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Integrating Body and Brain Systems in Addiction Neuroscience
... 43,48 Neurocardiac dynamics, such as heart rate variability (HRV), underlie the heart-brain feedback loop that contributes to behavioral flexibility. 49,50 HRV is the variability in R-to R-spike intervals of the electrocardiogram that is regulated by neural mechanisms of the autonomic nervous system, reflecting efferent vagus and sympathetic nerve activity and afferent nerve activity mediated by the baroreceptors. High-frequency HRV reflects highfrequency heart rate oscillations (0.15-0.4 Hz) mediated by vagal activity. ...
... In line with this theory, evidence shows that HRV provides insight into the neural mechanisms of the flexible regulation of affective states and cognition. 48,49,52 Research suggests that low HRV predicts craving in individuals with SUD. 39,47 Increasing HRV may therefore improve autonomic homeostasis and behavioral flexibility 48,49,53 and, thus, enhance craving control. ...
... 48,49,52 Research suggests that low HRV predicts craving in individuals with SUD. 39,47 Increasing HRV may therefore improve autonomic homeostasis and behavioral flexibility 48,49,53 and, thus, enhance craving control. HRVB is a form of cardiorespiratory feedback training that aims to increase HRV and enhance vagal heart rate control. ...
Background:
The limited success of conventional anticraving interventions encourages research into new treatment strategies. Heart rate variability biofeedback (HRVB), which is based on slowed breathing, was shown to improve symptom severity in various disorders. HRVB, and certain rates of controlled breathing (CB), may offer therapeutic potential as a complementary drug-free treatment option to help control substance craving.
Methods:
This review evaluated current evidence on the effectiveness of HRVB and CB training as a complementary anticraving intervention, based on guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies that assessed a cardiorespiratory feedback or CB intervention with substance craving as an outcome were selected. Effect sizes were calculated for each study. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to evaluate the quality of each study reviewed.
Results:
A total of eight articles remained for final review, including controlled studies with or without randomization, as well as noncontrolled trials. Most studies showed positive results with a variety of methodological quality levels and effect size. Current HRVB studies rated moderately on methodological rigor and showed inconsistent magnitudes of calculated effect size (0.074-0.727) across populations. The largest effect size was found in a nonclinical college population of high food cravers utilizing the most intensive HRVB training time of 240 min.
Conclusions:
Despite the limitations of this review, there is beginning evidence that HRVB and CB training can be of significant therapeutic potential. Larger clinical trials are needed with methodological improvements such as longer treatment duration, adequate control conditions, measures of adherence and compliance, longitudinal examination of craving changes, and more comprehensive methods of craving measurement.
... The present study used a variable-centered model of cognitive change as a starting point against which to gauge the potential heterogeneity of change patterns observed at the level of individual patients in SUD treatment. We built on our previous CFA of cognitive abilities in a sample of 197 men and women who entered treatment for an alcohol and/or drug use disorder (23)(24)(25). CFA was used to specify the degree to which an a priori conceptual model 1 of four underlying cognitive ability constructs supported performance on 15 standardized neuropsychological tests that assessed the major domains of impairment found in heavy, chronic users of alcohol and other drugs (27,28). We showed evidence of convergent and discriminative validity for underlying ability constructs termed executive function, memory, verbal ability, and complex syntactic information processing speed. ...
... In the present study, we added two additional neuropsychological retests that were conducted in this sample at 26 and 52 weeks post-treatment entry (25) to determine the average level of changes in the cognitive abilities over the full 1-year testing interval. We output latent ability scores for each participant at each of the four test occasions from the variable-centered analysis in order to calculate person-centered empirical growth plots (31)(32)(33). ...
... Results are also consistent with the suggestion that there may be value to SUD treatment development in exploring a broad range of approaches to neurocognitive facilitation and rehabilitation. A resurgence of interest in creating cognitive adjuncts to addiction treatment approaches include techniques to rehabilitate or facilitate cognitive functions by training working memory and other executive and memory functions (72)(73)(74), and alternatively, to bolster non-cognitive emotion regulation functions that may indirectly improve cognitive control (25,75). ...
... The present study used a variable-centered model of cognitive change as a starting point against which to gauge the potential heterogeneity of change patterns observed at the level of individual patients in SUD treatment. We built on our previous CFA of cognitive abilities in a sample of 197 men and women who entered treatment for an alcohol and/or drug use disorder (23)(24)(25). CFA was used to specify the degree to which an a priori conceptual model 1 of four underlying cognitive ability constructs supported performance on 15 standardized neuropsychological tests that assessed the major domains of impairment found in heavy, chronic users of alcohol and other drugs (27,28). We showed evidence of convergent and discriminative validity for underlying ability constructs termed executive function, memory, verbal ability, and complex syntactic information processing speed. ...
... In the present study, we added two additional neuropsychological retests that were conducted in this sample at 26 and 52 weeks post-treatment entry (25) to determine the average level of changes in the cognitive abilities over the full 1-year testing interval. We output latent ability scores for each participant at each of the four test occasions from the variable-centered analysis in order to calculate person-centered empirical growth plots (31)(32)(33). ...
... Results are also consistent with the suggestion that there may be value to SUD treatment development in exploring a broad range of approaches to neurocognitive facilitation and rehabilitation. A resurgence of interest in creating cognitive adjuncts to addiction treatment approaches include techniques to rehabilitate or facilitate cognitive functions by training working memory and other executive and memory functions (72)(73)(74), and alternatively, to bolster non-cognitive emotion regulation functions that may indirectly improve cognitive control (25,75). ...
