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Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study

Year 2024, Volume: 7 Issue: 1, 103 - 113, 25.01.2024
https://doi.org/10.33438/ijdshs.1360544

Abstract

This study investigated the effects of a psychophysiological intervention programmed, comprising heart rate variability biofeedback (HRV BFB) and cognitive restructuring (CR), on the self-regulation skills of an 18-year-old female squash athlete who represents the Korean national team. The participant underwent ten programme sessions in a laboratory. HRV was measured during a 10-minute baseline period of natural breathing and during BFB-guided breathing exercises. Two questionnaires, the Competitive State Anxiety Inventory-2 (CSAI-2) and the Cognitive Emotion Regulation Questionnaire (CERQ), were used to assess the participant's psychological state. Descriptive statistics were employed to analyze changes in HRV and psychological state from the initial test to the post-test. Qualitative findings indicated improvements in the participant's self-regulation skills, particularly in her ability to transform negative thoughts. In conclusion, the intervention programme shows potential in enhancing self-regulation skills to the athlete. The combination of HRV biofeedback and cognitive restructuring appears to lead to positive changes in self-regulation, which could benefit athletes in managing their psychological state and improving competitive performance. Further research and practical applications are continued needed to fully explore the programme's efficacy.

References

  • Appelhans, B.M., & Luecken, L.J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3): 229-240. [CrossRef]
  • Beauchamp, M.K., Harvey, R.H. & Beauchamp, P.H. (2012). An integrated biofeedback and psychological skills training program for Canada’s Olympic short-track speed skating team. Journal of Clinical Sport Psychology, 6(1):67-84. [PubMed]
  • Beck, A.T. (1988). Cognitive approaches to panic disorder: Theory and therapy. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 91-109). Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc.
  • Beck, A.T., Sokol, L., Clark, D.A., Berchick, R. & Wright, F. (1992). A crossover study of focused cognitive therapy for panic disorder. The American Journal of Psychiatry, 149(6): 778-783. [PubMed]
  • Beckham, A.J., Greene, T.B. & Meltzer-brody, S. (2013). A pilot study of heart rate variability biofeedback therapy in the treatment of perinatal depression on a specialized perinatal psychiatry inpatient unit. Archives of Women’s Mental Health, 16(1): 59-65. [PubMed]
  • Berntson, G.G., Bigger, J.T. Jr, & Van Der Molen, M.W. (1997). Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology, 34(6): 623-648. [PubMed]
  • Choi, Y.H., & Lee, J.H. (1998). Cognitive behavioural therapy for panic disorder. Journal of Korean Neuropsychiatric Association, 37(4): 603-619. [PubMed]
  • Choudhary, R., Triveti, V., & Choudhary, S.G. (2016). Effect of heart rate variability biofeedback training on the performance of track athletes. International Journal of Therapies and Rehabilitation Research, 5(4): 166-174. [PubMed]
  • Clark, D.M. (1993). Cognitive mediation of panic attacks induced by biological challenge tests. Advances in Behaviour Research and Therapy. 15(1): 75-84. [CrossRef]
  • Clark, D.M.; Salkovskis, P.M., & Chalkley, A.J. (1985). Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 16(1): 23-30. [PubMed]
  • D’ascenzi, F., Alvino, F., & Mondillo, S. (2014). Precompetitive assessment of heart rate variability in elite female athletes during play offs. Clinical Physiology and Functional Imaging, 34(3): 230-236. [PubMed]
  • Davis, P., Sime, W.E., & Robertson, J. (2007). Sport psychophysiology and peak performance applications of stress management. In P. M. Lehrer, R. L. Woolfolk & W. E. Sime (Eds.), Principles and practices of stress management (3rd ed.) (pp. 615-637). New York, US: Guilford Press. [CrossRef]
  • Dupee, M., Werthner, P., & Forneris, T. (2015). A preliminary study on the relationship between athletes’ ability to self-regulate and world ranking. Biofeedback, 43(2): 57-63. [CrossRef]
  • Dziembowska, I., Izdebski, P., & Cysewski, P. (2016). Effects of heart rate variability biofeedback on EEG alpha asymmetry and anxiety symptoms in male athletes: A pilot study. Applied Psychophysiology and Biofeedback, 41 (2): 141-150. [PubMed]
  • Ferguson, K.N., & Hall, C. (2020). Sport biofeedback: Exploring implication and limitation to use. The Sport Psychologist, 34: 232-241. [CrossRef]
  • Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European Journal of Psychological Assessment, 23(3): 141-149. [CrossRef]
  • Garnefski, N., Kraaij, V., & Spinhoven, P. (2002). Manual for the use of the cognitive emotion regulation questionnaire. Leiderdorp, The Netherlands: Datec, Leiderdorp.
  • Gross, M.J., Hall, R., & Shearer, D.A. (2017). Resonant frequency training in elite sport: A case study example. Journal of Sport Psychology in Action, 8(3): 173-183. [CrossRef]
