Skip to main content
Top
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Effect of short-term heart rate variability biofeedback on long-term abstinence in alcohol dependent patients – a one-year follow-up

Authors: Ana Isabel Penzlin, Kristian Barlinn, Ben Min-Woo Illigens, Kerstin Weidner, Martin Siepmann, Timo Siepmann

Published in: BMC Psychiatry | Issue 1/2017

Login to get access

Abstract

Background

A randomized controlled study (RCT) recently showed that short-term heart rate variability (HRV) biofeedback in addition to standard rehabilitation care for alcohol dependence can reduce craving, anxiety and improve cardiovascular autonomic function. In this one-year follow-up study we aimed to explore whether completion of 2-week HRV-Biofeedback training is associated with long-term abstinence. Furthermore, we sought to identify potential predictors of post-treatment abstinence.

Methods

We conducted a survey on abstinence in patients with alcohol dependence 1 year after completion of an RCT comparing HRV-biofeedback in addition to inpatient rehabilitation treatment alone (controls). Abstinence rates were compared and analysed for association with demographic data as well as psychometric and autonomic cardiac assessment before and after completion of the biofeedback training using bivariate and multivariate regression analyses.

Results

Out of 48 patients who participated in the RCT, 27 patients (9 females, ages 42.9 ± 8.6, mean ± SD) completed our one-year follow-up. When including in the analysis only patients who completed follow-up, the rate of abstinence tended to be higher in patients who underwent HRV-biofeedback 1 year earlier compared to those who received rehabilitative treatment alone (66.7% vs 50%, p = ns). This non-significant trend was also observed in the intention-to-treat analysis where patients who did not participate in the follow-up were assumed to have relapsed (46,7% biofeedback vs. 33.3% controls, p = ns). Neither cardiac autonomic function nor psychometric variables were associated with abstinence 1 year after HRV-biofeedback.

Conclusion

Our follow-up study provide a first indication of possible increase in long-term abstinence after HRV-biofeedback for alcohol dependence in addition to rehabilitation.

