Effects of a Breath Focused Mindfulness Meditation Intervention on Dissociation and Heart Rate Variability in Patients with PTSD and Dissociative Symptoms Pubblico

Jain, Jahnvi (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/hh63sx072?locale=it
Published

Abstract

The purpose of this study was to evaluate the effects of a breath-focused mindfulness intervention on dissociation and heart rate variability (HRV) in patients with posttraumatic stress disorder (PTSD) and dissociative symptoms. HRV is a psychophysiological indicator of autonomic nervous system (ANS) function. Dissociative PTSD patients have been found to have dysregulated HRV in response to stressful stimuli. Mindfulness-based interventions have been shown to improve ANS functioning in various populations, and thus may be useful in addressing these problems in dissociative traumatized patients. Thus, I hypothesize that an improvement in ANS functioning, manifested physiologically as improved HRV, will be associated with improved dissociative symptoms in traumatized dissociative patients following a mindfulness intervention. A total of 30 female African American participants aged 18-65 (Mean = 42.8, SD = 13.0) were recruited from Grady Memorial Hospital in Atlanta, GA and underwent clinical assessments for PTSD and dissociative symptoms. Following consent, participants completed 6 brief (15 minute) breath-focused mindfulness meditation (BFMM) sessions. HRV data was collected during each session and subsequently analyzed using frequency domain analysis. Results showed a significant correlation between an increase in HRV and decrease in dissociative disengagement. Dissociation and PTSD symptoms significantly decreased from pre- to post-treatment. The findings of this study provide compelling evidence that breath-focused mindfulness may improve ANS functioning and dissociative symptoms in traumatized people.

Table of Contents

I.    Introduction………………………………….……………………………………............……….....1

A.  Posttraumatic Stress Disorder (PTSD) and Dissociation…….………………………………..1

1.    PTSD and dissociation

2.    Connecting clinical significance with biological evidence: Neurobiological basis of PTSD

3.    Unique neurophysiological characteristics of dissociative PTSD patients

4.    Psychophysiological differences between non-dissociative and dissociative PTSD

B.   Heart rate variability…………………………………………………………….........………….....6

1.    Heart rate variability as a measure of ANS functioning

2.    Low HRV characterizes psychiatric disorders

3.    HRV as a biomarker in the context of PTSD 

4.    HRV in dissociation

C.   Treatments to address autonomic abnormalities

associated with dissociation: Mindfulness interventions………......................................12

1.    Origins and anthropological perspective of mindfulness

2.    Biological effects of mindfulness

3.    Mindfulness and PTSD

4.    Mindfulness and dissociation

5.    Addressing a gap in the literature: How mindfulness affects HRV in dissociative PTSD patients

D.  Research Question………………..………………………….………………………….........……20

II.  Methods……………………………………………………………………………..…............…….21

A.  Participants……………………………………………………………………....…...........……….21

B.   Clinical Measures…………………………………..…………………………....….........……….23

1.    Multidimensional Dissociation Inventory (MDI)

2.    Modified PTSD Symptom Scale (MPSS)

C.   Breath Focused Mindfulness Meditation (BFMM)…………………....……....…..……….23

D.  Psychophysiological Measures……………………………………………………….…….…….24

1.    Electrocardiogram (ECG)

2.    Heart Rate Variability (HRV)

E.   Statistical Analysis…………………………….………………………....……....…….…......….25

III.  Results………………………………………………………………....……....…....….........…….27

A.   Dissociation and PTSD symptom changes from pre to post treatment……..………..27

B.   Dissociation and HRV changes from pre to post treatment……………………….…….30

C.   Changes in HRV and dissociative disengagement after BFMM

treatment…...........................................................................................................…....33

IV. Discussion

A.  Overview of Study………………………………………………......……………….....…..…….35

B.   Mindfulness addresses dissociation as a treatment barrier….....……….…....……….35

C.   Dissociative disengagement and treatment resistance……………....….......……..….38

D.  Mindfulness addresses disengagement through interoception………..…...….……...41

E.   Mindfulness and adaptive response to stress……………………………..……..……..….43

F.   Mindfulness and ANS dysregulation in other psychiatric disorders……..…..……...44

V.  Limitations………………………………………………………………....……….........…….….46

VI. Future Directions ………………………………………………………....…..….........…….….47

VII. Conclusion …………………………………...…………………………....…..…...……......….48

VIII. Works Cited…………………………………………………………....…..……….…..…....….49

IX.  List of Figures

A.  Figure 1. Diagram of R-R intervals between successive heartbeats which is used to determine HRV …………………………………………………..…………....…..……….…….………8

B.   Figure 2. HRV is determined by how flexibly one is able to move between the two ANS branches …………………......................................................................……..….……….7

C.   Figure 3. Scatter plot showing relationship between PTSD and dissociation scores at pre-intervention time point ………………....…..……….…………………………..………….29

D.  Figure 4. Scatter plot showing relationship between PTSD and dissociation symptoms at post-intervention time point ……………………………....…..……….……….………….29

E.   Figure 5. Scatter plot showing change in MDI and MPSS scores from pre to post intervention..……………………………....…..……….………………………………….................….30

F.   Figure 6. Scatter plot showing HRV averages during first five seconds of breath focus condition in first BFMM session and MDI scores at pre intervention……..……………31

G.  Figure 7. Scatter plot showing HRV averages during first five seconds of breath focus condition in sixth BFMM session and MDI scores at post intervention………….….….32

H.  Figure 8. Scatter plot showing change in average HRV during breath focus condition (1st 5 sec) and change in MDI scores from pre to post intervention……………….…….32

I.     Figure 9. Scatter plot showing change in average HRV during rest condition and change in MDI scores from pre to post treatment…………………………………………….……33

J.    Figure 10. Increase in HRV during breath focus condition is associated with decrease in dissociative disengagement symptoms…………………………………………….....……34

X. List of Tables

A.  Table 1. Participant demographic and clinical characteristics……………….……..................................................................................................................................……...….22

B.   Table 2. Dissociation symptoms significantly improved from pre to post BFMM treatment............................................................................................................................28

C.   Table 3. PTSD symptoms significantly improved from pre to post BFMM treatment…….................................................................................................................................28

D.  Table 4. Changes in HRV from pre to post intervention during 1st 5 seconds of the different conditions……….………………………………………………....…..……….…………….31

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