heart rate variability
Research Papers
Biofeedback Interventions for Impulsivity-related Processes in Addictive Disorders
Abstract Purpose of Review Biofeedback is a promising technique that has been used as a treatment tool for different psychological disorders. In this regard, central (neurofeedback) and peripheral psychophysiological signals are presented as comprehensible stimuli with the aim of training specific processes. This review summarizes recent evidence about its use for the treatment of impulsivity-related processes in addictive disorders. Recent Findings Neurofeedback (NFB) protocols, based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), have focused on substance use disorders. Biofeedback protocols using peripheral measures have been mainly based on heart rate variability and focused on behavioral addictions. EEG-NFB reported good results in the reduction of hyperarousal, impulsivity and risk taking in alcohol use disorder, and decreased rates of smoking and less craving in nicotine addiction. In fMRI-NFB, effective NFB performance has been related with better clinical outcomes in substance use disorders; however, its implication for treatment is still unclear. Heart rate variability biofeedback results are scarce, but some interventions have been recently designed aimed at treating behavioral addictions. Summary In addictive disorders, biofeedback interventions for impulsivity-related processes have shown promising results, although the literature is still scarce. Further research should aim at proving the effectiveness of biofeedback protocols as a treatment option for impulsivity in addictive disorders.
View Full Paper →Efficacy of bio- and neurofeedback for depression: a meta-analysis
BACKGROUND: For many years, biofeedback and neurofeedback have been implemented in the treatment of depression. However, the effectiveness of these techniques on depressive symptomatology is still controversial. Hence, we conducted a meta-analysis of studies extracted from PubMed, Scopus, Web of Science and Embase. METHODS: Two different strings were considered for each of the two objectives of the study: A first group comprising studies patients with major depressive disorder (MDD) and a second group including studies targeting depressive symptomatology reduction in other mental or medical conditions. RESULTS: In the first group of studies including patients with MDD, the within-group analyses yielded an effect size of Hedges' g = 0.717, while the between-group analysis an effect size of Hedges' g = 1.050. Moderator analyses indicate that treatment efficacy is only significant when accounting for experimental design, in favor of randomized controlled trials (RCTs) in comparison to non RCTs, whereas the type of neurofeedback, trial design, year of publication, number of sessions, age, sex and quality of study did not influence treatment efficacy. In the second group of studies, a small but significant effect between groups was found (Hedges' g = 0.303) in favor of bio- and neurofeedback against control groups. Moderator analyses revealed that treatment efficacy was not moderated by any of the sociodemographic and clinical variables. CONCLUSIONS: Heart rate variability (HRV) biofeedback and neurofeedback are associated with a reduction in self-reported depression. Despite the fact that the field has still a large room for improvement in terms of research quality, the results presented in this study suggests that both modalities may become relevant complementary strategies for the treatment of MDD and depressive symptomatology in the coming years.
View Full Paper →Healing the Neurophysiological Roots of Trauma: A Controlled Study Examining LORETA Z-Score Neurofeedback and HRV Biofeedback for Chronic PTSD
Introduction: Posttraumatic stress disorder (PTSD) has been linked to abnormalities within three neural networks: default mode (DMN), salience (SN), and central executive (CEN). This study examined the effectiveness of LORETA z-score neurofeedback (LZNF) training for altering current source within these networks and reducing symptoms associated with PTSD. Methods: Twenty-three adults with chronic PTSD were randomly assigned to 15 sessions of either LZNF (n = 12) or heart rate variability biofeedback (HRVB; n = 11). Psychosocial and physiological assessments were completed at baseline and postintervention. Results: The LZNF group showed very large, statistically significant decreases in symptoms on the PTSD Checklist for DSM-V (PCL-5; p = .003, d = 2.09) and Beck Anxiety Inventory (BAI; p = .003, d = 2.13). The HRVB group also showed very large decreases on the PCL-5 (p = .006, d = 1.40) and medium effects on the BAI (p = .018, d = 0.76). Between-group comparisons showed medium to large effects of group type in favor of LZNF (PCL-5 d = 0.57; BAI d = 0.94), although not statistically significant. LZNF Responders (n = 9) demonstrated very large, statistically significant decreases in abnormal z-scores within all targeted networks (DMN p = .012, d = 0.96; SN p = .008, d = 1.32; CEN p = .008, d = 1.33). Conclusion: The positive outcomes of this study provide preliminary evidence to support LZNF training as a specific, effective, and tolerable intervention for adults with chronic PTSD
