Conference Program | Friday, April 4, 2025
Location:
Venue: Maymont
Building: 1000 Westover Building
Address: 1001 Spottswood Road, Richmond, VA 23220
8:00 - 8:15 am - Check In
8:15 - 8:30 am - Welcome and Overview of HRV
Dr. Carmen Russoniello, Dr. Raouf Gharbo, Dr. James Burch, & Dr. Thomas Chelimsky
8:30 - 9:30 am - Feature Presentation:
Emerging naturalistic methodology: Autonomic Complexity as a Dynamic Marker of Affect Regulation in Depression by Strange
Self-regulation often is disrupted in depression, and is characterized by prolonged negative affect and inflexible parasympathetic activity. I will describe my lab’s research demonstrating that inflexible autonomic responses to sadness may interfere with successful affect regulation and confer vulnerability to depression. Beyond the laboratory, measuring these self-regulatory processes in everyday life could inform our understanding of phenotypes of depression, and could reveal novel intervention targets for improving regulation success. I will discuss our recent findings from an ambulatory assessment study that measured affective and physiological responses to regulation attempts in everyday life, in a sample with remitted major depressive disorder (rMDD) and healthy comparison participants. We measured two dimensions of regulation success in everyday life: perceived success with regulating affect, and physiological success (parasympathetic augmentation following regulation attempts). We examined the concordance between these two ambulatory metrics of regulation success, and their neural correlates during an emotion regulation task. Individuals with rMDD had less physiological success (attenuated parasympathetic augmentation after regulation attempts) and less perceived success in everyday life. These dimensions of real-world success were only weakly associated, suggesting unique contributions to self-regulation, and they had partially distinct neural correlates. When reappraising negative stimuli during fMRI, greater perceived success in everyday life was dimensionally associated with more activity in an explicit regulation network. In contrast, physiological success predicted greater activation of implicit and explicit regulation circuitry in response to negative stimuli, and enhanced downregulation of salience network activity (amygdala, insula) during reappraisal. These results suggest that linking autonomic complexity with behavior in everyday life can provide a window into dissociable dimensions of self-regulatory functioning. They also indicate that integrating ambulatory and brain-based metrics can allow us to elucidate self-regulatory phenotypes with distinct neurophysiological mechanisms and intervention targets. I will conclude by discussing our current work on this topic, which aims to clarify; the proximal impact of an at-home heart rate variability biofeedback intervention on regulation success in everyday life, for individuals with different regulatory phenotypes.
Level:Intermediate
Risks/Utility/Validity: The content of the presentation is benign. HRV biofeedback has documented evidence of effectiveness for improving symptoms of depression.
GAP Correction: This session will teach the target audience about emerging research that can inform our understanding of how individual differences in autonomic complexity relate to affect regulation success and vulnerability to depression. The audience will better understand how digital phenotyping approaches (e.g., with wearable devices and ecological momentary assessment) can be used to identify subtypes of depression that function differently in everyday life. Audience members will better understand potential neural mechanisms underlying successful regulation of affect and parasympathetic activity and how heart rate variability biofeedback might impact regulatory functioning in everyday life.
Focus: 10% Clinical/90% Research
DEIJ Consideration: Although this work is still in its early stages, as technology (e.g., wearable devices) becomes more ubiquitous, automated interventions based on passive monitoring can be studied and delivered to diverse populations, overcoming some of the common barriers to receiving standard interventions (e.g., access to clinicians).
CE Credits: 1.0
Presented by: Jonathan Stange, PhD
Jonathan Stange is an Assistant Professor of Psychology at the University of Southern California, where he directs the Cognition and Affect Regulation Lab. Jon’s NIMH-funded research focuses on identifying cognitive and affective processes involved in the regulation of negative affect, as they relate to vulnerability for depression and suicide. His work integrates several levels of analysis, including fMRI and measures of autonomic psychophysiology and behavior in the lab and in everyday life. Jon’s work has particularly focused on intensive longitudinal designs, including person-centered modeling approaches to elucidate questions about how individuals vary over time, and in what contexts their risk might be greatest. The goal of his work is to identify personalized targets for intervention to improve regulatory success (e.g., HRV biofeedback), and in doing so, to reduce risk for problems such as depression and suicide.
