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Ruchiwit M, Vuthiarpa S, Ruchiwit K, Muijeen K, Phanphairoj K. A Synthesized Model for Applying Stress Management and Biofeedback Interventions in Research Utilization: A Systematic Review and Meta-analysis. Clin Pract Epidemiol Ment Health 2024; 20:e17450179276691. [PMID: 38660573 PMCID: PMC11037511 DOI: 10.2174/0117450179276691231229071003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 04/26/2024]
Abstract
Background Stress management and biofeedback interventions have been shown to be effective in improving mental and physical health outcomes. However, previous research studies and synthesized models for applying these interventions in research utilization are insufficient. Objective This study aimed to synthesize a model for applying stress management and biofeedback interventions in research utilization. Methods A systematic review and meta-analysis were conducted according to the PRISMA guidelines.Multiple studies were used to assess the effectiveness of applying stress management and biofeedback interventions published from 2017 to 2023. The process included identifying the research questions, conducting a comprehensive literature search, assessing study quality, extracting data, synthesizing the data, analyzing and interpreting the findings, drawing conclusions, and making recommendations. Results The results indicated a significant mean effect size without evidence of publication bias. The effect sizes of the subgroups among the study variables were not significantly different [Q = 4.02, p = .26]. However, there were significant differences regarding the mean effect sizes among the studies [Q = 63.59, p < .001] and also in terms of the test of subgroups among the participants [Q = 8.49, p = .04]. Conclusion The results emphasize the importance of evidence-based practice and highlight the need for ongoing evaluation and refinement of interventions. The proposed model was supported by related theories and research studies in order to ensure the robustness and reliability to guide practice and future research in the field of biofeedback interventions. By following this model, researchers and practitioners can ensure that stress management and biofeedback interventions are evidence-based and are effective in improving mental and physical health outcomes.
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Affiliation(s)
- Manyat Ruchiwit
- Faculty of Nursing, Rattana Bundit University, Pathumthani, Thailand
| | - Sararud Vuthiarpa
- Faculty of Nursing, Rattana Bundit University, Pathumthani, Thailand
| | - Kampol Ruchiwit
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Kasorn Muijeen
- Faculty of Nursing, Thammasat University, Pathumthani, Thailand
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Conway FN, Kane H, Dorsainvil M, Kennedy P, Cance JD. Mobile resonance frequency breathing smartphone application to support recovery among people with opioid use disorder: Study protocol for feasibility study. PLoS One 2024; 19:e0296278. [PMID: 38295049 PMCID: PMC10829996 DOI: 10.1371/journal.pone.0296278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Experiencing drug cravings is an aspect of substance use disorders that frequently compromises the recovery efforts of people who use drugs. Most treatment approaches that address drug cravings either involve cognitive strategies or medication. Few interventions directly address the physiological aspects of craving, such as increased heart rate. Previous research has demonstrated that slow-paced breathing may be effective in managing drug cravings by manipulating an individual's heart rate. The purpose of this paper is to describe a study protocol for an intervention that offers resonance frequency breathing training for managing cravings via a smartphone application (app). METHODS This trial is registered in ClinicalTrials.gov (Identifier: NCT05830773). The intervention focuses on persons in recovery from opioid use disorder who receive services from the Texas Health and Human Service Commission Recovery Support Services division. Participants will be trained to use Camera Heart Rate Variability (CHRV), a resonance frequency breathing app. The CHRV app measures heart rate and the volumetric variations of blood circulation. When experiencing stress, anxiety, or cravings, participants will use the app to practice breathing exercises. Participants (N = 60) will also complete surveys at baseline, 4 weeks, and 8 weeks; the survey questions, covers demographic characteristics, personal trauma history, substance use experience, and utilization of substance use treatment services. The surveys will also include psychosocial measures of craving, stress, and anxiety to allow the study team to assess changes between baseline and study completion. Participants who complete the full 8-week intervention will be invited to participate in a 30-minute interview about their experience with the app. Interviews will provide details on implementation outcomes, including acceptability, appropriateness, and feasibility. CONCLUSION Many evidence-based interventions for opioid use require interpersonal communication with individuals in one's recovery network. However, individuals may be unable to engage others in their recovery network in the moments when they are experiencing cravings or stress- and anxiety-related triggers. Therefore, recovery support interventions that emphasize individual self-management of cravings, stress, and anxiety when they occur can empower individuals in recovery and enhance existing interventions.
