Transcript AABT2007

Diaphragmatic Breathing and Heart Rate Variability Biofeedback for
Decreasing Compulsive Behaviors in Borderline Personality Disorder
Milton Brown, Chantelle Thomas, and Richard Gevirtz
California School of Professional Psychology at Alliant International University, San Diego, CA
Heart rate variability (HRV) is generally suppressed in a variety of
disorders of emotion, including borderline personality disorder (BPD),
which is thought of as a disorder of chronic and pervasive emotion
dysregulation (Linehan, 1993). HRV biofeedback is a technique that
gives feedback about fluctuations in HRV during diaphragmatic
breathing to optimize the rate and quality of breathing to maximize
HRV. The goal is to improve emotion regulation by strengthening
homeostatic reflexes and vagal tone. Initial case reports and small
research studies suggest that HRV biofeedback may help with anger
and anxiety disorders (Bhat & Bhat, 1999; Gevirtz, 2003), but no
studies have yet examined HRV interventions for reducing emotiondependent behaviors. Furthermore, no studies have evaluated this
technique for emotion regulation in BPD.
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biofeedback
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sham device
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biofeedback
The current study utilizes a single-subject design to evaluate the
effectiveness of HRV biofeedback for treating compulsive behaviors
in BPD.
Method
Participant (N = 1):
■ female, age 55, Caucasian, middle-class
■ current diagnoses: borderline personality disorder,
major depressive disorder, generalized anxiety disorder
■ weekly individual therapy (outside the study)
Measures:
• Self-Monitoring: daily count of compulsive behaviors and daily Likert
ratings of anxiety, anger, shame, and compulsion urges.
• Yale-Brown Obsessive Compulsive Scale (YBOCS): an interviewbased rating scale measuring severity of OCD.
• Taylor Manifest Anxiety Scale (TMAS-28; Taylor, 1953). Twenty-eight
True-False statements reflect somatic, behavioral, emotional, and
cognitive signs of trait anxiety.
• Beck Depression Inventory (BDI-II, 2nd Ed.): self-reported depression
symptoms over a two-week period.
• Suicidal Behavior Questionnaire (SBQ). A brief self-report measure of
suicide threats and ideation.
Results
● The participant practiced moderately and inconsistently.
• sham practice: 70% of days (M = 5.8 min./day)
• biofeedback practice: 46% of days
• practice sessions were shorter than recommended
• not practiced during urges or distress
start of
biofeedback
Points
60
55
60
73
16
17
● Anxiety was not related to compulsive urges or behaviors.
Procedures:
Instructions: daily practice of device-assisted breathing and also
whenever urge to engage in compulsive behavior or at the start of
any episode of intense emotion.
Baseline (2 weeks): sham biofeedback device combined with
diaphragmatic breathing (no instructions about breathing pace or volume).
Intervention (2 weeks): slow diaphragmatic breathing (about 5-6
breaths per minute) with the aide of a StressEraser, a handheld HRV
biofeedback device. 100 points recommended as daily goal.
● There were fewer compulsive acts on days with greater
practice of HRV biofeedback.
● Overall, compulsive behaviors were not less when the
participant practiced HRV biofeedback compared to when
the participant practiced the sham device.
Baseline Data:
Conclusions
YBOCS: Skin-picking was her only compulsive behavior.
obsession
compulsion
score
12 (max=20)
10 (max=20)
daily total time 2 hrs
35 min.
longest (typical) daily interval
obsession-free interval:
compulsion-free interval:
Date
10/18
10/19
10/21
10/23
10/25
10/28
3-Day
Interval
12
12
13
13
14
15
40 minutes
5 hours
TMAS = 13 (low general somatic anxiety; max=28)
BDI = 21 (moderate current depression)
SBQ - previous suicide attempt, but no suicide ideation in the last year.
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biofeedback
● This study did not find much evidence for the efficacy of
HRV biofeedback for compulsive behaviors in borderline
personality disorder. More evidence is needed.
● More research is needed to evaluate the effects of a
sufficient dose of HRV biofeedback
• participant compliance must be improved
• more participants will allow a multiple-baseline design