Advertisement

Applied Psychophysiology and Biofeedback

, Volume 44, Issue 1, pp 9–20 | Cite as

Pilot Study of a Single Session Heart Rate Variability Biofeedback Intervention on Veterans’ Posttraumatic Stress Symptoms

  • Donna L. SchumanEmail author
  • Michael O. Killian
Article

Abstract

Veterans with posttraumatic stress symptoms exhibit reduced heart rate variability characteristic of autonomic nervous system dysregulation. Studies show heart rate variability biofeedback (HRVB) is effective in reducing posttraumatic stress symptoms by improving autonomic functioning. Participants in this pilot study were veterans of different war eras with military-related posttraumatic stress symptoms. The study aims were to examine the impact of a single session HRVB intervention on posttraumatic stress symptoms and heart rate variability, test persistence of effects, and determine if veterans would find the intervention acceptable. One group (n = 6) received training in diaphragmatic breathing and heart rate variability biofeedback, augmented by twice-daily practice using a smart phone and breath pacing app. A second group (n = 6) received only a single session of diaphragmatic breathing training. After 4 weeks, participants in the second group (n = 5) received the full intervention. HRVB significantly reduced global posttraumatic stress symptoms, whereas diaphragmatic breathing alone did not. Further, veterans found the approach acceptable, as demonstrated by a high degree of adherence with prescribed practice, low study attrition, and continued use over time. Results of this pilot study warrant further refinement of a protocol utilizing mHealth to treat posttraumatic stress symptoms in military populations.

Keywords

Heart rate variability Posttraumatic stress disorder Veterans Autonomic 

Notes

Acknowledgements

This research was supported by the Pat Tillman Foundation, the Foundation for Education and Research in Biofeedback (FERB), and a university graduate dissertation enhancement grant as part of a Three Paper Dissertation. We extend a special thanks to Dr. Wesley Center, Jeff Hensley, LPC, and Elizabeth Reep, LCSW, for their contributions to this research project. The lead author wishes to thank her dissertation committee for guidance during all phases of the research, and Bryan Butler, LPC and Kristen Elliott, LPC for assistance with preliminary data collection. Both authors wish to acknowledge Dr. Paul Lehrer for feedback and guidance. We wish to thank Ian Boggero, PhD, Cincinnati Children’s Hospital, Cincinnati, OH, for editing assistance and statistical consultation and Kristen McQuerry, PhD, Center for Clinical and Translational Science, Applied Statistics Laboratory, University of Kentucky, for statistical consultation.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This human subjects study was approved by the university Institutional Review Board and was performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and subsequent amendments.

Informed Consent

All participants gave informed consent prior to study inclusion. Any details that could possibly identify participants were omitted.