This presenter has no financial interest to disclose.
9:30 - 11:00 am - Panel Presentation: Applied HRV/B
Three Sessions/CE Credits: 1.5
09:30A-10:00A
Computational model for analysis of heart rate and blood pressure during the Valsalva Maneuver by Olufsen
The Valsalva Maneuver (VM) is a low-risk and highly accessible autonomic test used to measure the baroreflex response to forced breathing to 40 mmHg for 15 seconds. This presentation will demonstrate the Valsalva Analyzer software using computational modeling and data processing to extract biomarkers from VM time-series blood pressure (BP) and electrocardiogram (ECG) data for a 15-second forced breathing challenge. The software facilitates the identification of diagnostic criteria and causal mechanisms for autonomic function. This software inputs an ECG signal identifies R and S peaks, and the RR-intervals. This signal is used to predict heart rate and the R-S magnitude respiration. Then, systolic, and diastolic blood pressure are captured, and an intrathoracic pressure signal is estimated. The VM phases, BP and HR points are identified by the software and numerous clinical ratios are computed. Using systolic, pulse, and intrathoracic pressure, parameter estimation is used to predict heart rate, blood pressure, sympathetic, and parasympathetic signaling. Results including over 35 metrics including mean blood pressure and heart rate, maximum and minimum heart rate, Valsalva ratio, and measures of baroreceptor sensitivity. The software developed here is intended for analysis of VM data, but the methodology employed can be extended to other autonomic tests. Its strength lies in combining quantities extracted from raw data with model outputs, we augment clinical data with a mathematical microscope that provides insight into immeasurable autonomic quantities.
Level:Intermediate
Risks/Utility/Validity: None.
Focus: 100% Research
DEIJ Consideration: This general software is open-source and provide an easy way to analyze heart rate and blood pressure measurements from any population group.
Presented by Mette Olufsen, PhD
Dr. Olufsen is passionate about unraveling the complexities of cardiovascular dynamics and autonomic control systems, dedicating her career to modeling disease states and their impacts. For her PhD, she designed a structured tree model that allows you to predict hemodynamics coupling large and small vessels, including in one of the first model-based anesthesia simulators. Later, she focused on creating advanced models to enhance the understanding of cardiovascular control, including developing new software to analyze hemodynamic data recorded during the Valsalva maneuver. Dr. Olufsen’s interdisciplinary approach combines imaging, fluid dynamics, and dynamical systems with sensitivity analysis and parameter estimation. Recently, she has explored critical areas such as lesion removal during pulmonary balloon-angioplasty for patients with pulmonary hypertension, the dynamics of postural tachycardia, and cardiovascular recovery in heart transplant recipients. Dr. Olufsen’s team also developed a model elucidating the effects of inflammation on cardiovascular markers, which holds promise for early sepsis detection through continuous monitoring of heart rate and blood pressure.
This presenter has no financial interest to disclose.
