Neuroanatomical substrates for the volitional regulation of heart rate

The control of physiological arousal can assist in the regulation of emotional state. A subset cortical and subcortical brain regions are implicated in autonomic control of bodily arousal during emotional behaviors. Here, we combined human functional neuroimaging with autonomic monitoring to identify neural mechanisms that support the volitional regulation of heart rate, a process that may be assisted by visual feedback. During functional magnetic resonance imaging (fMRI), 15 healthy adults performed an experimental task in which they were prompted voluntarily to increase or decrease cardiovascular arousal (heart rate) during true, false, or absent visual feedback. Participants achieved appropriate changes in heart rate, without significant modulation of respiratory rate, and were overall not influenced by the presence of visual feedback. Increased activity in right amygdala, striatum and brainstem occurred when participants attempted to increase heart rate. In contrast, activation of ventrolateral prefrontal and parietal cortices occurred when attempting to decrease heart rate. Biofeedback enhanced activity within occipito-temporal cortices, but there was no significant interaction with task conditions. Activity in regions including pregenual anterior cingulate and ventral striatum reflected the magnitude of successful task performance, which was negatively related to subclinical anxiety symptoms. Measured changes in respiration correlated with posterior insula activation and heart rate, at a more lenient threshold, change correlated with insula, caudate, and midbrain activity. Our findings highlight a set of brain regions, notably ventrolateral prefrontal cortex, supporting volitional control of cardiovascular arousal. These data are relevant to understanding neural substrates supporting interaction between intentional and interoceptive states related to anxiety, with implications for biofeedback interventions, e.g., real-time fMRI, that target emotional regulation

Effect of Brief Biofeedback via a Smartphone App on Stress Recovery: Randomized Experimental Study.

BACKGROUND:Smartphones are often vilified for negatively influencing well-being and contributing to stress. However, these devices may, in fact, be useful in times of stress and, in particular, aid in stress recovery. Mobile apps that deliver evidence-based techniques for stress reduction, such as heart rate variability biofeedback (HRVB) training, hold promise as convenient, accessible, and effective stress-reducing tools. Numerous mobile health apps that may potentially aid in stress recovery are available, but very few have demonstrated that they can influence health-related physiological stress parameters (eg, salivary biomarkers of stress). The ability to recover swiftly from stress and reduce physiological arousal is particularly important for long-term health, and thus, it is imperative that evidence is provided to demonstrate the effectiveness of stress-reducing mobile health apps in this context. OBJECTIVE:The purpose of this research was to investigate the physiological and psychological effects of using a smartphone app for HRVB training following a stressful experience. The efficacy of the gamified Breather component of the Happify mobile health app was examined in an experimental setting. METHODS:In this study, participants (N=140) underwent a laboratory stressor and were randomly assigned to recover in one of three ways: with no phone present, with a phone present, with the HRBV game. Those in the no phone condition had no access to their phone. Those in the phone present condition had their phone but did not use it. Those in the HRVB game condition used the serious game Breather on the Happify app. Stress recovery was assessed via repeated measures of salivary alpha amylase, cortisol, and self-reported acute stress (on a 1-100 scale). RESULTS:Participants in the HRVB game condition had significantly lower levels of salivary alpha amylase during recovery than participants in the other conditions (F2,133=3.78, P=.03). There were no significant differences among the conditions during recovery for salivary cortisol levels or self-reported stress. CONCLUSIONS:These results show that engaging in a brief HRVB training session on a smartphone reduces levels of salivary alpha amylase following a stressful experience, providing preliminary evidence for the effectiveness of Breather in improving physiological stress recovery. Given the known ties between stress recovery and future well-being, this study provides a possible mechanism by which gamified biofeedback apps may lead to better health

Psychobiological factors of resilience and depression in late life.

