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Comparing Heart Rate Analytical Methods to Examine Engagement During Imaginal Prolonged Exposure Therapy: Multicase

Alexandra H Cowden Hindash1, Allison Diamond Altman1, Julia Levitan1

  • 1Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco (Cowden Hindash, Inslicht); Advanced Postdoctoral Fellowship in Women's Health, Office of Academic Affiliations, Veterans Health Administration, San Francisco (Cowden Hindash, Inslicht); Department of Psychology, University of California, Berkeley, Berkeley (Diamond Altman, Levitan).

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Summary

This study explored using mobile health technology to track heart rates during prolonged exposure therapy for PTSD. Physiological data revealed varying patient engagement levels, suggesting a link between engagement and treatment outcomes.

Keywords:
PTSDPhysiological reactivityProlonged exposure therapyPsychotherapyTechnology in Mental HealthTreatment mechanisms

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Area of Science:

  • Psychiatry and Mental Health
  • Digital Health and mHealth
  • Biomedical Engineering

Background:

  • Mobile health (mHealth) technologies offer novel ways to study psychotherapy mechanisms.
  • Exposure-based therapies, like prolonged exposure (PE), can be enhanced by real-time physiological monitoring.
  • Understanding treatment mechanisms is crucial for improving patient outcomes in posttraumatic stress disorder (PTSD).

Purpose of the Study:

  • To examine three analytical approaches for utilizing continuous physiological data during PE therapy for PTSD.
  • To identify physiological markers associated with treatment response in PTSD patients undergoing PE therapy.
  • To explore the role of emotional engagement in PE therapy using heart rate data.

Main Methods:

  • Collected photoplethysmogram (PPG)-measured heart rates from three veterans during PE therapy sessions.
  • Analyzed heart rate data to assess emotional engagement, initial emotion activation, and extinction processes.
  • Employed correlation analysis and multilevel modeling to link physiological data with self-reported distress.

Main Results:

  • One participant with overengagement showed no benefit from PE therapy.
  • One participant with initial underengagement experienced clinical improvement.
  • Optimal engagement correlated with positive clinical improvements in one participant.

Conclusions:

  • mHealth technologies can provide insights into psychotherapy treatment mechanisms.
  • Standardized analytical approaches are needed for cross-study comparisons and a deeper understanding of treatment.
  • Physiological markers, particularly related to engagement, may predict treatment response in PTSD.
  • Further research with larger sample sizes is warranted to validate these findings.