Abstract

Case Report

Heart Rate Variability Biofeedback and Psychotherapy in Polycystic Ovary Syndrome: Description of a Case Report to Shed Light on this Understudied Condition

Carlo Pruneti, Sara Guidotti* and Chiara Cosentino

Published: 20 September, 2023 | Volume 6 - Issue 3 | Pages: 135-142

Background: Although there is minimal information on the role of stress in PCOS, it is well-known that it may trigger the exacerbation and maintenance of the disease. Despite there being only a few studies in the literature, many researchers highlighted situations of autonomic hyperactivation characterizing PCOS. In light of these assumptions, the purpose of this study is to report on a patient who underwent psychological intervention to enhance stress management skills.
Case: A 30-year-old woman was referred by the endocrinologist. From a clinical-psychological point of view, the condition of the patient was characterized by a modest psychophysiological activation. Interpersonal difficulties did not allow the patient to benefit from the social support of her loved ones, further favoring the maintenance of the excessive arousal generated by stressful life events. The patient was treated with HRV-Biofeedback integrated within cognitive-behavioral psychotherapy.
Discussion: The multidimensional intervention brought benefits to the patient, teaching her better stress management strategies (i.e., reduction of psychological symptoms and improvement of hormonal tests). Keeping in mind the interplay between physiological, psychological, and interpersonal factors is fundamental in all psycho-somatic and somato-psychic disorders and is crucial to enhance the use of specific treatments to restore psychophysical well-being.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001142 Cite this Article Read Full Article PDF

Keywords:

Polycystic ovary syndrome; Clinical psychology; Stress; Heart rate variability; Biofeedback; Psychotherapy

