Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

Abstract

BackgroundPsychological resilience is critical to minimize the health effects of traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia, or posttraumatic stress disorder. Mind-body practices, such as relaxation breathing and mindfulness meditation, help to reduce arousal and may reduce the likelihood of such psychological distress. To better understand resilience-building practices, we are conducting the Biofeedback-Assisted Resilience Training (BART) study to evaluate whether the practice of slow, paced breathing with or without heart rate variability biofeedback can be effectively learned via a smartphone app to enhance psychological resilience.ObjectiveOur objective was to conduct a limited, interim review of user interactions and study data on use of the BART resilience training app and demonstrate analyses of real-time sensor-streaming data.MethodsWe developed the BART app to provide paced breathing resilience training, with or without heart rate variability biofeedback, via a self-managed 6-week protocol. The app receives streaming data from a Bluetooth-linked heart rate sensor and displays heart rate variability biofeedback to indicate movement between calmer and stressful states. To evaluate the app, a population of military personnel, veterans, and civilian first responders used the app for 6 weeks of resilience training. We analyzed app usage and heart rate variability measures during rest, cognitive stress, and paced breathing. Currently released for the BART research study, the BART app is being used to collect self-reported survey and heart rate sensor data for comparative evaluation of paced breathing relaxation training with and without heart rate variability biofeedback.ResultsTo date, we have analyzed the results of 328 participants who began using the BART app for 6 weeks of stress relaxation training via a self-managed protocol. Of these, 207 (63.1%) followed the app-directed procedures and completed the training regimen. Our review of adherence to protocol and app-calculated heart rate variability measures indicated that the BART app acquired high-quality data for evaluating self-managed stress relaxation training programs.ConclusionsThe BART app acquired high-quality data for studying changes in psychophysiological stress according to mind-body activity states, including conditions of rest, cognitive stress, and slow, paced breathing.

The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses

“…Resilience-strengthening interventions have been used in several occupational settings to relieve workers' stress response [22]. Further investigation into this topic is worthwhile because smartphone applications may be more feasible to implement than other interventions, which are restricted by time and place [23].…”

“…BT incorporates aspects of real-time RSA-biofeedback and shorter meditation practices. The BT has been studied previously in traumatic patients with positive results [23].…”

“…In addition to computer-assisted biofeedback, there is a growing interest in the use of smartphone applications for biofeedback to promote better stress-management and relaxation [17,22]. In other words, smartphones can be used as a tool for biofeedback training (BT) because smartphones and the Internet are popular, conveniently accessible, and have an array of technological capabilities [17,23].…”

Adversity History Predicts Self-Reported Autonomic Reactivity and Mental Health in US Residents During the COVID-19 Pandemic

“…These approaches (e.g., sensorimotor psychotherapy and relaxation training) use interoception techniques (i.e., the noting of sensations, discomforts, pain, tension, pleasurers, and cues) to increase positive feelings toward physical sensations and help with integrating sensations and body regulation (78). Interventions including yoga (79), mindfulness-based stress reduction (80), and biofeedback (81) have been shown to reduce threat-responsive autonomic reactivity and have benefits for mental health. Additional research should explore their use as a therapeutic method or as part of a multi-method intervention to assist with coping during large scale crises such as the COVID-19 pandemic.…”

Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring

“…HRV measurement is regularly used as a biofeedback tool in mobile health (mHealth) interventions that target acute stress relief [45][46][47] but may also be useful for interventions that aim to provide users with feedback on their resilience over a longer timeframe. A recent literature review confirmed that HRV has potential as a biomarker for resilience but suggested that more longitudinal studies are needed that use wearable sensors to observe HRV in a naturalistic context of real-life and associate it with resilience-related outcomes, as most of the evidence is based on cross-sectional population studies [27].…”