10:00A-10:30A -
HRVB for First Responders by Andersen
Science has demonstrated that internal physiological states during stress occur continuously to shape perception, cognition, emotion and behaviour. The role of police is unique among first responders, requiring the ability to successfully use weapons and tactics during intense physiological stress reactivity while simultaneously being ready to engage in controlled verbal-social interaction to de-escalate situations that do not call for the use of force. Clearly, maintaining flexibility between states of pure sympathetic and modified sympathetic/parasympathetic arousal is necessary and requires expertise in the modulation of the autonomic nervous system. Chronic stress and allostatic load further increase the risk of occupational errors and poor health outcomes among law enforcement officers. Our research group tailored and tested breathing techniques for police building on various established theories and clinical practice (vagal tank theory: Laborde et al., 2018; polyvagal theory: Porges, 2007; neurovisceral integration model: Thayer et al., 2009; Lehrer et al., 2013). The current presentation describes a decade of research on the application of heart rate variability biofeedback (HRVB) in novel ways among law enforcement officers during active field training and assessment. For example, officers are taught to rapidly shift physiological states by using ambulatory equipment for an HRVB paced breathing protocol that maximizes resonant frequency and comfort (we call this ‘Recovery Breathing’). As a further extension of HRVB used at the speed of operation, we developed the ‘Reset Breath’ maximizing short term RSA. Through bidirectional signaling between the lungs and the brain, HRVB observations indicate that the Reset Breath modulates sympathetic and parasympathetic interplay via communication among the vagus nerve, the mid-brain, and the prefrontal cortex. This change in brain function provides a brief window of opportunity for the officer to refocus their attention enabling the officer to regain situational awareness and focus on the resources available to help them meet the demands of the situation. The talk will also address the associated benefits of training HRVB in police (e.g., reductions in use of force and shooting errors, improved health).
Level:Intermediate
Risks/Utility/Validity: Limitations include relatively small samples – although over 10 years of research we have worked with over 300 officers on this work. We are only one research group and welcome other researchers to replicate our work.
GAP Correction: Concrete protocol that researchers and clinicians can follow to introduce the psychophysiological and applied HRVB techniques into their practice with first responders and law enforcement professionals.
Focus: 20% Clinical/80% Research
DEIJ Consideration: We pay particular interest to sex and gender issues, as the field of policing is a highly masculinized career. We are mindful of the treatment and unique experience of female officers and explore potential sex differences in psychophysiological outcomes. We highlight the importance of tailoring interventions that address the needs of everyone and particularly those of marginalized populations.
Presented by Judith Pizarro Andersen, PhD
Dr. Judith P. Andersen is an Associate Professor in the Department of Psychology at the University of Toronto at Mississauga and holds an affiliation with the Temerty School of Medicine at the University of Toronto. As the Director of the Health, Adaptation, and Research on Trauma (HART) Lab, she leads an innovative research program in psychophysiology, exploring the effects of severe and chronic stress on health and functioning, particularly among populations such as law enforcement officers and LGBT+ individuals. With over 15 years of dedicated research experience, she has developed pioneering biologically based resilience interventions. Her work utilizes heart rate variability biofeedback as a method to enhance health and mitigate the use of lethal force in policing contexts. Additionally, Dr. Andersen serves as an Associate Editor for the British Journal of Health Psychology and is a co-author of the widely used textbook Health Psychology (Taylor, Sirois, Andersen). Faculty website (http://hartlab.net).
This presenter has no financial interest to disclose.
10:30A-11A-
Biofeedback Training in the VA: A Review of National Program Development and Outcomes by Pierce
While biofeedback training has a long history in Veteran’s Affairs (VA) research and clinical services, the recent Whole Health emphasis on patient-centered and integrative health approaches has led to renewed interest and expanded access across this large integrated system of care. Since its designation as a Veterans Health Administration “List 1” complementary integrative health (CIH) approach, biofeedback training has become part of the veterans’ medical benefits package and is provided at all VA Medical Centers or through community referrals as clinically appropriate. As demand for biofeedback training has grown in the VA, program enhancement efforts have focused on the development of clinician training programs and a supportive professional community of practice for biofeedback trainers. As a result VA clinicians have adopted delivery strategies such as offering individual and group Heart Rate Variability training as a first line complementary approach when appropriate for disorders that have been identified as high priority among Veteran populations. These strategies have shown positive outcomes for improving well-being and reducing symptoms of distress among Veterans with depression and post-traumatic stress disorders. Moreover, agency-wide reviews of demonstrated increased rates of subsequent initiation and completion of evidence-based psychotherapies for Veterans who participated in biofeedback training and other CIH approaches.
Level: Intermediate
Risks/Utility/Validity: Treatments and outcomes discussed in this presentation will be related to practice with Veterans in a VA medical center setting and results may not be directly comparable to other patient populations or treatment settings. There are no other known limitations or severe or common risks to disclose.
