Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

Abstract

Background/AimsThe relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study is to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C. MethodsThis study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n = 23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography. ResultsAt the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group (P < 0.001 for both), and the severity of GI symptoms (P = 0.003), anxiety (P < 0.001), depression (P < 0.001), and stress (P < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly and inversely associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from -0.37 to -0.68). Changes in the LF/HF ratio were also significantly and positively associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from 0.38 to 0.60). ConclusionsCBT was effective in managing symptoms in young IBS-C patients and the improvement of symptoms was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.

Neurovisceral regulatory circuits of affective resilience in youth

“…Here's the good news: these phenomena are reversible! In line with research in adults (Chambers & Allen, 2002; Jang, Hwang, Padhye, & Meininger, 2017), we have previously shown, that HRV re‐increases following antidepressant treatment with selective serotonin reuptake inhibitors in adolescents with depression (Koenig et al, 2018). Clinical improvement (decrease in depression severity) was associated with increased HRV and decreased HR.…”

Cardiovagal modulation in pediatric functional gastrointestinal disorders

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“…A prospective study in adults with IBS showed increased cardiovagal modulation as subjects improved while undergoing cognitive behavioral therapy (CBT). 22 Since CBT itself is known to increase cardiovagal modulation, this result could reflect either CBT or disease improvement or both. Our long-term goal is to distinguish these possibilities by following our cohort prospectively as they improve irrespective of treatment modality.…”

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

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“…An autonomic threat response can be facilitated by ventral vagal complex (VVC) withdrawal, sympathetic activation, dorsal vagal complex activation, or their combination. Prolonged threat activation disrupts psychosocial and gastrointestinal function and may be maintained by impaired brain-body feedback loops, threat cue sensitization, disruption of affiliative social interactions that stimulate safety-related systems, and adverse niche construction in high frequency HRV with concurrent decrease in GI symptoms, anxiety and stress in constipation-predominant IBS after 8 weeks of CBT (Jang, Hwang, Padhye, & Meininger, 2017).…”