A Topical Review of Conjunctive Heart Rate Variability Biofeedback and Acceptance and Commitment Therapy for Pediatric Disorders of Gut–Brain Interaction

Abstract

Objective: Disorders of gut-brain interaction (DGBI) affect a large segment of the pediatric population, significantly impacting quality of life and functioning. Recent findings indicate emerging psychological therapies targeting autonomic mechanisms may be effective treatment approaches. This article reviews utilization of conjunctive heart rate variability biofeedback (HRVB) alongside acceptance and commitment therapy (ACT) in the treatment of DGBI. Method: This study includes a topical review of HRVB as an adjunct to ACT in the context of autonomic regulation in DGBI intervention. An overview of our treatment model at the Center for Applied Biobehavioral Sciences (CABS) and procedures for future replication is provided. Clinic referrals, administrative processes, patient intake, education and measures, and treatment protocol are outlined. A review of previous studies at CABS and their outcomes are detailed. Results: Previous data suggests that utilization of HRVB as an adjunctive approach to psychological therapies which target autonomic regulation, such as ACT, alongside standard medical treatment should be considered in pediatric DGBI management. CABS outcomes support the inclusion of HRVB to target autonomic dysregulation in DGBI to improve symptomatology and functioning in this population. Conclusion: HRVB and ACT appear to be promising treatments for pediatric DGBI to be included in psychological and multidisciplinary clinical settings. Given the correlates of autonomic nervous system dysregulation in adults and preliminary findings in pediatric DGBI, these may be useful approaches for targeting the autonomic mechanisms of DGBI symptomatology. We address future directions for research to replicate and extend the findings for use in clinical settings. Implications for Impact StatementHeart rate variability biofeedback and acceptance and commitment therapy may be effective and promising treatments to be included in psychological and multidisciplinary clinical settings for pediatric disorders of gut-brain interaction (DGBI). These interventions may work by targeting the autonomic nervous system, potentially improving DGBI symptoms and functioning in the pediatric population. These treatments require further research and validation, which this article aims to demonstrate.