Heart Rate Variability Biofeedback May Reduce Craving and Substance Use During SUD Recovery
Second-generation heart rate variability biofeedback (HRVB) reduced negative affect, craving, and substance use in individuals in early recovery from severe substance use disorder (SUD), according to phase 2 trial results published in JAMA Psychiatry.
“For individuals seeking SUD recovery, everyday experiences of negative affect like stress and anxiety and salient cues can serve as potent triggers for substance use that appear to be automatic, in the sense that they bypass individuals’ conscious intentions not to use alcohol and other drugs (AOD),” wrote David Eddie, PhD, ABPP, Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, and study coauthors. “HRVB is a biobehavioral intervention involving rhythmic breathing at resonance frequency that stimulates the baroreflex to potentially offset these vulnerabilities.”
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The phase 2 trial included 120 patients in the first year of a current SUD recovery attempt with the goal of total AOD abstinence. Participants were randomized to receive either second-generation HRVB via a wearable device (n=70) and treatment as usual (TAU) or TAU only (n=50) over 8 weeks. The researchers used ecological momentary assessment to capture changes in negative affect, positive affect, craving, and substance use over the treatment period.
HRVB was associated with significant reductions in negative affect (b, –0.01; z, –3.21; P = .001) and craving (b, –0.01; z, –4.60; P < .001), while the control group displayed increases in both outcomes. The HRVB intervention was also associated with a 64% reduction in AOD use compared to control. There were no differences observed for positive affect.
Within-person analyses also showed that those receiving HRVB were less likely to use AOD after craving (b, –0.18; 95% CrI, –0.32 to –0.03).
“Taken together, the present findings suggest HRVB can support SUD recovery in clinically meaningful ways and may be a valuable complement to first-line treatments,” the authors wrote. “HRVB is particularly attractive as it can be delivered at low cost, has no contraindications, has no adverse effects, and is safe and easy to learn.”
In addition to employing a larger sample size and a placebo group, the authors suggest that subsequent phase 3 trials examine HRVB’s effectiveness during active substance use, as well as its longer-term impact on SUD recovery.