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Affiliation(s)
- Fiona N. Conway
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Heather Kane
- RTI International, Durham, North Carolina, United States of America
| | | | - Patrick Kennedy
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jessica D. Cance
- RTI International, Durham, North Carolina, United States of America
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Lin J, Namaky N, Costello M, Uchino BN, Allen JP, Coan JA. Social Regulation of the Neural Threat Response Predicts Subsequent Markers of Physical Health. Psychosom Med 2023; 85:763-771. [PMID: 37531617 PMCID: PMC10837312 DOI: 10.1097/psy.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Social support has been linked to a vast range of beneficial health outcomes. However, the physiological mechanisms of social support are not well characterized. Drawing on functional magnetic resonance imaging and health-related outcome data, this study aimed to understand how neural measures of "yielding"-the reduction of brain activity during social support-moderate the link between social support and health. METHODS We used a data set where 78 participants around the age of 24 years were exposed to the threat of shock when holding the hand of a partner. At ages 28 to 30 years, participants returned for a health visit where inflammatory activity and heart rate variability were recorded. RESULTS Findings showed a significant interaction between dorsal anterior cingulate cortex-related yielding and perceived social support on C-reactive protein levels ( β = -0.95, SE = 0.42, z = -2.24, p = .025, 95% confidence interval = -1.77 to -0.12). We also found a significant interaction between hypothalamus-related yielding and perceived social support on baseline heart rate variability ( β = 0.51, SE = 0.23, z = 2.19, p = .028, 95% confidence interval = 0.05 to 0.97). CONCLUSIONS Greater perceived social support was associated with lower C-reactive protein levels and greater baseline heart rate variability among individuals who were more likely to yield to social support in the dorsal anterior cingulate cortex and hypothalamus years earlier. The current study highlights the construct of yielding in the link between social support and physical health.
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Affiliation(s)
- Jingrun Lin
- Department of Psychology, University of Virginia
| | - Nauder Namaky
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, and RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center
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Lalanza JF, Lorente S, Bullich R, García C, Losilla JM, Capdevila L. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback 2023; 48:275-297. [PMID: 36917418 PMCID: PMC10412682 DOI: 10.1007/s10484-023-09582-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Heart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported.
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Affiliation(s)
- Jaume F Lalanza
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sonia Lorente
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Area, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Raimon Bullich
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carlos García
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lluis Capdevila
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Departament of Basic Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
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Ruyak S, Roberts MH, Chambers S, Ma X, DiDomenico J, De La Garza R, Bakhireva LN. The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women. Alcohol Clin Exp Res 2023; 47:1088-1099. [PMID: 37526587 PMCID: PMC10394275 DOI: 10.1111/acer.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Accepted: 03/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The SARS-CoV-2/COVID-19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS-CoV-2/COVID-19 pandemic via a baseline self-report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women. METHODS Pregnant and postpartum women were identified from the ENRICH-2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14-day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within-subject (WS) and between-subject (BS) effects and adjusted for pregnancy status and participant age. RESULTS The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14-day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = -0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use. CONCLUSIONS These findings highlight the negative effect of the SARS-CoV-2/COVID-19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder.
