Heart rate variability, negative affect, and personality disorder symptomology in women receving treatment for alcohol dependence

Alcohol dependence (AD) is resistant to treatment and many patients relapse within the first year following care. There is a need to better understand specific factors that predict and moderate treatment response to help in the formulation of improved treatments for AD. One promising individual difference factor that is thought to influence AD treatment efficacy is the ability to regulate affect, that is, an individual's ability to understand or accept his or her emotional experience, engage in strategies to manage uncomfortable emotions in an adaptive manner, and respond appropriately to negative mood. To date, the psychophysiological components of affect regulation that occur outside of conscious awareness have not been well studied, although evidence suggests that individual differences in the ability to modulate arousal contribute to the development and maintenance of AD. The present study is an initial investigation of the relationship of psychophysiological indices of arousal modulation to levels of pre-treatment symptoms of anxiety and depression, as well as to changes in these symptoms over the course of treatment, in a sample of 50 women entering a 12-week clinical trial of CBT for alcohol dependence. Indices of heart rate variability (HRV), electrocardiogram (ECG) derived measures of neurocardiac signaling, were used to operationalize modulation of psychophysiological arousal. Potential differences in the relationship of HRV to anxiety and depression in participants with symptoms of cluster-B personality disorders (PDs) was also explored. At pre-treatment baseline, depression and PD symptomology, but not anxiety, were inversely associated with measures of HRV. Measures of pre-treatment HRV failed to directly predict change in anxiety and depression through the course of treatment. However, HRV did moderate the relationship between baseline and post-treatment levels of anxiety. Specifically, greater reduction in anxiety through the course of AD treatment was predicted by higher basal anxiety, only when this high basal anxiety co-occurred with high HRV. The present results are discussed within the framework of Polyvagal Theory (Porges, 2003). It is hypothesized that HRV may be an indicator of a biological mechanism that contributes to affect dysregulation in individuals with co-occurring AD and PD symptomology. Clinical implications of this perspective are discussed, and future directions for research are suggested.