Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations

Harmsel, J. F. ter; Noordzij, Matthijs Leendert; Goudriaan, Anna E.; Dekker, Jack; Swinkels, Lise; Pol, Thimo M. van der; Popma, Arne

doi:10.1016/j.ijpsycho.2020.11.009

Cited by 29 publications

(37 citation statements)

References 74 publications

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“…For example, JITAIs can encourage patients to practice relevant treatment skills (e.g., urge management or emotion regulation skills) for resisting compensatory behaviors after a binge episode. Preliminary evidence suggests that momentary interventions can facilitate real time use of emotion regulation skills (Ter Harmsel et al, 2021). Although JITAIs may be particularly beneficial for individuals with poor self-regulation, no study to date has tested whether the addition of JITAIs to treatments for BN improves treatment outcomes for individuals with baseline deficits in emotion regulation and impulsivity.…”

Section: Introductionmentioning

confidence: 99%

Self‐regulation deficits moderate treatment outcomes in a clinical trial evaluating just‐in‐time adaptive interventions as an augmentation to cognitive‐behavioral therapy for bulimia‐spectrum eating disorders

Presseller

Michael

Trainor

et al. 2022

Intl J Eating Disorders

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Objective Just‐in‐time adaptive interventions (JITAIs), momentary interventions delivered at identified times of risk, may improve skill utilization during cognitive‐behavioral therapy (CBT‐E) for bulimia‐spectrum eating disorders (BN‐EDs). JITAIs may be especially helpful for individuals with self‐regulation deficits, including emotion regulation deficits and elevated impulsivity. Method Participants (N = 55 with BN‐EDs) received 16 sessions of CBT‐E with electronic self‐monitoring and were randomized to receive JITAIs (JITAIs‐On) or not receive JITAIs (JITAIs‐Off). Baseline Difficulties in Emotion Regulation Scale (DERS) and UPPS‐P Impulsive Behavior Scale (UPPS‐P) total scores were examined as moderators of baseline to post‐treatment change in binge episodes, compensatory behaviors, and Eating Disorder Examination (EDE) global score using repeated measures ANOVAs. Results Emotion regulation difficulties significantly moderated compensatory behavior change (F[1, 51] = 4.31, p = .04, ηp2 = 0.08) such that individuals with emotion regulation deficits demonstrated greater improvements in the JITAIs‐On condition. Impulsivity moderated change in binge episodes (F[1, 51] = 8.94, p = .004, ηp2 = 0.15) and compensatory behaviors (F[1, 51] = 7.83, p = .007, ηp2 = 0.13), such that individuals with high impulsivity showed greater improvement in the JITAIs‐On condition. Neither DERS nor UPPS‐P scores moderated EDE global score change. Discussion JITAIs appear particularly beneficial for facilitating skill use during treatment for BN‐EDs for individuals with self‐regulation deficits, yielding improved treatment outcomes. Public Significance Statement Reminders to use therapy skills that are delivered via smartphone as an individual goes about their daily life may improve treatment response among individuals with bulimia nervosa who have difficulty coping with emotions or who tend to act impulsively. Results from this study indicate that individuals with these difficulties benefitted more from cognitive‐behavioral therapy when it was accompanied by in‐the‐moment reminders to use therapeutic skills, which may facilitate long‐term recovery. Clinical Trials.gov Registration Number NCT03673540.

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Section: Introductionmentioning

confidence: 99%

Self‐regulation deficits moderate treatment outcomes in a clinical trial evaluating just‐in‐time adaptive interventions as an augmentation to cognitive‐behavioral therapy for bulimia‐spectrum eating disorders

Presseller

Michael

Trainor

et al. 2022

Intl J Eating Disorders

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“…For individuals who are verbally less strong, have problems with interoception, and/or have problems with adherence, an intervention that addresses these individual factors may be helpful. Biocueing could be a suitable extra tool to support the development of coping strategies, as well as interoception, thereby strengthening an individual in stress- and emotion regulation ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach

et al. 2022

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IntroductionTo optimize treatment, it is of utmost importance to take into account the myriad of biological, social, and psychological changes that young people go through during adolescence which make them more vulnerable for developing mental health problems. Biocueing, a non-invasive method to transform physiological parameters into an observable signal, could strengthen stress- and emotion regulation by cueing physiologically unusual values in daily life. The aim of this study is to investigate the usability, feasibility, and exploratory effect of biocueing in addition to ENgage YOung people earlY (ENYOY), a moderated digital social therapy-platform, in young people with emerging mental health complaints.MethodsA user-centered mixed-method design was used. A focus group was conducted to optimize the ENYOY-platform and biocueing intervention. Biocueing was operationalized by a smartwatch and the Sense-IT app. A within-subjects design was used; 10 days for all participants ‘biofeedback off' (control), followed by 10 days ‘biofeedback on' (experimental). Emotional awareness and perceived stress were measured using ecological momentary assessment. Eight individuals participated. User-friendliness, usability, and acceptance were assessed using a qualitative design.ResultsFindings from the focus group resulted in several adaptations of the biocueing intervention to the ENYOY-platform and vice versa. The average measurement compliance rate was 78.8%. Level-one findings showed different individual effects on perceived stress and emotional awareness. Level-two analyses showed no overall effects on perceived stress (B = −0.020, p = 0.562) and overall positive effects on emotional awareness (B = 0.030, p = 0.048) with small effect sizes (Improvement Rate Difference = 0.05–0.35). The intervention was found to be acceptable and showed moderate usability. Participants indicated they experienced improvements in reflection on feelings and changes in behavior, such as pausing and evaluating the situation.ConclusionThese preliminary results show that biocueing could be a promising addition to digital treatment platforms and help young people become more emotionally aware. Improvements should be made regarding the usability and acceptability of the smartwatch, as well as more extensive integration of the biocueing intervention with a digital treatment platform. It would be relevant to gain a better understanding of which individuals would benefit most from an additional biocueing intervention.

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“…To our knowledge, this study is one of the first attempts to enroll and evaluate a smartwatch-based biocueing intervention in a forensic outpatient population with aggression regulation difficulties [ 25 ]. Our study revealed a cautiously positive attitude toward the use of biocueing as an addition to regular therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Biocueing can be seen as a specific, personalized type of biofeedback [ 25 ]. In the process of biofeedback, instruments monitor physiological parameters (eg, heart rate, skin conductance, and respiration), transform these measurements into auditory or visual signals, and present these signals to the user directly [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study

et al. 2021

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Background The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

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Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations

Cited by 29 publications

References 74 publications

Self‐regulation deficits moderate treatment outcomes in a clinical trial evaluating just‐in‐time adaptive interventions as an augmentation to cognitive‐behavioral therapy for bulimia‐spectrum eating disorders

Self‐regulation deficits moderate treatment outcomes in a clinical trial evaluating just‐in‐time adaptive interventions as an augmentation to cognitive‐behavioral therapy for bulimia‐spectrum eating disorders

Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach

Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study

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