Brief Heart Rate Variability Biofeedback for. Chrys Kim & David Eddie
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1 Brief Heart Rate Variability Bifeedback fr Yung Adults Receiving Inpatient Treatment fr Substance Use Disrders Chrys Kim & David Eddie AAPB Prtland, May 16, 2013
2 Intrductin Substance use disrders (SUDs) are precipitusly p difficult t treat. Cgnitive and behaviral treatments are effective fr many, yet majrity f individuals receiving treatment are nt able t maintain abstinence after treatment. Remains a need fr effective treatments that cnsider physilgical, as well as psychlgical mechanisms cntributing t SUDs.
3 Intrductin Heart rate variability bifeedback (HRV BFB) is an effective treatment fr depressin. Usually delivered ver weekly sessins. HRV BFB might be an effective addendum t traditinal SUD treatments. Inpatient SUD treatment, hwever, is traditinally 4 weeks, nt
4 Intrductin Investigated feasibility and efficacy f brief, 3-sessin HRV BFB interventin, designed t fit int the cnfines f traditinal 28-day SUD inpatient treatment prgram. Cllabrated with Carn Fundatin t deliver HRV BFB interventin, alng with treatment as usual at 28-day inpatient rehabilitatin facility.
5 Participants 48 nging admissins frm Yung Adult Male unit (ages 20 25) at Carn Treatment Center (Wernersville, PA). Inclusin criteria At least seventy-tw tw hurs since last use f alchl r ther drugs. Cmpleted detx. Exclusin criteria Having received previus HRV BFB training. Any serius medical cnditin (pacemaker, cardiac arrhythmia, hypertensin, diabetes). Severe psychiatric cnditin (e.g., psychsis), r neurlgical cnditin (e.g., Parkinsn s Disease) that wuld cntraindicate physilgical assessment and interpretatin. Patients t currently taking medicatins such as MAOIs, alpha/beta blckers, r mst detxificatin medicatins (e.g., Librium, methadne) were excluded.
6 Physilgical Measures Electrcardigram (ECG): Pre-amplified electrcardigraph sensrs; psitive, negative, and grund electrdes attached t participant s arms and ankle (Thught Technlgy Infinity). Finger pulse: A bld vlume pulse (BVP) phtplethysmgraph sensr affixed t the right index finger. Skin temperature: Thermistr sensr affixed t the right index finger. Respiratin: High durability strain gauge latex rubber band fixed with velcr respiratin belt placed arund abdmen. Skin Cnductance: Tw silver-silver chlride electrdes affixed t thenar eminence and hypthenar eminence f the palm f the right hand.
7 Psychlgical Measures Reasns fr Drinking/Using g Questinnaire: 29-item questinnaire (Labuvie & Bates, 2002) assesses reasns that an individual engages in substance use. Cntains three subscales (scial, disinhibitin, and suppressin). Items cded n a 3-pint scale frm Nt at all imprtant t Very Imprtant. Penn Alchl Craving Scale (mdified; PACS): Five-item instrument fr assessing craving (Flannery, Vlpicelli, & Pettinati, 1999). Frequency, intensity, and duratin f thughts abut substance use assessed alng with ability t resist using.
8 Psychlgical Measures Fllw-up questinnaire 23-item questinnaire including measures f craving, depressin, anxiety, smnlence, cnfidence f maintaining sbriety in cming mnth. Delivered ver phne at 1, 2 and 3 mnths after discharge frm treatment.
9 Experimental Grup * Jennings, J. R., Kamarck, T., Stewart, C., Eddy, M., & Jhnsn, P. (1992). Alternate cardivascular baseline assessment techniques: Vanilla r resting baseline. Psychphysilgy, 29,
10 Cntrl Grup
11 Results 48 initial participants, p 5 drpped after leaving the treatment facility fr persnal reasns. (3 experimental & 2 cntrls) 1 excluded d because f arrhythmia. h 1 participant s data excluded frm analysis due t an ECG recrding errr. N utliers detected. Final n= 41
12 Results All participants had at least 2 SUD diagnses. All participants met criteria fr dependence fr at least ne substance. Experimental participants practiced with EmWave bifeedback device minutes a day (SD= 12.02).
