Hostname: page-component-5d84bcc8dc-sxhvn Total loading time: 0 Render date: 2026-09-06T11:19:47.363Z Has data issue: false hasContentIssue false
  • English
  • Français

Investigating the Effect of Mindfulness Training on Heart Rate Variability in Mental Health Outpatients: A Pilot Study

Published online by Cambridge University Press:  13 August 2014

Alexis Wheeler ,
Linley Denson ,
Chris Neil ,
Graeme Tucker ,
Maura Kenny ,
John F. Beltrame ,
Geoffrey Schrader  and
Michael Proeve
Alexis Wheeler
Affiliation:
School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
Linley Denson
Affiliation:
School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
Chris Neil
Affiliation:
Discipline of Medicine, The University of Adelaide, The Queen Elizabeth Hospital Campus, Adelaide, South Australia, Australia
Graeme Tucker
Affiliation:
Department of Health, Adelaide, South Australia, Australia Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
Maura Kenny
Affiliation:
The Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
John F. Beltrame
Affiliation:
Discipline of Medicine, The University of Adelaide, The Queen Elizabeth Hospital Campus, Adelaide, South Australia, Australia
Geoffrey Schrader
Affiliation:
Discipline of Psychiatry, The University of Adelaide, Adelaide, South Australia, Australia
Michael Proeve*
Affiliation:
School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
*
Address for correspondence: Dr Michael Proeve, The University of Adelaide, School of Psychology, Level 4, Hughes Building, The University of Adelaide, Adelaide SA 5005, Australia. Email: michael.proeve@adelaide.edu.au
Get access

Abstract

Depression is associated with increased cardiac morbidity and mortality in people with and without cardiac risk factors, and this relationship is, in part, mediated by heart rate variability (HRV). Increased heart rate and reduced HRV are common in depressed patients, which may explain their higher cardiac risk. This pilot study investigated whether mindfulness-based cognitive therapy (MBCT) promoted objective changes in (1) HRV, and (2) depressive symptoms and quality of life, in mental health outpatients. Twenty-seven adults meeting criteria for DSM-IV Axis I disorders completed an 8-week MBCT program. Data were collected on three occasions, 8 weeks apart; twice before and once after MBCT. Participants completed the Short Form-36 and the Center for Epidemiological Studies Depression Scale (CES-D) at each test period. Heart rate and HRV were measured during electrocardiographic monitoring before and after a cognitive stressor. At baseline, 78% of participants met criteria for depression (CES-D ≥16). Multivariate analyses revealed a significant treatment effect for SF-36 physical summary score and depression (as a dichotomous variable), but not for HRV. This pilot study highlights the immediate psychological and health benefits of MBCT. Low power may have influenced the lack of a finding of an association between HRV and MBCT. However, the feasibility of the study design has been established, and supports the need for larger and longer-term studies of the potential physiological benefits of MBCT for cardiac health.

