Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol.

The Use of Heart Rate Variability Biofeedback and Neurofeedback for Traumatic Brain Injury

Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence.

Area of Investigation and Hypothesis: Decreased heart rate variability (HRV) has been used as a predictor of cardiac and all-cause mortality. Studies have documented decreased HRV in a variety of conditions, including posttraumatic stress disorder (PTSD), depression, age, coronary artery disease (CAD), diabetes mellitus (DM), and tobacco use but improvement with beta blocker (BB) treatment. No prior study evaluated the relationship between military sexual trauma (MST) exposure and HRV outcomes. The hypothesis of this study was that female veterans exposed to MST would have lower time domain HRV measures than a reference cohort reporting non-exposure. Methods and Procedures: Electronic medical records (EMR) containing Holter and electrocardiogram (ECG) tracings of female veterans 21 to 86 years of age examined from January 2007 through December 2010 at a Veterans Affairs (VA) Medical Center were used for this historical cohort study. The sample contained female veterans with MST exposure (n = 27) and a reference group (n = 99) with no reported MST. Log transformed standard deviation of all normal to normal intervals (SDNN) and log transformed square root of the mean of the sum of the squares of differences between adjacent normal to normal intervals (RMSSD) were the primary comparison outcome measures and were derived from the mean of three 10-second ECG or Holter tracings for each subject. The MST universal screening tool, the PTSD ChecklistCivilian instrument, and the Patient Health Questionnaire-9 instrument for depression were used by the VA for diagnosis. History of MST, PTSD, depression, CAD, DM, tobacco use, and beta blocker treatment was obtained from the EMR. The expedited study was approved by the University of Tennessee Health Science Center and VA institutional review boards and the VA Research and Development Committee. Results: The mean (M) measures of log transformed SDNN and standard deviations (SD) differed significantly (p = .0001) between subjects with MST exposure (M = 3.25, SD = 0.11) and the reference cohort (M = 3.74, SD = 0.06). The mean measures of log transformed RMSSD and SD differed significantly (p = .001) between female veterans with MST exposure (M = 3.43, SD = 0.10) and the reference cohort (M = 3.81, SD = 0.05). Eighty percent of female veterans with MST had PTSD. Female veterans with MST (M = 41, SD = 11.67) were significantly (p = .002) younger in years than those with no MST exposure (M = 51, SD = 14.14). The projected SDNN of a 25 year old with MST exposure was comparable to that of a 69 year old without MST, while the RMSSD of a 25 year old with MST exposure was comparable to that of an 81 year old. Conclusions: Female veterans with MST had significantly lower HRV at a younger age compared to a reference cohort that contained veterans with PTSD from other traumas, including combat-related PTSD. Early HRV decline in female veterans with MST may increase risk of premature death.

Introduction and Purpose:Rigorous training of elite athletes can lead to nonfunctional overreaching (NFOR) and overtraining (OT), both of which decrease performance and increase the risk of injury. Heart rate variability (HRV) is a measure of autonomic nervous system balance. Reductions in HRV are associated with NFOR and OT. Breath-based biofeedback increases HRV through activation of the baroreceptor reflex.Purpose:This case study explored the impact of breath-based HRV biofeedback (HRV-BF) training on daily resting HRV values of a female triathlete and the association between daily HRV with subjective performance indicators of workout quality and amount of postworkout energy.Methods:A 24-year-old female triathlete completed an 8-week A-B repeated-measures study—A: baseline; 4 weeks and B: intervention HRV-BF training; 4 weeks. The subject recorded daily resting HRV for 120 seconds, completed regular daily training, and measured workout performance and postworkout energy levels on a 0 to 10 scale. During B, the subject added 15 minutes of HRV-BF 5 times per week.Results:With HRV-BF, median HRV level increased (A: 137; B: 191) and the interquartile band narrowed (A: 83–184; B: 142–201), suggesting higher HRV with less variability. The subject had more days at highest readiness (A: 35%; B: 62%). Median values for reports of workout performance and postworkout energy increased.Conclusions:This study found that, for this subject, 15 minutes of HRV-BF, 5 times per week, was associated with increased HRV and improved subjective workout performance. Further research exploring HRV measures and biofeedback to inform athletic performance is warranted.

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

GENERAL COMMENTARY article Front. Hum. Neurosci., 07 November 2013Sec. Brain Health and Clinical Neuroscience Volume 7 - 2013 | https://doi.org/10.3389/fnhum.2013.00747

To assess outcomes of veterans who participated in mindfulness-based stress reduction (MBSR). Posttraumatic stress disorder (PTSD) symptoms, depression, functional status, behavioral activation, experiential avoidance, and mindfulness were assessed at baseline, and 2 and 6 months after enrollment. At 6 months, there were significant improvements in PTSD symptoms (standardized effect size, d = -0.64, p< 0.001); depression (d = -0.70, p<0.001); behavioral activation (d = 0.62, p<0.001); mental component summary score of the Short Form-8 (d = 0.72, p<0.001); acceptance (d = 0.67, p<0.001); and mindfulness (d = 0.78, p<0.001), and 47.7% of veterans had clinically significant improvements in PTSD symptoms. MBSR shows promise as an intervention for PTSD and warrants further study in randomized controlled trials.

Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire-Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening (p = .0005), completing treatment (p = .03), and completing TF-CBT with fidelity (p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD (p = .001) and depressive (p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.

