Using the body to calm the mind: An examination of heart rate variability biofeedback as a tool to reduce generalised anxiety disorder symptoms

我们都会时不时地担心，但对于一些患有广泛性焦虑症（GAD）的人来说，担心会变得无法控制、耗时和痛苦。广泛性焦虑症不仅会对我们的思维和感觉产生负面影响，还会影响我们的身体健康。当人们长时间过度焦虑时，往往伴随着身体的变化。一个重要的变化是每次心跳之间的时间间隔。在健康的身体中，每次心跳之间的时间间隔是不规律的。每次连续心跳之间的时间间隔（以毫秒计）称为心率变异性（HRV）。高HRV（例如，连续心跳之间的时间变化大）与健康的身心有关。先前的研究表明，高HRV与能够更好地管理我们的情绪状态有关，例如能够减少消极情绪状态的强度。广泛性焦虑症患者在较长一段时间内往往会经历低HRV，因为在经历非常高水平的担忧和低HRV之间存在关联。如果不及时治疗，低HRV也会使人们在以后的生活中面临心脏健康不佳的风险。广泛性焦虑症的推荐治疗方法是认知行为疗法（CBT）。这种疗法帮助人们更好地理解思想、感觉和行为之间的关系。虽然这种治疗方法对很多人都有帮助，但恢复率有很大差异，只有50%的人在接受CBT治疗后从广泛性焦虑症中恢复过来。这意味着，虽然CBT对很多人有帮助，但也有一些人在治疗后没有康复。因此，研究治疗广泛性焦虑症的新方法是非常重要的。我们知道高度焦虑和低HRV之间存在联系。一种可能成功减轻广泛性焦虑症关键症状（如过度焦虑）的方法是提高人们的HRV，看看它是否能降低焦虑水平。心率变异与呼吸模式有关，所以心率变异可以通过教人们以特定的频率呼吸来提高。先前的研究表明，人的HRV升高与焦虑程度降低有关。然而，这项研究没有包括那些经历高度焦虑和担忧的人（如广泛性焦虑症），而且研究并不总是有高质量的设计。因此，根据我们目前掌握的信息，很难得出关于提高HRV作为广泛性焦虑症治疗效果的确切结论。我建议研究HRV升高与广泛性焦虑症症状之间的关系，并就HRV升高是否可能减轻广泛性焦虑症的症状（例如减少担忧程度）提供答案。我将通过：1。研究HRV的增加是否会影响导致过度忧虑的思维模式。2 .检查在几个疗程中增加HRV是否能减轻gad的症状。检查是否提供以身体为基础的干预（增加HRV）与以精神为基础的干预（认知训练以减少担忧）相结合，在减轻广泛性焦虑症症状方面比单独干预更有效。这项研究有可能为广泛性焦虑症提供一种新的治疗方法。如果增加HRV对减轻广泛性焦虑症的症状和其他治疗方法一样有效，那么这种新的治疗方法可以确保服兵役者在考虑他们更愿意接受哪种治疗时有更多的选择。如果增加HRV与认知疗法相结合可以提高认知训练的有效性，那么在未来的研究中有可能检验两种疗法联合使用的有效性。

We all worry from time to time, but for some people who experience an illness called generalised anxiety disorder (GAD), worrying can become uncontrollable, time consuming and distressing. As well as having a negative impact on the way we think and feel, GAD also affects our physical wellbeing. When people experience excessive worry over a long time period, this is often accompanied by changes in the body. One important change is in the time interval between each heartbeat. In a healthy body, the time interval between each heartbeat is not regular. The time gap (measured in milliseconds) between each consecutive heartbeat is called heart rate variability (HRV). High HRV (e.g. high variation in the time between consecutive heartbeats) is associated with a healthy body and mind. Previous research suggests that high HRV is associated with being able to better manage our mood states, for example being able to reduce the intensity of a negative mood state. People with GAD tend to experience low HRV over a prolonged period of time, as there is an association between experiencing very high levels of worry and low HRV. Left untreated, low HRV also puts people at risk of poor heart health later in life. A recommended treatment for GAD is cognitive behavioural therapy (CBT). This therapy helps people to better understand the relationship between thoughts, feelings and behaviours. Although this treatment is helpful for many people, there is a lot of variation in recovery rates, with only 50% of people recovering from GAD after CBT. This means that while CBT is helpful for lots of people, there are others who do not recover after treatment. It is therefore very important that we examine new approaches to treating GAD. We know that there is a link between experiencing high levels of worry and experiencing low HRV. One approach that may be successful in reducing key symptoms of GAD such as excessive worry, is to increase people's HRV to see if it reduces worry levels. HRV is linked to breathing patterns, so HRV can be increased by teaching people to beathe at a specific rate. Previous research has shown that increasing people's HRV is associated with lower levels of anxiety. However, this research did not include people who experience very high levels of anxiety and worry (as seen in GAD) and the research did not always have a high-quality design. So, based on the current information we have, it is difficult to draw firm conclusions about the effectiveness of increasing HRV as a treatment for GAD. I propose to examine the relationship between increased HRV and symptoms of GAD and to provide answers as to whether increasing HRV may reduce symptoms of GAD (e.g. reduce worry levels). I will do this by:1. Examining whether increasing HRV affects the thinking patterns that are known to underpin excessive worry.2. Examining whether increasing HRV over a number of sessions reduces symptoms of GAD.3. Examining whether providing a body-based intervention (increasing HRV) in combination with a mind-based intervention (cognitive training to reduce worry) is more effective at reducing GAD symptoms than either intervention by itself. This research has potential to provide a new type of therapy for GAD. If increasing HRV is as effective at reducing GAD symptoms as other treatments, then this new treatment approach could ensure that service-users have greater choice when thinking about what treatment they would prefer to engage with. If increasing HRV combined with cognitive therapy improves the effectiveness of cognitive training, then there is potential to examine the usefulness of offering both treatments in combination in future research.