References

  1. 3-D Yoga. (2008). Demo for “mechanics of respiration” CD ROM. Retrieved from https://www.youtube.com/watch?v=hp-gCvW8PRY.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Erlbaum.Google Scholar
  4. Eddie, D., Kim, C., Lehrer, P., Deneke, E., & Bates, M. E. (2014). A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders. Applied Psychophysiology and Biofeedback, 39(3–4), 181–192.CrossRefGoogle Scholar
  5. Erbes, C. R., Stinson, R., Kuhn, E., Polusny, M., Urban, J., Hoffman, J., et al. (2014). Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD. Military Medicine, 179(11), 1218–1222.  https://doi.org/10.7205/MILMED-D-14-00014.CrossRefGoogle Scholar
  6. Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953.  https://doi.org/10.1037/0022-006X.73.5.953.CrossRefGoogle Scholar
  7. Ginsberg, J. P., Berry, M. E., & Powell, D. A. (2010). Cardiac coherence and posttraumatic stress disorder in combat veterans. Alternative Therapies in Health and Medicine, 16(4), 52–60.Google Scholar
  8. Gross, M. J., Shearer, D. A., Bringer, J. D., Hall, R., Cook, C. J., & Kilduff, L. P. (2016). Abbreviated resonant frequency training to augment heart rate variability and enhance on-demand emotional regulation in elite sport support staff. Applied Psychophysiology and Biofeedback, 41(3), 263–274.  https://doi.org/10.1007/s10484-015-9330-9.CrossRefGoogle Scholar
  9. Grunert, B. K., Weis, J. M., Smucker, M. R., & Christianson, H. F. (2007). Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 317–328.  https://doi.org/10.1016/j.jbtep.2007.10.005.CrossRefGoogle Scholar
  10. Hassija, C. M., Jakupcak, M., & Gray, M. J. (2012). Numbing and dysphoria symptoms of posttraumatic stress disorder among Iraq and Afghanistan war veterans: A review of findings and implications for treatment. Behavior Modification, 36(6), 834–856.  https://doi.org/10.1177/0145445512453735.CrossRefGoogle Scholar
  11. Keane, T., Fairbank, J., Caddell, J., Zimering, R., Taylor, K., & Mora, C. (1989). Clinical evaluation of a measure to assess combat exposure. Psychological Assessment, 1, 53–55.CrossRefGoogle Scholar
  12. Lehrer, P., Vaschillo, B., Zucker, T., Graves, J., Katsamanis, M., Aviles, M., & Wamboldt, F. (2013). Protocol for heart rate variability biofeedback training. Biofeedback, 41(3), 98–109.  https://doi.org/10.5298/1081-5937-41.3.08.CrossRefGoogle Scholar
  13. 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(3), 177–191.  https://doi.org/10.1023/A:1009554825745.CrossRefGoogle Scholar
  14. Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505.  https://doi.org/10.1037/a0024485.CrossRefGoogle Scholar
  15. Mbuagbaw, L., Van Der Kop, M. L., Lester, R. T., Thirumurthy, H., Pop-Eleches, C., Ye, C., et al. (2013). Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. British Medical Journal Open, 3(12), e003950.  https://doi.org/10.1136/bmjopen-2013-003950.Google Scholar
  16. Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting & Clinical Psychology, 74, 898–907.  https://doi.org/10.1037/0022-006X.74.5.898.CrossRefGoogle Scholar
  17. MyBrainSolutions. (2016). MyCalmBeat (version 2.5) [mobile application software]. Retrieved from https://itunes.apple.com/us/app/mycalmbeat/id333216485?mt=8.
  18. Nagpal, M., Gleichauf, K., & Ginsberg, J. (2013). Meta-analysis of heart rate variability as a psychophysiological indicator of posttraumatic stress disorder. Journal of Trauma & Treatment, 3(2167–1222), 1000182.  https://doi.org/10.4172/2167-1222.1000182.Google Scholar
  19. Omerbegovic, M. (2009). Analysis of heart rate variability and clinical implications. Medical Archives, 63(2), 102–105.Google Scholar
  20. Polak, A. R., Witteveen, A. B., Denys, D., & Olff, M. (2015). Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: A pilot study. Applied Psychophysiology and Biofeedback, 40(1), 25–31.  https://doi.org/10.1007/s10484-015-9268-y.CrossRefGoogle Scholar
  21. Pyne, J. M., Constans, J. I., Wiederhold, M. D., Gibson, D. P., Kimbrell, T., Kramer, T. L., & Gevirtz, R. N. (2016). Heart rate variability: Pre-deployment predictor of post-deployment PTSD symptoms. Biological Psychology, 121, 91–98.  https://doi.org/10.1016/j.biopsycho.2016.10.008.CrossRefGoogle Scholar
  22. Resick, P. A., Galovski, T. E., Uhlmansiek, M. O. B., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243.CrossRefGoogle Scholar
  23. Rosenthal, R. (1994). Parametric measures of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 231–244). New York: Russell Sage Foundation.Google Scholar
  24. Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: Review and methodological considerations. Psychiatry, 71(2), 134–168.  https://doi.org/10.1521/psyc.2008.71.2.134.CrossRefGoogle Scholar
  25. Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health, 99(9), 1651–1658.  https://doi.org/10.2105/AJPH.2008.150284.CrossRefGoogle Scholar
  26. Sheskin, D. J. (2003). Handbook of parametric and nonparametric statistical procedures. Boca Raton: CRC Press.CrossRefGoogle Scholar
  27. Siebert, C. F., & Siebert, D. C. (2017). Data analysis with small samples and non-normal data: Nonparametrics and other strategies. New York: Oxford University Press.Google Scholar
  28. Steenkamp, M. M., & Litz, B. T. (2013). Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence. Clinical Psychology Review, 33(1), 45–53.  https://doi.org/10.1016/j.cpr.2012.10.002.CrossRefGoogle Scholar
  29. Sztajzel, J., Jung, M., & Bayes de Luna, A. (2008). Reproducibility and gender-related differences of heart rate variability during all-day activity in young men and women. Annals of Noninvasive Electrocardiology, 13, 270–277.  https://doi.org/10.1111/j.1542-474X.2008.00231.x.CrossRefGoogle Scholar
  30. Tan, G., Dao, T., Farmer, L., Sutherland, R., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Psychophysiology and Biofeedback, 36(1), 27–35.  https://doi.org/10.1007/s10484-010-9141-y.CrossRefGoogle Scholar
  31. Tan, G., Wang, P., & Ginsberg, J. (2013). Heart rate variability and posttraumatic stress disorder. Biofeedback, 41(3), 131–135.  https://doi.org/10.5298/1081-5937-41.3.05.CrossRefGoogle Scholar
  32. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation, 93(5), 1043–1065.  https://doi.org/10.1161/01.CIR.93.5.1043.CrossRefGoogle Scholar
  33. Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013a). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at http://www.ptsd.va.gov.
  34. Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013b). The PTSD Checklist for DSM-5 (PCL-5). Instrument available from the National Center for PTSD at http://www.ptsd.va.gov.
  35. Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., et al. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392.  https://doi.org/10.1037/pas0000260.CrossRefGoogle Scholar
  36. Zucker, T., Samuelson, K., Muench, F., Greenberg, M., & Gevirtz, R. (2009). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: A pilot study. Applied Psychophysiology and Biofeedback, 34(2), 135–143.  https://doi.org/10.1007/s10484-009-9085-2.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of Social WorkUniversity of KentuckyLexingtonUSA
  2. 2.College of Social WorkFlorida State UniversityTallahasseeUSA

Personalised recommendations