Neuropsychological and cognitive deficits are observed in the majority of persons with alcohol and drug use disorders and may interfere with treatment processes and outcomes. Although, on average, the brain and cognition improve with abstinence or markedly reduced substance use, better understanding of the heterogeneity in the time-course and extent of cognitive recovery at the individual level is useful to promote bench-to-bedside translation and inform clinical decision making. This study integrated a variable-centered and a person-centered approach to characterize diversity in cognitive recovery in 197 patients in treatment for a substance use disorder. We assessed executive function, verbal ability, memory, and complex information processing speed at treatment entry, and then 6, 26, and 52 weeks later. Structural equation modeling was used to define underlying ability constructs and determine the mean level of cognitive changes in the sample while minimizing measurement error and practice effects on specific tests. Individual-level empirical growth plots of latent factor scores were used to explore prototypical trajectories of cognitive change. At the level of the mean, small to medium effect size gains in cognitive abilities were observed over 1 year. At the level of the individual, the mean trajectory of change was also the modal individual recovery trajectory shown by about half the sample. Other prototypical cognitive change trajectories observed in all four cognitive domains included Delayed Gain, Loss of Gain, and Continuous Gain. Together these trajectories encompassed between 86 and 94% of individual growth plots across the four latent abilities. Further research is needed to replicate and predict trajectory membership. Replication of the present findings would have useful implications for targeted treatment planning and the new cognitive interventions being developed to enhance treatment outcomes.
... For example, the HRV of SUD patients can be affected by changes in neurovisceral dynamics, arousal modulation, baroreflex sensitivity, and stress reactivity, which can ultimately lead to compulsive addictive behaviors, similar to being directly affected by substance use or intoxication. 12 A decreased HRV in individuals with an SUD, including alcohol and cigarette disorders, reflects dysfunctional parasympathetic and vagal tone. 13,14 One study did not find differences in HRV between alcoholic and control subjects but suggested that HRV accounts for the degree of cravings for substances, including alcohol, even after controlling for the amount of alcohol assumption. ...
... 73 Persistent cravings, changes in self-regulation, cognitive control, and reward circuity within the mesolimbic dopamine system may be related to changes in the brain-body interaction loop. 12,74 This study detected a positive association of dysfunctional changes in brain function, accompanied by decreased HRV, with IGD. This relationship may reflect neurovisceral integration. ...
Heart rate variability (HRV) can be used to represent the regulatory adaptive system and is a proxy for neurovisceral integration. Consistent with the view that, like other addictions, Internet gaming disorder (IGD) involves disrupted regulatory function, the present study hypothesized that IGD patients would show (a) decreased HRV, (b) ineffective functional neural connectivity, and (c) differential patterns of association between HRV and functional neural connectivity relative to healthy controls (HCs). The present study included 111 young adults (53 IGD patients and 58 age- and sex-matched HCs) who underwent simultaneous recordings with an electrocardiogram and electroencephalogram during a resting state. Heart rate (HR), HRV, and functional neural connectivity were calculated using the graph theory approach. Compared with the HCs, the IGD patients exhibited elevated HR and decreased HRV based on the high frequency (HF), which reflects suppression of parasympathetic and/or vagal tone. The IGD patients also exhibited a heightened theta band characteristic path length (CPL) compared with HCs, indicating decreased efficacy of the functional network. Furthermore, IGD patients exhibited negative correlations between the standard deviation of the normal-to-normal interval index (SDNNi) and theta and delta CPL values, which were not observed in HCs. In conclusion, the present findings suggest that IGD patients might have maladaptive brain-body integration features involving disruptions of the autonomic nervous system and brain function.
... One theory posits that HRVB confers a benefit in SUD treatment by dampening visceral arousal through its effects on the baroreflex system , which provides an important neural pathway facilitating CAN integration of visceral information with cognitive and affective processes (Bates & Buckman, 2013). ...
Substance use disorder (SUD) exacts massive individual and public health burdens, in part because of its relapsing nature. First-line SUD treatments aim to strengthen affective and cognitive control to help individuals override impulses to use alcohol and other drugs, yet automatic physiological processes compromised by SUD interact with affective states and the environment, compromising effortful cognitive control and undermining attempts to avoid substance use. While existing first-line SUD treatments may indirectly help offset these vulnerabilities, none target them. Heart rate variability biofeedback (HRVB) involves rhythmic breathing that directly targets these deficits, complementing first-line SUD treatments. HRVB has evolved from a clinic-based treatment to an ambulatory intervention utilizing wearable biosensors and smartphone applications with capacity for just-in-time support of affective and behavioral self-regulation. There is evidence supporting the efficacy of HRVB for SUD, but more research is needed to fully assess HRVB’s potential to support SUD recovery and inform policy.
... Acceptability of HRV monitors is further bolstered by general knowledge that HRV is associated with, and predicts, variations in fitness and health. Psychologically and physiologically healthy individuals typically present with relatively higher levels of HRV, while those with underlying health conditions, including SUD, commonly show relatively lower HRV levels [17,18] (see Heiss et al., 2021 for an exception). ...
Purpose of Review:
Addiction and excessive substance use contribute to poor mental and physical health. Much research focuses tightly on neural underpinnings and centrally-acting interventions. To broaden this perspective, this review focuses on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors.