  • Hauer, R., Tessitore, A., & Tschan, H. (2020). Lacrosse athletes load and recovery monitoring: Comparison between objective and subjective methods. International Journal of Environmental Research and Public Health, 17(9): 3329. [PubMed]
  • Hong, S.T. (2011). Effect of arousal control training conjugated heart rate biofeedback for national substitute archery players. The Korean Contents Association, 11(9): 470-484.https://doi.org/10.5392/JKCA.2011.11.9.469
  • Hwang, S.H., Oh, W.S., & Lee, K.R. (2016). The review on application of heart rate variability in sport psychology. The Korean Journal of Physical Education, 55(6): 195-206. [PubMed]
  • Hwang, S.H. (2018). Heart rate variability and competitive anxiety assessment in basketball. The Korean Journal of Physical Education. 27(2): 261-270.
  • Janelle, C.M., & Naugle, K.M. (2012). Emotional reactivity. In G. Tenenbaum, R. C. Eklund, & A. Kamata (Eds.), Measurement in sport and exercise psychology (pp. 333-348). Champaign, IL: Human Kinetics. [CrossRef]
  • Kim, B.S., & Min, A. (2015). Utilization and interpretation of heart rate variability in stress clinics. Seoul: Bummun Education.
  • Kim, H.G., Cheon, E.J., & Koo, B.H. (2018). Stress and heart rate variability: A meta-analysis and review of the literature. Psychiatry investigation, 15(3): 235. [PubMed]
  • Lagos, L., Vaschillo, E., & Pandina, R. (2008). Heart rate variability biofeedback as a strategy for dealing with competitive anxiety: A case study. Biofeedback, 36(3): 109-115.
  • Lane, A.M., Sewell, D.F., & Nesti, M.S. (1999). Confirmatory factor analysis of the competitive state anxiety inventory-2. Journal of Sports Sciences, 17(6): 505-512. [PubMed]
  • Lehrer, P.M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5: 756. [PubMed]
  • Lehrer, P.M., Vaschillo, E., & Hamer, R.M. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5): 796-805. [PubMed]
  • Martens, R., Burton, D., & Smith, D. (1990). The development of the competitive state anxiety inventory-2 (CSAI-2). In R. Martens, R. S. Vealey, & D. Burton (Eds.), Competitive anxiety in sport (pp. 117-190). Champaign, IL: Human Kinetics.
  • Morales, J., Roman, V., & Fíguls, A. (2019). Physiological and psychological changes at the end of the soccer season in elite female athletes. Journal of Human Kinetics, 66: 99. [PubMed]
  • Mueller, K., Williams, P.S., & Heick, J. (2020). Heart rate variability biofeedback improves sports performance in an elite female athlete. Cardiopulmonary Physical Therapy Journal, 31(3): 123-132. [CrossRef]
  • Park, K.J., & Jeong, H. (2014). Assessing methods of heart rate variability. Annals of Clinical Neurophysiology, 16(2): 49-54. [CrossRef]
  • Paul, M., & Garg, K. (2012). The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology and Biofeedback, 37(2): 131-144. [PubMed]
  • Politano, L., Palladino, A., M. & Cozza, V. (2008). Usefulness of heart rate variability as a predictor of sudden cardiac death in muscular dystrophies. Acta Myologica: Myopathies and Cardiomyopathies: Official Journal of the Mediterranean Society of Myology, 27(3): 114-122. [PubMed]
  • Prinsloo, G.E., Rauch, H.G.L., & Derman, W.E. (2011). The effect of short duration heart rate variability (HRV) biofeedback on cognitive performance during laboratory induced cognitive stress. Applied Cognitive Psychology, 25(5): 792–801. [CrossRef]
  • Prinsloo, G.E., Rauch, H.L., & Derman, W.E. (2014). A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine. The Physician and Sports Medicine, 42(2): 88-99. [PubMed]
  • Rapee, R.M. (1986). Differential response to hyperventilation in panic disorder and generalized anxiety disorder. Journal of Abnormal Psychology, 95(1): 24-28. [CrossRef]
  • Reiner, R. (2008). Integrating a portable biofeedback device into clinical practice for patients with anxiety disorders: Results of a pilot study. Applied Psychophysiology and Biofeedback, 33(1): 55-61. [PubMed]
  • Robazza, C., Pellizzari, M., & Hanin, Y. (2004). Emotion self-regulation and athletic performance: An application of the IZOF model. Psychology of Sport and Exercise, 5: 379-404. [CrossRef]
  • Roberto, C., & Attilio, C. (2018). Heart rate variability: An overview and a few immediate/short-term assessments. Heart and Mind, 2(4): 111-118. [CrossRef]
  • Salkovskis, P.M., Clark, D.M., & Hackmann, A. (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behaviour Research and Therapy, 29(2): 161-166. https://doi.org/10.1016/0005-967(91) 90044-4
  • Strack, B.W. (2003). Effect of heart rate variability (HRV) biofeedback on batting performance in baseball. Alliant International University, San Diego.
  • Strano, S., Calcagnini, G., & Caselli, G. (1998). Respiratory sinus arrhythmia and cardiovascular neural regulation in athletes. Medicine and Science in Sports and Exercise, 30(2): 215-219. https://doi.org/10. 1097/00005768-99802000-00007
  • Thayer, J.F., Yamamoto, S.S., & Brosschot, J.F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology, 141(2): 122-131.[PubMed]
  • Thayer, J.F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of behavioral medicine, 37(2), 141-153. [PubMed]
Year 2024, Volume: 7 Issue: 1, 103 - 113, 25.01.2024
https://doi.org/10.33438/ijdshs.1360544

