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

项目摘要 酒精和其他药物使用（AOD）在早期物质使用障碍（SUD）恢复中的失误通常会出现 从厌恶的情感状态和压力之间的相互作用，共同引发使用的冲动。一个核心目标 一线认知行为SUD治疗的重点是加强情感和认知控制， 个人克服使用AOD冲动的能力。然而某些自动生理过程 通过SUD动态地与内部情感状态和环境线索相互作用， 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，涉及在共振频率（RF）下有节奏的呼吸，刺激身体的 压力反射机制来抵消这些心理生理缺陷。射频对自主神经功能正常化的影响 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 这可能会破坏治疗成果，并在这样做时支持更好的决策，动机，减少 渴望和注意力分配的变化。以前的研究HRV BFB集中在积极的行为 这些影响是在一系列的星期或几个月内累积的，而不是“在当下”。这些慢性行为 虽然这些变化具有临床价值，但需要耗费大量的人力和时间，从而降低了大规模的可能性。 采取干预措施。此外，第一代HRV BFB的常规日常练习模型可能仅 部分缓解了情绪失调的强烈瞬间发作，这些情绪失调是那些使用AOD的触发因素， 在早期SUD恢复中。相比之下，最近的研究表明，短暂暴露于射频呼吸， 心理社会压力的预期，或在诱导压力，有助于控制生理唤醒，减少状态 焦虑，并改善认知表现。我们认为，这种突发的时刻HRV BFB的做法， 作为一种有效的SUD治疗工具，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，该领域的最新进展已经产生了小型，轻便，可穿戴的生物传感器，可以允许 佩戴者在旅途中进行HRV BFB。这些设备也有能力作为一个及时的干预功能 通过在检测到自主神经过度觉醒时提示即时HRV BFB练习， 触发和敦促使用AOD。这个应用程序建立在一个机构的初步工作，谈到HRV BFB的 作为一线SUD治疗的补充，通过首次在这种疾病中探索这种切割， 第二代非卧床HRV BFB技术。我们的具体目标包括：1）评估门诊 SUD患者对HRV BFB的摄取，2）测试当前HRV BFB实践对 情感状态和物质使用，以及3）测试计划的每日HRV BFB实践的累积效应， 目前HRV BFB的做法，以及他们的相互作用，对物质使用。

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.