Abstract
Although trauma-focused cognitive behavioral therapy (TF-CBT) with exposure is an effective treatment for posttraumatic stress disorder (PTSD), not all patients recover. Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms. Patients (n = 8) with chronic PTSD were randomized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure. PTSD symptoms were measured before, during and after TF-CBT with the Impact of Event Scale-Revised. The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT. Although PTSD symptoms significantly decreased from pre to post treatment in both conditions, there was a clear trend towards a significantly faster (p = .051) symptom reduction in biofeedback compared to regular TF-CBT. The most important limitation was the small sample size. The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients. The mechanism of action of breathing biofeedback may relate to competing working memory resources decreasing vividness and emotionality, similar to eye movement desensitization and reprocessing. Future research is needed to examine this.
Highlights
With 80 % of the general Dutch population experiencing a traumatic event once in their life and 7–9 % developing a posttraumatic stress disorder (PTSD; Kessler et al 1995; de Vries and Olff 2009) optimal treatment should be available for patients suffering from this disorder
PTSD symptoms decreased over time for both conditions, PTSD symptom scores decreased faster over time in the biofeedback condition. This pilot study shows that breathing biofeedback is a feasible technique that can efficiently and safely be implemented during exposure therapy in PTSD patients, as it is easy to instruct to patients and easy to apprehend by patients during sessions
Notwithstanding the small sample size, a trend was clearly noticeable between conditions in favor of the biofeedback condition
Summary
With 80 % of the general Dutch population experiencing a traumatic event once in their life (de Vries and Olff 2009) and 7–9 % developing a posttraumatic stress disorder (PTSD; Kessler et al 1995; de Vries and Olff 2009) optimal treatment should be available for patients suffering from this disorder. Previous studies show significant rates of non-response (Schottenbauer et al 2008) and drop-out (Nijdam et al 2012; Schnurr et al 2007). This may relate to difficulties in fully engaging during exposure, due to resistance of the patient to become highly distressed, or even engaging in therapy (not showing up during the sessions or eventually drop-out). As engaging during the session is essential for exposure to be efficacious and for
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