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Accepted for/Published in: JMIR mHealth and uHealth

Date Submitted: Oct 23, 2018
Open Peer Review Period: Oct 24, 2018 - Dec 19, 2018
Date Accepted: Jun 17, 2019
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

Kizakevich P, Eckhoff RP, Lewis GF, Davila MI, Hourani LL, Watkins R, Weimer B, Wills T, Morgan JK, Morgan T, Meleth S, Lewis A, Krzyzanowski MC, Strange L, Ramirez D, Boyce M, Litavecz SD, Lane ME

Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

JMIR Mhealth Uhealth 2019;7(9):e12590

DOI: 10.2196/12590

PMID: 31493325

PMCID: 6754694

Psychological Resilience using Mobile Technologies for Paced Breathing and Heart Rate Variability Biofeedback

  • Paul Kizakevich; 
  • Randall P. Eckhoff; 
  • Gregory F. Lewis; 
  • Maria I. Davila; 
  • Laurel L. Hourani; 
  • Rebecca Watkins; 
  • Belinda Weimer; 
  • Tracy Wills; 
  • Jessica K. Morgan; 
  • Tim Morgan; 
  • Sreelatha Meleth; 
  • Amanda Lewis; 
  • Michelle C. Krzyzanowski; 
  • Laura Strange; 
  • Derek Ramirez; 
  • Matthew Boyce; 
  • Stephen D. Litavecz; 
  • Marian E. Lane

ABSTRACT

Background:

Psychological resilience is critical to minimize health effects to traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia or post-traumatic stress disorder. Reduction of physiological arousal via mindfulness meditation, relaxation breathing, and HRV biofeedback shortly after trauma may reduce the likelihood of such psychological distress. To better understand resilience-building practices, we are conducting the Biofeedback-Assisted Resilience Training (BART) study to evaluate whether practice of slow, paced breathing with or without heart rate variability (HRV) biofeedback can enhance psychological resilience.

Objective:

Our objective is to employ mobile technology to provide self-administered resilience-building training exercises, along with collecting research data such as psychological health assessments, cognitive stress response assessments, and HRV measurements.

Methods:

We developed the BART app to provide paced breathing resilience training, with or without HRV biofeedback, via a self-managed six-week protocol. The app receives streaming data from a Bluetooth-linked heart rate sensor and displays HRV biofeedback to indicate movement between calmer or stressful states. To evaluate the app, a population of military personnel, veterans, and civilian first responders used the app for six weeks of resilience training. App usage and HRV measures during rest, cognitive stress, and paced breathing were analyzed.

Results:

Forty-nine men and women were included in the analysis. As expected, HRV decreased significantly from rest to cognitive stress (p<.002), then rebounded approaching the at rest baseline during the post-stress recovery. Then, during resilience training, HRV increased very significantly (p<.0001) reflecting strong parasympathetic activation accompanying the paced breathing practice exercise.

Conclusions:

The BART app acquires quality data for studying changes in psychophysiological stress according to mind/body activity states, including conditions of rest, cognitive stress and slow, paced breathing.


 Citation

Please cite as:

Kizakevich P, Eckhoff RP, Lewis GF, Davila MI, Hourani LL, Watkins R, Weimer B, Wills T, Morgan JK, Morgan T, Meleth S, Lewis A, Krzyzanowski MC, Strange L, Ramirez D, Boyce M, Litavecz SD, Lane ME

Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

JMIR Mhealth Uhealth 2019;7(9):e12590

DOI: 10.2196/12590

PMID: 31493325

PMCID: 6754694

Per the author's request the PDF is not available.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.