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD

Impact of a Workplace Stress Reduction Program on Blood Pressure and Emotional Health in Hypertensive Employees

This study examined the impact of a workplace-based stress management program on blood pressure (BP), emotional health, and workplace-related measures in hypertensive employees of a global information technology company

Heart Rate Variability (HRV) biofeedback: a new training approach for operator’s performance enhancement

The widespread implementation of advanced and complex systems requires predominantly operators’ cognitive functions and less importance of human manual control. On the other hand, most operators perform their cognitive functions below their peak cognitive capacity level due to fatigue, stress, and boredom. Thus, there is a need to improve their cognitive functions during work. The goal of this paper is to present a psychophysiology training approach derived from cardiovascular response named heart rate variability (HRV) biofeedback. Description of resonant frequency biofeedback - a specific HRV training protocol - is discussed as well as its supported researches for the performance enhancement. HRV biofeedback training works by teaching people to recognize their involuntary HRV and to control patterns of this physiological response. The training is directed to increase HRV amplitude that promotes autonomic nervous system balance. This balance is associated with improved physiological functioning as well as psychological benefits. Most individuals can learn HRV biofeedback training easily which involves slowing the breathing rate (around six breaths/min) to each individual’s resonant frequency at which the amplitude of HRV is maximized. Maximal control over HRV can be obtained in most people after approximately four sessions of training. Recent studies have demonstrated the effectiveness of HRV biofeedback to the improvement of some cognitive functions in both simulated and real industrial operators.Peer Reviewe

The Effectiveness of the Quick Coherence Technique using Heart Rate Variability-Biofeedback Technology on the Recovery of Heart Coherence among University Students

Literature has established the effectiveness of self-regulatory techniques using Heart Rate Variability (HRV)-Biofeedback Technology in improving individual’s heart coherence. The current study aims to evaluate the effectiveness of Quick Coherence Technique, a self-regulatory technique, through the application of HRV-biofeedback technology on the level of heart coherence among university students. A total of 20 students of a technical public university participated in the study. The Quick Coherence Technique (QCT) and the emWave device and software of the HeartMath Institute were used to collect the data. According to the HRV power spectrum, the HRV data is divided under very low frequency (VLF), low frequency (LF), and high frequency (HF) frequency ranges. Based on the results, the use of HRV-biofeedback technology and the QCT had helped to increase the levels of HRV scores and heart coherence of the participants

Feasibility and Acceptability of Heart Rate Variability Biofeedback to Treat Fibromyalgia-Related Chronic Pain

Background: Fibromyalgia (FM) is characterized by chronic diffuse pain, fatigue, memory problems, sleep disturbance, depression, and mobility limitations. The Department of Defense (DoD) and Department of Veterans Health Administration (VA) recognize FM as potentially connected to service in the Persian Gulf War, and the rates of FM diagnosis and disability in the VA are rising. Purpose: The purpose of this dissertation was to assess the feasibility and acceptability of heart rate variability biofeedback (HRVB) as an intervention for the treatment of FM in Veterans. Problem/Aims: We conducted an integrative literature review (manuscript 1) and identified a gap in the literature related to HRVB to treat FM-related chronic pain. Overall, HRVB is a promising treatment for chronic pain; however, further research is needed to evaluate the relationship between HRVB and FM pain. We found only one study evaluating HRVB for the treatment of FM, and we did not identify any studies that evaluated the recommended HRVB practice protocols, or any qualitative studies investigating the individual experience of using HRVB. The specific aims of this dissertation were: Aim 1: Examine the feasibility of recruitment and retention of Veterans with fibromyalgia. Aim 2: Determine the feasibility of adherence to the recommended HRVB practice protocol using the emWave2. Aim 3: Examine participant acceptability and satisfaction with the intervention. Design: We used a sequential exploratory multi-method design to determine if it is feasible for Veterans with FM to follow a twice-daily 20-minute HRVB practice protocol. We conducted a focus group post-intervention to explore the participant’s experiences with HRVB. Theoretical framework: The theory of symptom self-management guided the study; it posits that when self-directed interventions are optimized, performance outcomes will improve. Findings: We found that it was not feasible for Veterans with FM to follow the recommended HRVB protocol. Barriers identified were conflicts with family obligations and work schedule as well as difficulties operating the HRVB device. Results from weekly questionnaires suggested an improvement in functional status and quality of life, but no change in pain levels. However, during the focus group discussion, the Veterans reported a reduction in pain levels as well as improvement in sleep, relaxation, and cognition. Conclusion: Limitations of this study were a small size (n=10), possible self-selection bias, and the lack of a control group. While the data suggests HRVB may improve the functional status and quality of life of those with FM, more research is needed