Keywords

mindfulnessheart rate variabilitydepressionquality of lifeanxietypsychiatric

Information

Type
Standard Papers
Information
Behaviour Change , Volume 31 , Issue 3 , September 2014 , pp. 175 - 188
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Agelink, M.W., Boz, C., Ullrich, H., & Andrich, J. (2002). Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Research, 113, 139–149.Google Scholar
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Baer, R.A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.Google Scholar
Bar, K.J., Greiner, W., Jochum, T., Friedrich, M., Wagner, G., & Sauer, H. (2004). The influence of major depression and its treatment on heart rate variability and pupillary light reflex parameters. Journal of Affective Disorders, 82, 245–252.Google Scholar
Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R., & Williams, J.M.G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behaviour Research and Therapy, 47, 366–373.Google Scholar
Bishop, S. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71–83.Google Scholar
Carney, R.M, Blumenthal, J.A., Freedland, K.E., Stein, P.K., Howells, W.B., Berkman, L.F., . . . Jaffe, A.S. (2005). Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Archives of Internal Medicine, 165, 1486–1491.Google Scholar
Carney, R.M., Saunders, R.D., Freedland, K.E., Stein, P., Rich, M.W., & Jaffe, A.S. (1995). Association of depression with reduced heart rate variability in coronary artery disease. American Journal of Cardiology, 76, 562–564.Google Scholar
Chang, H-A., Chang, C-C., Chen, C-L., Kuo, T.B.J., Lu, R-B., & Huang, S-Y. (2012). Major depression is associated with cardiac autonomic dysregulation. Acta Neuropsychiatrica, 24, 318–327.Google Scholar
Cheok, F., Schrader, G., Banham, D., Marker, J., & Hordacre, A-L. (2003) Identification, course, and treatment of depression after admission for a cardiac condition: Rationale and patient characteristics for the Identifying Depression as a Comorbid Condition (IDACC) project. American Heart Journal, 146, 978–984.Google Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.), Hillsdale, NJ: Erlbaum.Google Scholar
Delizonna, L.L., Williams, R.P., & Langer, E.J. (2009). The effect of mindfulness on heart rate control. Journal of Adult Development, 16, 61–65.Google Scholar
Ditto, B., Eclache, M., & Goldman, N. (2006). Short-term autonomic and cardiovascular effects of mindfulness body scan meditation. Annals of Behavioral Medicine, 32, 227–234.Google Scholar
Drago, S., Bergerone, S., Anselmino, M., Varalda, P.G., Cascio, B., Palumbo, L., Angelini, G., & Trevi, P.G. (2007). Depression in patients with acute myocardial infarction: Influence on autonomic nervous system and prognostic role. Results of a five-year follow-up study. International Journal of Cardiology, 115, 46–51.Google Scholar
Ensel, W. (1986). Measuring depression: The CES-D Scale. In Lin, N., Dean, A. & Ensel, W. (Eds.), Social support, life events and depression (pp. 51–70). New York: Academic Press.Google Scholar
Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716–721.Google Scholar
Finucane, A., & Mercer, S.W. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry, 6, 1–14.CrossRefGoogle ScholarPubMed
Friedman, B.H. (2007). An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biological Psychology, 74, 185–199.Google Scholar
Godfrin, K.A., & van Herringen, C. (2010). The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study. Behaviour Research and Therapy, 48, 738–746.Google Scholar
Golden, C.J., & Freshwater, S.M. (1998). Stroop Color and Word Test: A manual for clinical and experimental uses. Wood Dale, IL: Stoelting Co.Google Scholar
Gorman, J.M., & Sloan, R.P. (2000). Heart rate variability in depressive and anxiety disorders. American Heart Journal, 140, 77–83.Google Scholar
Grippo, A.J., & Johnson, A.K. (2002). Biological mechanisms in the relationship between depression and heart disease. Neuroscience and Biobehavioral Reviews, 26, 941–962.Google Scholar
Henry, B.L., Minassian, A., Paulus, M.P., Geyer, M.A., & Perry, W. (2010). Heart rate variability in bipolar mania and schizophrenia. Journal of Psychiatric Research, 44, 168–176.Google Scholar
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.Google Scholar
Kaviani, H., Hatami, N., & Javaheri, F. (2012). The impact of mindfulness-based cognitive therapy (MBCT) on mental health and quality of life in a sub-clinically depressed population. Archives of Psychiatry and Psychotherapy, 1, 21–28.Google Scholar
Kaviani, H., Hatami, N., & Shafiabadi, A.E. (2009). The impact of mindfulness-based cognitive therapy on the quality of life in non-clinically depressed people. Advances in Cognitive Science, 10, 39–48.Google Scholar
Kaviani, H., Javaheri, F., & Hatami, N. (2011). Mindfulness-based cognitive therapy (MBCT) reduces depression and anxiety induced by real stressful setting in non-clinical population. International Journal of Psychology and Psychological Therapy, 11, 285–296.Google Scholar
Kemp, A.H., Quintana, D.S., Gray, M.A., Felmingham, K.L., Brown, K., & Gatt, J.M. (2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67, 1067–1074.Google Scholar
Kenny, M.A., & Williams, J.M.G (2007). Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behaviour Research and Therapy, 45, 617–625.Google Scholar
Kingston, T., Dooley, B., Bates, A., Lawlor, E., & Malone, K. (2007). Mindfulness-based cognitive therapy for residual depressive symptoms. Psychology and Psychotherapy: Theory Research and Practice, 80, 193–203.Google Scholar
Kleiger, R.E., Miller, J.P., Bigger, J.T. Jr., & Moss, A.J. (1987). Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. American Journal of Cardiology, 59, 256–262.Google Scholar
Kuyken, W., Byford, S., Taylor, R.S., Watkins, E., Holden, E., White, K., . . . Teasdale, J.D. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 966–978.Google Scholar
La Rovere, M.T., Bigger, J.T. Jr., Marcus, F.I., Mortara, A., & Schwartz, P.J. (1998). Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. Lancet, 351, 478–484.Google Scholar