Recent Findings:
Cardiovascular signals are integrated via afferent pathways in networks of distributed brain regions that contribute to cognition, as well as emotion and behavior regulation, and are key antecedents and drivers of substance use behaviors. Heart rate variability (HRV), a biomarker of efficient neurocardiac regulatory control, is diminished by heavy substance use and substance use disorders. Promising evidence-based adjunctive interventions that enhance neurocardiac regulation include HRV biofeedback, resonance paced breathing, and some addiction medications.
Summary:
Cardiovascular communication with the brain through bidirectional pathways contributes to cognitive and emotional processing but is rarely discussed in addiction treatment. New evidence supports cardiovascular-focused adjunctive interventions for problematic substance use and addiction.
... Acceptability of HRV monitors is further bolstered by general knowledge that HRV is associated with, and predicts, variations in fitness and health. Psychologically and physiologically healthy individuals typically present with relatively higher levels of HRV, while those with underlying health conditions, including SUD, commonly show relatively lower HRV levels [17,18] (see Heiss et al., 2021 for an exception). HRV can be measured at rest or in response to a wide variety of challenges and, in 5 minutes or less, multiple measures of HRV can be obtained. ...
... Alcohol and other drug (AOD) use disorders impose an enormous personal and societal burden. In addition to widely reported psychological (Grant et al., 2015;Kelly et al., 2017), psychophysiological (Bates & Buckman, 2013;Eddie, Bates, et al., In press), and medical problems (Eddie et al., 2019;Whiteford et al., 2013) arising from these disorders, individuals with substance use problems also experience social exclusion, loss of societal standing, loss of access to resources, and general disengagement from civic life (Buchanan, 2004;Hengartner et al., 2013;Marie & Miles, 2008;Vilsaint et al., 2019). Collectively, this gives rise to a massive societal toll of around $520 billion each year in medical expenses, loss of productivity, accidents, and crime (Sacks et al., 2015). ...
Objective:
Alcohol and other drug (AOD) use disorders impose a prodigious personal and societal burden. While most remit, little is known about the achievements accrued as people accomplish and sustain addiction recovery. Greater knowledge regarding the nature and prevalence of such achievements, when such achievements occur, what factors influence accrual of achievements, and how such achievements relate to other indices of functioning would support treatment and policy planning, and may instill hope for individuals and families seeking AOD problem resolution.
Methods:
Nationally representative, cross-sectional survey of United States (US) population of persons who have overcome an AOD problem (N = 2,002), assessing individual factors and achievements in 4 domains: self-improvement; family engagement; civic, and economic participation. Logistic and linear regression models tested theorized associations among variables.
Results:
Most (80.1%) achieved at least one achievement associated with the 4 domains. A linear monotonic relationship was observed with greater achievements accruing with greater time in recovery. Accrual of achievements after AOD problem resolution was related to racial minority status, more education, earlier age of substance use initiation, illicit drugs as primary substance used, more years since resolving AOD problem, more psychiatric diagnoses, lower psychological distress, and regular 12-step program attendance. Multiple regression analyses found greater total achievements were independently associated with greater self-esteem, happiness, quality of life, and recovery capital.
Conclusions:
Most individuals achieve an increasing number of achievements with time since AOD problem resolution, and these are associated with gains in measures of well-being that may support ongoing AOD problem remission, and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Berridge's incentive salience hypothesis 6 have led to important contributions in this area, but the specific ways in which body systems actively contribute to flexible or inflexible behavior towards alcohol and other drugs continues to receive only limited attention. [7][8][9][10] The neurophysiology, functional anatomy, and molecular mechanisms of the bidirectional information streams that connect neural and cardiovascular processes have been well characterized. 11 From this literature, the central autonomic network (CAN) was described as a coordinated network of forebrain, midbrain, and brain stem structures that centrally meditate autonomic nervous system functioning. ...
Much research seeks to articulate the brain structures and pathways implicated in addiction and addiction recovery. Prominent neurobiological models emphasize the interplay between cortical and limbic brain regions as a main driver of addictive processes, but largely do not take into consideration sensory and visceral information streams that link context and state to the brain and behavior. Yet these brain-body information streams would seem to be necessary elements of a comprehensive model of addiction. As a starting point, we describe the overlap between one current model of addiction circuitry and the neural network that not only regulates cardiovascular system activity, but receives feedback from peripheral cardiovascular processes through the baroreflex loop. We highlight the need for neurobiological, molecular, and behavioral studies of neural and peripheral cardiovascular signal integration during the experience of internal states and environmental contexts that drive alcohol and other drug use behaviors. We end with a call for systematic, mechanistic research on the promising, yet largely unexamined benefits to addiction treatment of neuroscience-informed, adjunctive interventions that target the malleability of the cardiovascular system to alter brain processes.
... Bates and Buckman 2013;Price and Crowell 2016;Quintana et al. 2013a), including substance addiction (for a meta-analysis, seeQuintana et al. 2013b) and, more recently, Internet addiction(Hong et al. 2018;Hsieh and Hsiao 2016;Kim et al. 2016;Lin et al. 2014;Moretta and Buodo 2018;Moretta et al. 2019; Park et al. 2019). ...