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Affiliation(s)
- Sharon Ruyak
- College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Stephanie Chambers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Xingya Ma
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard De La Garza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
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Bates ME, Price JL, Leganes-Fonteneau M, Muzumdar N, Piersol K, Frazier I, Buckman JF. The Process of Heart Rate Variability, Resonance at 0.1 hz, and the Three Baroreflex Loops: A Tribute to Evgeny Vaschillo. Appl Psychophysiol Biofeedback 2022; 47:327-340. [PMID: 35536496 PMCID: PMC9088144 DOI: 10.1007/s10484-022-09544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marsha E. Bates
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Julianne L. Price
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Mateo Leganes-Fonteneau
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Neel Muzumdar
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Kelsey Piersol
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Ian Frazier
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Jennifer F. Buckman
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
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Yen CF, Ko CH, Hsu CY, Wu HC, Yang YY, Wang PW. A Pilot Randomized Control Study on Effect Brief Heart Rate Variability Biofeedback as a Complementary Treatment in Men with Methamphetamine Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095230. [PMID: 35564623 PMCID: PMC9105208 DOI: 10.3390/ijerph19095230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/24/2022]
Abstract
The aims of this study were to investigate the efficacy of heart rate variability biofeedback (HRVBFB) intervention in terms of reducing craving, severity of dependence, and rate of positive methamphetamine urine testing in men taking part in a methamphetamine use disorder outpatient treatment program. Sixty-one adult men received either HRVBFB treatment plus treatment as usual (TAU) over four weeks or TAU only. Men receiving HRVBFB showed significantly greater reductions in craving, dependence severity, and the rate of positive methamphetamine urine testing at the end of the intervention and four weeks of follow-up. The analyses further showed that the levels of craving and dependence severity at treatment entry were predictive of changes in craving and dependence severity at the end of treatment and follow-up, respectively. The baseline status of a positive methamphetamine urine test only predicted a positive methamphetamine urine test at the end of treatment, not at the end of the follow-up period. Our results showed HRVBFB intervention has merits as an adjunct treatment to ameliorate cravings and reduce the severity of dependence experienced by persons with methamphetamine use disorder. An added value of HRVBFB intervention is the fact that it can be easily and affordably implemented in everyday life.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (C.-F.Y.); (C.-H.K.); (Y.-Y.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (C.-F.Y.); (C.-H.K.); (Y.-Y.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung 80276, Taiwan; (C.-Y.H.); (H.-C.W.)
| | - Hung-Chi Wu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung 80276, Taiwan; (C.-Y.H.); (H.-C.W.)
| | - Yu-Yi Yang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (C.-F.Y.); (C.-H.K.); (Y.-Y.Y.)
| | - Peng-Wei Wang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (C.-F.Y.); (C.-H.K.); (Y.-Y.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-67-312-1101 (ext. 6822)
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Price JL, Bates ME, Morgano J, Todaro S, Uhouse SG, Vaschillo E, Vaschillo B, Pawlak A, Buckman JF. Effects of arousal modulation via resonance breathing on craving and affect in women with substance use disorder. Addict Behav 2022; 127:107207. [PMID: 34953433 DOI: 10.1016/j.addbeh.2021.107207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Craving for alcohol and other drugs is a complex in-the-moment experience that involves within-person changes in physiological arousal and affect. We evaluated the utility of a just-in-time, self-administered resonance breathing smartphone application (app) to reduce craving and improve affect in women during outpatient treatment for substance use disorders (SUD). METHODS Women (N = 57) receiving outpatient addiction treatment were randomized to practice either cardiovascular resonance breathing (0.1 Hz/6 breaths per minute) or a sham (∼0.23 Hz/14 breaths per minute) in the face of urges over an 8-week intervention. Craving (Penn Alcohol Craving Scale) and affect (Positive and Negative Affect Scale) were collected weekly throughout the intervention. App data were uploaded weekly to assess frequency of use. Generalized Estimated Equations modeled craving and affect as a function of group randomization and app use frequency across the 8-week intervention. FINDINGS Higher levels of craving were associated with more frequent app use. The group X app use interaction was significant for craving. Frequent app use during the intervention phase was associated with lower craving levels in the resonance breathing group relative to the sham group over the 8-week intervention. There was no effect of app use frequency on affect measures. CONCLUSIONS Women assigned to practice sham breathing who used the intervention frequently experienced elevations in craving that are commonly reported during outpatient SUD treatment. Women assigned to resonance breathing who used the intervention frequently did not experience such increases. Resonance breathing may be protective against triggers in outpatient treatment. Physiological mechanisms are discussed.
