A pilot study of ambulatory Heart Rate Variability Biofeedback for substance use disorder

项目总结 酒精和其他药物使用(AOD)在早期物质使用障碍(SUD)康复中的失误通常会出现 来自令人厌恶的情感状态和压力源之间的相互作用，这些因素共同引发了使用的冲动。一个中心目标 认知行为SUD治疗的一线是加强情感和认知控制，以增加 个人克服冲动使用AOD的能力。然而，某些自动的生理过程 通过与内部情感状态和环境线索动态互动来破坏努力认知 控制并胜过认知目标，以避免物质使用。心率变异性生物反馈(HRV BFB)是 一种生物行为干预，包括以共振频率(RF)进行有节奏的呼吸，以刺激身体的 压力反射机制，以弥补这些心理生理缺陷。射频作用下的自主神经归一化 呼吸被认为通过中断或抑制自动内脏反应来加强认知控制努力 这可能会破坏治疗成果，并在这样做的同时支持更好的决策、动力、减少 渴望，以及注意力分配的转移。以往对HRV BFB的研究主要集中在积极行为方面 在一系列的几周或几个月内产生的影响，而不是“在当下”。这些慢性行为 虽然临床上有价值，但引起的变化是劳动和时间密集型的，从而降低了大规模的可能性 对干预的理解。此外，第一代HRV BFB的常规日常练习模式可能只会 部分缓解强烈的瞬间情绪失调，这些情绪失调是AOD使用的触发因素 在苏德恢复的早期。相比之下，最近的研究表明，短暂暴露在射频呼吸中 心理社会压力的预期，或在诱导压力期间，有助于控制生理唤醒，减少状态 焦虑，并改善认知表现。我们假设，这种瞬间HRV BFB练习的爆发可以 作为一种有效的Sud治疗工具，在最需要的时候帮助个人自我调节激烈的情绪。 令人兴奋的是，该领域的最新进展催生了小型、轻便、可穿戴的生物传感器，这种传感器可以 佩戴者在旅途中进行HRV BFB。这些设备还具有作为即时干预的能力 通过在检测到自主神经过度觉醒时提示即时HRV BFB练习，以缓冲显著 触发和催促使用AOD。此应用程序建立在与HRV BFB的对话的大量前期工作的基础上 通过首次探索这种疾病的切割，有可能成为一线SUD治疗的补充 EDGE，第二代，可移动，HRV BFB技术。我们的具体目标包括：1)评估非卧床 短暂性心律失常患者对HRV BFB的摄取；2)测试即刻HRV BFB练习的日水平效应 情感状态和物质使用，以及3)测试每日计划的HRV BFB练习的累积效果， 当前HRV BFB实践，以及它们在物质使用上的相互作用。

PROJECT SUMMARY Alcohol and other drug use (AOD) lapses in early substance use disorder (SUD) recovery typically arise from interactions between aversive affective states and stressors that together elicit urges to use. A central goal of first-line cognitive-behavioral SUD treatments is to strengthen affective and cognitive control to increase individuals’ ability to override impulses to use AOD. Yet certain automatic physiological processes compromised by SUD dynamically interact with internal affective states and environmental cues to undermine effortful cognitive control and outcompete cognitive goals to avoid substance use. Heart rate variability biofeedback (HRV BFB) is a biobehavioral intervention involving rhythmic breathing at resonance frequency (RF) that stimulates the body’s baroreflex mechanism to offset these psychophysiological deficits. The autonomic normalization effected by RF breathing is thought to bolster cognitive control efforts by interrupting or dampening automatic-visceral reactions that can undermine treatment gains, and in doing so support better decision-making, motivation, reductions in craving, and shifts in attention allocation. Previous studies of HRV BFB have focused on positive behavioral effects that accrue over a series of weeks or months, rather than ‘in-the-moment’. These chronic behavior changes, although clinically valuable, are labor and time intensive to elicit, reducing the likelihood of large-scale uptake of the intervention. Further, first-generation HRV BFB’s regular daily practice model is likely to only partially mitigate the intense momentary bouts of emotion dysregulation that are triggers for AOD use in those in early SUD recovery. In contrast, recent studies have demonstrated that a brief exposure to RF breathing in anticipation of psychosocial stress, or during induced stress, helps to control physiological arousal, reduce state anxiety, and improve cognitive performance. We posit that such bursts of in-the-moment HRV BFB practice could serve as a potent SUD treatment tool that helps individuals self-regulate intense emotions when needed most. Excitingly, recent advances in the field have given rise to small, lightweight, wearable biosensors that can allow wearers to do HRV BFB on-the-go. These devises also have the capacity to function as a just-in-time intervention by prompting in-the-moment HRV BFB practice when autonomic hyperarousal is detected, to buffer salient triggers and urges to use AOD. This application builds on a body of preliminary work speaking to HRV BFB’s potential as an addendum to first-line SUD treatments by exploring for the first time in this disorder this cutting edge, second-generation, ambulatory, HRV BFB technology. Our specific aims include, 1) assessing ambulatory HRV BFB’s uptake by individuals with SUD, 2) testing day-level effects of in-the-moment HRV BFB practice on affective states and substance use, and 3) testing the accumulative effects of scheduled daily HRV BFB practice, in-the-moment HRV BFB practice, and their interaction, on substance use.