Based on the biopsychosocial model of Internet addiction, this study tested a moderated mediation model of familial (i.e., perceived autonomy-supportive parenting), psychological (i.e., need satisfaction) and biological (i.e., baseline respiratory sinus arrhythmia, RSA) factors to investigate how they jointly impact Internet addiction in emerging adults; specifically, we explored whether RSA moderated the mediating effect of need satisfaction on the relation between perceived autonomy-supportive parenting and Internet addiction. A total of 146 Chinese undergraduates completed questionnaires on autonomy-supportive parenting, need satisfaction and Internet addiction. RSA data were also obtained. Path analysis was used to test the proposed mediation and moderated mediation models. The results indicated that while the impact of perceived autonomy-supportive parenting on Internet addiction was mediated by need satisfaction, RSA moderated this indirect effect. The indirect effect of autonomy-supportive parenting on Internet addiction via need satisfaction was much stronger in adults with low levels of RSA than in those with high levels of RSA. Our findings highlight the joint impact of biological, psychological, and social-environmental factors on Internet addiction and have important implications for the prevention of and intervention against emerging adults’ Internet addiction.
... (7)(8)(9). Consideration of cardiovascular processes as embedded components of affect and cognition implies that these processes contribute to motivated human behavior, including behavioral flexibility toward alcohol and other drugs (10)(11)(12). This is important because several non-invasive, low-cost behavioral interventions that help normalize cardiovascular functioning have demonstrated efficacy across various mental and physical health conditions (13)(14)(15)(16)(17)(18)(19)(20). ...
Conscious attempts to regulate alcohol and drug use are often undermined by automatic attention and arousal processes that are activated in the context of salient cues. Response to these cues involves body and brain signals that are linked via dynamic feedback loops, yet no studies have targeted the cardiovascular system as a potential conduit to alter automatic neural processes that maintain cue salience. This proof-of-concept study examined within-person changes in neural response to parallel but unique sets of visual alcohol-related cues at two points in time: prior to versus following a brief behavioral intervention. The active intervention was resonance breathing, a rhythmical breathing task paced at 0.1 Hz (6 breaths per minute) that helps normalize neurocardiac feedback. The control intervention was a low-demand cognitive task. Functional magnetic resonance imaging (fMRI) was used to assess changes in brain response to the cues presented before (A1) and after (A2) the intervention in 41 emerging adult men and women with varying drinking behaviors. The resonance breathing group exhibited significantly less activation to A2 cues compared with A1 cues in left inferior and superior lateral occipital cortices, right inferior lateral occipital cortex, bilateral occipital pole, and temporal occipital fusiform cortices. This group also showed significantly greater activation to A2 cues compared with A1 cues in medial prefrontal, anterior and posterior cingulate, and precuneus cortices, paracingulate, and lingual gyri. The control group showed no significant changes. Thus, following resonance breathing, activation in brain regions involved in visual processing of cues was reduced, while activation in brain areas implicated in behavioral control, internally directed cognition, and brain–body integration was increased. These findings provide preliminary evidence that manipulation of the cardiovascular system with resonance breathing alters neural activation in a manner theoretically consistent with a dampening of automatic sensory input and strengthening of higher-level cognitive processing.
... Central control of psychophysiological processes via the autonomic nervous system has been implicated in the ability to adaptively self-regulate emotional responses to changing internal and environmental demands (10,11). This control is accomplished by the central autonomic network, a brain system that integrates neural signaling in cerebral, limbic, and brain stem areas to modulate physiological activity in coordination with cognitive and emotional demands (5,(12)(13)(14)(15). This coordination allows an individual to respond in appropriate magnitude to interoceptive and exteroceptive cues and challenges, and to recover quickly from perturbation (10,15). ...
Difficulty regulating emotion is a cardinal feature of borderline personality disorder (BPD), yet little is known about the automatic psychophysiological processes involved in this phenotype. Inconsistent findings have emerged from studies that employed limited assessments (e.g., heart rate variability, skin conductance) of autonomic nervous system response to emotional contexts, and compared groups based on the presence or absence of BPD as a categorical diagnosis. This exploratory study assessed a comprehensive set of autonomic nervous system processes in 44 individuals (22 with BPD) at rest, in response to emotionally evocative stimuli, and during a subsequent recovery period. BPD was characterized with a dimensional measure of BPD symptom severity, as a well by categorical diagnosis. At baseline and across experimental tasks, higher heart rate was observed in those diagnosed with BPD compared to controls, and in those expressing greater BPD symptom severity. These effects, however, were fully mediated by differences in physical exercise. In contrast, during recovery from emotional activation, greater symptom severity predicted consistently higher levels of multiple sympathetic and parasympathetic processes compared to lower symptom severity. Overall, these findings suggest that the heart rate elevations sometimes observed in those diagnosed with BPD may be associated with individual and group differences in levels of physical exercise. Results further indicate that adaptive psychophysiological recovery responses following emotional challenge may be disrupted in proportion to BPD symptom severity, independently of exercise. Results highlight the utility of considering lifestyle factors and symptom severity in studies of emotional activation and regulation processes in BPD.
... Most current recovery tools focus on cognitive strategies that dampen negative affect and strengthen self-control (i.e., executive capacity and self-efficacy) to reduce the salience of substance use cues and stressors (Hendershot, Witkiewitz, George, & Marlatt, 2011;Marlatt, 1996). The automatic physiological processes that trigger negative emotional states and elicit craving (Bates & Buckman, 2013;Eddie et al., 2013; Thayer & Lane, 2009), however, can undermine, outpace, or disrupt cognitive inten- tions ( Thayer & Friedman, 2002). This sug- gests that a combination of physiologically-and cognitively-mediated strategies may be useful for intervening in reactions to triggers that are instigated outside of (or prior to) conscious awareness. ...