Trial registration

The original randomized controlled trial was registered in the German Clinical Trials Register (DRKS00004618). This one-year follow-up survey has not been registered.
Literature
2.
go back to reference Preuss UW, Zimmermann J, Schultz G, Watzke A, Schmidt P, Löhnert B, et al. Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment. Subst Abuse Rehabil. 2012;3:35–42.CrossRefPubMedPubMedCentral Preuss UW, Zimmermann J, Schultz G, Watzke A, Schmidt P, Löhnert B, et al. Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment. Subst Abuse Rehabil. 2012;3:35–42.CrossRefPubMedPubMedCentral
3.
go back to reference Newham R, Russell C, Davies JB. Planned and unplanned discharge from alcohol services in Scotland, 2004-2008. Alcohol Alcohol. 2010;45(1):64–9.CrossRefPubMed Newham R, Russell C, Davies JB. Planned and unplanned discharge from alcohol services in Scotland, 2004-2008. Alcohol Alcohol. 2010;45(1):64–9.CrossRefPubMed
4.
go back to reference McKay JR, Weiss RV. A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow ups: preliminary results and methodological issues. Eval Rev. 2001;25(2):113–61.CrossRefPubMed McKay JR, Weiss RV. A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow ups: preliminary results and methodological issues. Eval Rev. 2001;25(2):113–61.CrossRefPubMed
5.
go back to reference McKay JT, Foltz C, Stephens RC, Leahy PJ, Crowley EM, Kissin W. Predictors of alcohol and crack cocaine use outcomes over a 3-year follow up in treatment seekers. J Subst Abus Treat. 2005;28(Suppl 1):S73–82.CrossRef McKay JT, Foltz C, Stephens RC, Leahy PJ, Crowley EM, Kissin W. Predictors of alcohol and crack cocaine use outcomes over a 3-year follow up in treatment seekers. J Subst Abus Treat. 2005;28(Suppl 1):S73–82.CrossRef
6.
go back to reference Rose GL, Skelly JM, Badger GJ, Ferraro TA, Helzer JE. Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence. Addict Behav. 2015;41:223–31.CrossRefPubMed Rose GL, Skelly JM, Badger GJ, Ferraro TA, Helzer JE. Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence. Addict Behav. 2015;41:223–31.CrossRefPubMed
7.
go back to reference Schellekens AF, de Jong CA, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry. 2015;30(1):128–36.CrossRefPubMed Schellekens AF, de Jong CA, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry. 2015;30(1):128–36.CrossRefPubMed
8.
go back to reference Oslin D, Cary M, Slaymaker V, Colleran C, Blow F. Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking. Drug Alcohol Depend. 2009;103(4):131–6.CrossRefPubMed Oslin D, Cary M, Slaymaker V, Colleran C, Blow F. Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking. Drug Alcohol Depend. 2009;103(4):131–6.CrossRefPubMed
9.
go back to reference Schneekloth T, Biernacka J, Hall-Flavin D, et al. Alcohol craving as a predictor of relapse. Am J Addict. 2012;21:20–6.CrossRef Schneekloth T, Biernacka J, Hall-Flavin D, et al. Alcohol craving as a predictor of relapse. Am J Addict. 2012;21:20–6.CrossRef
10.
go back to reference Penzlin AI, Siepmann T, Illigens BM, Weidner K, Siepmann M. Heart rate variability biofeedback in patients with alcohol dependence: a randomized controlled study. Neuropsychiatr Dis Treat. 2015;11:2619–27.CrossRefPubMedPubMedCentral Penzlin AI, Siepmann T, Illigens BM, Weidner K, Siepmann M. Heart rate variability biofeedback in patients with alcohol dependence: a randomized controlled study. Neuropsychiatr Dis Treat. 2015;11:2619–27.CrossRefPubMedPubMedCentral
11.
go back to reference German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). Documentation standards III for the evaluation of treatment of addicts (Dokumentationsstandards III für die evaluation der Behandlung von Abhängigen). Sucht. 2001;47(2):3–94. [German] German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). Documentation standards III for the evaluation of treatment of addicts (Dokumentationsstandards III für die evaluation der Behandlung von Abhängigen). Sucht. 2001;47(2):3–94. [German]
12.
go back to reference Eddie D, Kim C, Lehrer P, Deneke E, Bates M. A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders. Appl Psychophysiol Biofeedback. 2014;39(3-4):181–92.CrossRefPubMedPubMedCentral Eddie D, Kim C, Lehrer P, Deneke E, Bates M. A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders. Appl Psychophysiol Biofeedback. 2014;39(3-4):181–92.CrossRefPubMedPubMedCentral
13.
go back to reference Windthorst P, Mazurak N, Kuske M, Hipp A, Giel KE, Enck P, et al. Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: an exploratory pilot study. J Psychosom Res. 2017;93:6–13.CrossRefPubMed Windthorst P, Mazurak N, Kuske M, Hipp A, Giel KE, Enck P, et al. Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: an exploratory pilot study. J Psychosom Res. 2017;93:6–13.CrossRefPubMed
14.
go back to reference Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997;34(6):623–48.CrossRefPubMed Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997;34(6):623–48.CrossRefPubMed
15.
go back to reference Benarroch E. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc. 1993;68:988–1001.CrossRefPubMed Benarroch E. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc. 1993;68:988–1001.CrossRefPubMed
16.
go back to reference Devinsky O, Morrell MJ, Vogt BA. Contributions of anterior cingulate cortex to behavior. Brain. 1993;118:279–306.CrossRef Devinsky O, Morrell MJ, Vogt BA. Contributions of anterior cingulate cortex to behavior. Brain. 1993;118:279–306.CrossRef
17.
go back to reference Thayer J, Hansen A, Saus-Rose E, Johnsen B. Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009;37:141–53.CrossRefPubMed Thayer J, Hansen A, Saus-Rose E, Johnsen B. Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009;37:141–53.CrossRefPubMed
18.
go back to reference Kemp A, Quintana D, Felmingham K, Matthews S, Jelinek H. Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One. 2012;7:e30777.CrossRefPubMedPubMedCentral Kemp A, Quintana D, Felmingham K, Matthews S, Jelinek H. Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One. 2012;7:e30777.CrossRefPubMedPubMedCentral
19.
go back to reference Quintana D, Guastella A, McGregor I, Hickie I, Kemp A. Heart rate variability predicts alcohol craving in alcohol dependent outpatients: further evidence for HRV as a psychophysiological marker of self-regulation. Drug Alcohol Depend. 2013;132(1-2):395–8.CrossRefPubMed Quintana D, Guastella A, McGregor I, Hickie I, Kemp A. Heart rate variability predicts alcohol craving in alcohol dependent outpatients: further evidence for HRV as a psychophysiological marker of self-regulation. Drug Alcohol Depend. 2013;132(1-2):395–8.CrossRefPubMed
20.
go back to reference Garland EL, Franken IHA, Howard MO. Cue-elicited heart rate variability and Attentional bias predict alcohol relapse following treatment. Psychopharmacology. 2012;222(1):17–26.CrossRefPubMed Garland EL, Franken IHA, Howard MO. Cue-elicited heart rate variability and Attentional bias predict alcohol relapse following treatment. Psychopharmacology. 2012;222(1):17–26.CrossRefPubMed
21.
go back to reference Schacht JP, Anton RF, Myrick H. Functional neuroimaging studies of alcohol cue reactivity: a quantitative meta-analysis and systematic review. Addict Biol. 2013;18(1):121–33.CrossRefPubMed Schacht JP, Anton RF, Myrick H. Functional neuroimaging studies of alcohol cue reactivity: a quantitative meta-analysis and systematic review. Addict Biol. 2013;18(1):121–33.CrossRefPubMed
Metadata
Title
Effect of short-term heart rate variability biofeedback on long-term abstinence in alcohol dependent patients – a one-year follow-up
Authors
Ana Isabel Penzlin
Kristian Barlinn
Ben Min-Woo Illigens
Kerstin Weidner
Martin Siepmann
Timo Siepmann
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1480-2

Other articles of this Issue 1/2017

BMC Psychiatry 1/2017 Go to the issue