Abstract

References

  • Appelhans, B.M., & Luecken, L.J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3): 229-240. [CrossRef]
  • Beauchamp, M.K., Harvey, R.H. & Beauchamp, P.H. (2012). An integrated biofeedback and psychological skills training program for Canada’s Olympic short-track speed skating team. Journal of Clinical Sport Psychology, 6(1):67-84. [PubMed]
  • Beck, A.T. (1988). Cognitive approaches to panic disorder: Theory and therapy. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 91-109). Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc.
  • Beck, A.T., Sokol, L., Clark, D.A., Berchick, R. & Wright, F. (1992). A crossover study of focused cognitive therapy for panic disorder. The American Journal of Psychiatry, 149(6): 778-783. [PubMed]
  • Beckham, A.J., Greene, T.B. & Meltzer-brody, S. (2013). A pilot study of heart rate variability biofeedback therapy in the treatment of perinatal depression on a specialized perinatal psychiatry inpatient unit. Archives of Women’s Mental Health, 16(1): 59-65. [PubMed]
  • Berntson, G.G., Bigger, J.T. Jr, & Van Der Molen, M.W. (1997). Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology, 34(6): 623-648. [PubMed]
  • Choi, Y.H., & Lee, J.H. (1998). Cognitive behavioural therapy for panic disorder. Journal of Korean Neuropsychiatric Association, 37(4): 603-619. [PubMed]
  • Choudhary, R., Triveti, V., & Choudhary, S.G. (2016). Effect of heart rate variability biofeedback training on the performance of track athletes. International Journal of Therapies and Rehabilitation Research, 5(4): 166-174. [PubMed]
  • Clark, D.M. (1993). Cognitive mediation of panic attacks induced by biological challenge tests. Advances in Behaviour Research and Therapy. 15(1): 75-84. [CrossRef]
  • Clark, D.M.; Salkovskis, P.M., & Chalkley, A.J. (1985). Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 16(1): 23-30. [PubMed]
  • D’ascenzi, F., Alvino, F., & Mondillo, S. (2014). Precompetitive assessment of heart rate variability in elite female athletes during play offs. Clinical Physiology and Functional Imaging, 34(3): 230-236. [PubMed]
  • Davis, P., Sime, W.E., & Robertson, J. (2007). Sport psychophysiology and peak performance applications of stress management. In P. M. Lehrer, R. L. Woolfolk & W. E. Sime (Eds.), Principles and practices of stress management (3rd ed.) (pp. 615-637). New York, US: Guilford Press. [CrossRef]
  • Dupee, M., Werthner, P., & Forneris, T. (2015). A preliminary study on the relationship between athletes’ ability to self-regulate and world ranking. Biofeedback, 43(2): 57-63. [CrossRef]
  • Dziembowska, I., Izdebski, P., & Cysewski, P. (2016). Effects of heart rate variability biofeedback on EEG alpha asymmetry and anxiety symptoms in male athletes: A pilot study. Applied Psychophysiology and Biofeedback, 41 (2): 141-150. [PubMed]
  • Ferguson, K.N., & Hall, C. (2020). Sport biofeedback: Exploring implication and limitation to use. The Sport Psychologist, 34: 232-241. [CrossRef]
  • Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European Journal of Psychological Assessment, 23(3): 141-149. [CrossRef]
  • Garnefski, N., Kraaij, V., & Spinhoven, P. (2002). Manual for the use of the cognitive emotion regulation questionnaire. Leiderdorp, The Netherlands: Datec, Leiderdorp.
  • Gross, M.J., Hall, R., & Shearer, D.A. (2017). Resonant frequency training in elite sport: A case study example. Journal of Sport Psychology in Action, 8(3): 173-183. [CrossRef]
  • Hauer, R., Tessitore, A., & Tschan, H. (2020). Lacrosse athletes load and recovery monitoring: Comparison between objective and subjective methods. International Journal of Environmental Research and Public Health, 17(9): 3329. [PubMed]
  • Hong, S.T. (2011). Effect of arousal control training conjugated heart rate biofeedback for national substitute archery players. The Korean Contents Association, 11(9): 470-484.https://doi.org/10.5392/JKCA.2011.11.9.469
  • Hwang, S.H., Oh, W.S., & Lee, K.R. (2016). The review on application of heart rate variability in sport psychology. The Korean Journal of Physical Education, 55(6): 195-206. [PubMed]
  • Hwang, S.H. (2018). Heart rate variability and competitive anxiety assessment in basketball. The Korean Journal of Physical Education. 27(2): 261-270.
