Effects of arousal modulation via resonance breathing on craving and affect in women with substance use disorder

Abstract

Background: Craving for alcohol and other drugs is a complex in-the-moment experience that involves within-person changes in physiological arousal and affect. We evaluated the utility of a just-in-time, self-administered resonance breathing smartphone application (app) to reduce craving and improve affect in women during outpatient treatment for substance use disorders (SUD).

Methods: Women (N = 57) receiving outpatient addiction treatment were randomized to practice either cardiovascular resonance breathing (0.1 Hz/6 breaths per minute) or a sham (∼0.23 Hz/14 breaths per minute) in the face of urges over an 8-week intervention. Craving (Penn Alcohol Craving Scale) and affect (Positive and Negative Affect Scale) were collected weekly throughout the intervention. App data were uploaded weekly to assess frequency of use. Generalized Estimated Equations modeled craving and affect as a function of group randomization and app use frequency across the 8-week intervention.

Findings: Higher levels of craving were associated with more frequent app use. The group X app use interaction was significant for craving. Frequent app use during the intervention phase was associated with lower craving levels in the resonance breathing group relative to the sham group over the 8-week intervention. There was no effect of app use frequency on affect measures.

Conclusions: Women assigned to practice sham breathing who used the intervention frequently experienced elevations in craving that are commonly reported during outpatient SUD treatment. Women assigned to resonance breathing who used the intervention frequently did not experience such increases. Resonance breathing may be protective against triggers in outpatient treatment. Physiological mechanisms are discussed.

Keywords: Alcohol use disorder; Baroreflex; Cardiovascular; Clinical trial; Heart rate variability; Resonance breathing.

Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Published by Elsevier Ltd.

Figures

Fig. 1.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram.

Fig. 2.

Timeline of study involvement.

Fig. 3.

Sample mean for A) craving, and B) positive and negative affect across study involvement. Weeks 2 and 3 served as a baseline, intervention was ongoing weeks 4–11, and post-test was conducted during week 12. Both positive (dashed line) and negative (solid line) affect were within the normative range for a healthy population but wide variability is observed. Error bars are standard deviation. Note: PANAS was not collected at weeks 2, 3, or 12.

Fig. 4.

Mesh surface plots for craving levels across weeks 4–12 between the RB (left) and sham (right) groups. Low stable levels of craving are observed for frequent users of the app in the RB group. In contrast, frequent users of sham show elevated, volatile craving levels across all weeks.

Fig. 5.

Mesh surface plot for negative affect across weeks 4–11 for RB (left panel) and sham (right panel). Similar to craving scores, low, stable levels are observed in the frequent users of the RB app, whereas frequent use of the sham app was associated with more volatile patterns. However, group means show that women in the RB group consistently had elevated negative affect scores relative to the sham.