13 Physilgical changes in experimental grup frm baseline t resnance frequency breathing task during sessin 1 Ntes. n = 41; HR= heart rate, pnn50= percent f nrmal-t-nrmal intervals greater than 50ms, SDNN= standard deviatin f nrmal-t-nrmal intervals, Rmssd= square rt f the mean squared difference f successive nrmalt-nrmal intervals, Hf HRV= high frequency range f the pwer spectral analysis, Lf HRV= lw frequency range f the pwer spectral analysis, Vlf HRV= very lw frequency range f the pwer spectral analysis
14 4 RRI Spectrum PSD [10^5 ms^2/hz] Sessin1, Task 1 (Baseline / Plain Vanilla) Participant #44 Experimental Grup Frequency [Hz] 4 RRI Spectrum Sessin1, Task 2 (breathing at 6 breaths per minute) PSD [10^5 ms^2/hz] ] Frequency [Hz] 4 RRI Spectrum Sessin1, Task 3 (breathing at resnance frequency breaths per minute) [10^5 ms^2/hz] PSD Frequency [Hz]
![5 Frequency [Hz] 4 RRI Spectrum Sessin1, Task 2 (breathing at 6 breaths per minute) PSD [10^5 ms^2/hz] ]3 2 1 0](/docs-images/56/7784196/images/page_14.jpg "0.0 0.1 0.2 0.3 0.4 0.5 Frequency [Hz] 4 RRI Spectrum Sessin1, Task 3 (breathing at resnance frequency - 4.")
15 Physilgical changes in experimental grup frm pre-sessin t end f sessin during sessin 1 Ntes. n = 41
16 Physilgical differences between experimental and cntrl grups at baseline, sessin 3
17 Ttal reductin in alchl and drug craving frm sessin 1 t sessin 3, by grup. Tta lreduc n incraving( (Sessin1 3) Change= 18.3% 8 participants p saw reductin >50% Change= 12.5% 5 participants saw reductin >50% 7 ExperimentalGrupCntrlGrup 95% CI [-7.5, -3.2] 95% CI [-6.4, -1.1] t(39) =.99, p =.33, d =.35
18 Results Fllw-up Experimental grup: - 18 cmpleted fllw-up 1-15 cmpleted fllw-up 2-11 cmpleted fllw-up 3 Cntrl grup: - 9 cmpleted fllw-up 1-2 cmpleted fllw-up 2-1 cmpleted fllw-up 3
19 Pstscript Anecdtal feedback frm participants was extremely psitive, especially frm thse with cmrbid anxiety/panic disrders. Clinical staff nticed a treatment effect and encuraged their patients ts t participate pate in the trial. HRV BFB is nw a standard interventin used in the yung adult units at the facility. Patients learn HRV BFB using handheld bifeedback devices ne-n-ne with cunselrs and practice in grup.
20 Cnclusins N significant differences in within treatment craving between grups, but effect size is prmising. Fllw-up was nt successful. Unable t determine psttreatment effects. Pssible allegiance effects Anecdtal feedback was very psitive. Brief HRV BFB may have imprtant utility regardless f chrnic effects n HRV.
21 Cntributrs Chrys Kim MA 1 David Eddie MS 1 Marsha E. Bates PhD 1 Paul Lehrer PhD 2 Erin Deneke PhD 3 Tm Deitzler CADC, CCS, CCDP, CCJP 3 Brnya Vaschill MD 1 Evgeny Vaschill PhD 1 1 Rutgers University, Center f Alchl Studies, Piscataway NJ 2 University f Medicine & Dentistry New Jersey, Piscataway NJ 3 Carn Fundatin, Wernersville PA Please send crrespndence t David Eddie, [email protected]
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