  • Janelle, C.M., & Naugle, K.M. (2012). Emotional reactivity. In G. Tenenbaum, R. C. Eklund, & A. Kamata (Eds.), Measurement in sport and exercise psychology (pp. 333-348). Champaign, IL: Human Kinetics. [CrossRef]
  • Kim, B.S., & Min, A. (2015). Utilization and interpretation of heart rate variability in stress clinics. Seoul: Bummun Education.
  • Kim, H.G., Cheon, E.J., & Koo, B.H. (2018). Stress and heart rate variability: A meta-analysis and review of the literature. Psychiatry investigation, 15(3): 235. [PubMed]
  • Lagos, L., Vaschillo, E., & Pandina, R. (2008). Heart rate variability biofeedback as a strategy for dealing with competitive anxiety: A case study. Biofeedback, 36(3): 109-115.
  • Lane, A.M., Sewell, D.F., & Nesti, M.S. (1999). Confirmatory factor analysis of the competitive state anxiety inventory-2. Journal of Sports Sciences, 17(6): 505-512. [PubMed]
  • Lehrer, P.M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5: 756. [PubMed]
  • Lehrer, P.M., Vaschillo, E., & Hamer, R.M. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5): 796-805. [PubMed]
  • Martens, R., Burton, D., & Smith, D. (1990). The development of the competitive state anxiety inventory-2 (CSAI-2). In R. Martens, R. S. Vealey, & D. Burton (Eds.), Competitive anxiety in sport (pp. 117-190). Champaign, IL: Human Kinetics.
  • Morales, J., Roman, V., & Fíguls, A. (2019). Physiological and psychological changes at the end of the soccer season in elite female athletes. Journal of Human Kinetics, 66: 99. [PubMed]
  • Mueller, K., Williams, P.S., & Heick, J. (2020). Heart rate variability biofeedback improves sports performance in an elite female athlete. Cardiopulmonary Physical Therapy Journal, 31(3): 123-132. [CrossRef]
  • Park, K.J., & Jeong, H. (2014). Assessing methods of heart rate variability. Annals of Clinical Neurophysiology, 16(2): 49-54. [CrossRef]
  • Paul, M., & Garg, K. (2012). The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology and Biofeedback, 37(2): 131-144. [PubMed]
  • Politano, L., Palladino, A., M. & Cozza, V. (2008). Usefulness of heart rate variability as a predictor of sudden cardiac death in muscular dystrophies. Acta Myologica: Myopathies and Cardiomyopathies: Official Journal of the Mediterranean Society of Myology, 27(3): 114-122. [PubMed]
  • Prinsloo, G.E., Rauch, H.G.L., & Derman, W.E. (2011). The effect of short duration heart rate variability (HRV) biofeedback on cognitive performance during laboratory induced cognitive stress. Applied Cognitive Psychology, 25(5): 792–801. [CrossRef]
  • Prinsloo, G.E., Rauch, H.L., & Derman, W.E. (2014). A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine. The Physician and Sports Medicine, 42(2): 88-99. [PubMed]
  • Rapee, R.M. (1986). Differential response to hyperventilation in panic disorder and generalized anxiety disorder. Journal of Abnormal Psychology, 95(1): 24-28. [CrossRef]
  • Reiner, R. (2008). Integrating a portable biofeedback device into clinical practice for patients with anxiety disorders: Results of a pilot study. Applied Psychophysiology and Biofeedback, 33(1): 55-61. [PubMed]
  • Robazza, C., Pellizzari, M., & Hanin, Y. (2004). Emotion self-regulation and athletic performance: An application of the IZOF model. Psychology of Sport and Exercise, 5: 379-404. [CrossRef]
  • Roberto, C., & Attilio, C. (2018). Heart rate variability: An overview and a few immediate/short-term assessments. Heart and Mind, 2(4): 111-118. [CrossRef]
  • Salkovskis, P.M., Clark, D.M., & Hackmann, A. (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behaviour Research and Therapy, 29(2): 161-166. https://doi.org/10.1016/0005-967(91) 90044-4
  • Strack, B.W. (2003). Effect of heart rate variability (HRV) biofeedback on batting performance in baseball. Alliant International University, San Diego.
  • Strano, S., Calcagnini, G., & Caselli, G. (1998). Respiratory sinus arrhythmia and cardiovascular neural regulation in athletes. Medicine and Science in Sports and Exercise, 30(2): 215-219. https://doi.org/10. 1097/00005768-99802000-00007
  • Thayer, J.F., Yamamoto, S.S., & Brosschot, J.F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology, 141(2): 122-131.[PubMed]
  • Thayer, J.F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of behavioral medicine, 37(2), 141-153. [PubMed]
There are 46 citations in total.

