Rationale and Objective: Given the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans, evaluating and developing innovative treatment options for post-traumatic stress disorder (PTSD) is vital, particularly new treatments that have limited or no side effects. Few existing treatments for PTSD have been proven to be highly effective, and the associated deficits in attention and recall remain a serious issue affecting veteran families and communities. The proposed treatment uses biofeedback training to teach the veteran to self-regulate heart rhythms -- the small beat-to-beat changes in heart rate. The technique is simple, easy to learn, can be applied in daily life, and is well-tolerated by individuals with PTSD. The proposal presents preliminary results showing that the biofeedback treatment improved thinking and memory in OIF/OEF veterans with PTSD. The potential benefits of the therapy are increased coping ability in everyday life and improved thinking and memory, leading to enhanced resilience in our veterans. This research will also provide new information about relationships between the heart and the ability to process information in the environment, which will extend the scientific literature leading to increased overall understanding of PTSD.

Ultimate Applicability of the Research

What types of patients will it help and how will it help them? The target population is post-combat veterans diagnosed with PTSD. Patients learn the biofeedback techniques to improve their heart rate variability (HRV) with a trained Biofeedback Practitioner, enabling the patient to self-regulate their responses to new stressors and diminish both cognitive and physiological symptoms of PTSD.

What are the potential clinical applications, benefits, and risks? HRV biofeedback is an accepted therapeutic technique that has already shown improvements in patients with anxiety or anger problems, coronary diseases, and in healthy patients exposed to stress. PTSD-induced deficits in concentration and recall undoubtedly contribute to added relational stress. The proposed study offers a real-world solution in the lives of PTSD veterans by dealing with the treatment of attention and memory issues needed to function. The positive repercussions of meaningful improvements in thinking and memory for post-war veterans would directly impact the everyday lives of their caregivers, families, and indirectly, the American Public through improved functional status and psychological and physical well-being of these returning warriors. Risk management is easily implemented by having in place well-developed written policies and procedures that are strictly adhered to by all researchers. No significant physical, social, or legal risk is anticipated in association with participating in this study. All proposed procedures have been widely used over a long period of time by the investigators and others. There have been noted, but few, cases of relaxation-induced anxiety, but these effects are mild and not associated with HRV biofeedback. Other negative reactions that have been associated with biofeedback-assisted relaxation (such as sensation of heaviness, feelings of sadness, disturbing thoughts, or mind wandering) are rare, mild, brief, and easily reversed. All these reactions can be prevented by an experienced Biofeedback Practitioner with precautions, patient education, and careful monitoring. The pilot portion of the study was approved by the Dorn VAMC (Department of Veterans Affairs Medical Center) Institutional Review Board as posing no more than minimal risk to the subjects.

What is the projected time it may take to achieve a patient-related outcome? Patient training can be accomplished in about 8 weeks. We will reassess the persistence of benefits 8 weeks after the end of biofeedback training. A fully developed HRV biofeedback clinical program could be immediately implemented in a clinical setting, thereby providing a ready resource that will contribute to the future recovery and resilience of service members.

How will this study advance the field of research? The proposed study investigates the clinical use of a novel PTSD treatment technology by focusing on the understudied aspect of the daily functioning of PTSD veterans and by investigating an application of biofeedback for PTSD-induced deficits in concentration and recall. The time to explore promising new interventions is now, while the majority of new combatants are recently returned from deployment, or even still in uniform. Proactive program development can help providers take action before PTSD takes root in the individual. Long term, the potential impact of the proposed findings may bring reduction in the many medical consequences of PTSD, such as depression, sleep disruption, regulation of abnormal circadian patterns, and heart disease.