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Heart rate variability biofeedback for adverse childhood experiences

May 6, 2022
Arnaud Delorme, PhD

Biofeedback therapy builds upon the mind-body connection. The underlying principle is that not only does the mind affect the body – but the body also affects the mind. We can thus learn to “hack” our mind by learning how a conscious change of a bodily sensation affects our mental state. This recently published peer-reviewed study was conducted by IONS Scientist Arnaud Delorme using a Biofeedback Heartmath device.

In biofeedback therapy, patients get real-time information about biological measures such as heart rate in addition to talking about the traumatic event. This allows patients to reestablish the connection between physical sensations and emotional experiences. Heightened awareness around this connection can help them regain the power over their reactions. The desired outcome of biofeedback therapy is thus improved mood regulation and disruption of destructive thought patterns. 

Patients with psychiatric conditions caused by trauma are often out of touch with their bodily sensations. This disconnect impairs healing. The patient is unconsciously responding to bodily sensations caused by the trauma, manifesting as various psychiatric conditions, instead of consciously choosing their reaction. Biofeedback can help the patient getting more conscious about their reaction and thus getting empowered to break the negative mind-body feedback loop.

In this study, the biofeedback parameter Heart Rate Variability (HRV) was used in conjunction with therapy for people having lived adverse childhood experiences (ACEs). HRV is a measure of the difference in time intervals between heartbeats. A high HRV indicates that the heart rate is relatively irregular. A low HRV, on the contrary, suggests a more regular pattern with similar time intervals between heartbeats. 

High HRV is associated with better health and ability to recover from stress since it indicates a heart functioning that’s more malleable and responsive to its environment. Emotionally stressful situations – such as ACEs – affect the sympathetic/parasympathetic balance. As soon as the stressor disappears, the system goes back into lower HR and higher HRV. 

To benefit from biofeedback therapy, patients need to be willing to face and feel uncomfortable physical sensations and emotions related to the trauma. This is referred to as intero-nociceptive therapy. Previous studies on biofeedback therapy and PTSD showed a significant increase in HRV and reduced post-traumatic stress symptoms. 

Why investigating the potential benefits of biofeedback and intero-nociceptive therapy for healing ACEs? First of all, ACEs are prevalent – about 60% of the adult population have had at least one adverse childhood experience. Secondly, when left untreated, ACEs have been shown to cause a higher risk of psychiatric conditions such as depressions, suicide attempts, alcoholism, substance abuse, and overall impaired health. The consequences are issues with mood regulation and relationship problems. 

Status quo also fails to adequately address ACEs. While prolonged exposure therapy and cognitive processing therapy have shown to be effective for PTSD, this is not always the case for ACEs. Could biofeedback therapy with intero-nociceptive emotion exposure become the standard approach to help heal ACEs? 

In this study, 100 participants were selected. To be eligible, they needed to have experienced at least one adverse childhood experience. 

All patients were either diagnosed with trauma or developmental trauma disorder. Patients were guided to revisit the traumatic experience and describe any sensations or pain that arose. A HeartMath biofeedback device delivered sound as real-time feedback on the HRV, allowing patients to be aware of their heart coherence (the Heartmath measure of HRV) as they recall the painful experience

Overall HRV was lower among study participants than in the general population, consistent with low HRV indicating stress.

The results of the treatment showed significant differences in both heart rate and HRV. HR was on average 3.4bpm higher at the onset compared to the end of the treatment, suggesting that the therapy had the desired effect. HRV decreased significantly within a session, suggesting the patients felt increased stress when revisiting the trauma. HRV was also higher at the onset compared to the end of the treatment. 

The conclusion of this study is that HRV biofeedback therapy with intero-nociceptive emotion exposure shows promising results in improving patient wellbeing. The drop in HR between phase 1 and phase 2 suggests reduced chronic stress. If future studies show that the results are repeatable, biofeedback therapy with intero-nociceptive emotion exposure could become the go-to therapy for ACEs.


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