JMIR Publications

ABSTRACT

Background:

Just-in-time intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions require attention and motivation to participate, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Passive interventions, developed by the human-computer interaction community, offer an opportunity to intervene with minimal attention and motivation. Offset heart rate biofeedback is a type of passive intervention powered by entrainment and can mitigate the physiological and psychological response to stressors.

Objective:

This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving.

Methods:

We conducted an out-of-lab, between-group, controlled experiment with 34 participants who were moderately dependent on alcohol. We elicited alcohol craving through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol using heart rate variability, self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and the experimental group.

Results:

We found that during alcohol exposure, offset heart rate biofeedback had a significant effect on heart rate variability and self-reported craving. During alcohol recovery, the intervention had a significant effect on heart rate variability except for the last block of alcohol recovery. In addition, the intervention had a significant effect on self-reported craving throughout alcohol recovery. Pair-wise comparisons indicated that the participants who received offset heart rate biofeedback experienced lower change in physiological response and lower self-reported craving, compared to participants who did not receive offset heart rate biofeedback. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback.

Conclusions:

Offset heart rate biofeedback has the potential to mitigate cue-elicit craving in-the-moment with little attention. The results of this study opened a new opportunity for the behavioral health and ubiquitous computing communities to develop just-in-time systems that intervene in cognitively and emotionally demanding contexts.