GAP Correction: Providers offering heart rate variability training need to learn to deliver that intervention within the integrated health systems that support access and patient-centered care. The VA Whole Health System of care offers an example of the program development strategies and practices that enhance and promote adoption of biofeedback training by clinicians within a complex system and treating special patient populations.
Focus: 70% Clinical/30% Research
DEIJ Consideration: Discussion will include review of how the application of biofeedback training in the VA is demonstrating the efficacy of this approach with the diverse populations seen in a public health setting. Veteran populations participating in biofeedback training are generally older, have more comorbidities, and come from lower socioeconomic backgrounds than non-Veterans.
Presented by Whitney N. Pierce, PsyD, RN, BCB
Whitney Pierce, PsyD, RN, BCB, RYT, is a licensed psychologist, registered nurse, registered yoga teacher, and board certified biofeedback provider. Whitney is the clinical director for Whole Health at VA St. Louis HealthCare System, and she serves as the national biofeedback champion for the Office of Patient Centered Care and Cultural Transformation’s Integrative Health Coordinating Center. During her psychology internship and residency training, she was mentored in biofeedback training by a staff psychologist who was also a US Army Veteran. Whitney now gets to pay this gift forward by providing biofeedback training to Veterans and promoting further training and mentoring opportunities for clinicians across the VA Healthcare System.
11:00 - 12:00 pm - Feature Presentation
The moderating role of heart-rate variability in health and illness by Gidron
The major causes of death worldwide include cancer, heart disease, stroke and COPD, among others. Though different clinical entities, these conditions are predicted by similar unhealthy behaviors (e.g., smoking) and biological processes including oxidative stress, inflammation and sympathetic over-activity. One major homeostatic body agent, the vagal nerve, is related to healthier life-styles and inhibits oxidative stress, inflammation and sympathetic activity. Activity of the vagus is indexed by heart-rate variability (HRV), fluctuations in the intervals between normal heart-beats. High HRV predicts a lower risk of stroke and heart-attacks and predicts a higher chance to survive stroke, heart attacks and cancer, independent of confounders. Yet, most researchers do not examine whether HRV moderates effects of other prognostic factors in diseases. I will first review studies showing that HRV moderates biological responses to stress and the brain-immune associations. Both have immense implications for understanding resilience and the homeostatic roles of the vagus. I will then show evidence that High HRV moderates effects of prognostic variables in diseases. This will include high HRV moderating effects of disease-relapse on death, HRV moderating effects of cancer treatments on survival, and HRV moderating the cytokine profiles in cardiac patients. The latter showed more coherent factors of cytokines in patients with high than with low HRV. All these have both scientific and clinical implications. Scientifically, this informs us about the homeostatic and synchronizing roles of the vagal nerve in diseases. Clinically, these results enable us to identify which patients may benefit from vagal nerve activation or from other treatments.
Level:Intermediate
Risks/Utility/Validity: Some of the studies are based on short ECG measures. The studies are prospective-correlational, not experimental, hence no causal inferences could be made.
GAP Correction: Scientists and clinicians treat heart-rate variability (HRV) as a predictor or outcome. However, HRV may also moderate effects of other risk factors on clinical outcomes. This gap will be addressed in my talk and its scientific and clinical implications will be explained.
Focus: 20% Clinical/80% Research
DEIJ Consideration: The studies presented come from different countries and cultures.
CE Credits: 1.0
Presented by: Yori Gidron, PhD
Dr. Gidron is a professor of health psychology at the Faculty of social welfare and health sciences, Univ. of Haifa, Israel. He is a psychoneuroimmunologist, and specializes in neuro-cognitive modulation of health and illness. His main research focus is on the protective roles of the vagal nerve in severe diseases. He examines its role in cancer, heart disease and other conditions, in hospitals and also conducts some experimental basic science work.
This presenter has no financial interest to disclose.