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Eddie D, Bates ME, Buckman JF. Closing the brain-heart loop: Towards more holistic models of addiction and addiction recovery. Addict Biol 2022; 27:e12958. [PMID: 32783345 PMCID: PMC7878572 DOI: 10.1111/adb.12958] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 07/26/2020] [Indexed: 01/03/2023]
Abstract
Much research seeks to articulate the brain structures and pathways implicated in addiction and addiction recovery. Prominent neurobiological models emphasize the interplay between cortical and limbic brain regions as a main driver of addictive processes, but largely do not take into consideration sensory and visceral information streams that link context and state to the brain and behavior. Yet these brain-body information streams would seem to be necessary elements of a comprehensive model of addiction. As a starting point, we describe the overlap between one current model of addiction circuitry and the neural network that not only regulates cardiovascular system activity but also receives feedback from peripheral cardiovascular processes through the baroreflex loop. We highlight the need for neurobiological, molecular, and behavioral studies of neural and peripheral cardiovascular signal integration during the experience of internal states and environmental contexts that drive alcohol and other drug use behaviors. We end with a call for systematic, mechanistic research on the promising, yet largely unexamined benefits to addiction treatment of neuroscience-informed, adjunctive interventions that target the malleability of the cardiovascular system to alter brain processes.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Marsha E. Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, USA,Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, USA,Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
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Vest N, Reinstra M, Timko C, Kelly J, Humphreys K. College programming for students in addiction recovery: A PRISMA-guided scoping review. Addict Behav 2021; 121:106992. [PMID: 34087765 PMCID: PMC8259809 DOI: 10.1016/j.addbeh.2021.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The health and well-being of students in recovery from substance use disorder are increasingly being recognized as a priority on college campuses. This scoping review maps the state of the existing literature evaluating collegiate recovery programming to highlight research gaps and inform policy. METHOD We conducted a systematic search of articles related to collegiate recovery programming published before August 2020. The 15 extracted study characteristics included publication type, study design, primary outcomes, reporting of behavioral addictions, mutual-help group attendance, sample demographic information, school size, ownership, and funding source. RESULTS The PRISMA-guided search strategy identified 357 articles for abstract review; of 113 articles retained for full-text review, 54 studies met criteria for inclusion. Primary outcomes were coded into four domains: clinical, recovery experience, program characterization, and stigma. Most (57%) used quantitative observational designs and 41% employed qualitative research designs. Government or foundation grants funded 11% of the studies. CONCLUSION The domains identified offer a framework for healthcare providers, college administrators, and researchers to understand and improve programs, thereby better serving this vulnerable student group.
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Affiliation(s)
- Noel Vest
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States.
