# Development and Pilot Investigation of Heart Rate Variability Biofeedback for Smoking Cessation

> **NIH NIH R34** · RUTGERS, THE STATE UNIV OF N.J. · 2020 · $232,500

## Abstract

ABSTRACT
Cigarette remains the leading cause of preventable death and poses an immense economic and health burden,
in particular for those affected by comorbid anxiety and mood disorders. Cigarette smokers who suffer from
elevated emotional distress smoke at greater rates, report greater dependence, and experience tremendous
difficulty quitting. Negative reinforcement models of cigarette dependence suggest that transdiagnostic
processes that promote avoidance and escape of affective distress contribute to the development and
maintenance of smoking. Transdiagnostic vulnerabilities may also explain why individuals with depressive and
anxiety symptoms (i.e., emotional distress) are particularly prone to smoking dependence and poor cessation
outcomes. Novel smoking cessation interventions designed to target transdiagnostic vulnerabilities largely rely
upon the development of cognitive-behavioral strategies. However, automatic visceral responses to emotional
distress may impede the utilization of intentional self-control strategies. One notable gap in the development of
integrated and behavioral treatments for cigarette smokers with elevations in emotional distress is directly
addressing transdiagnostic physiological processes, such as cardiac vagal activity that underlie smoking and
emotional disorder comorbidity. Cardiac vagal activity is critical in the effective modulation of physiological
and emotional processes. Dysregulation in this system is observed across various forms of psychopathology
and cigarette smoking, and associated with symptom severity and recovery. Heart rate variability biofeedback
(HRVB) interventions offer a simple and effective means of promoting cardiac vagal tone and flexibility, but
have not yet been applied to smokers with comorbid emotional disorder symptoms. Informed by this research,
the current proposal seeks to fill an existing gap in the development of integrated transdiagnostic interventions
for smokers with elevations in emotional distress by developing and pilot testing HRVB as a treatment adjunct
for smoking cessation. We expect two significant outcomes from the proposed research. To determine whether
an integrated HRVB and smoking cessation treatment (1) is feasible in smokers with co-occurring elevations in
emotional distress; and (2) results in significantly greater smoking cessation outcomes as compared to a
contact time matched sham breathing condition. We will also examine whether HRVB improves continuous
smoking outcomes and emotional distress. Finally, we will explore distress tolerance, and cardiac vagal tone
and flexibility, as treatment mechanisms. Via the development of a biobehavioral smoking cessation treatment,
the proposal is expected to push the current status quo of novel smoking cessation intervention programs and
have a significant positive impact on smokers with comorbid emotional psychopathology.

## Key facts

- **NIH application ID:** 9964740
- **Project number:** 5R34DA043751-03
- **Recipient organization:** RUTGERS, THE STATE UNIV OF N.J.
- **Principal Investigator:** Teresa Maria Leyro
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $232,500
- **Award type:** 5
- **Project period:** 2018-09-15 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9964740

## Citation

> US National Institutes of Health, RePORTER application 9964740, Development and Pilot Investigation of Heart Rate Variability Biofeedback for Smoking Cessation (5R34DA043751-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9964740. Licensed CC0.

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