12:00 - 1:00 pm (with lunch) - Feature Presentation:
Perioperative ambulatory HRV and surgical outcomes: Targeting the Brain-Heart-Immune Axis to Promote Resilience Recovery after Surgery by Acker
Here we will report findings from two clinical studies that explore the brain-heart-immune axis as a potential contributor to perioperative resilience in older adults. The HiPPIE study used heart rate variability measured in natural, real-world environments with a wearable wristband during sleep to extract risk profiles for post-operative delirium in older adults. We will also present data exploring the relationship between HRV, postoperative inflammatory resolution, and psychological distress related to upcoming surgery. Second, we will highlight results from an interventional neuro-immune modulation pilot study in which we sought to actively enhance brain-heart immune axis function in participants pre-operatively using at home transcutaneous, auricular vagus nerve stimulation. We will present results related to feasibility, compliance, subjective stress reports, and EEG changes resulting from consistent at home use of this neuro-modulation device.
Level: Intermediate
Risks/Utility/Validity: No major risks
GAP Correction: HRV methods to help predict poor outcomes. Use of wearable devices to collect outcome relevant information from older adult patients.
Focus:40%/Clinical/60% Research
CE Credits: 1.0
Presented by: Leah Christine Acker, PhD, MD
Dr. Leah Acker is a neurosurgical anesthesiologist and assistant professor in Anesthesiology, Neurobiology and Electrical and Computer Engineering at Duke University. She is the principal investigator of the Anesthesiology, Cognitive neuroscience, and Engineering Research (ACkER) lab, which seeks to identify and enhance the mechanisms underlying perioperative cognitive resilience in older adults. Dr Acker earned a PhD in Medical Engineering and Physics in 2014 from the Harvard-MIT Division of Health Sciences and Technology and an MD from Duke in 2017. She completed residency in 2022 and was the Anesthesiology ACES Chief Resident. Dr Acker and her team recently concluded an NIH-funded, 139-participant study entitled, Heart rate variability in Postoperative Delirium and Inflammatory Endpoints. This study used wearable wristbands to examine the Brain-Heart-Immune axis, a framework she developed, as a potential contributor to postoperative cognitive dysfunction in older adults
This presenter has no financial interest to disclose.
1:00 - 2:00 pm Panel Presentation:
Heart Rate Variability Biofeedback (HRVB) as an Adjunct to Evidence-based therapies for anxiety disorders by Lehrer, Gevirtz
Evidence-based therapies such as CBT or ACT have been shown to be effective in treating anxiety disorders, but the effect sizes for many of the diagnoses are moderate to small. In addition, drop out rates, especially for exposure-based protocols, are high. In this sessio0n, I will lay out the rationale and supporting evidence for the addition of HRVB to these evidence-based therapies. Mechanisms such as inhibitory learning, extinction, and vagal tone are proposed mechanisms for exposure therapies and they have been shown to be affected by the Central Autonomic Network. Using HRVB may offer methods for improving treatment outcome.
Level: Intermediate
Risks/Utility/Validity: Very few risks have been associated with the HRVB protocols. Risks associated with CBT or ACT are well known but rare.
GAP Correction: How to implement the HRVB protocol into CBT or ACT
Focus: 90% Clinical/10% Research
DEIJ Consideration: Cultural competence is built into evidence-based therapies and will be discussed briefly.
CE Credits: 1.0
Presented by Richard Gevirtz, PhD and Paul Lehrer, PhD
Dr. Richard Gevirtz is a Distinguished Professor of Psychology at the California School of Professional Psychology at Alliant International University in San Diego. He has been in involved in research and clinical work in applied psychophysiology and biofeedback for the last 30 years and was the president of the Association for Applied Psychophysiology and Biofeedback, 2006-2007. He is certified in Biofeedback and holds Fellow status from the Biofeedback Certification International Association.His primary research interests are in understanding the physiological and psychological mediators involved in disorders such as anxiety, chronic muscle pain, fibromyalgia, and gastrointestinal pain. In this vein, he has studied applications of heart rate variability biofeedback for anxiety, pain, gastrointestinal, cardiac rehabilitation and other disorders. He is the author of many journal articles and chapters on these topics. He also maintains a part time clinical practice treating patients with anxiety and stress related disorders.