Heart rate variability biofeedback (HRV BFB) shows promise as an adjunct intervention for individuals receiving treatment for substance use disorder (SUD), potentially due to its capacity to reduce craving and negative affect. The present study sought to examine the utility of integrating HRV biofeedback into a college recovery housing program and gauging its ability to reduce craving and negative affect in young adults in remission from SUD. Forty-six residents of an SUD recovery house at a public university in the northeastern United States took part in a non-randomized controlled trial. The active intervention was 12 weeks of HRV BFB performed over a college semester. The control intervention was a semester-long, waitlist condition. Changes in craving, perceived stress, anxiety, and depressive symptoms were measured across time during the active HRV BFB intervention and compared to changes that occurred during the waitlist period using piecewise regression analyses. Significant reductions in craving were noted during HRV BFB, but not during the waitlist control condition; however, the difference in slopes between conditions was not statistically significant. Levels of self-reported craving, stress, anxiety, and depression varied substantially between participants and across time. The results suggest that use of HRV BFB in the college recovery setting as a tool to help reduce craving warrants further examination, particularly among individuals with elevated craving. Added value of HRV BFB comes from the fact that it can be easily and affordably implemented in everyday life.
... This study used a holistic perspective of the cardiovascular system in ostensibly healthy young adults who either did not drink, engaged in social drinking (but not binge drinking), or routinely engaged in binge drinking, to characterize subtle cardiovascular changes that may occur early in an individual's drinking history. Cardiovascular dysfunction was captured with: (a) average functionality at rest and in response to acute sympathetic (paced sighing at 0.033 Hz) and parasympathetic (paced breathing at 0.1 Hz) challenges; (b) variability in HR, which is a widely-used measure of adaptive cardiac responsivity; and, (c) sensitivity of the baroreflex, which reflects system functionality across cardiac and vascular systems and brain -body interconnection (Bates & Buckman, 2013). Cardiovascular dysfunction was also explored by developing new measures that were hypothesized to enhance detection of subtle preclinical changes. ...
Binge drinking is widespread on American college campuses, but its effects on the cardiovascular system are poorly understood. This study sought evidence of preclinical cardiovascular changes in binge drinking young adults (n = 24) compared to nondrinking (n = 24) and social drinking (n = 23) peers during baseline, paced sighing (0.033 Hz), and paced breathing (0.1 Hz) tasks. Binge drinkers showed consistent but often statistically nonsignificant evidence of greater sympathetic activation and reduced baroreflex sensitivity. Interestingly, the structure of group-averaged baseline heart rate spectra was considerably different between groups in the low frequency range (0.05–0.15 Hz). In particular, the binge drinking group–averaged spectra showed several spectral peaks not evident in the other groups, possibly indicating two functionally distinct subranges (0.05–0.08 and 0.08–0.15 Hz) that reflect vascular tone baroreflex activity and heart rate baroreflex activity, respectively. Vascular tone baroreflex gain and power in two peaks in the 0.05–0.08 Hz range were associated with years of drinking in the binge drinking group. Vascular dysfunction may be an early indicator of drinking-related change in the cardiovascular system.
... These branches work in an antagonistic , yet complementary fashion . The sympathetic branch is responsible for the rapid mobilization of resources to prepare the individual to respond to a stressor or task ( Bates & Buckman , 2013 ) . Increases in HR , and BP are characteristic of sympathetic arousal ( Kemeny , 2003 ) . ...
Borderline personality disorder (BPD) is a complex disorder characterized by intense and rapidly shifting affective states, instability in self-image, chronic feelings of emptiness, and dissociation. Individuals with BPD commonly engage in substance use, and self-injurious and suicidal behaviors as a way to manage intolerable affect. To date, the cognitive components of emotion dysregulation in BPD have received much research attention. The collateral psychophysiological processes, however, remain poorly understood. Because emotion regulation is mediated by both cognitive and physiological processes, this knowledge gap may be limiting progress in the treatment of BPD. Thus, this investigation sought to comprehensively assess psychophysiological differences between individuals with BPD and healthy controls, and examine whether a loss of flexibility in fundamental autonomic nervous system (ANS) processes may contribute to the emotion dysregulation observed in BPD. Psychophysiological differences between individuals with BPD and healthy controls were assessed at rest, during exposure to emotionally evocative images selected from the International Affective Picture System (IAPS), and during a post cue exposure recovery period, with additional tests for the effects of dissociative tendencies on cue reactivity, and substance use on cue exposure recovery. Indices of heart rate variability (HRV), electrocardiogram (ECG) derived measures of neurocardiac signaling, as well as continuously recorded blood pressure (BP) and skin conductance (SC) were used to operationalize modulation of psychophysiological arousal. At baseline, the BPD group showed significantly higher heart rate (HR) and greater skin conductance variance (SCV) compared to the control group, but were similar on measures of HRV and blood pressure variability (BPV). Across tasks, there were significant main effects of group and time (cue reactivity and cue recovery) on HR and SCV, and a main effect of time for HRV. However, no interaction effects were observed, suggesting groups were not different in how they responded to or recovered from exposure to emotionally evocative stimuli. This was in spite of the fact that participants with BPD rated the images as subjectively more arousing than controls. Notably though, a posteriori analyses found that BPD severity moderated psychophysiological response to, as well as recovery from, exposure to emotionally evocative images. In addition, analyses for the effects of trait dissociative tendencies on cue reactivity showed trait dissociation moderated change in HRV and BPV from baseline to cue exposure. Analyses for the effects of substance use on cue exposure recovery, however, were limited by unanticipated low levels of past month and past year substance use within the BPD group, though past month alcohol use negatively impacted systolic arterial blood pressure variability during recovery from exposure to emotionally evocative images. Results are discussed within the context of polyvagal theory and future research directions are considered.