| | - Meg Reinstra
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States
| | - Christine Timko
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
| | - John Kelly
- Harvard Medical School, Boston, MA 02114, United States
| | - Keith Humphreys
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
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Substance Use and Addiction Affect More Than the Brain: the Promise of Neurocardiac Interventions. CURRENT ADDICTION REPORTS 2021; 8:431-439. [DOI: 10.1007/s40429-021-00379-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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You M, Laborde S, Salvotti C, Zammit N, Mosley E, Dosseville F. Influence of a Single Slow-Paced Breathing Session on Cardiac Vagal Activity in Athletes. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00467-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Substance craving changes in university students receiving heart rate variability biofeedback: A longitudinal multilevel modeling approach. Addict Behav 2019; 97:35-41. [PMID: 31132527 DOI: 10.1016/j.addbeh.2019.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Previously published findings from a study of university students living in substance use disorder (SUD) recovery housing showed an eight-session heart rate variability biofeedback (HRVB) intervention significantly reduced craving. That study, however, uncovered pronounced inter-participant variability in craving change patterns through the course of HRVB that warranted further exploration. The purpose of the current investigation was to examine how within- and between-person factors may have differentially influenced craving changes. METHODS A longitudinal multilevel modeling approach was used with time at level-1 nested within persons at level-2. Multilevel models of change were estimated to model craving trajectories and predictor relationships over time as a function of age, sex, length of abstinence, daily HRVB practice, anxiety, depression, and stress. RESULTS A quadratic pattern of craving reductions was found, indicating that craving reductions accelerated over time for some participants. Daily HRVB practice of >12 min and older age significantly enhanced craving reductions over time. Increases in depressive symptoms attenuated the effects of HRVB on craving. The other predictors were not significantly associated with craving in this study. The true R2 for the final model indicated that 20.5% of the variance in craving was explained by older age, daily HRVB >12 min, and within-person changes in depression. CONCLUSIONS HRVB shows promise as an accessible, scalable, and cost-effective complementary anti-craving intervention. Healthcare providers may help persons recovering from SUD to better manage substance craving by the routine and strategic use of HRVB practice.
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15
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Leyro TM, Buckman JF, Bates ME. Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders. Curr Opin Psychol 2019; 30:92-97. [PMID: 31055246 DOI: 10.1016/j.copsyc.2019.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
Heart rate variability (HRV) biofeedback is an accessible, cost-effective intervention that has demonstrated clinical value for numerous physical and mental health conditions; however, research on HRV biofeedback in substance use disorders (SUD) is in its nascence. We argue that HRV biofeedback may be particularly beneficial as an adjunct treatment for SUD by targeting bodily systems that are known to be disrupted by chronic substance use and are not historically the focus of psychosocial or pharmacological SUD treatment approaches. In addition to advocating for HRV biofeedback applications in SUD, we identify several gaps within the existing experimental literature, and propose new studies that could accelerate understanding of how and for whom HRV biofeedback is most likely to promote positive behavior change.
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Affiliation(s)
- Teresa M Leyro
- Rutgers University - New Brunswick, Department of Psychology, Tillett Hall, 53 Avenue E, Piscataway Township, NJ, 08854, USA.
| | - Jennifer F Buckman
- Rutgers University - New Brunswick, Department of Kinesiology and Health, 70 Lipman Drive, New Brunswick, NJ, 08854, USA; Rutgers University - New Brunswick, Center of Alcohol Studies, 607 Allison Road, Piscataway Township, NJ, 08854, USA
| | - Marsha E Bates
- Rutgers University - New Brunswick, Department of Kinesiology and Health, 70 Lipman Drive, New Brunswick, NJ, 08854, USA; Rutgers University - New Brunswick, Center of Alcohol Studies, 607 Allison Road, Piscataway Township, NJ, 08854, USA
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16
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D'Souza JM, Wardle M, Green CE, Lane SD, Schmitz JM, Vujanovic AA. Resting Heart Rate Variability: Exploring Associations With Symptom Severity in Adults With Substance Use Disorders and Posttraumatic Stress. J Dual Diagn 2019; 15:2-7. [PMID: 30418104 PMCID: PMC6511322 DOI: 10.1080/15504263.2018.1526431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Substance use disorders and posttraumatic stress symptoms are commonly comorbid. Previous studies have established that those with substance use disorders or posttraumatic stress disorder (PTSD) have lower high frequency-heart rate variability (HF-HRV) compared to controls, suggesting that low HF-HRV may be a biomarker of a common physiological mechanism underlying both disorders. We evaluated HF-HRV as a potential biomarker of a common underlying process by testing whether lower HF-HRV related to greater severity of substance use and PTSD symptoms in individuals with both substance use disorders and at least four symptoms of PTSD. Methods: HF-HRV was measured in 49 adults with substance use disorders and at least four symptoms of PTSD. We performed a series of regressions controlling for age to test whether low HF-HRV was associated with greater substance use disorder and PTSD symptom severity. Substance use disorder symptoms were measured by the Addiction Severity Index and PTSD symptoms were measured by the Clinician-Administered PTSD Scale and the PTSD Checklist. Results: After controlling for age, low resting HF-HRV was significantly associated with drug and alcohol symptom severity but not PTSD symptom severity. Conclusions: HF-HRV may be more sensitive to the severity of drug and alcohol use rather than PTSD. Findings may suggest that in PTSD populations, HF-HRV may primarily index comorbid substance use disorder symptoms. HF-HRV could serve as an objective measure of substance use severity and should be further investigated as a predictor of outcomes in treatment for substance use disorders.
