Resting Heart Rate Variability: Exploring Associations With Symptom Severity in Adults With Substance Use Disorders and Posttraumatic Stress

Abstract

Objective: Substance use disorders (SUDs) and post-traumatic stress symptoms are commonly comorbid. Previous studies have established that those with SUD or post-traumatic stress disorder (PTSD) have lower high frequency-heart rate variability (HF-HRV) compared to controls, suggesting low HF-HRV may be a biomarker of a common physiological mechanism underlying both disorders. We evaluated HF-HRV as a potential biomarker of a common underlying process by testing whether lower HF-HRV related to greater severity of substance use and PTSD symptoms in individuals with both substance use disorders and at least four symptoms of PTSD. Methods: HF-HRV was measured in 49 adults with SUD and at least four symptoms of PTSD. We performed a series of regressions controlling for age to test whether low HF-HRV was associated with greater SUD and PTSD symptom severity. SUD symptoms were measured by the Addiction Severity Index and PTSD symptoms were measured by the Clinician-Administered PTSD Scale and the PTSD Checklist. Results: After controlling for age, low resting HF-HRV was significantly associated with drug and alcohol symptom severity but not PTSD symptom severity. Conclusions: HF-HRV may be more sensitive to the severity of drug and alcohol use rather than PTSD. Findings may suggest that in PTSD populations, HF-HRV may primarily index comorbid SUD symptoms. HF-HRV could serve as an objective measure of substance use severity and should be further investigated as a predictor of outcomes in treatment for SUD.

Substance Misuse Decreases Heart Rate Variability

“…Because the inspection of HRV involves noninvasive methods, those with substance use disorders could conduct self-assessments in their home environment [22]. HRV has been used as a biomarker for severe substance use disorder [18] and also as a useful biomarker for other addictions, such as video game addiction [23] and alcohol addiction. According to the results of this study, the biological HRV age may be more sensitive than traditional HRV parameters, such as LF and HF, to be a biomarker on addiction subjects.…”

Rapid eye movement sleep parasympathetic activity predicts wake hyperarousal symptoms following a traumatic event

“…In that sample, HR acceleration significantly differed between PTSD‐diagnosed participants and trauma‐exposed controls (TECs), but HRV did not (Mäder et al, 2021). In contrast, D'Souza et al (2019) did not find an association between daytime HF‐power and PTSD symptom severity. Recent studies investigating HRV report negative correlations between HF‐power and PTSD severity (Rissling et al, 2016) during sleep, but not wakefulness.…”

Clinical relevance of stress biomarkers as health-disease indicators

“…The use of biomarkers is a growing need to understand the influence of psychological factors on a person's physical health, particularly in stress-related disorders. 1,5 Research in this area gives rise to more specific interventions in the field of psychotherapy, since assuming that all individuals respond in the same way to stress is reductionist, which is why it is important to advance in the study of this topic and contribute more evidence on the effectiveness of the different psychotherapies used, such as cognitive-behavioral therapy, mindfulness, biofeedback, among others, 2,8,9,40,46,47 as well as recognizing the importance of inter-subject differences when developing interventions based on more effective and personalized evidence. 15 Current health models require integrative perspectives that contemplate both the cognitive, affective and behavioral dimension as well as the physiological one, in order to measure and understand in its complexity the individual differences involved in the health process-disease.…”

“…5 It has been discovered that stressful experiences can favor the appearance of aggressive behaviors and social violence 6 as well as an increase in the consumption of alcohol, tobacco and toxic substances. [7][8][9][10] Likewise, bidirectional associations have been observed between stress and addictions, 11 as well as between stress and physiological and mental illnesses. 12,13 In order to have a broader understanding of this problem, it is necessary to take into account the importance of inter-individual differences, since stress affects each person differently; the level of vulnerability, previous life experiences, type of stressor (social, environmental, academic, economic, family, work, etcetera), intensity, duration, frequency and subjective perception of stress play an important role in the coping capacity of the individual.…”