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

BACKGROUND: Psychological 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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754694/
https://www.ncbi.nlm.nih.gov/pubmed/31493325
http://dx.doi.org/10.2196/12590
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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 PubMed
description BACKGROUND: Psychological 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. OBJECTIVE: Our 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. METHODS: We 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. RESULTS: To 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. CONCLUSIONS: The 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 pubmed-67546942019-10-31 Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology 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 JMIR Mhealth Uhealth Original Paper BACKGROUND: Psychological 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. OBJECTIVE: Our 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. METHODS: We 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. RESULTS: To 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. CONCLUSIONS: The 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. JMIR Publications 2019-09-06 /pmc/articles/PMC6754694/ /pubmed/31493325 http://dx.doi.org/10.2196/12590 Text en ©Paul N Kizakevich, Randall P Eckhoff, Gregory F Lewis, Maria I Davila, Laurel L Hourani, Rebecca Watkins, Belinda Weimer, Tracy Wills, Jessica K Morgan, Tim Morgan, Sreelatha Meleth, Amanda Lewis, Michelle C Krzyzanowski, Derek Ramirez, Matthew Boyce, Stephen D Litavecz, Marian E Lane, Laura B Strange. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.09.2019. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
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
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
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754694/
https://www.ncbi.nlm.nih.gov/pubmed/31493325
http://dx.doi.org/10.2196/12590
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