... There are also reports of positive relationships between HRV and executive functioning (EF; reviewed in , cognitive control processes that support planning and execution of goal-directed activity. These associations with negative affect (NA) and its sequelae, and with EF, are consistent with theories conceptualizing HRV as a measure of bidirectional neurocardiac communication that reflects adaptive mechanisms of affective and cognitive self-regulation (Bates & Buckman, 2013;Benarroch, 1997;Berntson et al., 2007). ...
High frequency heart rate variability (HRV) is a measure of neurocardiac communication thought to reflect predominantly parasympathetic cardiac regulation. Low HRV has been associated empirically with clinical and subclinical levels of anxiety and depression and, more recently, high levels of HRV have been associated with better performance on some measures of executive functioning (EF). These findings have offered support for theories proposing HRV as an index measure of a broad, self-regulatory capacity underlying aspects of emotion regulation and executive control. This study sought to test that proposition by using a structural equation modeling approach to examine the relationships of HRV to negative affect (NA) and EF in a large sample of U.S. adults ages 30s-80s. HRV was modeled as a predictor of an NA factor (self-reported trait anxiety and depression symptoms) and an EF factor (performance on three neuropsychological tests tapping facets of executive abilities). Alternative models also were tested to determine the utility of HRV for predicting NA and EF, with and without statistical control of demographic and health-related covariates. In the initial structural model, HRV showed a significant positive relationship to EF and a nonsignificant relationship to NA. In a covariate-adjusted model, HRV's associations with both constructs were nonsignificant. Age emerged as the only significant predictor of NA and EF in the final model, showing inverse relationships to both. Findings may reflect population and methodological differences from prior research; they also suggest refinements to the interpretations of earlier findings and theoretical claims regarding HRV.
Copyright © 2015. Published by Elsevier B.V.
Alcohol use disorder is by far the most prevalent substance use disorder in the general population and is a major contributor to disease worldwide. Recovery from the disorder is a dynamic process of change, and individuals take many different routes to resolve their alcohol problems and seek to achieve a life worth living. Total abstention is not the only solution and robust recovery involves more than changing drinking practices. This volume brings together multidisciplinary research on recovery processes, contexts, and outcomes as well as new ideas about the multiple pathways involved. Experts chart the individual, social, contextual, community, economic, regulatory, policy, and structural influences that are vital to understanding alcohol use disorder and recovery. The book recommends new approaches to conceptualizing and assessing recovery alongside new avenues for research, community engagement, and policy that constitute a major shift in the practice and policy landscape.
Alcohol use disorder is by far the most prevalent substance use disorder in the general population and is a major contributor to disease worldwide. Recovery from the disorder is a dynamic process of change, and individuals take many different routes to resolve their alcohol problems and seek to achieve a life worth living. Total abstention is not the only solution and robust recovery involves more than changing drinking practices. This volume brings together multidisciplinary research on recovery processes, contexts, and outcomes as well as new ideas about the multiple pathways involved. Experts chart the individual, social, contextual, community, economic, regulatory, policy, and structural influences that are vital to understanding alcohol use disorder and recovery. The book recommends new approaches to conceptualizing and assessing recovery alongside new avenues for research, community engagement, and policy that constitute a major shift in the practice and policy landscape.
Interoception, the ability to perceive internal bodily sensations, and heart rate variability (HRV) share common physiological pathways, including the baroreflex feedback loop. The baroreflex can be activated by resonance breathing, wherein respiration is paced at 6 times per minute (0.1 Hz), eliciting immediate physiological changes and longer-term therapeutic responses.
This registered report characterizes baroreflex functioning as a cardiac mechanism of interoception in a two-session study (n = 67). The heartbeat discrimination task was used to obtain indices of interoceptive accuracy, sensibility and metacognition. Baroreflex functioning was measured as HRV at 0.1 Hz and baroreflex sensitivity (BRS); high frequency (HF) HRV was calculated as a control. Cardiovascular indices were measured at baseline and during active and control paced breathing after which changes in interoception were measured.
The first hypothesis was that baseline baroreflex functioning would predict individual differences in interoceptive awareness. The second hypothesis was that resonance breathing would increase participants' ability to detect their own heartbeats, and that this effect would be mediated by increases in 0.1 Hz HRV and BRS. Data were collected upon in principle acceptance of the manuscript.
We found a negative relationship of interoceptive accuracy with baseline HF HRV and BRS, and a positive relationship between metacognitive interoception and 0.1HZ HRV, BRS and HF HRV. We found that changes in 0.1 Hz HRV and BRS during resonance breathing positively correlate with increases in interoceptive accuracy.
Our results show that the extent to which breathing recruits the resonant properties of the cardiovascular system can facilitate the conscious perception of participants' heartbeats. We interpret this as an increase in vagal afferent signaling and baroreflex functioning following resonance breathing. We put forward an alternative explanation that HRV modulation can reduce interoceptive prediction errors, facilitating the conscious perception of interoceptive signals, and consider the role of resonance breathing on mental health from an interoceptive inference perspective.
