# A pilot study of ambulatory Heart Rate Variability Biofeedback for substance use disorder

> **NIH NIH R21** · MASSACHUSETTS GENERAL HOSPITAL · 2022 · $210,000

## Abstract

PROJECT SUMMARY
 Alcohol and other drug use (AOD) lapses in early substance use disorder (SUD) recovery typically arise
from interactions between aversive affective states and stressors that together elicit urges to use. A central goal
of first-line cognitive-behavioral SUD treatments is to strengthen affective and cognitive control to increase
individuals’ ability to override impulses to use AOD. Yet certain automatic physiological processes compromised
by SUD dynamically interact with internal affective states and environmental cues to undermine effortful cognitive
control and outcompete cognitive goals to avoid substance use. Heart rate variability biofeedback (HRV BFB) is
a biobehavioral intervention involving rhythmic breathing at resonance frequency (RF) that stimulates the body’s
baroreflex mechanism to offset these psychophysiological deficits. The autonomic normalization effected by RF
breathing is thought to bolster cognitive control efforts by interrupting or dampening automatic-visceral reactions
that can undermine treatment gains, and in doing so support better decision-making, motivation, reductions in
craving, and shifts in attention allocation. Previous studies of HRV BFB have focused on positive behavioral
effects that accrue over a series of weeks or months, rather than ‘in-the-moment’. These chronic behavior
changes, although clinically valuable, are labor and time intensive to elicit, reducing the likelihood of large-scale
uptake of the intervention. Further, first-generation HRV BFB’s regular daily practice model is likely to only
partially mitigate the intense momentary bouts of emotion dysregulation that are triggers for AOD use in those
in early SUD recovery. In contrast, recent studies have demonstrated that a brief exposure to RF breathing in
anticipation of psychosocial stress, or during induced stress, helps to control physiological arousal, reduce state
anxiety, and improve cognitive performance. We posit that such bursts of in-the-moment HRV BFB practice could
serve as a potent SUD treatment tool that helps individuals self-regulate intense emotions when needed most.
Excitingly, recent advances in the field have given rise to small, lightweight, wearable biosensors that can allow
wearers to do HRV BFB on-the-go. These devises also have the capacity to function as a just-in-time intervention
by prompting in-the-moment HRV BFB practice when autonomic hyperarousal is detected, to buffer salient
triggers and urges to use AOD. This application builds on a body of preliminary work speaking to HRV BFB’s
potential as an addendum to first-line SUD treatments by exploring for the first time in this disorder this cutting
edge, second-generation, ambulatory, HRV BFB technology. Our specific aims include, 1) assessing ambulatory
HRV BFB’s uptake by individuals with SUD, 2) testing day-level effects of in-the-moment HRV BFB practice on
affective states and substance use, and 3) testing the accumulative effects of scheduled daily H...

## Key facts

- **NIH application ID:** 10493863
- **Project number:** 1R21DA056468-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** DAVID EDDIE
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $210,000
- **Award type:** 1
- **Project period:** 2022-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10493863

## Citation

> US National Institutes of Health, RePORTER application 10493863, A pilot study of ambulatory Heart Rate Variability Biofeedback for substance use disorder (1R21DA056468-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10493863. Licensed CC0.

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