What if biofeedback-mediated stress management techniques could help reverse the biologic damage caused by heart failure?
Two researchers at Cleveland Clinic are testing this hypothesis with some encouraging results. Christine S. Moravec, PhD, Department of Cardiovascular Medicine, and Michael G. McKee, PhD, BCB, Department of Psychology and Psychiatry, conducted a pilot study in which advanced-stage heart failure patients awaiting transplants used biofeedback combined with stress management techniques.
The Effects of Stress
“Many patients with cardiovascular disease also experience psychological distress related to physical limitations and other life stressors, which can impact their quality of life,” Dr. Moravec says.
“We hope to influence the way subjects respond to stressful events in daily life,” Dr. McKee says. “We want them to learn how to react to fewer events, react less intensely when they do, and recover more quickly.”
Coupling stress management techniques with biofeedback can improve patients’ physical health while equipping them with coping strategies for use in everyday life.
Additionally, since the body’s stress response and heart failure both involve over-activation of the sympathetic nervous system and insufficient activation of the parasympathetic nervous system, techniques associated with stress management may actually help to interfere with some aspects of heart failure progression.
The researchers also wanted to test a hypothesis that these techniques actually could reverse some of the changes that occur at a cellular and molecular level and can lead to heart failure.
Biofeedback Training Sessions
Biofeedback is a method of training individuals to regulate their physical reactions to stress. Electronic instruments record and display information about body processes of which a person usually is unaware.
During sessions with a certified biofeedback therapist, Cleveland Clinic study participants were taught how to use biofeedback techniques and to understand the link between mental processes and physiologic arousal.
“Noninvasive sensors are used to measure physiological parameters, including finger temperature, skin conductance, breathing rate, heart rate, blood pressure and muscle tension,” Dr. McKee says. “A biofeedback coach or therapist explains the output of the sensors and teaches the individual how to regulate the parameters through a combination of relaxation techniques, guided imagery and cognitive behavioral therapy when needed.”
Heart Failure and the Nervous System
In patients with heart failure, the weakening heart muscle compensates by increasing and activating the sympathetic nervous system, creating what is known as the “fight-or-flight” response. In this situation, the heart beats harder and faster to keep blood flowing through the muscle. However, as the disease progresses, the cellular energy reserves of the sympathetic nervous system are diminished and are unable to meet the demands of the heart muscle.
At the same time, heart failure is known to impair the parasympathetic nervous system, which has the opposite function of the sympathetic nervous system, including slowing the heartbeat. Scientists now are seeing that in heart failure patients, there may be an imbalance between these two parts of the nervous system.
When they began the pilot study, Dr. Moravec and Dr. McKee hoped to show that biofeedback training could help heart failure patients reduce the activity of the sympathetic nervous system and increase the activity of the parasympathetic nervous system, slowing the progression of the disease and leading to the reversal of some of the adverse biological changes in patients’ hearts.
“At the very least, the biofeedback will help patients to have a sense of control over their symptoms using noninvasive techniques instead of medications with potential harmful side effects,” Dr. McKee says.
Dr. Moravec studied the original hearts of the dozen transplant patients in the biofeedback study and determined that eight showed some degree of recovery of the functional alterations in heart cells and muscles.
“These preliminary results are promising and have the potential to impact other chronic diseases,” Dr. Moravec says. “We are also conducting pilot studies in patients with stable coronary artery disease and multiple sclerosis.”
Dr. McKee and Dr. Moravec continue their research at Cleveland Clinic’s George M. and Linda H. Kaufman Center for Heart Failure, but finding the necessary support is challenging due to federal funding cuts.
“We have proof of concept, but we need funding to do a larger randomized controlled study,” Dr. Moravec says. “Several post-transplant patients have told us how much it helped them, which makes our research even more imperative.”