Heart rate variability biofeedback intervention involves slow breathing at a rate of ~6 breaths per min (resonance breathing) to maximize respiratory and baroreflex effects on heart period oscillations. This intervention has wide-ranging clinical benefits and is gaining empirical support as an adjunct therapy for biobehavioral disorders, including asthma and depression. Yet, little is known about the system-level cardiovascular changes that occur during resonance breathing or the extent to which individuals differ in cardiovascular benefit. This study used a computational physiology approach to dynamically model the human cardiovascular system at rest and during resonance breathing. Noninvasive measurements of heart period, beat-to-beat systolic and diastolic blood pressure, and respiration period were obtained from 24 healthy young men and women. A model with respiration as input was parameterized to better understand how the cardiovascular processes that control variability in heart period and blood pressure change from rest to resonance breathing. The cost function used in model calibration corresponded to the difference between the experimental data and model outputs. A good match was observed between the data and model outputs (heart period, blood pressure, and corresponding power spectral densities). Significant improvements in several modeled cardiovascular functions (e.g., blood flow to internal organs, sensitivity of the sympathetic component of the baroreflex, ventricular elastance) were observed during resonance breathing. Individual differences in the magnitude and nature of these dynamic responses suggest that computational physiology may be clinically useful for tailoring heart rate variability biofeedback interventions for the needs of individual patients.
Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.
Human adaptability involves interconnected biological and psychological control processes that determine how successful we are in meeting internal and environmental challenges. Heart rate variability (HRV), the variability in consecutive R-wave to R-wave intervals (RRI) of the electrocardiogram, captures synergy between the brain and cardiovascular control systems that modulate adaptive responding. Here we introduce a qualitatively new dimension of adaptive change in HRV quantified as a redistribution of spectral power by applying the Wasserstein distance with exponent 1 metric (W(1)) to RRI spectral data. We further derived a new index, D, to specify the direction of spectral redistribution and clarify physiological interpretation. We examined gender differences in real time RRI spectral power response to alcohol, placebo and visual cue challenges. Adaptive changes were observed as changes in power of the various spectral frequency bands (i.e., standard frequency domain HRV indices) and, during both placebo and alcohol intoxication challenges, as changes in the structure (shape) of the RRI spectrum, with a redistribution towards lower frequency oscillations. The overall conclusions from the present study are that the RRI spectrum is capable of a fluid and highly flexible response, even when oscillations (and thus activity at the sinoatrial node) are pharmacologically suppressed, and that low frequency oscillations serve a crucial but less studied role in physical and mental health.
Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence.
Inflammation can cause damage and even death. What controls this primitive and potentially lethal innate immune response to injury and infection? Molecular and neurophysiological studies during the past decade have revealed a pivotal answer: immunity is coordinated by neural circuits that operate reflexively. The afferent arc of the reflex consists of nerves that sense injury and infection. This activates efferent neural circuits, including the cholinergic anti-inflammatory pathway, that modulate immune responses and the progression of inflammatory diseases. It might be possible to develop therapeutics that target neural networks for the treatment of inflammatory disorders.
The brain is the key organ of the response to stress because it determines what is threatening and, therefore, potentially stressful, as well as the physiological and behavioral responses which can be either adaptive or damaging. Stress involves two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Beyond the "flight-or-fight" response to acute stress, there are events in daily life that produce a type of chronic stress and lead over time to wear and tear on the body ("allostatic load"). Yet, hormones associated with stress protect the body in the short-run and promote adaptation ("allostasis"). The brain is a target of stress, and the hippocampus was the first brain region, besides the hypothalamus, to be recognized as a target of glucocorticoids. Stress and stress hormones produce both adaptive and maladaptive effects on this brain region throughout the life course. Early life events influence life-long patterns of emotionality and stress responsiveness and alter the rate of brain and body aging. The hippocampus, amygdala, and prefrontal cortex undergo stress-induced structural remodeling, which alters behavioral and physiological responses. As an adjunct to pharmaceutical therapy, social and behavioral interventions such as regular physical activity and social support reduce the chronic stress burden and benefit brain and body health and resilience.
An individual's tendency to show exaggerated or otherwise dysregulated cardiovascular reactions to acute stressors has long been associated with increased risk for clinical and preclinical endpoints of coronary heart disease (CHD). However, the ‘brain-body’ pathways that link stressor-evoked cardiovascular reactions to CHD risk remain uncertain. This review summarizes emerging neuroimaging research indicating that individual differences in stressor-evoked blood pressure reactivity (a particular form of cardiovascular reactivity) are associated with activation patterns in corticolimbic brain areas that are jointly involved in processing stressors and regulating the cardiovascular system. As supported empirically by activation likelihood estimates derived from a meta-analysis, these corticolimbic areas include divisions of the cingulate cortex, insula, and amygdala — as well as networked cortical and subcortical areas involved in mobilizing hemodynamic and metabolic support for stress-related behavioral responding. Contextually, the research reviewed here illustrates how behavioral medicine and health neuroscience methods can be integrated to help characterize the ‘brain-body’ pathways that mechanistically link stressful experiences with CHD risk.
