Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

BackgroundPsychological resilience is critical to minimize the health effects of traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia, or posttraumatic stress disorder. Mind-body practices, such as relaxation breathing and mindfulness m...

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Main Authors: Kizakevich, Paul N, Eckhoff, Randall P, Lewis, Gregory F, Davila, Maria I, Hourani, Laurel L, Watkins, Rebecca, Weimer, Belinda, Wills, Tracy, Morgan, Jessica K, Morgan, Tim, Meleth, Sreelatha, Lewis, Amanda, Krzyzanowski, Michelle C, Ramirez, Derek, Boyce, Matthew, Litavecz, Stephen D, Lane, Marian E, Strange, Laura B
Format: Article
Language:English
Published: JMIR Publications 2019-09-01
Series:JMIR mHealth and uHealth
Online Access:https://mhealth.jmir.org/2019/9/e12590/
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author Kizakevich, Paul N
Eckhoff, Randall P
Lewis, Gregory F
Davila, Maria I
Hourani, Laurel L
Watkins, Rebecca
Weimer, Belinda
Wills, Tracy
Morgan, Jessica K
Morgan, Tim
Meleth, Sreelatha
Lewis, Amanda
Krzyzanowski, Michelle C
Ramirez, Derek
Boyce, Matthew
Litavecz, Stephen D
Lane, Marian E
Strange, Laura B
author_facet Kizakevich, Paul N
Eckhoff, Randall P
Lewis, Gregory F
Davila, Maria I
Hourani, Laurel L
Watkins, Rebecca
Weimer, Belinda
Wills, Tracy
Morgan, Jessica K
Morgan, Tim
Meleth, Sreelatha
Lewis, Amanda
Krzyzanowski, Michelle C
Ramirez, Derek
Boyce, Matthew
Litavecz, Stephen D
Lane, Marian E
Strange, Laura B
author_sort Kizakevich, Paul N
collection DOAJ
description BackgroundPsychological resilience is critical to minimize the health effects of traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia, or posttraumatic stress disorder. Mind-body practices, such as relaxation breathing and mindfulness meditation, help to reduce arousal and may reduce the likelihood of such psychological distress. To better understand resilience-building practices, we are conducting the Biofeedback-Assisted Resilience Training (BART) study to evaluate whether the practice of slow, paced breathing with or without heart rate variability biofeedback can be effectively learned via a smartphone app to enhance psychological resilience. ObjectiveOur objective was to conduct a limited, interim review of user interactions and study data on use of the BART resilience training app and demonstrate analyses of real-time sensor-streaming data. MethodsWe developed the BART app to provide paced breathing resilience training, with or without heart rate variability biofeedback, via a self-managed 6-week protocol. The app receives streaming data from a Bluetooth-linked heart rate sensor and displays heart rate variability biofeedback to indicate movement between calmer and stressful states. To evaluate the app, a population of military personnel, veterans, and civilian first responders used the app for 6 weeks of resilience training. We analyzed app usage and heart rate variability measures during rest, cognitive stress, and paced breathing. Currently released for the BART research study, the BART app is being used to collect self-reported survey and heart rate sensor data for comparative evaluation of paced breathing relaxation training with and without heart rate variability biofeedback. ResultsTo date, we have analyzed the results of 328 participants who began using the BART app for 6 weeks of stress relaxation training via a self-managed protocol. Of these, 207 (63.1%) followed the app-directed procedures and completed the training regimen. Our review of adherence to protocol and app-calculated heart rate variability measures indicated that the BART app acquired high-quality data for evaluating self-managed stress relaxation training programs. ConclusionsThe BART app acquired high-quality data for studying changes in psychophysiological stress according to mind-body activity states, including conditions of rest, cognitive stress, and slow, paced breathing.
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spelling doaj.art-33b28c1034544202894c1113047a2d662022-12-21T17:24:37ZengJMIR PublicationsJMIR mHealth and uHealth2291-52222019-09-0179e1259010.2196/12590Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health MethodologyKizakevich, Paul NEckhoff, Randall PLewis, Gregory FDavila, Maria IHourani, Laurel LWatkins, RebeccaWeimer, BelindaWills, TracyMorgan, Jessica KMorgan, TimMeleth, SreelathaLewis, AmandaKrzyzanowski, Michelle CRamirez, DerekBoyce, MatthewLitavecz, Stephen DLane, Marian EStrange, Laura BBackgroundPsychological resilience is critical to minimize the health effects of traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia, or posttraumatic stress disorder. Mind-body practices, such as relaxation breathing and mindfulness meditation, help to reduce arousal and may reduce the likelihood of such psychological distress. To better understand resilience-building practices, we are conducting the Biofeedback-Assisted Resilience Training (BART) study to evaluate whether the practice of slow, paced breathing with or without heart rate variability biofeedback can be effectively learned via a smartphone app to enhance psychological resilience. ObjectiveOur objective was to conduct a limited, interim review of user interactions and study data on use of the BART resilience training app and demonstrate analyses of real-time sensor-streaming data. MethodsWe developed the BART app to provide paced breathing resilience training, with or without heart rate variability biofeedback, via a self-managed 6-week protocol. The app receives streaming data from a Bluetooth-linked heart rate sensor and displays heart rate variability biofeedback to indicate movement between calmer and stressful states. To evaluate the app, a population of military personnel, veterans, and civilian first responders used the app for 6 weeks of resilience training. We analyzed app usage and heart rate variability measures during rest, cognitive stress, and paced breathing. Currently released for the BART research study, the BART app is being used to collect self-reported survey and heart rate sensor data for comparative evaluation of paced breathing relaxation training with and without heart rate variability biofeedback. ResultsTo date, we have analyzed the results of 328 participants who began using the BART app for 6 weeks of stress relaxation training via a self-managed protocol. Of these, 207 (63.1%) followed the app-directed procedures and completed the training regimen. Our review of adherence to protocol and app-calculated heart rate variability measures indicated that the BART app acquired high-quality data for evaluating self-managed stress relaxation training programs. ConclusionsThe BART app acquired high-quality data for studying changes in psychophysiological stress according to mind-body activity states, including conditions of rest, cognitive stress, and slow, paced breathing.https://mhealth.jmir.org/2019/9/e12590/
spellingShingle Kizakevich, Paul N
Eckhoff, Randall P
Lewis, Gregory F
Davila, Maria I
Hourani, Laurel L
Watkins, Rebecca
Weimer, Belinda
Wills, Tracy
Morgan, Jessica K
Morgan, Tim
Meleth, Sreelatha
Lewis, Amanda
Krzyzanowski, Michelle C
Ramirez, Derek
Boyce, Matthew
Litavecz, Stephen D
Lane, Marian E
Strange, Laura B
Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
JMIR mHealth and uHealth
title Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
title_full Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
title_fullStr Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
title_full_unstemmed Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
title_short Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology
title_sort biofeedback assisted resilience training for traumatic and operational stress preliminary analysis of a self delivered digital health methodology
url https://mhealth.jmir.org/2019/9/e12590/
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