Heart Rate Variability Biofeedback for Substance Use Disorder: A Randomized Clinical Trial

Area of Science:

• Clinical Psychology
• Psychiatry
• Behavioral Science

Background:

• Preliminary studies indicate heart rate variability biofeedback (HRVB) may alleviate craving and negative affect in individuals with substance use disorder (SUD).
• Few studies have investigated the impact of HRVB on actual substance use outcomes.
• No prior research has examined second-generation wearable HRVB technology for SUD treatment.

Purpose of the Study:

• To assess the efficacy of second-generation HRVB in reducing negative affect, positive affect, craving, and alcohol and other drug (AOD) use in adults with SUD.
• To evaluate HRVB as a potential intervention for improving recovery outcomes in individuals with SUD.

Main Methods:

• A phase 2 randomized clinical trial involving 120 adults with SUD undergoing 8 weeks of outpatient treatment.
• Participants were randomized to receive HRVB plus treatment as usual (TAU) or TAU only.
• Ecological momentary assessment was used to measure primary outcomes including negative affect, positive affect, craving, and substance use.

Main Results:

• HRVB was associated with significant reductions in negative affect and craving over 8 weeks, while the control group showed increases.
• Participants in the HRVB group had a significantly lower proportion of AOD use days (64% reduction) compared to controls.
• HRVB mitigated the association between craving and subsequent AOD use, indicating a potential mechanism of action.

Conclusions:

• Second-generation HRVB shows potential as an effective treatment for reducing negative affect, craving, and substance use in individuals with SUD during early recovery.
• HRVB may improve SUD treatment outcomes by disrupting the craving-to-use cycle.
• Further investigation in phase 3 trials is warranted to confirm these findings and establish HRVB as a viable therapeutic option for SUD.