Listening to the heart: A meta-analysis of cognitive behavior therapy impact on the heart rate of patients with anxiety disorders

Gonçalves, Raquel; Rodrigues, Helga; Novaes, Felipe Carvalho; Árbol, Javier Rodríguez; Volchan, Eliane; Coutinho, Evandro Silva Freire; Figueira, Ivan; Ventura, Paula

doi:10.1016/j.jad.2014.09.058

Cited by 23 publications

(20 citation statements)

References 67 publications

(145 reference statements)

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“…Heightened physiological reactivity to trauma cues at pretreatment has been observed consistently in laboratory research, [4][5][6][7][8][9][10][11][12][13] and is considered a robust objective predictor of the presence of PTSD symptoms. [17,18] In the current study, pre-and posttreatment results indicate that PE is associated with significant reductions in physiological reactivity to trauma imagery, extending results of previous investigations [28][29][30][31] to the context of a well-defined and disseminated evidence-based protocol, and to an ecologically valid sample of treatment-seeking veterans. Reduction in physiological reactivity to trauma imagery also adds to a growing literature highlighting the effectiveness of PE in addressing objective measures of functioning, including reduced mental health service utilization [52] and normalization of cortisol responses.…”

Section: Discussionsupporting

confidence: 81%

“…[30] Accordingly, physiological reactivityparticularly HR reactivity-to trauma imagery represents an informative correlate of response to PTSD treatment. [31] However, such a paradigm is yet to be applied when evaluating specific broadly disseminated evidence-based therapies for PTSD, [32] and most protocols have not focused on methods that could be reasonably implemented outside laboratory or funded research settings.…”

Section: Introductionmentioning

confidence: 99%

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Taking the Pulse of Prolonged Exposure Therapy: Physiological Reactivity to Trauma Imagery as an Objective Measure of Treatment Response

Wangelin

Tuerk

2015

Depress Anxiety

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Taking the Pulse of Prolonged Exposure Therapy: Physiological Reactivity to Trauma Imagery as an Objective Measure of Treatment Response

Wangelin

Tuerk

2015

Depress Anxiety

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“…[30].). Only few studies have addressed these variables as possible treatment outcome variables: Adult studies have shown that cognitions in SAD change as a result of CBT [34], but results are inconclusive about changes in heart rate [35]. Regarding behavior, an increase in parentperceived social skills in children after CBT was shown [22].…”

Section: Sad-specific State Assessment Of Treatment Successmentioning

confidence: 99%

Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

Asbrand

Heinrichs

Schmidtendorf

et al. 2020

Child Psychiatry Hum Dev

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A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre-to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns. Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.

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“…Heart rate variability has been extensively studied and validated as a biomarker of the anxiety related disorders[ 135 ]. HF-HRV is a change-sensitive marker that parallels positive effects of treatment, with increases in HF-HRV following treatment for depression[ 136 ].…”

Section: Heart Rate Variability Researchmentioning

confidence: 99%

“…Successful completion of cognitive behavioral therapy reduces psychophysiological activity in PTSD[ 128 , 137 ], PD[ 138 , 139 ], OCD[ 140 ], GAD[ 103 ], SAD[ 141 ], and specific phobias[ 142 ]. Therefore, HF-HRV is a potential biomarker of treatment efficacy for the anxiety related disorders[ 135 ]. However, more research is needed to examine the efficacy of psychotherapy on HRV.…”

Section: Heart Rate Variability Researchmentioning

confidence: 99%

Biobehavioral assessment of the anxiety disorders: Current progress and future directions

Abbott

Shirali

Haws

et al. 2017

WJP

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It is difficult to accurately assess and differentially diagnose the anxiety disorders. The current system of assessment relies heavily on the subjective measures of client self-report, clinical observation, and clinical judgment. Fortunately, recent technological advances may enable practitioners to utilize objective, biobehavioral measures of assessment in a clinical setting. The current body of literature on two of these biobehavioral tools (eye-tracking and electrocardiogram devices) is promising, but more validation and standardization research is needed to maximize the utility of these devices. Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders. Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information. This objective, real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation. Recently developed wearable and highly portable electrocardiogram devices, like the wearable fitness and behavior tracking devices used by many consumers, may be particularly suited for providing this feedback to clinicians. Utilizing these biobehavioral devices would supply an objective, dimensional component to the current categorical diagnostic assessment system. We posit that if adequate funding and attention are directed at this area of research, it could revolutionize diagnostic and on-going assessment practices and, in doing so, bring the field of diagnosis out of the 20th century.

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Listening to the heart: A meta-analysis of cognitive behavior therapy impact on the heart rate of patients with anxiety disorders

Cited by 23 publications

References 67 publications

Taking the Pulse of Prolonged Exposure Therapy: Physiological Reactivity to Trauma Imagery as an Objective Measure of Treatment Response

Taking the Pulse of Prolonged Exposure Therapy: Physiological Reactivity to Trauma Imagery as an Objective Measure of Treatment Response

Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

Biobehavioral assessment of the anxiety disorders: Current progress and future directions

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