Integrating a Portable Biofeedback Device into Clinical Practice for Patients with Anxiety Disorders: Results of a Pilot Study

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.

[1]  Daniel J. Cox,et al.  Increasing adherence to behavioral homework assignments , 1988, Journal of Behavioral Medicine.

[2]  John T. Cacioppo,et al.  Heart Rate Variability: Stress and Psychiatric Conditions , 2007 .

[3]  J. Thayer,et al.  Spectral characteristics of heart period variability during cold face stress and shock avoidance in normal subjects , 1996, Clinical Autonomic Research.

[4]  G. Strauss-Blasche,et al.  Relative Timing Of Inspiration And Expiration Affects Respiratory Sinus Arrhythmia , 2000, Clinical and experimental pharmacology & physiology.

[5]  Juhani Airaksinen,et al.  Anxiety and Hostility Are Associated With Reduced Baroreflex Sensitivity and Increased Beat-to-Beat Blood Pressure Variability , 2003, Psychosomatic medicine.

[6]  The Effects of Exercise , 1980 .

[7]  R. Fried,et al.  The psychology and physiology of breathing : in behavioral medicine, clinical psychology, and psychiatry , 1993 .

[8]  G Arnold,et al.  Effect of respiration rate on short-term heart rate variability , 1999 .

[9]  W. Agras,et al.  Adherence to instructions to practice relaxation exercises. , 1983, Journal of consulting and clinical psychology.

[10]  P. Lehrer,et al.  Research on clinical issues in stress management. , 2007 .

[11]  V. Somers,et al.  Heart Rate Variability: , 2003, Journal of cardiovascular electrophysiology.

[12]  S. Seaman,et al.  Client implementation of therapist recommendations predicted by client perception of fit, difficulty of implementation, and therapist influence , 1999 .

[13]  Donald W. Novey.  Clinician's Complete Reference to Complementary/Alternative Medicine , 2000 .

[14]  P. Lehrer,et al.  Resonant Frequency Biofeedback Training to Increase Cardiac Variability: Rationale and Manual for Training , 2000, Applied psychophysiology and biofeedback.

[15]  R Balon,et al.  Decreased R‐R variance in panic disorder patients , 1990, Acta psychiatrica Scandinavica.

[16]  M H Bonnet,et al.  Heart Rate Variability in Insomniacs and Matched Normal Sleepers , 1998, Psychosomatic medicine.

[17]  V. Mashin,et al.  Analysis of the heart rate variability in negative functional states in the course of psychological relaxation sessions , 2000, Human Physiology.

[18]  Evgeny G. Vaschillo,et al.  Communications to the EditorHeartbeat Synchronizes With Respiratory Rhythm Only Under Specific Circumstances , 2004 .

[19]  L. K. Tripathi,et al.  Respiration And Heart Rate Variability : A Review With Special Reference To Its Application In Aerospace Medicine , 2022 .

[20]  Bronya Vaschillo,et al.  Heartbeat synchronizes with respiratory rhythm only under specific circumstances. , 2004, Chest.

[21]  P G Katona,et al.  Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control. , 1975, Journal of applied physiology.

[22]  R. Tarazi,et al.  Assessment of parasympathetic control of heart rate by a noninvasive method. , 1984, The American journal of physiology.

[23]  Paul D. Bromley,et al.  Effects of exercise on heart rate variability: inferences from meta-analysis. , 2005, Medicine and science in sports and exercise.

[24]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[25]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[26]  B. Moely,et al.  The WISC-R Third Factor: What does it mean? , 1983 .

[27]  P. Grossman,et al.  Anxiety reduces baroreflex cardiac control in older adults with major depression. , 1999, Psychosomatic medicine.

[28]  J. Murdoch.  A Technique for Assessing Adherence to Relaxation Training Instructions , 2000, Psychological reports.

[29]  D. Brodie,et al.  Effects of Short-Term Psychological Stress on the Time and Frequency Domains of Heart-Rate Variability , 2000, Perceptual and motor skills.

[30]  Download Here.  State-Trait Anger Expression Inventory , 2006 .

[31]  Robert L. Woolfolk,et al.  Principles and practice of stress management, 3rd ed. , 2007 .

[32]  N. Kazantzis.  Power to detect homework effects in psychotherapy outcome research. , 2000, Journal of consulting and clinical psychology.

[33]  P. Lehrer,et al.  Principles And Practice Of Stress Management , 1984 .

[34]  K. Junghanns,et al.  Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. , 2002, Journal of psychosomatic research.

[35]  Catherine M. Stoney,et al.  Depressed Mood Is Related to High-Frequency Heart Rate Variability During Stressors , 2000, Psychosomatic medicine.

[36]  Weichung Joe Shih,et al.  Heart Rate Variability Biofeedback Increases Baroreflex Gain and Peak Expiratory Flow , 2003, Psychosomatic medicine.

[37]  F. Nieto,et al.  Effects of an angry temperament on coronary heart disease risk : The Atherosclerosis Risk in Communities Study. , 2001, American journal of epidemiology.

[38]  Julian F. Thayer,et al.  Autonomic characteristics of generalized anxiety disorder and worry , 1996, Biological Psychiatry.

[39]  D L Eckberg,et al.  Human sinus arrhythmia as an index of vagal cardiac outflow. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[40]  F. Deane,et al.  PSYCHOLOGISTS' USE OF HOMEWORK ASSIGNMENTS IN CLINICAL PRACTICE , 1999 .

[41]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[42]  Mark S. Schwartz,et al.  Biofeedback: A Practitioner's Guide , 1987 .

[43]  S. Porges.  The polyvagal perspective , 2007, Biological Psychology.

[44]  Shou-En Lu,et al.  Heart rate variability biofeedback: effects of age on heart rate variability, baroreflex gain, and asthma. , 2006, Chest.

[45]  H. Rüddel,et al.  Autonomic Dysfunctions in Patients with Anxiety Throughout Therapy , 2004 .