Effect of heart rate variability biofeedback on extinction learning in healthy individuals and individuals with panic disorder and agoraphobia

暴露疗法，包括面对恐惧的刺激或情况，是一种行之有效的治疗病理性焦虑的方法。然而，高脱落率和无应答率要求研究介导治疗应答及其潜在机制的个体差异。我们最近证明，低水平的迷走神经介导的心率变异性（vmHRV）在惊恐障碍和广场恐怖症患者预测辍学和暴露治疗后的残留症状。此外，我们在几项研究中发现，vmHRV水平低的个体在灭绝学习中表现出缺陷，这可以作为暴露疗法的实验室模型。因此，在目前的项目中，我们希望测试HRV生物反馈训练对消退学习有促进作用的假设。首先，我们希望在更大的健康个体样本中调查这个研究问题，以测试HRV生物反馈是否会影响消退学习，特别是在vmHRV水平较低的个体中，从而为个性化适应症提供基础。此外，我们想研究HRV生物反馈在惊恐障碍和广场恐怖症患者中的作用，因为这些患者群体通常表现出较低的vmHRV水平和消退学习的缺陷。早期的研究结果，主要是在非临床人群中，表明HRV生物反馈有效地减少了压力和焦虑。因此，目前的研究状况提出了一个问题，即在惊恐障碍和广场恐怖症患者中进行HRV生物反馈训练是否有助于消退学习并降低病理性焦虑水平。

Exposure therapy, which involves confronting the feared stimulus or situation, is a well-established and effective treatment for pathological anxiety. However, high dropout and non-responder rates call for the investigation of individual differences that mediate the treatment response and its underlying mechanisms. We recently demonstrated that low levels of vagally mediated heart rate variability (vmHRV) in patients with panic disorder and agoraphobia predict dropout from and residual symptoms after exposure treatment. Moreover, we found in several studies that individuals with low levels of vmHRV show deficits in extinction learning which serves as a laboratory model for exposure therapy. With the current project we, therefore, want to test the assumption that HRV biofeedback training has a facilitating effect on extinction learning. First, we want to investigate this research question in a larger sample of healthy individuals to test whether HRV biofeedback effects extinction learning particularly in individuals with low levels of vmHRV, thus, providing the basis for an individualized indication. In addition, we want to investigate the effect of HRV biofeedback in individuals with panic disorder and agoraphobia since this patient population shows generally lower levels of vmHRV and also deficits in extinction learning. Earlier findings, predominantly in non-clinical populations, show that HRV biofeedback effectively reduces stress and anxiety. Thus, the current state of research raises the question whether HRV biofeedback training in individuals with panic disorder and agoraphobia facilitates extinction learning and reduces pathological anxiety levels.