A mixed methods investigation of heart rate variability training for women with irritable bowel syndrome

This concurrent mixed method, exploratory, multiple case study examined the experience of Heart Rate Variability Biofeedback (HRV BFB) training for women (n=8) with chronic irritable bowel syndrome (IBS). IBS is a multifaceted, functional gastrointestinal syndrome that can chronically disrupt overall health and social functioning. The growing prevalence and financial, social, and personal impact of IBS call for the development of multi-component, psychophysiological approaches that are based on the nature and severity of the condition, the needs of the individual, and a balancing of autonomic functioning. HRV BFB retrieves and transforms heart rate and respiration measurements into visual and auditory feedback. This study's multi-component treatment protocol demonstrated one way that HRV BFB could be incorporated as the central feature of a training process integrating physiological, psychological, behavioral, and cognitive change. Prior research efforts concerning both IBS and HRV BFB have been predominately quantitative; to date, no qualitative or mixed method studies about HRV BFB for IBS have been published. This intervention included eight weekly, supervised HRV training sessions and daily at-home practice using the StressEraser(TM) hand-held device. Continuous and pre/post data were collected via 5 questionnaires (Rome III Questionnaire, Symptom Checklist-90-R, IBS Severity Scale, IBS Quality of Life Measure, and Health and Daily Habit Questionnaire) and HRV biofeedback recordings. Concurrent analysis of quantitative and qualitative data combined statistical analysis of questionnaire scores and HRV measurements (t-tests) with a three-stage qualitative coding process based on grounded theory principles. Change over time reflected significant improvements in symptom severity (p=.0122), psychological health (p=.0079), and two measures of HRV (LF %: p=.0033; HRV Max-Min: p=.0345). HRV SDNN results were inconclusive, and quality of life scores showed non-significant improvement (p=.0732). This training protocol provided psychophysiological education, introduced mind-body perspectives on health and wellness, and increased levels of self knowledge, self care, self regulation, and self awareness.;Keywords: irritable bowel syndrome, heart rate variability, biofeedback, mixed method research.