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A Pilot Study of Brief Heart Rate Variability Biofeedback to Reduce Craving in Young Adult Men Receiving Inpatient Treatment for Substance Use Disorders

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Abstract

The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day substance abuse disorder inpatient treatment program. Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over 3 weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a hand-held HRV BFB device. HRV BFB training was well tolerated by participants and supported by treatment staff. Men receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. In addition, an interaction effect was observed in analyses that accounted for baseline craving levels, wherein heart rate variability (HRV) levels at treatment entry were predictive of changes in craving in the TAU group only. Low baseline levels of HRV were associated with increases in craving, whereas higher baseline HRV levels were associated with greater decreases in craving from start to end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Given that alcohol and drug craving often precipitates relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with substance use disorders.

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References

  • Andreotti, C., Thigpen, J. E., Dunn, M. J., Watson, K., Potts, J., Reising, M. M., et al. (2011). Cognitive reappraisal and secondary control coping: Associations with working memory, positive and negative affect, and symptoms of anxiety/depression. Anxiety, Stress & Coping,. doi:10.1080/10615806.2011.631526.

    Google Scholar 

  • Appelhans, B. M., & Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10, 229–240.

    Article  Google Scholar 

  • Benarroch, E. E. (2008). The arterial baroreflex. Neurology, 71, 1733–1738.

    Article  PubMed  Google Scholar 

  • Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79, 307–318.

    Article  PubMed Central  PubMed  Google Scholar 

  • Berridge, K. C. (2012). From prediction error to incentive salience: Mesolimbic computation of reward motivation. European Journal of Neuroscience, 35, 1124–1143.

    Article  PubMed Central  PubMed  Google Scholar 

  • Brody, S., Krause, C., Veit, R., & Rau, H. (1998). Cardiovascular autonomic dysregulation in users of MDMA (“Ecstasy”). Psychopharmacology (Berl), 136, 390–393.

    Article  Google Scholar 

  • Carney, R. M., Saunders, R. D., Freedland, K. E., Stein, P., Rich, M. W., & Jaffe, A. S. (1995). Association of depression with reduced heart rate variability in coronary artery disease. The American Journal of Cardiology, 76, 562–564.

    Article  PubMed  Google Scholar 

  • Cohen, S. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health. The Claremont symposium on applied social psychology (pp. 31–67). Thousand Oaks, CA: Sage Publishing.

    Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.

    Article  PubMed  Google Scholar 

  • Cooke, W. H., Hoag, J. B., Crossman, A. A., Kuusela, T. A., Tahvanainen, K. U. O., & Eckberg, D. L. (1999). Human responses to upright tilt: A window on central autonomic integration. The Journal of Physiology, 517, 617–628.

    Article  PubMed Central  PubMed  Google Scholar 

  • de Maesschalck, R., Jouan-Rimbaud, D., & Massart, D. L. (2000). The mahalanobis distance. Chemometrics and Intelligent Laboratory Systems, 50, 1–18.

    Article  Google Scholar 

  • Diamond, L. M., & Aspinwall, L. G. (2003). Emotion regulation across the life span: An integrative perspective emphasizing self-regulation, positive affect, and dyadic processes. Motivation and Emotion, 27, 125–156.

    Article  Google Scholar 

  • Dishman, R. K., Nakamura, Y., Garcia, M. E., Thompson, R. W., Dunn, A. L., & Blair, S. N. (2000). Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. International Journal of Psychophysiology, 37(2), 121–133.

    Article  PubMed  Google Scholar 

  • First, M. B., & Gibbon, M. (2004). The structured clinical interview for DSM-IV axis I disorders (SCID-I) & the structured clinical interview for DSM-IV axis II disorders (SCID-II). In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment, vol. 2: Personality assessment (pp. 134–143). Hoboken, NJ: Wiley.

    Google Scholar 

  • Flannery, B. A., Volpicelli, J. R., & Pettinati, H. M. (1999). Psychometric properties of the Penn alcohol craving scale. Alcoholism, Clinical and Experimental Research, 23, 1289–1295.

    Article  PubMed  Google Scholar 

  • Forgas, J. P. (2008). Affect and cognition. Perspectives on Psychological Science, 3(2), 94–101.

    Article  Google Scholar 

  • Franken, I. H. A. (2003). Drug craving and addiction: Integrating psychological and neuropsychopharmacological approaches. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 27(4), 563–579.

    Article  PubMed  Google Scholar 

  • Garland, E. L., & Roberts-Lewis, A. (2013). Differential roles of thought suppression and dispositional mindfulness in posttraumatic stress symptoms and craving. Addictive Behaviors, 38, 1555–1562.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gorman, J. M., & Sloan, R. P. (2000). Heart rate variability in depressive and anxiety disorders. American Heart Journal, 140(4), 77–83.

    Article  PubMed  Google Scholar 

  • Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of general psychology, 2, 271–299.

    Article  Google Scholar 

  • Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291.

