Heart rate variability predicts outcome of short-term psychotherapy at the workplace, 2022, Balint et al

[Andy]

Abstract

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary–adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy.

A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4–12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/psyp.14150

 

[alktipping]

"The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by ." I doubt their is any evidence whatsoever for this statement .

 

[Sean]

A single-arm, uncontrolled, explorative study

*sigh*

 

[Hutan]

in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary–adrenal axis with its product cortisol.

Cortisol concentrations were neither affected by intervention nor by symptom course.

So, cortisol wasn't affected by the psychotherapy intervention.
I note that the abstract doesn't say whether the psychotherapy intervention had any impact on the results of surveys of impairment, or on numbers of people on sick leave. (edited)

I'm not sure I care enough to go see if the paper itself gives the answers to these questions.

Of course, regression to the mean would suggest that there was some improvement in somebody over the period the intervention was applied.

 

[Hutan]

( written at the end - Ugh, sorry, I'm boring even myself. Go and do something nice for yourself rather than bother with this.)

I see that 65 people presented themselves for this 'psychotherapy in the workplace'. Only 23 ended up providing enough data.

Cortisol
Intervention had no impact on cortisol levels, which did not appear to be abnormal to start with.

HRV

The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017).

They are really reaching there.
24 hour HRV was 27 at baseline, and 29 after therapy.
Daytime HRV was 24 at baseline and 25 after therapy
Sleep HRV was 34 at baseline and 36 after therapy

There were no significant differences between mean HRV values at baseline and follow-up (Table 2).

So, nothing. And few of the participants recorded abnormal HRVs to start with

Further, there were only few participants with markedly reduced HRV.

It looks like there were some minor improvements in the surveys after the intervention, exactly as would be expected in an unblinded treatment that isn't really doing much e.g
SF-12 Mental component - 32/100 to 44/100
PHQ9 (Depression) - 11/27 to 9/27
Emotional irritation - 19/35 to 16/35
Cognitive irritation - 14/21 to 11/21

The participants have a range of things supposedly wrong with them. If low HRV indicates poor physical health, then it's not surprising that people with low HRV tend, after the psychotherapy, to still be struggling with a range of difficulties related to trying to work.

 

[Trish]

( written at the end - Ugh, sorry, I'm boring even myself. Go and do something nice for yourself rather than bother with this.)

Yet another example of researchers doing poor quality research and desperate for publication claiming effectiveness when there is none.