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Affiliation(s)
- Johann M D'Souza
- a Department of Psychology , University of Houston , Houston , Texas , USA
| | - Margaret Wardle
- b Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , Texas , USA.,c Department of Psychology , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Charles E Green
- b Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Scott D Lane
- b Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Joy M Schmitz
- b Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Anka A Vujanovic
- a Department of Psychology , University of Houston , Houston , Texas , USA
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17
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Bates ME, Lesnewich LM, Uhouse SG, Gohel S, Buckman JF. Resonance-Paced Breathing Alters Neural Response to Visual Cues: Proof-of-Concept for a Neuroscience-Informed Adjunct to Addiction Treatments. Front Psychiatry 2019; 10:624. [PMID: 31543840 PMCID: PMC6739688 DOI: 10.3389/fpsyt.2019.00624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022] Open
Abstract
Conscious attempts to regulate alcohol and drug use are often undermined by automatic attention and arousal processes that are activated in the context of salient cues. Response to these cues involves body and brain signals that are linked via dynamic feedback loops, yet no studies have targeted the cardiovascular system as a potential conduit to alter automatic neural processes that maintain cue salience. This proof-of-concept study examined within-person changes in neural response to parallel but unique sets of visual alcohol-related cues at two points in time: prior to versus following a brief behavioral intervention. The active intervention was resonance breathing, a rhythmical breathing task paced at 0.1 Hz (6 breaths per minute) that helps normalize neurocardiac feedback. The control intervention was a low-demand cognitive task. Functional magnetic resonance imaging (fMRI) was used to assess changes in brain response to the cues presented before (A1) and after (A2) the intervention in 41 emerging adult men and women with varying drinking behaviors. The resonance breathing group exhibited significantly less activation to A2 cues compared with A1 cues in left inferior and superior lateral occipital cortices, right inferior lateral occipital cortex, bilateral occipital pole, and temporal occipital fusiform cortices. This group also showed significantly greater activation to A2 cues compared with A1 cues in medial prefrontal, anterior and posterior cingulate, and precuneus cortices, paracingulate, and lingual gyri. The control group showed no significant changes. Thus, following resonance breathing, activation in brain regions involved in visual processing of cues was reduced, while activation in brain areas implicated in behavioral control, internally directed cognition, and brain-body integration was increased. These findings provide preliminary evidence that manipulation of the cardiovascular system with resonance breathing alters neural activation in a manner theoretically consistent with a dampening of automatic sensory input and strengthening of higher-level cognitive processing.
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Affiliation(s)
- Marsha E Bates
- Cardiac Neuroscience Laboratory, Department of Kinesiology and Health, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Center of Alcohol Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Laura M Lesnewich
- Center of Alcohol Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Cardiac Neuroscience Laboratory, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Sarah Grace Uhouse
- Center of Alcohol Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Cardiac Neuroscience Laboratory, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Suril Gohel
- Department of Health Informatics, School of Health Professions, Rutgers University-Newark, Newark, NJ, United States
| | - Jennifer F Buckman
- Cardiac Neuroscience Laboratory, Department of Kinesiology and Health, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Center of Alcohol Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States
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