View Full Paper →Neuromodulation Based on rTMS Affects Behavioral Measures and Autonomic Nervous System Activity in Children with Autism
Many children with autism spectrum disorder (ASD) exhibit symptoms associated with autonomic nervous system (ANS) dysfunction indicative of low psychophysiological flexibility. It is suggested that ASD symptoms are associated with generalized abnormalities in the central nervous system, including structures and networks involved in the top-down regulation of the ANS. Repetitive transcranial magnetic stimulation (rTMS) has been suggested as a possible therapy to target ANS regulation deficits in ASD. In the current study we used neuromodulation based on rTMS over the dorsolateral prefrontal cortex (DLPFC) to reduce sympathetic arousal and increase parasympathetic activity in children with ASD. In a study on 27 children with autism we administered weekly 0.5 Hz rTMS bilaterally over the DLPFC with concurrent recording of autonomic activity. Statistical analysis of time and frequency domain heart rate variability (HRV) indices and skin conductance level (SCL) revealed a strong linear regression of most HRV and SCL measures. Several parental behavioral rating scores improved post-TMS and showed a correlation with autonomic outcomes; in particular, parasympathetic indices of HRV negatively correlated with repetitive and stereotyped behaviors, while sympathetic arousal indices showed positive correlation with the same behaviors. The paper discusses potential neurobiological mechanisms involved in post-TMS autonomic balance and aberrant behavior improvements
View Full Paper →Increasing Performance of Professional Soccer Players and Elite Track and Field Athletes with Peak Performance Training and Biofeedback: A Pilot Study
The aim of this pilot study was to investigate the effects of an intervention consisting of mental coaching combined with either electro encephalogram (EEG) alpha power feedback or heart rate variability (HRV) feedback on HRV, EEG outcomes and self-reported factors related to stress, performance, recovery and sleep quality in elite athletes. A prospective pilot study was performed with two distinct cohorts. Soccer players were provided with four sessions of mental coaching combined with daily HRV biofeedback (Group A); track and field athletes were provided with four sessions of mental coaching in combination with daily neurofeedback (Group B). Measurements were performed at baseline, post intervention and at 5 weeks follow-up. Objective measures: EEG and ECG. Subjective measures: Numeric Rating Scale for performance, Pittsburgh Sleep Quality Index, Rest and Stress Questionnaire and Sports Improvement-60. Group characteristics were too distinct to compare the interventions. Linear mixed models were used to analyze differences within groups over time. In Group A, significant changes over time were present in alpha power at 5 of 7 EEG locations (p < 0.01-0.03). LF/HF ratio significantly increased (p = 0.02) and the concentration (p = 0.02) and emotional scale (p = 0.03) of the SIM-60 increased significantly (p = 0.04). In Group B, the HRV low frequency power and recovery scale of the REST-Q significantly increased (p = 0.02 and <0.01 resp.). Other measures remained stable or improved non-significantly. A mental coaching program combined with either HRV or EEG alpha power feedback may increase HRV and alpha power and may lead to better performance-related outcomes and stress reduction. Further research is needed to elucidate the effects of either type of feedback and to compare effects with a control group.
View Full Paper →Brain computer interface game applications for combined neurofeedback and biofeedback treatment for children on the autism spectrum
Individuals with autism spectrum disorder (ASD) show deficits in social and communicative skills, including imitation, empathy, and shared attention, as well as restricted interests and repetitive patterns of behaviors. Evidence for and against the idea that dysfunctions in the mirror neuron system are involved in imitation and could be one underlying cause for ASD is discussed in this review. Neurofeedback interventions have reduced symptoms in children with ASD by self-regulation of brain rhythms. However, cortical deficiencies are not the only cause of these symptoms. Peripheral physiological activity, such as the heart rate and its variability, is closely linked to neurophysiological signals and associated with social engagement. Therefore, a combined approach targeting the interplay between brain, body, and behavior could be more effective. Brain-computer interface applications for combined neurofeedback and biofeedback treatment for children with ASD are currently nonexistent. To facilitate their use, we have designed an innovative game that includes social interactions and provides neural- and body-based feedback that corresponds directly to the underlying significance of the trained signals as well as to the behavior that is reinforced.
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