Diaphragmatic Breathing and Heart Rate Variability Biofeedback for Decreasing Compulsive Behaviors in Borderline Personality Disorder Milton Brown, Chantelle Thomas, and Richard Gevirtz California School of Professional Psychology at Alliant International University, San Diego, CA Heart rate variability (HRV) is generally suppressed in a variety of disorders of emotion, including borderline personality disorder (BPD), which is thought of as a disorder of chronic and pervasive emotion dysregulation (Linehan, 1993). HRV biofeedback is a technique that gives feedback about fluctuations in HRV during diaphragmatic breathing to optimize the rate and quality of breathing to maximize HRV. The goal is to improve emotion regulation by strengthening homeostatic reflexes and vagal tone. Initial case reports and small research studies suggest that HRV biofeedback may help with anger and anxiety disorders (Bhat & Bhat, 1999; Gevirtz, 2003), but no studies have yet examined HRV interventions for reducing emotion-dependent behaviors. Furthermore, no studies have evaluated this technique for emotion regulation in BPD. The current study utilizes a single-subject design to evaluate the effectiveness of HRV biofeedback for treating compulsive behaviors in BPD. Method Participant (N = 1): ■ female, age 55, Caucasian, middle-class ■ current diagnoses: borderline personality disorder, major depressive disorder, generalized anxiety disorder ■ weekly individual therapy (outside the study) Measures: Self-Monitoring: daily count of compulsive behaviors and daily Likert ratings of anxiety, anger, shame, and compulsion urges. Yale-Brown Obsessive Compulsive Scale (YBOCS): an interview-based rating scale measuring severity of OCD. Taylor Manifest Anxiety Scale (TMAS-28; Taylor, 1953). Twenty-eight True-False statements reflect somatic, behavioral, emotional, and cognitive signs of trait anxiety. Beck Depression Inventory (BDI-II, 2nd Ed.): self-reported depression symptoms over a two-week period. Suicidal Behavior Questionnaire (SBQ). A brief self-report measure of suicide threats and ideation. Procedures: Instructions: daily practice of device-assisted breathing and also whenever urge to engage in compulsive behavior or at the start of any episode of intense emotion. Baseline (2 weeks): sham biofeedback device combined with diaphragmatic breathing (no instructions about breathing pace or volume). Intervention (2 weeks): slow diaphragmatic breathing (about 5-6 breaths per minute) with the aide of a StressEraser, a handheld HRV biofeedback device. 100 points recommended as daily goal. Baseline Data: YBOCS: Skin-picking was her only compulsive behavior. obsession compulsion score 12 (max=20) 10 (max=20) daily total time 2 hrs 35 min. longest (typical) daily interval obsession-free interval: 40 minutes compulsion-free interval: 5 hours TMAS = 13 (low general somatic anxiety; max=28) BDI = 21 (moderate current depression) SBQ - previous suicide attempt, but no suicide ideation in the last year. start of biofeedback start of sham device start of biofeedback Results ● The participant practiced moderately and inconsistently. sham practice: 70% of days (M = 5.8 min./day) biofeedback practice: 46% of days practice sessions were shorter than recommended not practiced during urges or distress 3-Day Date Interval Points 10/18 12 60 10/19 12 55 10/21 13 60 10/23 13 73 10/25 14 16 10/28 15 17 ● Anxiety was not related to compulsive urges or behaviors. ● There were fewer compulsive acts on days with greater practice of HRV biofeedback. ● Overall, compulsive behaviors were not less when the participant practiced HRV biofeedback compared to when the participant practiced the sham device. Conclusions ● This study did not find much evidence for the efficacy of HRV biofeedback for compulsive behaviors in borderline personality disorder. More evidence is needed. ● More research is needed to evaluate the effects of a sufficient dose of HRV biofeedback participant compliance must be improved more participants will allow a multiple-baseline design start of biofeedback start of biofeedback