Cognitive behavioral therapy with heart rate variability biofeedback for chronic pain

Abstract

Background: Cognitive behavioral therapy (CBT) is one of the recommended treatment approaches for chronic pain, whereby on average the effects are small; however, CBT mainly addresses psychobehavioral and hardly any physiological processes. Heart rate variability biofeedback (HRV-BF) could be a possible extension of CBT. Previous studies found a reduced HRV in chronic pain and an improvement of HRV after HRV-BF. Accordingly, the combination of both therapies appears to be promising. Objectives: This article describes the development of a combined manual of CBT and HRV-BF. An ongoing randomized controlled pilot study is currently exploring the feasibility. Material and methods: The approach is based on the integration of selected CBT techniques with HRV-BF elements, which are tested for their synergistic effects and feasibility. The pilot study will be conducted on 20 patients with chronic musculoskeletal pain (according to version 11 of the International Statistical Classification of Diseases and Related Health Problems, ICD-11) and the presence of a somatic symptom disorder (according to version 5 of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5). Results: The developed short-term therapy consists of 12 sessions. The therapy goals are, for example, the development of adaptive behavior, the restructuring of maladaptive cognition and an improvement in emotion regulation as well as HRV self-regulation. Conclusion: Through the integrated short-term therapy, potentially relevant physiological processes can be addressed in addition to psychobehavioral processes. Although there are already findings on the effectiveness of both CBT and HRV-BF, the benefits of their joint application have yet to be evaluated.