Effect of a Biofeedback Intervention on Heart Rate Variability in Individuals With Panic Disorder: A Randomized Controlled Trial

Herhaus, Benedict; Siepmann, Martin; Kahaly, George J.; Conrad, Rupert; Petrowski, Katja

doi:10.1097/psy.0000000000001031

Cited by 14 publications

(13 citation statements)

References 62 publications

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“…Mediational and temporal analyses from prior panic and anxiety trials with CART support this notion in that the correction of sustained hypocapnia by therapeutically increasing P co 2 levels mediated improvements in panic symptoms, symptom appraisal, and perceived control (75,98,99). Trainings such as heart rate variability biofeedback have not demonstrated mediational evidence for heart rate variability and P co 2 (100) or do not assess P co 2 (101) despite proposing hyperventilation-reducing mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Biofeedback Training to Increase Pco 2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

et al. 2023

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Objective: Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety. Method: One hundred twenty English-or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise PCO 2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up. Results: In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW. Conclusions: For asthma patients with high anxiety, our brief training designed to raise PCO 2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for PCO 2 as a potential physiological target for anxiety reduction in asthma. Trial Registration: Clinicaltrials.gov Identifier: NCT00975273.

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Section: Discussionmentioning

confidence: 99%

Biofeedback Training to Increase Pco 2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

et al. 2023

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“…Furthermore, this finding aligns with previous studies reporting an increase in SDNN after HRV-BF intervention in other disorders (e.g., Refs. (20,54)). In a secondary analysis of this HRV-BF intervention, we analyzed within-session HRV changes and observed that participants learned to increase their HRV (48).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Heart Rate Variability Biofeedback for Somatic Symptom Disorder: A Pilot Randomized Controlled Trial

Krempel

Martin

2022

Psychosom Med

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ObjectivePatients with somatic symptom disorder (SSD) often receive targeted intervention only after a long duration of illness. Moreover, the reported effect sizes of interventions for SSD are small. Therefore, improvement and evaluation of interventions are needed. Preliminary evidence suggests autonomic imbalance, for example, lower heart rate variability (HRV) in SSD. HRV biofeedback (HRV-BF) as a method for self-regulation shows initial positive effects in chronic pain and functional syndromes. The aim of this study was to evaluate the efficacy of a brief HRV-BF intervention for SSD.MethodsOf a total of 50 participants with SSD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) who were recruited and randomly assigned to four sessions of HRV-BF (n = 25) or autogenic training (AT; n = 25), 49 participants were analyzed (female, 77.6%; mean [standard deviation] age = 45.3 [14.4] years). The primary outcomes were somatic symptom severity (Screening for Somatoform Disorders, numeric rating scale) and HRV. Secondary outcomes were psychological characteristics of SSD (e.g., the Somatic Symptom Disorder 12 scale, health concerns, emotion regulation). The data were collected before and after intervention and were analyzed with repeated-measures analyses of variance and post hoc t tests.ResultsSymptom severity improved after both, HRV-BF and AT. Standard Deviation of the NN Interval and psychological symptoms improved significantly more strongly in the HRV-BF than in the AT group (e.g., Standard Deviation of the NN Interval: ηp2 interaction = 0.10, p = .047).ConclusionsThe improvements in somatic symptoms, but specifically in cognitive-affective symptoms and autonomic regulation, suggest that HRV-BF with only four sessions is a potentially useful intervention option for SSD. Thus, adding this short HRV-BF intervention to existing psychological treatments for SSD may be promising.Trial Registration: German Clinical Trial Register identifier DRKS00017099 (https://www.drks.de).

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“…Studies were published between 1984 and 2022 (Figure 3). Regarding site location, eight (50%) studies were conducted in the United States [53][54][55][56][57][58][59][60], three (19%) in England [61][62][63], and one (6%) in each of The Netherlands [64], Italy [65], Belgium [66], Germany [67], and Japan [68]. Table 3 presents details on the publication year, geographic location, study design, study population (clinical diagnosis, number of patients, sex, and age), breathwork technique (style and methods), and breathwork protocol (duration of sessions, frequency, treatment period, and follow-up).…”

Section: Publication Analysismentioning

confidence: 99%

Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

et al. 2023

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Anxiety disorders are the most common group of mental disorders, but they are often underrecognized and undertreated in primary care. Dysfunctional breathing is a hallmark of anxiety disorders; however, mainstays of treatments do not tackle breathing in patients suffering anxiety. This scoping review aims to identify the nature and extent of the available research literature on the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders using the DSM-5 classification system. Using the PRISMA extension for scoping reviews, a search of PubMed, Embase, and Scopus was conducted using terms related to anxiety disorders and breathwork interventions. Only clinical studies using breathwork (without the combination of other interventions) and performed on adult patients diagnosed with an anxiety disorder using the DSM-5 classification system were included. From 1081 articles identified across three databases, sixteen were included for the review. A range of breathwork interventions yielded significant improvements in anxiety symptoms in patients clinically diagnosed with anxiety disorders. The results around the role of hyperventilation in treatment of anxiety were contradictory in few of the examined studies. This evidence-based review supports the clinical utility of breathwork interventions and discusses effective treatment options and protocols that are feasible and accessible to patients suffering anxiety. Current gaps in knowledge for future research directions have also been identified.

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Effect of a Biofeedback Intervention on Heart Rate Variability in Individuals With Panic Disorder: A Randomized Controlled Trial

Cited by 14 publications

References 62 publications

Biofeedback Training to Increase Pco 2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

Biofeedback Training to Increase Pco 2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

Efficacy of Heart Rate Variability Biofeedback for Somatic Symptom Disorder: A Pilot Randomized Controlled Trial

Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

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