Abstract
This study examined the effectiveness of a portable Respiratory Sinus Arrhythmia (RSA) biofeedback device as an adjunct to CBT in persons with anxiety disorders and other disorders associated with autonomic dysfunction attending outpatient treatment. Participants were 24 individuals attending outpatient cognitive behavioral treatment for a range of anxiety disorders. Participants were assessed over a 3 week period. Outcomes included measures of anxiety (STAI-Y), sleep disturbances (PSQI), anger (STAEI), and subjective questions about the effectiveness of the device as a treatment adjunct. Significant reductions were found for anxiety and anger and for certain sleep variables (e.g. sleep latency). There was a significant dos–effect in that those who were more compliant had significantly greater reductions in most domains including sleep, anger and trait anxiety. Overall, participants found the device more helpful than other relaxation techniques such as mediation, yoga and unassisted breathing techniques but less helpful than exercise. The most frequently endorsed side effects were dizziness (15%) and sleepiness (55%). These preliminary results suggest that portable RSA biofeedback appears to be a promising treatment adjunct for disorders of autonomic arousal and is easily integrated into treatment. Results support the need for further investigation with more rigorous experimental designs.
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Backhaus, J., Junghanns, K., Broocks, A., Riemann, D., & Hohagen, F. (2002). Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research, 53(3), 737–740.
Barlow, D. (1988). Anxiety and its disorders. New York: Guilford Press.
Berntson, G. G., & Cacioppo, J. T. (2004). Heart rate variability: Stress and psychiatric conditions. In M. Malik & A. J. Camm (Eds.), Dynamic electrocardiography (pp. 57–64). New York: Blackwell/Futura.
Bonnet, M. H., & Arand, D. (1998). Heart rate variability in insomniacs and matched normal sleepers. Psychosomatic Medicine, 60(5), 610–615.
Buysee, D., Reynolds, C., Monk, T., Berman, S., & Kupfer, D. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.
Cox, D. J., Tisdelle, D. A., & Culbert, J. P. (1988). Increasing adherence to behavioral homework assignments. Journal of Behavioral Medicine, 11, 519–522.
Delaney, J. P., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91, 515–524.
Eckberg, D. (1983). Human sinus arrhythmia as an index of vagal cardiac outflow. Journal of Applied Physiology, 54(4), 961–966.
Fouad, F. M., et al. (1984). Assessment of parasympathetic control of heart rate by a noninvasive method. American Journal of Physiology, 246, 838–842.
Fried, R., & Grimaldi, J. (1993). The psychology and physiology of breathing in behavioral medicine, clinical psychology and psychiatry. New York: Plenum.
Friedman, B. H., Thayer, J. F., & Tyrrell, R. A. (1996). Spectral characteristics of heart period variability during cold face stress and shock avoidance in normal subjects. Clinical Autonomic Research, 6, 147–152.
Hughes, J. W., & Stoney, C. M. (2000). Depressed mood is related to high-frequency heart rate variability during stressors. Psychosomatic Medicine, 62, 796–803.
Gevirtz R., & Lehrer P. (2003). Resonant frequency heart rate biofeedback. In M. S. Schwartz & F. Andrasik (Eds.), Biofeedback: A practitioner’s guide (pp. 245–250). Guilford Press.
Greenberg, J. S. (2004). Comprehensive stress management. MA: McGraw-Hill College.
Katona, P., et al. (1975). Respiratory sinus arrhythmia: Noninvasive measure of parasympathetic cardiac control. Journal of Applied Physiology, 39(5), 801–805.
Kazantzis, N. (2000). Power to detect homework effects in psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 68, 166–170.
Kazantzis, N., & Deane, F. (1999). Psychologists’ use of homework assignments in clinical practice. Professional Psychology: Research and Practice, 20, 581–585.
Lehrer, P. M. (2007). Biofeedback training to increase heart rate variability. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed., pp. 227–248). NY: Guilford.
Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback, 25, 177–191.
Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S.-E., Eckberg, D. L., Edelberg, R., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805.
Lehrer, P. M., & Woolfolk, R. L. (2007). Research on clinical issues in stress management. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed., pp. 703–721). NY: Guilford.
Mashin, V., & Mashina, M. (2000). Analysis of the heart rate variability in negative functional states in the course of psychological relaxation sessions. Human Physiology, 26(4), 420–425.
Murdoch, J. (2000). A technique for assessing adherence to relaxation training instructions. Psychological Reports, 87(2), 523–524.
