Baseline resting heart rate variability predicts post‐traumatic stress disorder treatment outcomes in adults with co‐occurring substance use disorders and post‐traumatic stress

Abstract

Post-traumatic stress disorder (PTSD) symptoms are highly prevalent among individuals with substance use disorders (SUD), presenting a difficult-to-treat, complex comorbidity. Prognostic factors for treatment outcomes may characterize heterogeneity of the treated population and/or implicate mechanisms of action that are salient for improving treatments. High frequency heart rate variability (HF-HRV) is a suggested biomarker for emotion regulation-the ability to generate appropriate emotional responses via the influence of the parasympathetic nervous system on the heart. This initial study investigated the utility of baseline resting HF-HRV for predicting PTSD symptoms and substance use outcomes following treatment of 37 SUD participants with comorbid PTSD symptoms. Participants completed either standard cognitive-behavioral therapy (CBT) for SUD or a novel treatment of integrated posttraumatic stress and substance use that combined CBT for SUD with cognitive processing therapy for PTSD. Analyses demonstrated that higher HF-HRV predicted greater reduction in PTSD symptoms following both types of treatment. This suggests prognostic value of HF-HRV as a predictor of PTSD treatment outcomes; those with poorer autonomic emotional regulation may not respond as well to psychotherapy in general. This hypothesis-generating analysis identifies a putative biomarker that might have utility in treatment prediction. K E Y W O R D Sheart rate variability, PTSD, substance use, trauma, treatment How to cite this article: Soder HE, Wardle MC, Schmitz JM, Lane SD, Green C, Vujanovic AA. Baseline resting heart rate variability predicts posttraumatic stress disorder treatment outcomes in adults with co-occurring substance use disorders and post-traumatic stress. Psychophysiology.

Heart Rate Variability in Schizophrenia and Autism

“…Reduced SDNN and low frequency power measures of HRV are commonly believed to be due to suppressed autonomic functioning, which often occurs in response to chronic stress ( 51 , 52 ). The higher heart rate and normalized HR in schizophrenia is also consistent with an increased stress response.…”

Relevance of Objective Measures in Psychiatric Disorders—Rest-Activity Rhythm and Psychophysiological Measures

“…The psychophysiological markers have value in predicting high and low responders to psychotherapy or pharmacotherapy [ 48 , 49 ]. Patients with anxiety, especially phobia, that had the strongest physiological reactions to distressing hierarchy cues, had better responses to systemic desensitization [ 50 ].…”

“…Another example of intraindividual change is the use of difference in means, a physiological metric whereby individual differences in mean BPM, microsiemens, or other physiological units are calculated across treatment points or between conditions (i.e. stressful condition vs neutral condition) [ 48 , 62 , 63 ]. This metric has been associated with the degree of clinician-rated prognosis, is proposed to reflect symptom dimensions or subclassification within PTSD, and even points towards profiles of symptoms with distinct psychophysiologies [ 48 , 64 ].…”

“…stressful condition vs neutral condition) [ 48 , 62 , 63 ]. This metric has been associated with the degree of clinician-rated prognosis, is proposed to reflect symptom dimensions or subclassification within PTSD, and even points towards profiles of symptoms with distinct psychophysiologies [ 48 , 64 ].…”

“…Individual physiological arousal patterns have related to components of intervention. This can be done through hierarchical linear modelling—as opposed to traditional difference score approach—a more sensitive test of individual changes in arousal [ 48 , 65 ].…”