This presenter has no financial interest to disclose.
Paul Lehrer received his clinical psychology degree from Harvard University. He has published nearly 100 papers on psychophysiological therapies, and has served as the president of the International Society for Advancement of Respiratory Psychophysiology and the Association for Applied Psychophysiology and Biofeedback.. He authored or coauthored many of the seminal papers on heart rate variability biofeedback and is one of the two or three most cited researchers on this topic. He is senior editor of Principles and Practice of Stress Management, now 4th edition, and is editor-in-chief of Applied Psychophysiology and Biofeedback. He has taught and has practiced and supervised psychotherapy for 50 years at Rutgers Robert Wood Johnson Medical School. He now practices privately, where he regularly combines these approaches with verbal psychotherapies.
This presenter has no financial interest to disclose.
2:00 - 2:10 pm - Break
2:10 - 03:10 pm - Feature Presentation:
HRV and Adaptation: The Future of Heart Rate Variability by Thayer
The intimate connection between the brain and the heart via the vagus nerve was enunciated by Claude Bernard over 150 years ago. Darwin in his classic book on the expression of emotion in man and animals also stressed the importance of the vagus nerve. The neurovisceral integration model builds on this pioneering work and revives interest in the vagus. It has been proposed that vagally-mediated heart rate variability (HRV) is a transdiagnostic marker for psychopathology. Both cross-sectional and longitudinal studies suggest an important role for HRV in the identification of those at risk for psychopathology as well as being a potential marker for treatment outcome. The present talk further elaborates the model and updates it with recent results. Supportive evidence from recent studies of neuroimaging, fear conditioning, attention, and executive function show that low HRV predicts hypervigilance, poor safety learning, and inefficient allocation of attentional and cognitive resources. In addition, the role of vagal afferents in emotion and fear extinction will be discussed. Importantly, evidence will be presented on the potential role of HRV in resilience to poor outcomes. HRV may provide a transdiagnostic target for the understanding of the etiology as well as the diagnosis and treatment of stress-related mental disorders.
Level: Advanced
Risks/Utility/Validity: None
GAP Correction: Improve understanding of the physiological basis for heart rate variability biofeedback
Focus: 15% Clinical/85% Research
DEIJ Consideration: Improve understanding of the physiological basis for heart rate variability biofeedback
CE Credits: 1.0
Presented by: Julian F. Thayer, PhD
Dr. Julian F. Thayer received his PhD from New York University in psychophysiology with a minor in quantitative methods. Dr. Thayer is currently Distinguished University Professor of Psychological Sciences at the University of California, Irvine and the Ohio Eminent Scholar Professor in Health Psychology Emeritus and Academy Professor at The Ohio State University. He has published over 500 research papers and is one of the world’s leading experts on heart rate variability. Dr. Thayer has received numerous research awards including the Sigma Xi Research Recognition Award, the Early Career Award for Contributions to Psychosomatic Medicine from the American Psychosomatic Society, and distinguished scientist awards from the Association for Applied Psychophysiology and Biofeedback, The Society for Psychophysiological Research, the Society of Behavioral Medicine, the Academy of Behavioral Medicine Research, and the American Psychosomatic Society. Dr. Thayer was elected to the National Academy of Medicine in 2023. From 2020 to 2023 he was identified by the Web of Science as a “Highly Cited Researcher”, a designation given to the top 0.1% of researchers.
This presenter has no financial interest to disclose.
# of CE credits allowable for maximum attendance:
6.5 CE Credits
Instructional Levels
Instructional LEVELS for this conference are categorized as Intermediate, and Advanced. Complete information, including session descriptions, learning objectives, presenter bios, associated risks, practice GAP and correction analysis, clinical and/or research focus and subject matter classifications are available online, where possible, at www.aapb.org, in full compliance with APA and AMA continuing education requirements.