Family resilience theory suggests that families can collectively overcome distress and build resilience, while empirical research shows that parents can influence their children’s Post-Traumatic Stress Disorder (PTSD) symptoms. The aim of this study is to examine the intergenerational associations between resilience and traumatic exposure, with PTSD symptoms within mother-daughter dyads. The sample included 309 Rwandan mother-daughter dyads who had experienced traumatic events. Participants completed the PTSD Checklist for DSM-5 to assess PTSD symptoms, the Life Events Checklist to measure traumatic experiences, and the Nicholson McBride Resilience Questionnaire to evaluate their resilience levels. The data were analyzed using Actor-Partner Interdependence Model statistical techniques. Results show associations of mothers’ resilience and resilience of their daughters with mothers’ resilience negatively associated with their own and their daughters’ PTSD symptoms, while daughters’ resilience is negatively associated with their own and their mothers’ PTSD symptoms. Furthermore, mothers’ traumatic experiences were positively associated with both their own PTSD symptoms and those of their daughters. In contrast, daughters’ traumatic experiences were only associated with their own PTSD symptoms. Resilience and traumatic experiences of mothers and daughters mutually impact their PTSD symptoms, suggesting that interventions targeting both resilience and trauma could benefit both generations. Furthermore, parents transmit not only their PTSD symptoms but also their resilience. Notably, the resilience of children can have a reciprocal impact positively influencing both their own well-being and that of their parents.

This article describes the administration of a heart rate variability (HRV) biofeedback intervention designed to reduce posttraumatic stress disorder (PTSD) severity in post-9/11 service members. The study recruited 33 male OEF/OIF/OND combat veterans in a Los Angeles transitional housing program. Twenty-seven veterans completed the study. Participants attended eight once-weekly HRV biofeedback group sessions. For the first four weeks, veterans learned to use biofeedback to regulate physiological stress responses. The latter four weeks consisted of real-life biofeedback application and coaching. Results suggest that consistent HRV biofeedback practice was essential for HRV improvement, which may help alleviate PTSD.

Emotional Reactivity in Posttraumatic Stress Disorder:Behavioural and Neurobiological Correlates of Underlying Mechanisms and the Role of Emotional Memory Modification

The relationship between recent PTSD secondary to sexual assault, hippocampal volume and resting state functional connectivity in adolescent girls

This study aimed to examine the same-sex matching effect of posttraumatic stress disorder (PTSD) symptoms from parents to children and the mediating role of children' sense of security and catastrophization. Longitudinal data from 447 parent-child dyads were acquired using self-report scales. Parents (77.0% mothers; Mage = 40.15 years old) reported their PTSD symptoms 3 months after Super Typhoon Lekima, and children (55.9% girls; Mage = 13.40 years old) reported their PTSD symptoms, sense of security, and catastrophization 3 months and 15 months after the typhoon. Results showed that intrusion in mothers predicated intrusion, avoidance, and hyperarousal symptoms in daughters, while avoidance and hyperarousal in mothers predicted the same symptoms in daughters. This was not observed in any other parent-child dyads. Moreover, mothers' intrusion positively predicted daughters' PTSD symptoms via daughters' sense of security and then catastrophization, while mothers' hyperarousal showed the opposite prediction. These findings suggest that a same-sex matching effect occurs from mothers to daughters in terms of intrusion, avoidance, and hyperarousal symptoms of PTSD. Thus, clinical interventions that target daughters' PTSD symptoms should also consider mothers' intrusion and avoidance symptoms. Moreover, it may be possible to develop interventions to improve daughters' sense of security.

ABSTRACTObjectives: This study aimed to assess the underexplored effects of posttraumatic stress disorder (PTSD) symptoms on objective and subjective successful aging and to inquire whether emotional complexity moderates these effects.Methods: Community-dwelling older adults (N = 127, mean age = 67.86, SD = 11.07) rated their PTSD symptoms and completed measures of objective and subjective successful aging. They further reported their emotions on a daily basis over 14 days.Results: After controlling for background characteristics, self-rated health and cumulative lifetime adversity, results showed that higher PTSD symptoms were related to less successful aging, both objective and subjective. However, this relationship existed only amongst older adults with low emotional complexity, but not amongst those with high emotional complexity.Conclusion: The findings suggest that high emotional complexity buffers against the negative effects of PTSD symptoms on successful aging. Interventions that empower emotional complexity amongst traumatized older adults may attenuate these negative effects.

To evaluate the association between trauma exposure type, number and type of DSM-5 posttraumatic stress disorder (PTSD) symptoms, and binge eating symptoms. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III: 2012-2013), which surveyed a nationally representative sample of 36,309 non-institutionalized US civilians aged 18 years and older. Trauma exposure, PTSD, and binge eating symptoms were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5). Three groups were compared: trauma-exposed individuals with no/low PTSD symptoms, those with subthreshold PTSD, and those with threshold PTSD. Among both men and women, zero-inflated negative binomial regression analyses demonstrated that individuals with subthreshold and threshold PTSD endorsed a greater number of binge eating symptoms than trauma-exposed individuals with no/low PTSD symptoms (unstandardized coefficient [B] range, 0.33-0.92). Relative to witnessing trauma, combat-related trauma was associated with fewer binge eating symptoms in men (B = -0.62, SE = 0.17), while child maltreatment was associated with a greater number of binge eating symptoms in women (B = 0.28, SE = 0.12). Negative cognitions and mood symptoms in particular were associated with a greater number of binge eating symptoms (B range, 0.09-0.10). Subthreshold and threshold PTSD are associated with binge eating symptoms in both men and women. Similar to drugs and alcohol, binge eating may be used as a strategy to alleviate distressing symptoms of PTSD.