Details

Primary Language English
Subjects Physical Activity and Health
Journal Section Original Article
Authors

Boram Kım This is me 0000-0002-5421-0850

Seunghyun Hwang This is me 0000-0002-2800-6418

Hoseok Kang This is me 0000-0003-0993-4793

Early Pub Date December 25, 2023
Publication Date January 25, 2024
Published in Issue Year 2024 Volume: 7 Issue: 1

Cite

APA Kım, B., Hwang, S., & Kang, H. (2024). Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study. International Journal of Disabilities Sports and Health Sciences, 7(1), 103-113. https://doi.org/10.33438/ijdshs.1360544
AMA Kım B, Hwang S, Kang H. Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study. International Journal of Disabilities Sports &Health Sciences. January 2024;7(1):103-113. doi:10.33438/ijdshs.1360544
Chicago Kım, Boram, Seunghyun Hwang, and Hoseok Kang. “Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study”. International Journal of Disabilities Sports and Health Sciences 7, no. 1 (January 2024): 103-13. https://doi.org/10.33438/ijdshs.1360544.
EndNote Kım B, Hwang S, Kang H (January 1, 2024) Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study. International Journal of Disabilities Sports and Health Sciences 7 1 103–113.
IEEE B. Kım, S. Hwang, and H. Kang, “Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study”, International Journal of Disabilities Sports &Health Sciences, vol. 7, no. 1, pp. 103–113, 2024, doi: 10.33438/ijdshs.1360544.
ISNAD Kım, Boram et al. “Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study”. International Journal of Disabilities Sports and Health Sciences 7/1 (January 2024), 103-113. https://doi.org/10.33438/ijdshs.1360544.
JAMA Kım B, Hwang S, Kang H. Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study. International Journal of Disabilities Sports &Health Sciences. 2024;7:103–113.
MLA Kım, Boram et al. “Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study”. International Journal of Disabilities Sports and Health Sciences, vol. 7, no. 1, 2024, pp. 103-1, doi:10.33438/ijdshs.1360544.
Vancouver Kım B, Hwang S, Kang H. Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study. International Journal of Disabilities Sports &Health Sciences. 2024;7(1):103-1.


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