INTERMEDIATE: Content builds upon the learner's foundational knowledge, familiarity with the literature and/or experience in a content area. Programming at this level includes more depth than at a beginning level program. It could also serve as a refresher course for individuals who have a background in a content area and are interested in learning more contemporary applications.
ADVANCED: Builds upon established experience, knowledge, and skills in the content area. This may include more diverse applications to specific populations, or a novel application of the skill presented. Advanced level programming tends to be more specialized in nature and allows the learner to integrate and enhance knowledge and skills into their practice or other professional domains.
For those psychologists using the modality of biofeedback and interested in efficacy, science, and latest clinical applications. This conference (1) presents research relevant to psychological practice, education, and science; (2) it is our intention to host a continuing educational offering to help psychologists to keep up with the most current scientific evidence regarding assessment, intervention, and education; and (3) we believe that this program would allow psychologists, or other healthcare and mental healthcare practitioners, to increase competencies in order to improve services to patients/clients. This conference is IN NO WAY a substitute for the basic academic, accredited education and training needed for entry into the field of psychology.
Learning Objectives
1. Describe how individual differences in autonomic complexity relate to affect regulation success and vulnerability to depression
2. Compare how potential subtypes of depression function differently in everyday life
3. Recognize the utility of passive ambulatory monitoring of autonomic complexity
4. Describe potential neural mechanisms underlying successful regulation of affect and parasympathetic activity
5. Analyze the role of biofeedback and autonomic testing methods, including the Valsalva Maneuver, in assessing autonomic function and extracting key physiological biomarkers
6. Evaluate the impact of chronic stress and autonomic modulation on occupational performance, specifically within high-stress professions such as law enforcement and veteran populations.
7. Compare and contrast the application of heart rate variability biofeedback (HRVB) interventions across different populations, including law enforcement officers and veterans, to enhance physiological regulation and psychological resilience.
8. Discuss the practical challenges and ethical considerations in implementing biofeedback interventions in real-world settings, such as field training for police officers and large healthcare systems like the Veterans Health Administration.
9. Apply psychophysiological theories, such as polyvagal theory and neurovisceral integration, to the design and implementation of biofeedback interventions aimed at improving autonomic flexibility and stress resilience.
10. Critique existing training models for police officers and veterans, exploring how biofeedback can be integrated into current protocols to enhance situational awareness, decision-making, and overall well-being.
11. Summarize the concept of moderation in health sciences
12. Summarize evidence showing the moderating roles of HRV in health
13. Summarize evidence showing the moderating roles of HRV in disease prognosis
14. List the potential clinical implications of these moderating roles
15. Describe the brain-heart-immune axis and its potential contribution to post-operative recovery.
16. Describe post-operative delirium and its potential autonomic contributors.
17. Describe transcutaneous auricular vagus nerve stimulation and its potential utility for at home use.
18. Describe methods for measuring HRV in real-world settings with minimal participant burden, even in diverse populations.
19. Describe the basic HRVB protocol including the establishment of “rescue breathing”
20. List the basic foundations of either CBT or ACT
21. Explain how heart rate variability biofeedback (HRVB) can enhance inhibitory learning, extinction, and vagal tone to improve outcomes in exposure-based treatments for anxiety disorders.
22. Describe the physiology of the vagus
23. Explain how HRV is measured
24. Describe the role of the vagus nerve in health and disease
Analyze the role of vagally-mediated HRV as a transdiagnostic marker for psychopathology and its implications for identifying individuals at risk for mental health disorders
References
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2. Stange, J. P., Li, J., Xu, E. P., Ye, Z., Zapetis, S. L., Phanord, C. S., ... & Langenecker, S. A. (2023). Autonomic complexity dynamically indexes affect regulation in everyday life. Journal of Psychopathology and Clinical Science, 132(7), 847-866.
3. Mather, M., & Thayer, J. F. (2018). How heart rate variability affects emotion regulation brain networks. Current Opinion in Behavioral Sciences, 19, 98-104.