    Article  PubMed  Google Scholar 

  • Hasin, D. S., Fenton, M. C., Beseler, C., Park, J. Y., & Wall, M. M. (2012). Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients. Drug and Alcohol Dependence, 122(1), 28–37.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hassett, A. L., Radvanski, D. C., Vaschillo, E., Vaschillo, B., Sigal, L. H., Karavidas, M. K., et al. (2007). A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Applied Psychophysiology and Biofeedback, 32(1), 1–10.

    Article  PubMed  Google Scholar 

  • Hewitt, P. L., Flett, G. L., & Mosher, S. W. (1992). The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample. Journal of Psychopathology and Behavioral Assessment, 14(3), 247–257.

    Article  Google Scholar 

  • Ingjaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003a). Reduced heart rate variability in chronic alcohol abuse: Relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54, 1427–1436.

    Article  PubMed  Google Scholar 

  • Ingjaldsson, J. T., Thayer, J. F., & Laberg, J. C. (2003b). Preattentive processing of alcohol stimuli. Scandinavian Journal of Psychology, 44, 161–165.

    Article  PubMed  Google Scholar 

  • Jennings, J. R., Kamarck, T., Stewart, C., Eddy, M., & Johnson, P. (1992). Alternate cardiovascular baseline assessment techniques: Vanilla or resting baseline. Psychophysiology, 29, 742–750.

    Article  PubMed  Google Scholar 

  • Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback, 32(1), 19–30.

    Article  PubMed  Google Scholar 

  • Kemp, A. H., & Quintana, D. S. (2013). The relationship between mental and physical health: Insights from the study of heart rate variability. International Journal of Psychophysiology, 89(3), 288–296.

    Article  PubMed  Google Scholar 

  • Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24(2), 97–129.

    Article  PubMed  Google Scholar 

  • Labouvie, E., & Bates, M. E. (2002). Reasons for alcohol use in young adulthood: Validation of a three-dimensional measure. Journal of Studies on Alcohol, 63, 145–155.

    PubMed  Google Scholar 

  • Lehrer, P., 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.

    Article  PubMed  Google Scholar 

  • Lehrer, P., Vaschillo, E., Vaschillo, B., Lu, S. E., Eckberg, D. L., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65, 796–805.

    Article  PubMed  Google Scholar 

  • Lehrer, P., Vaschillo, E., Vaschillo, B., Lu, S. E., Scardella, A., Siddique, M., et al. (2004). Biofeedback treatment for asthma. Chest Journal, 126, 352–361.

    Article  Google Scholar 

  • Lyonfields, J. D., Borkovec, T. D., & Thayer, J. F. (1995). Vagal tone in generalized anxiety disorder and the effects of aversive imagery and worrisome thinking. Behavior Therapy, 26, 457–466.

    Article  Google Scholar 

  • Malpas, S. C., Whiteside, E. A., & Maling, T. J. (1991). Heart rate variability and cardiac autonomic function in men with chronic alcohol dependence. British Heart Journal, 65, 84–88.

    Article  PubMed Central  PubMed  Google Scholar 

  • McCraty, R., Atkinson, M., & Tomasino, D. (2003). Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. The Journal of Alternative & Complementary Medicine, 9, 355–369.

    Article  Google Scholar 

  • Meule, A., Freund, R., Skirde, A. K., Vögele, C., & Kübler, A. (2012). Heart rate variability biofeedback reduces food cravings in high food cravers. Applied Psychophysiology and Biofeedback, 37(4), 241–251.

    Article  PubMed  Google Scholar 

  • Nolan, R. P., Kamath, M. V., Floras, J. S., Stanley, J., Pang, C., Picton, P., et al. (2005). Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. American Heart Journal, 149, 1137.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187.

    Article  PubMed  Google Scholar 

  • O’Brien, C. P. (2005). Anticraving medications for relapse prevention: A possible new class of psychoactive medications. American Journal of Psychiatry, 162, 1423–1431.

    Article  PubMed  Google Scholar 

  • Paliwal, P., Hyman, S. M., & Sinha, R. (2008). Craving predicts time to cocaine relapse: Further validation of the now and brief versions of the cocaine craving questionnaire. Drug and Alcohol Dependence, 93(3), 252–259.

    Article  PubMed Central  PubMed  Google Scholar 

  • Paul, M., & Garg, K. (2012). The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology and Biofeedback, 37(2), 131–144.

    Article  PubMed  Google Scholar 

  • Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine, 76(Supplement 2), S86–S90.

    Article  PubMed Central  PubMed  Google Scholar 

  • Quintana, D. S., Guastella, A. J., McGregor, I. S., Hickie, I. B., & Kemp, A. H. (2013). Heart rate variability predicts alcohol craving in alcohol dependent outpatients: Further evidence for HRV as a psychophysiological marker of self-regulation. Drug and Alcohol Dependence, 132, 395–398.

    Article  PubMed  Google Scholar 

  • Reyes del Paso, G. A., Langewitz, W., Mulder, L. J. M., Roon, A., & Duschek, S. (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: A review with emphasis on a reanalysis of previous studies. Psychophysiology, 50, 477–487. doi:10.1111/psyp.12027.