Mussgay, L., & Ruddel, H. (2004). Autonomic dysfunctions in patients with anxiety throughout therapy. Journal of Psychophysiology, 18(1), 27–37.
Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74, 116–143.
Sandercock, G., Bromley, P., & Brodie, D. (2005). Effects of exercise on heart rate variability: Inferences from meta-analysis. Medicine and Science in Sports and Exercise, 37(3), 433–439.
Scheel, M. J., Seaman, S., Roach, K., Mullin, T., & Blackwell-Mahoney, K. (1999). Client implementation of therapist recommendations predicted by client perception of fit, difficulty of implementation, and therapist influence. Journal of Counseling Psychology, 46, 1–9.
Schipke, J. D., et al. (1999). Effect of respiration rate on short-term heart rate variability. Journal of Clinical Basic Cardiology, 2, 92–95.
Schwartz, M. (1987). Biofeedback: A practitioners guide. New York. Guilford.
Spielberger, C. D. (1988). State-Trait Anger Expression Inventory. Orlando, FL: Psychological Assessment Resources.
Spielberger, C. D. (1989). State-Trait Anxiety Inventory: A comprehensive bibliography. Palo Alto, CA: Consulting Psychologists Press.
Spielberger, C. D., Gorsuch, R. L., Luschene, R. E, Vagg, P. R., & Jacobs, G.A. (1983). Manual for the State-Trait Anxiety Inventory form Y. CA: Mind Garden Press.
Strauss-Blasche, G., Moser, M., et al. (2000). Relative timing of inspiration and expiration affects respiratory sinus arrhythmia. Clinical and Experimental Pharmacology and Physiology, 27, 601–606.
Sultanoff, B., & Zalaquett, C. (2000). Relaxation therapies. In D. Novey (Ed.), Clinician’s complete reference to complementary & alternative medicine (pp. 114–129). New York: Mosby.
Taylor, C. B., Agras S. W., Schneider, J. A., & Allen, R. A. (1983). Adherence to instructions to practice relaxation exercises. Journal of Consulting & Clinical Psychology, 51(6), 940–941.
Thayer, J. F., Friedman, B. H., & Borkovec, T. D. (1996). Autonomic characteristics of generalized anxiety disorder and worry. Biological Psychiatry, 39, 255–266.
Tripathi Lt. Col. K. K. (2004). Respiration and heart rate variability: A review with special reference to its application in aerospace medicine. Indian Journal of Aerospace Medicine, 48(1), 64–75.
Vaschillo, E., Vaschillo, B, & Lehrer, P. M. (2004). Heartbeat synchronizes with respiratory rhythm only under specific circumstances. Chest, 126, 1385–1386.
Virtanen, R., et al. (2003). Anxiety and hostility are associated with reduced baroreflex sensitivity and increased beat-to-beat blood pressure variability. Psychosomatic Medicine, 65(5), 751–756.
Watkins, L. L., Grossman, P., Krishnan, R., & Blumenthal, J. A. (1999). Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosomatic Medicine, 61, 334–340.
Williams, J. E., Nieto, F. J., Sanford, C. P., et al. (2001). Effects of an angry temperament on coronary heart disease risk: The atherosclerosis risk in communities study. American Journal of Epidemiology, 154, 230–235.
Yeragani, V. K., Balon, R., Pohl, R., Ramesh, C., Glitz, D., Weinberg, P., & Merlos, B. (1995). Decreased R–R variance in panic disorder patients. Acta Psychiatrica Scandinavica, 81, 554–559.
Yucha, C., & Gilbert, C. (2004). Evidence based practice in biofeedback & neurofeedback. Wheat Ridge, CO: AAPB.
Acknowledgements
The study was supported by a grant from the Helicor, Inc., the makers of the Stress Eraser portable biofeedback device used in the current study. Investigators have no other financial conflicts of interest with the Sponsor. The author would like to acknowledge Doug Seiden, Miguel Humara, Jamie Albin, and Frederick Muench for their involvement with the study and preparation of this manuscript.
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This study was conducted at the Behavioral Associates and The CBT Institute in New York, NY from 6/06 through 8/06.
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Reiner, R. Integrating a Portable Biofeedback Device into Clinical Practice for Patients with Anxiety Disorders: Results of a Pilot Study. Appl Psychophysiol Biofeedback 33, 55–61 (2008). https://doi.org/10.1007/s10484-007-9046-6
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DOI: https://doi.org/10.1007/s10484-007-9046-6