4. Pizzoli, S. F., Marzorati, C., Gatti, D., Monzani, D., Mazzocco, K., & Pravettoni, G. (2021). A meta-analysis on heart rate variability biofeedback and depressive symptoms. Scientific Reports, 11(1), 6650.
5. Stange, J. P., Hamilton, J. L., Fresco, D. M., & Alloy, L. B. (2017). Flexible parasympathetic responses to sadness facilitate spontaneous affect regulation. Psychophysiology, 54(7), 1054-1069.
6. Randall, E. B., Billeschou, A., Brinth, L. S., Mehlsen, J., & Olufsen, M. S. (2019). A model-based analysis of autonomic nervous function in response to the Valsalva maneuver. Journal of Applied Physiology, 127(5), 1386-1402.
7. Ohira H, Matsunaga M, Osumi T, Fukuyama S, Shinoda J, Yamada J, Gidron Y. (2013). Vagal nerve activity as a moderator of brain-immune relationships. Journal of Neuroimmunology, 260, 28-36.
8. De Couck, M. D., Maréchal, R., Moorthamers, S., Laethem, J-L. V. & Gidron, Y.(2016). Vagal nerve activity predicts overall survival in metastatic pancreatic cancer, mediated by inflammation. Cancer Epidemiology, 40, 47-51.
9. Randall, E. B., Randolph, N. Z., & Olufsen, M. S. (2020). Persistent instability in a nonhomogeneous delay differential equation system of the Valsalva maneuver. Mathematical Biosciences, 319, 108292.
10. Andersen, JP, Arpaia, J, Gustafsberg, H., Poplawski, S., Di Nota, PM. (2024). The International Performance, Resilience and Efficiency Program Protocol for the Application of HRV Biofeedback in Applied Law Enforcement Settings. Journal of Applied Psychophysiology and Biofeedback, DOI: 10.1007/s10484-024-09644-3
11. *Di Nota, P.M., *Scott, S.C., Huhta, J.-M., Gustafsberg, H., & Andersen, J.P. (2024). Physiological responses to organizational stressors among police managers. Journal of Applied Psychophysiology and Biofeedback, DOI: https://doi.org/10.1007/s10484-023-09613-2
12. Etingen B., Smith, B.M., Zeliadt, S.B., Kaitz, J.E., Barker, A.M., Hyde, J.K., Fix, G.M., Reed, D.E. 2nd, Anderson, E., Hogan, T.P., & Bokhour, B.G. (2023). VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment. Journal of General Internal Medicine. 38(14):3144-3151. doi: 10.1007/s11606-023-08296-z.
13. Bokhour, B.G., Hyde J., Kligler B., Gelman, H., Gaj, L. Barker, A.M., Douglas, J. DeFaccio, R., Taylor, S.L., & Zeliadt, S.B. (2022). From patient outcomes to system change: evaluating the impact of VHA's implementation of the whole health system of care. Health Services Research. 57(S1): 53-65. doi: 10.1111/1475-6773.13938.
14. Weber, CS, et al. (2010). Low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers. European Journal of Applied Physiology, 109, 201-211.
15. Atar, O., Ram, R., Avivi, I., Amit, O., Vitkon, R., Luttwak, E., Bar-On, Y., & Gidron Y. (2023) Vagal nerve activity predicts prognosis in diffused large B-Cell lymphoma and multiple myeloma. Journal of Clinical Medicine. 12 (3): 908 (12 pages).
16. Mol, MBA., Straus, MTA., van Osch, FHM., Vogelaar, FJ., Barten, DG., Farchi, M., (2021). Foudraine, NA., & Gidron, Y. Heart-rate-variability (HRV), predicts outcomes in COVID-19. Plos One. 16(10) (12 pages).
17. Acker, L. Kevin Xu, and J. P. Ginsberg. "The brain–heart-immune axis: a vago-centric framework for predicting and enhancing resilient recovery in older surgery patients." Bioelectronic Medicine 10.1 (2024): 21.
18. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017 Sep 28;5:258. doi: 10.3389/fpubh.2017.00258. PMID: 29034226; PMCID: PMC5624990.
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