    Article  PubMed  Google Scholar 

  • Robinson, T. E., & Berridge, K. C. (1993). The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Research. Brain Research Reviews, 18, 247–291.

    Article  PubMed  Google Scholar 

  • Sinha, R. (2011). New findings on biological factors predicting addiction relapse vulnerability. Current Psychiatry Reports, 13(5), 398–405.

    Article  PubMed Central  PubMed  Google Scholar 

  • Song, H. S., & Lehrer, P. M. (2003). The effects of specific respiratory rates on heart rate and heart rate variability. Applied Psychophysiology and Biofeedback, 28, 13–23.

    Article  PubMed  Google Scholar 

  • Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Psychophysiology and Biofeedback, 36, 27–35.

    Article  PubMed  Google Scholar 

  • Task-Force. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation, 93, 1043–1065.

    Article  Google Scholar 

  • Taylor, J. A., Carr, D. L., Myers, C. W., & Eckberg, D. L. (1998). Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation, 98, 547–555.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., & Friedman, B. H. (2002). Stop that! Inhibition, sensitization, and their neurovisceral concomitants. Scandinavian Journal of Psychology, 43, 123–130.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of Behavioral Medicine, 37, 141–153.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61, 201–216.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart-brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience and Biobehavioral Reviews, 33(2), 81–88.

    Article  PubMed  Google Scholar 

  • Thurber, M. R., Bodenhamer-Davis, E., Johnson, M., Chesky, K., & Chandler, C. K. (2010). Effects of heart rate variability coherence biofeedback training and emotional management techniques to decrease music performance anxiety. Biofeedback, 38(1), 28–40.

    Article  Google Scholar 

  • Tiffany, S. T. (1990). A cognitive model of drug urges and drug-use behavior: Role of automatic and nonautomatic processes. Psychological Review, 97, 147–168.

    Article  PubMed  Google Scholar 

  • Tindell, A. J., Smith, K. S., Berridge, K. C., & Aldridge, J. W. (2009). Dynamic computation of incentive salience: “Wanting” what was never “liked”. The Journal of Neuroscience, 29, 12220–12228.

    Article  PubMed Central  PubMed  Google Scholar 

  • Vaschillo, E., Lehrer, P., Rishe, N., & Konstantinov, M. (2002). Heart rate variability biofeedback as a method for assessing baroreflex function: A preliminary study of resonance in the cardiovascular system. Applied Psychophysiology and Biofeedback, 27, 1–27.

    Article  PubMed  Google Scholar 

  • Vaschillo, E., Vaschillo, B., Buckman, J. F., Bates, M. E., & Pandina, R. J. (2010). Resonances in the cardiovascular system: Investigation and clinical applications. doi:10.5220/0002691200210028.

  • Vaschillo, E., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Applied Psychophysiology and Biofeedback, 31, 129–142.

    Article  PubMed  Google Scholar 

  • Verheul, R., van den Brink, W., & Geerlings, P. (1999). A three-pathway psychobiological model of craving for alcohol. Alcohol and Alcoholism, 34(2), 197.

    Article  PubMed  Google Scholar 

  • Weinstein, A. M., Feldtkeller, B. T., Law, F., Myles, J., & Nutt, D. J. (2000). The processing of automatic thoughts of drug use and craving in opiate-dependent individuals. Experimental and Clinical Psychopharmacology, 8(4), 549–553.

    Article  PubMed  Google Scholar 

  • Wells, R., Outhred, T., Heathers, J. A. J., Quintana, D. S., & Kemp, A. H. (2012). Matter over mind: A randomised-controlled trial of single-session biofeedback training on performance anxiety and heart rate variability in musicians. PLoS ONE, 7(10), e46597.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wills, T. A., Cleary, S., Filer, M., Shinar, O., Mariani, J., & Spera, K. (2001). Temperament and self-control related to early-onset substance use. Prevention Science, 2, 145–163.

    Article  PubMed  Google Scholar 

  • Zucker, T. L., Samuelson, K. W., Muench, F., Greenberg, M. A., & Gevirtz, R. N. (2009). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and post-traumatic stress disorder symptoms: A pilot study. Applied Psychophysiology and Biofeedback, 34, 135–143.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA

    D. Eddie, C. Kim & M. E. Bates

  2. Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

    P. Lehrer

  3. The Caron Foundation, Wernersville, PA, USA

    E. Deneke

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  2. C. Kim
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  3. P. Lehrer
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  4. E. Deneke
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Correspondence to D. Eddie or M. E. Bates.

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Eddie, D., Kim, C., Lehrer, P. et al. A Pilot Study of Brief Heart Rate Variability Biofeedback to Reduce Craving in Young Adult Men Receiving Inpatient Treatment for Substance Use Disorders. Appl Psychophysiol Biofeedback 39, 181–192 (2014). https://doi.org/10.1007/s10484-014-9251-z

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