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，担心可能会变得无法控制，耗时和痛苦。除了对我们的思维和感受方式产生负面影响外，GAD还影响我们的身体健康。当人们在很长一段时间内经历过度担忧时，这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则的。每次连续心跳之间的时间间隔（以毫秒为单位测量）称为心率变异性（HRV）。高HRV（例如，连续心跳之间的时间变化较大）与健康的身心有关。先前的研究表明，高心率变异性与能够更好地管理我们的情绪状态有关，例如能够降低消极情绪状态的强度。患有广泛性焦虑症的人往往会在很长一段时间内经历低心率变异性，因为经历非常高的担忧和低心率变异性之间存在关联。如果不进行治疗，低心率变异性也会使人们在以后的生活中面临心脏健康不良的风险。GAD的推荐治疗方法是认知行为疗法（CBT）。这种疗法有助于人们更好地理解思想，情感和行为之间的关系。虽然这种治疗对许多人有帮助，但恢复率有很大差异，只有50%的人在CBT后从GAD中恢复。这意味着，虽然CBT对很多人都有帮助，但也有其他人在治疗后无法康复。因此，我们研究治疗GAD的新方法非常重要。我们知道，在经历高水平的担忧和经历低HRV之间存在联系。一种可能成功减少GAD的关键症状（如过度担忧）的方法是增加人们的HRV，看看它是否能降低担忧水平。心率变异性与呼吸模式有关，所以心率变异性可以通过教人们以特定的频率跳动来提高。先前的研究表明，增加人们的HRV与较低的焦虑水平有关。然而，这项研究并没有包括那些经历非常高水平焦虑和担忧的人（如GAD中所见），而且这项研究并不总是有高质量的设计。因此，根据我们现有的信息，很难得出关于增加HRV作为GAD治疗方法的有效性的确切结论。我建议检查增加的HRV和GAD症状之间的关系，并提供答案，以增加HRV是否可以减少GAD的症状（例如，减少担心水平）。我将这样做：1。检查心率变异性的增加是否会影响人们的思维模式，而这种思维模式是过度担忧的基础。检查是否增加心率变异性在一些会议减少GAD的症状。检查是否提供基于身体的干预（增加HRV）与基于心理的干预（减少担忧的认知训练）相结合，比单独干预更有效地减少GAD症状。本研究有可能为广泛性焦虑症提供一种新的治疗方法。如果增加心率变异性在减少广泛性焦虑症症状方面与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务用户在考虑他们更愿意接受什么治疗时有更多的选择。如果增加心率变异性结合认知疗法可以提高认知训练的有效性，那么在未来的研究中，有可能研究联合提供这两种治疗的有用性。

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.