1. Emerging Applications of Heart Rate Variability Biofeedback: Trauma Richard Gevirtz, Ph.D., BCIAC CSPP@ AIU, San Diego, CA [email_address]
2. Posttraumatic Stress Disorder Criteria (DSM-IV-TR, 2000) Psychiatric Disorder, Classified as Anxiety Disorder Criterion A Traumatic Event Or, series of events Directly or indirectly experienced Subjective Response Involve: intense fear, helplessness, or horror Criterion B Reexperiencing Symptom Cluster Intrusive thoughts Distressing dreams Trauma cue distress Criterion C Avoidant Symptom Cluster Avoid trauma-related thoughts, places, feelings Criterion D Hyperarousal Symptom Cluster Insomnia Irritability, anger, hypervigilance
3.
4. Criterion A Traumatic Event Subjective Response Fear, helplessness, or horror Magnitude of subjective response Epidemiological study: PTSD onset depended most on it , not traumatic event (Breslau & Kessler, 2001) Peritraumatic hyperarousal Longitudinal: (elevated HR) to imaginal trauma cues at 1 month and at 3 months was most significant predictor of PTSD onset at 3 months (Elsesser, Sartory, & Tackenberg, 2005) Peritraumatic dissociation Meta-analysis of risk factors: most significant predictor of PTSD, and better predictor than prior events (Ozer, Best, Lipsey, Weiss, 2003) Subjective response CRITICAL to PTSD onset?
5.
6.
7.
8. Rostral Anterior Cingulate ↓ ↑ Right Anterior Insula Reexperiencing Dissociation Region implicated in awareness of bodily states ↓ Right Anterior Insula ↑ Medial Prefrontal Cortex Figure 1: Emotion Dysregulation in PTSD Regions implicated in regulation of emotion and arousal ↓ Medial Prefrontal Cortex Amygdala ↑ ↓ Amygdala Regions implicated in regulation of emotion and arousal Rostral Anterior Cingulate ↑ Emotional Undermodulation Emotional Overmodulation