Lehofer, M., Moser, M., Hoehn-Saric, R., McLeod, D., Liebmann, P., Dmovsek, B., . . . Zapotoczky, H.G. (1997). Major depression and cardiac autonomic control. Biological Psychiatry, 42, 914–919.Google Scholar
Licht, C.M., de Geus, E.G., van Dyck, R., & Penninx, B.W. (2010). Longitudinal evidence for unfavourable effects of antidepressants on heart rate variability. Biological Psychiatry, 68, 861–868.Google Scholar
Ma, S.H., & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse preventing effects. Journal of Consulting and Clinical Psychology, 72, 31–40.Google Scholar
Moser, M., Lehofer, M., Hoehn-Saric, R., McLeod, D.R., Hilderbrandt, G., Steinbrenner, B., . . . Zapotoczky, H.G. (1998). Increased heart rate in depressed subjects in spite of unchanged autonomic balance? Journal of Affective Disorders, 48, 115–124.Google Scholar
Nahshoni, E., Aravot, D., Aizenberg, D., Sigler, M., Zalsman, G., Strasberg, B., . . . Weizman, A. (2004). Heart rate variability in patients with major depression. Psychomatics, 45, 129–134.Google Scholar
NorthEast Monitoring. (2009). Holter LX Analysis. Maynard, MA: Author.Google Scholar
Penninx, B.W., Beekman, A.T., Honig, A., Deeg, D.J., Schoevers, R.A., van Eijk, J.T., & van Tilburg, W. (2001). Depression and cardiac mortality: Results from community-based longitudinal study. Archives of General Psychiatry, 58, 221–227.Google Scholar
Peressutti, C., Martin-Gonzalez, J.M., & Garcia-Manso, J.M. (2012). Does mindfulness meditation shift the cardiac automatic nervous system to a highly orderly operational state? International Journal of Cardiology, 154, 120–122.Google Scholar
Peressutti, C., Martin-Gonzalez, J.M., Garcia-Manso, J.M., & Mesa, D. (2010). Heart rate dynamics in different levels of Zen meditation. International Journal of Cardiology, 145, 142–146.Google Scholar
Phongsuphap, S., Pongsupap, Y., Chandanamattha, P., & Lursinsap, C. (2008). Changes in heart rate variability during concentration meditation. International Journal of Cardiology, 130, 481–484.Google Scholar
Pumprla, J., Howorka, K., Groves, D., Chester, M., & Nolan, J. (2002). Functional assessment of heart rate variability: Physiological basis and practical applications. International Journal of Cardiology, 84, 1–14.Google Scholar
Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.Google Scholar
Roth, B., & Robbins, D. (2004). Mindfulness-based stress reduction and health-related quality of life: Findings from a bilingual inner-city patient population. Psychosomatic Medicine, 66, 113–123.Google Scholar
SPSS for Mac OS X. (2008). Chicago, Illinois, USA: SPSS Inc.Google Scholar
StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.Google Scholar
Task Force of the European Society of Cardiology and the North American Society for Pacing and Electrophysiology. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation, 93, 1043–1065.Google Scholar
Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M., & Lau, M.A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.Google Scholar
Telles, S., Mohapatra, R.S., & Naveen, K.V. (2005). Heart rate variability spectrum during vipassana mindfulness meditation. Journal of Indian Psychology, 23, 1–5.Google Scholar
Telles, S., Raghavendra, B.R., Naveen, K.V., Manjunath, N.K., Kumar, S., & Subramanya, P. (2013). Changes in autonomic variables following two meditative states described in yoga texts. Journal of Alternative and Complementary Medicine, 19, 35–42.Google Scholar
Thayer, J.F., & Lane, R.D. (2007). The role of vagal function in the risk for cardiovascular disease and mortality. Biological Psychiatry, 74, 224–242.Google Scholar
Tucker, G., Adams, R., & Wilson, D. (2010). New Australian population scoring coefficients for the old version of the SF-36 & SF-12 health status questionnaires. Quality of Life Research, 19, 1069–1076.Google Scholar
Tucker, P., Adamson, P., Miranda, R. Jr., Scarborough, A., Williams, D., Groff, J., & McLean, H. (1997). Paroxetine increases heart rate variability in panic disorder. Journal of Clinical Psychopharmacology, 17, 370–376.Google Scholar
Udupa, K., Sathyaprabha, T.N., Thirthalli, J., Kishore, K.R., Lavekar, G.S., Raju, T.R., & Gangadhar, B.N. (2007). Alteration of cardiac autonomic functions in patients with major depression: A study using heart rate variability measures. Journal of Affective Disorders, 100, 137–141.Google Scholar
Udupa, K., Thirthalli, J., Sathyaprabha, T.N., Kishore, K.R., Raju, T.R., & Gangadhar, B.N. (2011). Differential actions of antidepressant treatments on cardiac autonomic alterations in depression: A prospective comparison. Asian Journal of Psychiatry, 4, 100–106.Google Scholar
Van Aalderen, J.R., Donders, A.R.T., Giommi, F., Spinhoven, P., Barendregt, H.P., & Speckens, A.E.M. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: A randomized controlled trial. Psychological Medicine, 42, 989–1001.Google Scholar
Van Zyl, L.T., Hasegawa, T., & Nagata, K. (2008). Effects of antidepressant treatment on heart rate variability in major depression: A quantitative review. BioPsychoSocial Medicine, 2, 12.CrossRefGoogle ScholarPubMed
Volkers, A.C., Tulen, J.H., van den Broek, W.W., Bruyn, J.A., Passchier, J., & Pepplinkhuizen, L. (2004). Effects of imipramine, fluvoxamine and depressive mood on autonomic cardiac functioning in major depressive disorder. Pharmacopsychiatry, 37, 18–25.Google Scholar
Ware, J.E. Jr., & Sherbourne, C.D. (1992) The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.Google Scholar
Watkins, L.L., Grossman, P., Krishnan, R., & Blumenthal, J.A. (1999). Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosomatic Medicine, 61, 334–340.Google Scholar
Wu, S-D., & Lo, P-C. (2008). Inward-attention meditation increases parasympathetic activity: A study based on heart rate variability. Biomedical Research, 29, 245–250.Google Scholar
Zich, J.M., Attkisson, C.C., & Greenfield, T.K. (1990). Screening for depression in primary care clinics: The CES-D and the BDI. International Journal of Psychiatry in Medicine, 20, 259–277.Google Scholar