits in social functioning and dysregulation of the hypothalamic-pituitary adrenergic (HPA) stress axis, little is known about the impact of NMPOU on psychosocial stress responses. Therefore, we measured physiological responses of the autonomic nervous system and the HPA axis to social rejection using the Cyberball paradigm. We compared 23 individuals with NMPOU, objectively confirmed by hair and urine analyses, with 29 opioid-naïve, healthy controls. As expected, heart rate variability (HRV), an index of parasympathetic activity, increased significantly during exclusion within controls, while in the NMPOU group only a trend in the same direction was found. However, increased HRV was robustly moderated by opioid craving indicating worse emotion regulation to social exclusion specifically in individuals with high opioid craving. Greater levels of the adrenocorticotropic hormone and cortisol responses to social rejection were found in the NMPOU group indicating hyperreactivity of the HPA axis to social exclusion. Self-ratings suggest that opioid users were aware of rejection, but less emotionally affected by exclusion. Furthermore, controls showed greater negative mood after the Cyberball confirming the task's validity. Moreover, NMPOU individuals reported a smaller social network size compared to controls. Present findings suggest that chronic NMPOU is associated with dysfunctional physiological responses to psychosocial stressors such as social rejection. In sum, NMPOU was associated with poorer regulation of the parasympathetic nervous system, especially under opioid craving highlighting its potential importance in relapse prevention.
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Affiliation(s)
- Sara L Kroll
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - DeWayne P Williams
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Martina Thoma
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Matthias Staib
- Psychological Institute, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland
| | - Tina M Binz
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006 Zurich, Switzerland
| | - Markus R Baumgartner
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006 Zurich, Switzerland
| | - Clemens Kirschbaum
- Institute of Biological Psychology, Technical University of Dresden, Zellescher Weg 19, 01069 Dresden, Germany
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
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15
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Pinter A, Szatmari S, Horvath T, Penzlin AI, Barlinn K, Siepmann M, Siepmann T. Cardiac dysautonomia in depression - heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat 2019; 15:1287-1310. [PMID: 31190834 PMCID: PMC6529729 DOI: 10.2147/ndt.s200360] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/21/2019] [Indexed: 01/05/2023] Open
Abstract
Depressive disorders are among the most important health problems and are predicted to constitute the leading cause of disease burden by the year 2030. Aside significant impact on quality of life, psychosocial well-being and socioeconomic status of affected patients, depression is associated with impaired cardiovascular health and increased mortality. The link between affective and cardiovascular disease has largely been attributed to dysregulation of the autonomic nervous system resulting in a chronic shift toward increased sympathetic and decreased parasympathetic activity and, consecutively, cardiac dysautonomia. Among proposed surrogate parameters to capture and quantitatively analyze this shift, heart rate variability (HRV) and baroreflex sensitivity have emerged as reliable tools. Attenuation of these parameters is frequently seen in patients suffering from depression and is closely linked to cardiovascular morbidity and mortality. Therefore, diagnostic and therapeutic strategies were designed to assess and counteract cardiac dysautonomia. While psychopharmacological treatment can effectively improve affective symptoms of depression, its effect on cardiac dysautonomia is limited. HRV biofeedback is a non-invasive technique which is based on a metronomic breathing technique to increase parasympathetic tone. While some small studies observed beneficial effects of HRV biofeedback on dysautonomia in patients with depressive disorders, larger confirmatory trials are lacking. We reviewed the current literature on cardiac dysautonomia in patients suffering from depression with a focus on the underlying pathophysiology as well as diagnostic workup and treatment.
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Affiliation(s)
- Alexandra Pinter
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Szabolcs Szatmari
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, Semmelweis University, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Tamas Horvath
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ana Isabel Penzlin
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Martin Siepmann
- Department of Psychosomatic Medicine and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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16
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Lin IM. Effects of a cardiorespiratory synchronization training mobile application on heart rate variability and electroencephalography in healthy adults. Int J Psychophysiol 2018; 134:168-177. [PMID: 30243751 DOI: 10.1016/j.ijpsycho.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
Cardiorespiratory synchronization training (CRST) uses diaphragmatic breathing to increase balance in the autonomic nervous system and reduce negative emotions. CRST integrated with high-technology mobile applications affords innovative and convenient home-based training. This study examined the effects of a CRST mobile application on heart rate variability (HRV) and electroencephalography (EEG) parameters in healthy adults. Ninety-six participants were randomly assigned to the CRST, relaxation training (RT; active control group), and control (C) groups. The CRST group received paced breathing training using a wearable device connected to a mobile application and received feedback on the HRV indices. The RT group received muscle relaxation training using a wearable device connected to a mobile application and received feedback on heart rate (HR). The training program was conducted for 1 h per week for 4 weeks. The C group did not receive any wearable device, mobile application, or psychological intervention. Psychological questionnaires on depression and anxiety and physiological measurements of the breathing rates, electrocardiography (ECG), and EEG were measured at the pretest and posttest. The CRST group showed significantly higher HRV indices and lower breathing rates at the posttest than the RT and C groups. There were no significant interaction effects on EEG parameters at pretest and posttest among the three groups. Use of a CRST mobile application increased balance in the autonomic nervous system at the resting state. This clinical evidence-based technologically advanced mobile application could be implemented in future clinical practice.
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Affiliation(s)
- I-Mei Lin
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan.
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