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

动态心率变异性生物反馈治疗物质使用障碍的初步研究

• 批准号: 10670398
• 负责人: DAVID EDDIE
• 金额: $ 26.58万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670398
• 关键词: Abstinence; Addendum; Affect; Affective; Alcohol consumption; Alcohol or Other Drugs use; Anxiety; Arousal; Attention; Baroreflex; Behavioral; Biofeedback; Breathing; Buffers; Bypass; Cardiovascular system; Cellular Phone; Chronic; Clinical; Clinical Sciences; Cognitive; Conscious; Cues; Data; Decision Making; Devices; Disease; Drug usage; Emotional; Emotions; Event; Exposure to; Feedback; Frequencies; Generations; Goals; Individual; Interruption; Intervention; Intuition; Maintenance; Mental Depression; Modeling; Motion; Motivation; Participant; Patients; Periodicity; Persons; Physiological; Physiological Processes; Pilot Projects; Predisposition; Provider; Psychophysiology; Psychosocial Stress; Randomized, Controlled Trials; Reaction; Recovery; Schedule; Series; Stress; Substance Use Disorder; System; Technology; Testing; Time; Visceral; Work; addiction; alcohol and other drug; anxiety states; behavior change; biobehavior; biological adaptation to stress; cognitive control; cognitive performance; cost; craving; emotion dysregulation; emotion regulation; experience; goal oriented behavior; heart rate variability; improved; light weight; negative affect; pilot test; prevent; stressor; substance use; tool; uptake; wearable sensor technology

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.

项目概要 药物滥用障碍 (SUD) 早期恢复过程中通常会出现酒精和其他药物使用 (AOD) 失误 来自厌恶情感状态和压力源之间的相互作用，共同引发使用的冲动。一个中心目标 一线认知行为 SUD 治疗的主要目的是加强情感和认知控制，以增加 个人抑制使用 AOD 冲动的能力。然而某些自动生理过程受到损害 SUD 与内部情感状态和环境线索动态互动，破坏努力的认知 控制和超越认知目标以避免物质使用。心率变异性生物反馈 (HRV BFB) 一种生物行为干预，涉及以共振频率 (RF) 进行有节奏的呼吸，刺激身体的 压力感受反射机制可以抵消这些心理生理缺陷。 RF 影响的自主神经正常化 呼吸被认为可以通过中断或抑制自动内脏反应来增强认知控制能力 这可能会损害治疗成果，并在此过程中支持更好的决策、激励、减少 渴望和注意力分配的转变。之前的 HRV BFB 研究主要集中在积极行为 效果是在几周或几个月内产生的，而不是“当下”的。这些慢性行为 改变虽然具有临床价值，但引起的劳动和时间密集，降低了大规模的可能性 干预措施的采用。此外，第一代 HRV BFB 的常规日常练习模式很可能只 部分缓解情绪失调的强烈瞬间发作，这些情绪失调是使用 AOD 的触发因素 在 SUD 恢复早期。相比之下，最近的研究表明，短暂暴露于射频呼吸 对心理社会压力的预期，或在诱发压力期间，有助于控制生理唤醒，减轻状态 焦虑，并提高认知能力。我们认为这种即时 HRV BFB 练习的爆发可以 作为一种有效的 SUD 治疗工具，可以帮助个人在最需要的时候自我调节强烈的情绪。 令人兴奋的是，该领域的最新进展催生了小型、轻量、可穿戴的生物传感器，可以允许 佩戴者可以在旅途中进行 HRV BFB。这些设备还具有及时干预的能力 当检测到自主神经过度兴奋时，提示进行即时 HRV BFB 练习，以缓冲显着的 触发并敦促使用 AOD。该应用程序建立在与 HRV BFB 相关的一系列前期工作的基础上 首次探索这种疾病作为一线 SUD 治疗的补充的潜力 边缘、第二代、动态、HRV BFB 技术。我们的具体目标包括，1) 评估动态 HRV BFB 被 SUD 个体采用，2) 测试即时 HRV BFB 练习的日水平效果 情感状态和物质使用，以及 3) 测试每日安排的 HRV BFB 练习的累积效果， 关于物质使用的即时 HRV BFB 实践及其相互作用。