A Hardware/Software Platform to Acquire Bioelectrical Signals. A Case Study: Characterizing Computer Access through Attention

This paper describes a hardware/software platform to acquire human body signals. In the field of physiological computing it is desirable to have a system that allows the synchronized acquisition of signals coming from different sources. Here is described how to unify the whole process of acquiring signals from both customized hardware and low cost commercial devices such as Neurosky’s mindwave. A case study using this platform is also shown: studying the feasibility of using sustained attention to access a computer. In order to do that brain activity was measured using Neurosky’s mindwave. The participants in this study were asked to keep their attention high/low for as long as possible during several trials. Experimentation was performed by 7 normally developed subjects and 3 people with cerebral palsy (CP). Our preliminary work shows that 60% of participants might be potential users of this technology. Eventually, modulating the attention to access a communication board needs a scanning period greater than 5.76s

Exploring public attitude toward biofeedback technologies: Knowledge, preferences and personality tendencies

Background: Biofeedback is increasingly used in the clinical area and in daily health monitoring through wearable devices (e.g. smart watches). Nevertheless, it remains rather unknown. This study aimed to assess, in a sample of Italian citizens, the level of knowledge, attitudes, perceived efficacy and personality tendencies which could affect the uptake of biofeedback technologies. Design and Methods: Participants were recruited by advertising the survey on the social networks, from March to May 2019. 160 subjects filled in an ad hoc online questionnaire assessing socio-demographic variables, clinical status, physical activity, knowledge and attitude towards biofeedback, psychological tendencies toward health.Results: Data showed a good level of interest in biofeedback training in spite of poor knowledge about such technologies. Sport and chronic diseases were not correlated to a greater use of biofeedback. People informed about biofeedback technologies were more interested in undergoing biofeedback training and had higher scores in the Health Locus of Control. Finally, people who showed a positive perception of their own health (Health Esteem) did not rely on these technologies.Discussion: Despite the huge spread of biofeedback technologies, our results disconfirmed the expectation that people having an active lifestyle or a disease were more familiar with biofeedback systems. The attitude toward such technologies seems to depend on individual tendencies.Conclusions: This study suggests the importance to improve general public literacy on biofeedback technologies, tailor tools on their needs and characteristics, empower people’s sense of internal health control for promoting a valid use and a proper knowledge of biofeedback

Biofeedback and Anxiety Disorders: A Critical Review of EMG, EEG, and HRV Feedback

Anxiety disorders are characterized by ongoing and situationally disproportionate fear and anxiety, and the associated significant distress and impairment of normal functioning (American Psychiatric Association, 2013). These disorders affect nearly one third of Americans in their lifetimes, indicating that a massive group of people stand to benefit from the development of effective and feasible treatments for anxiety symptoms (Valentiner, Fergus, Behar, & Conybeare, 2014). There are certainly many reasons why pharmaceutical treatments for anxiety disorders are so popular with patients and clinicians today, but there are significant drawbacks that should motivate researchers to develop better treatments. Researchers are investigating the general efficacy of biofeedback for anxiety, as well as which types of biofeedback may be most effective for which types of symptoms and disorders. In this review, I summarize findings on electromyography (EMG), electroencephalography (EEG), and heart rate variability (HRV) biofeedback treatments for anxiety. While EMG research seems to have stalled due to minimal supporting evidence, I recommend further research on EEG and HRV as adjunctive treatments for anxiety disorders.  Overall, further research on biofeedback will contribute to the transition away from the disease model of psychopathology with purely pharmaceutical treatment to the complex systems learning model in which the individual patient may receive unique skill-building therapies targeted to his or her particular needs.            Keywords: biofeedback, anxiety disorders, alternative treatment, neurofeedbac