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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).
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.
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.