References

  1. Sadeghi HM, Adeli I, Calina D, Docea AO, Mousavi T, Daniali M, Nikfar S, Tsatsakis A, Abdollahi M. Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. Int J Mol Sci. 2022 Jan 6;23(2):583. doi: 10.3390/ijms23020583. PMID: 35054768; PMCID: PMC8775814.
  2. Ostadmohammadi V, Jamilian M, Bahmani F, Asemi Z. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019 Jan 21;12(1):5. doi: 10.1186/s13048-019-0480-x. PMID: 30665436; PMCID: PMC6340184.
  3. Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What's new? Adv Clin Exp Med. 2017 Mar-Apr;26(2):359-367. doi: 10.17219/acem/59380. PMID: 28791858.
  4. Steegers-Theunissen RPM, Wiegel RE, Jansen PW, Laven JSE, Sinclair KD. Polycystic Ovary Syndrome: A Brain Disorder Characterized by Eating Problems Originating during Puberty and Adolescence. Int J Mol Sci. 2020 Nov 3;21(21):8211. doi: 10.3390/ijms21218211. PMID: 33153014; PMCID: PMC7663730.
  5. Yang S, Yang C, Pei R, Li C, Li X, Huang X, Wu S, Liu D. Investigation on the association of occupational stress with risk of polycystic ovary syndrome and mediating effects of HOMA-IR. Gynecol Endocrinol. 2018 Nov;34(11):961-964. doi: 10.1080/09513590.2018.1460340. Epub 2018 Jul 25. PMID: 30044172.
  6. Light RS, Chilcot J, McBride E. Psychological Distress in Women Living with Polycystic Ovary Syndrome: The Role of Illness Perceptions. Womens Health Issues. 2021 Mar-Apr;31(2):177-184. doi: 10.1016/j.whi.2020.11.003. Epub 2020 Dec 8. PMID: 33303354.
  7. Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018 Nov;62(2):318-325. doi: 10.1007/s12020-018-1692-3. Epub 2018 Jul 31. PMID: 30066285.
  8. Asik M, Altinbas K, Eroglu M, Karaahmet E, Erbag G, Ertekin H, Sen H. Evaluation of affective temperament and anxiety-depression levels of patients with polycystic ovary syndrome. J Affect Disord. 2015 Oct 1;185:214-8. doi: 10.1016/j.jad.2015.06.043. Epub 2015 Jul 26. PMID: 26241866.
  9. Bazarganipour F, Taghavi SA, Montazeri A, Ahmadi F, Chaman R, Khosravi A. The impact of polycystic ovary syndrome on the health-related quality of life: A systematic review and meta-analysis. Iran J Reprod Med. 2015 Feb;13(2):61-70. PMID: 25999994; PMCID: PMC4426142.
  10. Jarczok MN, Jarczok M, Mauss D, Koenig J, Li J, Herr RM, Thayer JF. Autonomic nervous system activity and workplace stressors--a systematic review. Neurosci Biobehav Rev. 2013 Sep;37(8):1810-23. doi: 10.1016/j.neubiorev.2013.07.004. Epub 2013 Jul 24. PMID: 23891906.
  11. Ji HR, Woo HL, Park YJ, Hwang DS, Lee JM, Lee CH, Jang JB, Park KS. Characteristics of heart rate variability in women with polycystic ovary syndrome: A retrospective cross-sectional study. Medicine (Baltimore). 2018 Sep;97(38):e12510. doi: 10.1097/MD.0000000000012510. PMID: 30235765; PMCID: PMC6160158.
  12. Tiwari R, Bajpai M, Tiwari S, Agrawal S. Comparison of frequency domain parameters of heart rate variability between women with polycystic ovarian disease and apparently healthy women. J Family Med Prim Care. 2022 Jun;11(6):3245-3250. doi: 10.4103/jfmpc.jfmpc_2510_20. Epub 2022 Jun 30. PMID: 36119170; PMCID: PMC9480740.
  13. Lalanza JF, Lorente S, Bullich R, García C, Losilla JM, Capdevila L. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback. 2023 Sep;48(3):275-297. doi: 10.1007/s10484-023-09582-6. Epub 2023 Mar 14. PMID: 36917418; PMCID: PMC10412682.
  14. Jacobson E. Interview with Edmund Jacobson. Biofeedback Self Regul. 1978 Sep;3(3):287-300. doi: 10.1007/BF00999297. PMID: 728486.
  15. Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, Levitt NS, Crowther NJ, Nyirenda M, Njelekela M, Ramaiya K, Nyan O, Adewole OO, Anastos K, Azzoni L, Boom WH, Compostella C, Dave JA, Dawood H, Erikstrup C, Fourie CM, Friis H, Kruger A, Idoko JA, Longenecker CT, Mbondi S, Mukaya JE, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Zinyama R, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Young EH, Smeeth L, Motala AA, Kaleebu P, Sandhu MS; African Partnership for Chronic Disease Research (APCDR). Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol. 2013 Dec;42(6):1754-71. doi: 10.1093/ije/dyt198. Erratum in: Int J Epidemiol. 2016 Dec 1;45(6):2210-2211. PMID: 24415610; PMCID: PMC3887568.
  16. Russo MA, Santarelli DM, O'Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (Sheff). 2017 Dec;13(4):298-309. doi: 10.1183/20734735.009817. PMID: 29209423; PMCID: PMC5709795.
  17. Jiménez Morgan S, Molina Mora JA. Effect of Heart Rate Variability Biofeedback on Sport Performance, a Systematic Review. Appl Psychophysiol Biofeedback. 2017 Sep;42(3):235-245. doi: 10.1007/s10484-017-9364-2. PMID: 28573597.
  18. Wagner B, Steiner M, Huber DFX, Crevenna R. The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain : A systematic review. Wien Klin Wochenschr. 2022 Jan;134(Suppl 1):11-48. doi: 10.1007/s00508-021-01827-w. Epub 2021 Mar 22. PMID: 33751183; PMCID: PMC8825385.
  19. Bertolotti G, Zotti AM, Michielin P, Vidotto G, Sanavio E. A computerized approach to cognitive behavioural assessment: an introduction to CBA-2.0 primary scales. J Behav Ther Exp Psychiatry. 1990 Mar;21(1):21-7. doi: 10.1016/0005-7916(90)90045-m. PMID: 2197296.
