Abstract
BackgroundSpecific phobias are among the most common anxiety disorders. Exposure therapy is the treatment of choice for specific phobias. However, not all patients respond equally well to it. Hence, current research focuses on therapeutic add-ons to increase and consolidate the effects of exposure therapy. One potential therapeutic add-on is biofeedback to increase heart rate variability (HRV). A recent meta-analysis shows beneficial effects of HRV biofeedback interventions on stress and anxiety symptoms. Therefore, the purpose of the current trial is to evaluate the effects of HRV biofeedback, which is practiced before and utilized during exposure, in spider-fearful individuals. Further, this trial is the first to differentiate between the effects of a HRV biofeedback intervention and those of a low-load working memory (WM) task.MethodsEighty spider-fearful individuals participate in the study. All participants receive a training session in which they practice two tasks (HRV biofeedback and a motor pseudo-biofeedback task or two motor pseudo-biofeedback tasks). Afterwards, they train both tasks at home for 6 days. One week later, during the exposure session, they watch 16 1-min spider video clips. Participants are divided into four groups: group 1 practices the HRV biofeedback and one motor pseudo-task before exposure and utilizes HRV biofeedback during exposure. Group 2 receives the same training, but continues the pseudo-biofeedback task during exposure. Group 3 practices two pseudo-biofeedback tasks and continues one of them during exposure. Group 4 trains in two pseudo-biofeedback tasks and has no additional task during exposure. The primary outcome is fear of spiders (measured by the Fear of Spiders Questionnaire and the Behavioral Approach Test). Secondary outcomes are physiological measures based on electrodermal activity, electrocardiogram and respiration.DiscussionThis RCT is the first one to investigate the effects of using a pre-trained HRV biofeedback during exposure in spider-fearful individuals. The study critically contrasts the effects of the biofeedback intervention with those of pseudo-tasks, which also require WM capacity, but which do not have a physiological base. If HRV biofeedback is effective in reducing fear of spiders, it would represent an easy-to-use tool to improve exposure-therapy outcomes.Trial registrationDeutsches Register Klinischer Studien, DRKS00012278. Registered on 23 May 2017, amendment on 5 October 2017.
Highlights
Specific phobias are among the most common anxiety disorders
During standard heart rate variability (HRV) biofeedback, participants are asked to inhale while their heart rate (HR) increases and to exhale while it decreases
In contrast to existing studies, the current study carefully compares the effects of a HRV biofeedback intervention with those of a low-load working memory (WM)-demanding task during exposure
Summary
Participants Participation is limited to spider-fearful participants aged 18 to 40 years. It includes seven phases: initial screening and diagnostic phase, randomization, (pseudo)-biofeedback training, practice at home, exposure to spider video clips, post-assessment and follow-up assessments. Post assessment Subsequent to the exposure session, the post assessment takes place: participants complete the STAI-S, the FSQ and the ASI-3 They answer three questions on their perceived self-efficacy in dealing with a spider and the post-exposure BAT is performed. Follow-up assessments One week and one month after the exposure session, participants are contacted by the research team and asked to complete an online version of the FSQ and to answer the questions on self-efficacy in handling a spider. All analyses will be reported with partial η2 as the effect size
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