Modern economic theory ignores the influence of emotions on decision-making. Emerging neuroscience evidence suggests that sound and rational decision making, in fact, depends on prior accurate emotional processing. The somatic marker hypothesis provides a systems-level neuroanatomical and cognitive framework for decision-making and its influence by emotion. The key idea of this hypothesis is that decision-making is a process that is influenced by marker signals that arise in bioregulatory processes, including those that express themselves in emotions and feelings. This influence can occur at multiple levels of operation, some of which occur consciously, and some of which occur non-consciously. Here we review studies that confirm various predictions from the hypothesis, and propose a neural model for economic decision, in which emotions are a major factor in the interaction between environmental conditions and human decision processes, with these emotional systems providing valuable implicit or explicit knowledge for making fast and advantageous decisions.
The effects of stressful life experience on learning are pervasive and vary greatly both within and between individuals. It is therefore unlikely that any one mechanism will underlie these complicated processes. Nonetheless, without identifying the necessary and sufficient circuitry, no complete mechanism or set of mechanisms can be identified. In this review, we provide two anatomical frameworks through which stressful life experience can influence processes related to learning and memory. In the first, stressful experience releases stress hormones, primarily from the adrenals, which directly impact brain areas engaged in learning. In the second, stressful experience indirectly alters the circuits used in learning via intermediary brain regions. Importantly, these intermediary brain regions are not integral to the stress response or learning itself, but rather link the consequences of a stressful experience with circuits used to learn associations. As reviewed, the existing literature provides support for both frameworks, with somewhat more support for the first but sufficient evidence for the latter which involves intermediary structures. Once we determine the circumstances that engage each framework and identify which one is most predominant, we can begin to focus our efforts on describing the neuronal and hormonal mechanisms that operate within these circuits to influence cognitive processes after stressful life experience.
Drug addiction is a chronically relapsing disorder that has been characterized by (1) compulsion to seek and take the drug, (2) loss of control in limiting intake, and (3) emergence of a negative emotional state (eg, dysphoria, anxiety, irritability) reflecting a motivational withdrawal syndrome when access to the drug is prevented. Drug addiction has been conceptualized as a disorder that involves elements of both impulsivity and compulsivity that yield a composite addiction cycle composed of three stages: 'binge/intoxication', 'withdrawal/negative affect', and 'preoccupation/anticipation' (craving). Animal and human imaging studies have revealed discrete circuits that mediate the three stages of the addiction cycle with key elements of the ventral tegmental area and ventral striatum as a focal point for the binge/intoxication stage, a key role for the extended amygdala in the withdrawal/negative affect stage, and a key role in the preoccupation/anticipation stage for a widely distributed network involving the orbitofrontal cortex–dorsal striatum, prefrontal cortex, basolateral amygdala, hippocampus, and insula involved in craving and the cingulate gyrus, dorsolateral prefrontal, and inferior frontal cortices in disrupted inhibitory control. The transition to addiction involves neuroplasticity in all of these structures that may begin with changes in the mesolimbic dopamine system and a cascade of neuroadaptations from the ventral striatum to dorsal striatum and orbitofrontal cortex and eventually dysregulation of the prefrontal cortex, cingulate gyrus, and extended amygdala. The delineation of the neurocircuitry of the evolving stages of the addiction syndrome forms a heuristic basis for the search for the molecular, genetic, and neuropharmacological neuroadaptations that are key to vulnerability for developing and maintaining addiction.
The vagal (high frequency [HF]) component of heart rate variability (HRV) predicts survival in post-myocardial infarction patients and is considered to reflect vagal antagonism of sympathetic influences. Previous studies of the neural correlates of vagal tone involved mental stress tasks that included cognitive and emotional elements. To differentiate the neural substrates of vagal tone due to emotion, we correlated HF-HRV with measures of regional cerebral blood flow (rCBF) derived from positron emission tomography (PET) and (15)O-water in 12 healthy women during different emotional states. Happiness, sadness, disgust and three neutral conditions were each induced by film clips and recall of personal experiences (12 conditions). Inter-beat intervals derived from electrocardiographic recordings during the 60-second scans were spectrally-analyzed, generating 12 separate measures of HF-HRV in each subject. The six emotion and six neutral conditions were grouped together and contrasted. We observed substantial overlap between emotion-specific rCBF and the correlation between emotion-specific rCBF and HF-HRV, particularly in the medial prefrontal cortex. Emotion-specific rCBF also correlated with HF-HRV in the caudate nucleus, periacqueductal gray and left mid-insula. We also observed that the elements of cognitive control inherent in this experiment (that involved focusing on the target mental state) had definable neural substrates that correlated with HF-HRV and to a large extent differed from the emotion-specific correlates of HF-HRV. No statistically significant asymmetries were observed. Our findings are consistent with the view that the medial visceromotor network is a final common pathway by which emotional and cognitive functions recruit autonomic support.
Heart rate variability (HRV) supports emotion regulation and is reduced by alcohol. Based on the resonance properties of the cardiovascular system, a new 0.1-Hz methodology was developed to present emotional stimuli and assess HRV reaction in participants (N=36) randomly assigned to an alcohol, placebo, or control condition. Blocked picture cues (negative, positive, neutral) were presented at a rate of 5 s on, 5 s off (i.e., 0.1-Hz frequency). SDNN, pNN50, and HF HRV were reduced by alcohol, compared to the placebo and control. The 0.1-Hz HRV index was diminished by alcohol and placebo, suggesting that autonomic regulation can be affected by cognitive expectancy. The 0.1-Hz HRV index and pNN50 detected changes in arousal during emotional compared to neutral cues, and the 0.1-Hz HRV index was most sensitive to negative valence. The 0.1-Hz HRV methodology may be useful for studying the intersection of cognition, emotion, and autonomic regulation.
Evaluative processes
- Berntson