Biofeedback Assisted Control of Respiratory Sinus Arrhythmia as a Biobehavioral Intervention for Depressive Symptoms in Patients After Cardiac Surgery: A Preliminary Study

Abstract

The current study investigated whether biofeedback training aimed at increasing respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, can reduce depressive symptoms in patients after cardiac surgery. This randomized controlled study enrolled 26 patients after first-time cardiac surgery. The patients were randomly assigned to an RSA-biofeedback group (N = 13) or to a treatment as usual group (N = 13). The biofeedback training consisted of five 45 min sessions designed to increase RSA. The outcome was assessed as changes in RSA and in the Centre for Epidemiologic Studies of Depression (CES-D) values from pre- to post-training. Both groups were comparable for demographic and biomedical characteristics. RSA increased significantly in patients who underwent RSA-biofeedback compared to controls. Moreover, the CES-D scores were reduced significantly from pre- to post-training in the RSA-biofeedback group compared to the controls. Changes in RSA were inversely related to changes in CES-D scores from pre- to post-training. These findings extend the effectiveness of RSA-biofeedback for increasing vagal modulation as well as for reducing depressive symptoms in post-surgical patients. Overall, the current study also suggests that this biobehavioral intervention may add to the efficacy of postoperative risk reduction programs and rehabilitation protocols in cardiac surgery patients.

Heart rate variability biofeedback: how and why does it work?

“…This center communicates directly with the amygdala, a center for emotional control, in a pathway extending through the insula (Volz et al, 1990; Henderson et al, 2004). Perhaps it is for this reason that various studies have shown positive HRV biofeedback effects for treating anxiety and depression (Karavidas et al, 2007; Reiner, 2008; Siepmann et al, 2008; McCraty et al, 2009; Nada, 2009; Zucker et al, 2009; Henriques et al, 2011; Tan et al, 2011; Patron et al, 2013). …”

“…Several studies have reported that HRVB might be effective in reducing symptoms of depression and/or anxiety (Karavidas et al, 2007; Reiner, 2008; Siepmann et al, 2008; McCraty et al, 2009; Nada, 2009; Zucker et al, 2009; Henriques et al, 2011; Tan et al, 2011; Patron et al, 2013). These results led to speculation that some other mechanism might be at work beyond the baroreflex gains.…”

Examining the relation between respiratory sinus arrhythmia and depressive symptoms in emerging adults: A longitudinal study

“…For example, two studies found that biofeedback increased RSA and reduced depressive symptoms in individuals with PTSD (Zucker, Samuelson, Muench, Greenberg, & Gevirtz, 2009) and in a group of post-cardiac surgery patients (Patron et al, 2012). Vagus nerve stimulation has also been proposed as a treatment for chronic, treatment-resistant depression.…”

Improving Managers’ Psychophysical Well-Being: Effectiveness of Respiratory Sinus Arrhythmia Biofeedback

“…Recent studies have also highlighted the effectiveness of biofeedback training aimed at increasing respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, in reducing autonomic nervous system dysregulation, by increasing cardiac vagal tone and baroreflex gain both in patients with cardiovascular diseases and healthy adults (Del Pozo et al 2004;Lehrer et al 2003;Nolan et al 2005;Patron et al 2013).…”