Effectiveness of 2 Just-in-Time Adaptive Interventions for Reducing Stress and Stabilizing Cardiac Autonomic Function: Microrandomized Trials.

backgroundHeart rate variability (HRV) indicates brain-body interaction and has been associated with a variety of mental and physical health indicators. Transient reductions in HRV, independent of bodily movement (so-called additional HRV reduction [AddHRVr]), may reflect moments of psychophysiological vulnerability. This metric is quantified by regressing bodily movement on the root mean square of successive differences and identifying reductions <0.5 SD of the predicted value in real time in everyday life.

objectiveWe aimed to apply this measure using wearables in everyday life to trigger low-threshold, 1-minute just-in-time adaptive interventions (JITAIs) to stabilize autonomic function and relieve perceived stress and ruminative thoughts. Thus, we compared moments of AddHRVr with random points in time with respect to the effects of brief JITAIs.

methodsIn 2 preregistered microrandomized trials, participants underwent a 1-day calibration period to derive individualized trigger settings and then received AddHRVr-triggered and random prompts throughout the following 3 days, asking for perceived stress and rumination. In study 1, participants (N=60) underwent a slow breathing intervention (0.1 Hz slow-paced breathing) following each prompt, and in study 2, participants (N=50) were microrandomized to both an external attention (ie, focusing attention on a nonliving object) and a mindful breathing intervention. HRV was assessed before, during, and following each intervention by means of the root mean squares of successive differences, SD of normal-to-normal beats, and high- and low-frequency HRV. Participants also reported on perceived stress and ruminative thoughts before and after the interventions.

resultsFollowing interventions in both studies, perceived stress and ruminative thoughts significantly declined irrespective of the kind of prompt and intervention (study 1-perceived stress: b=-0.12; P<.001 and ruminative thoughts: b=-0.11; P<.001 and study 2-perceived stress: b=-0.07; P=.01 and ruminative thoughts: b=-0.10; P=.002). AddHRVr-triggered prompts resulted in a stronger increase in HRV during the slow-paced breathing (b=0.08; P=.02) and mindful breathing interventions (b=0.10; P=.03), and elevated HRV metrics in a time frame of 10 minutes following the interventions in contrast to random prompts (study 1: b=0.12; P<.001 and study 2: b=0.10; P=.03).

conclusionsBoth studies show, for the first time, that transient, nonmetabolic reductions in HRV (AddHRVr) can be used to trigger brief JITAIs in real time by wearables to stabilize autonomic function, thus potentially promoting cardiac health. The findings suggest that although psychological benefits emerged independent of the cardiac autonomic state, slow-paced breathing or directing attention for 1 minute to either the own body or nonliving objects seemed to boost autonomic flexibility when HRV was compromised.

trial registrationGerman Clinical Trial Register DRKS00035684; https://www.drks.de/search/de/trial/DRKS00035684 and DRKS00035685; https://www.drks.de/search/de/trial/DRKS00035685.