  20. Hathaway SR, McKinley JC. MMPI-2 Minnesota Multiphasic Personality Inventory-2. Adattamento Italiano di P. Pancheri, S. Sirigatti, eds. Firenze: Organizzazioni Speciali. 1995.
  21. Cloninger CR. A systematic method for clinical description and classification of personality variants. A proposal. Arch Gen Psychiatry. 1987 Jun;44(6):573-88. doi: 10.1001/archpsyc.1987.01800180093014. PMID: 3579504.
  22. Cattell RB, Karen A, Cattell S, Cattell HE. 15PF-5 Manuale, adattamento italiano di Saulo Sirigatti e Cristina Stefanile. Firenze: Organizzazioni Speciali. 2001; ISBN: 88-09-40215-4.
  23. Fuller GD. Biofeedback methods and procedures in clinical practice. Biofeedback Press. 1979.
  24. Fava GA, Kellner R, Perini GI, Fava M, Michelacci L, Munari F, Evangelisti LP, Grandi S, Bernardi M, Mastrogiacomo I. Italian validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ). Can J Psychiatry. 1983 Mar;28(2):117-23. doi: 10.1177/070674378302800208. PMID: 6839279.
  25. McCraty R. Science of the heart, volume 2 exploring the role of the heart in human performance an overview of research conducted by the HeartMath Institute. Heart-Math Institute. 2016; ISBN 978-1-5136-0636-1.
  26. McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Health Med. 2015 Jan;4(1):46-61. doi: 10.7453/gahmj.2014.073. PMID: 25694852; PMCID: PMC4311559.
  27. Chrousos GP, Boschiero D. Clinical validation of a non-invasive electrodermal biofeedback device useful for reducing chronic perceived pain and systemic inflammation. Hormones (Athens). 2019 Jun;18(2):207-213. doi: 10.1007/s42000-019-00098-5. Epub 2019 Feb 25. PMID: 30805908; PMCID: PMC6690857.
  28. Reneau M. Heart Rate Variability Biofeedback to Treat Fibromyalgia: An Integrative Literature Review. Pain Manag Nurs. 2020 Jun;21(3):225-232. doi: 10.1016/j.pmn.2019.08.001. Epub 2019 Sep 26. PMID: 31501080.
  29. Windthorst P, Mazurak N, Kuske M, Hipp A, Giel KE, Enck P, Nieß A, Zipfel S, Teufel M. Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study. J Psychosom Res. 2017 Feb;93:6-13. doi: 10.1016/j.jpsychores.2016.11.014. Epub 2016 Dec 5. PMID: 28107894.
  30. Zucker TL, Samuelson KW, Muench F, Greenberg MA, Gevirtz RN. The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study. Appl Psychophysiol Biofeedback. 2009 Jun;34(2):135-43. doi: 10.1007/s10484-009-9085-2. Epub 2009 Apr 25. PMID: 19396540.
  31. De Witte NAJ, Buyck I, Van Daele T. Combining Biofeedback with Stress Management Interventions: A Systematic Review of Physiological and Psychological Effects. Appl Psychophysiol Biofeedback. 2019 Jun;44(2):71-82. doi: 10.1007/s10484-018-09427-7. PMID: 30604099.
  32. Schoenberg PL, David AS. Biofeedback for psychiatric disorders: a systematic review. Appl Psychophysiol Biofeedback. 2014 Jun;39(2):109-35. doi: 10.1007/s10484-014-9246-9. PMID: 24806535.
  33. Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014 Jul 21;5:756. doi: 10.3389/fpsyg.2014.00756. PMID: 25101026; PMCID: PMC4104929.
  34. Saito R, Sawamura D, Yoshida K, Sakai S. Relationship between the proficiency level and anxiety-reducing effect in a one-time heart rate variability biofeedback: A randomized controlled trial. Medicine (Baltimore). 2021 Nov 12;100(45):e27742. doi: 10.1097/MD.0000000000027742. PMID: 34766586.
  35. Schäfer SK, Ihmig FR, Lara H KA, Neurohr F, Kiefer S, Staginnus M, Lass-Hennemann J, Michael T. Effects of heart rate variability biofeedback during exposure to fear-provoking stimuli within spider-fearful individuals: study protocol for a randomized controlled trial. Trials. 2018 Mar 16;19(1):184. doi: 10.1186/s13063-018-2554-2. PMID: 29548298; PMCID: PMC5857097.
  36. Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med. 2016 Dec;39(6):935-946. doi: 10.1007/s10865-016-9782-2. Epub 2016 Aug 11. PMID: 27515801.
  37. Leventhal H, Leventhal EA, Contrada RJ. Self-regulation, health, and behavior: A perceptual-cognitive approach. Psychology & Health. 1998; (4):717–733.
  38. Hagger MS, Koch S, Chatzisarantis NLD, Orbell S. The common sense model of self-regulation: Meta-analysis and test of a process model. Psychol Bull. 2017 Nov;143(11):1117-1154. doi: 10.1037/bul0000118. Epub 2017 Aug 14. PMID: 28805401.
  39. Mani H, Chudasama Y, Hadjiconstantinou M, Bodicoat DH, Edwardson C, Levy MJ, Gray LJ, Barnett J, Daly H, Howlett TA, Khunti K, Davies MJ. Structured education programme for women with polycystic ovary syndrome: a randomised controlled trial. Endocr Connect. 2018 Jan;7(1):26-35. doi: 10.1530/EC-17-0274. Epub 2017 Nov 13. PMID: 29133383; PMCID: PMC5744630.
  40. Pruneti C, Guidotti S. Cognition, Behavior, Sexuality, and Autonomic Responses of Women with Hypothalamic Amenorrhea. Brain Sci. 2022 Oct 26;12(11):1448. doi: 10.3390/brainsci12111448. PMID: 36358374; PMCID: PMC9688049.
  41. He W, Chen M, Zu X, Li Y, Ning K, Qi L. Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic floor biofeedback treatment. BJU Int. 2010 Apr;105(7):975-7. doi: 10.1111/j.1464-410X.2009.08850.x. Epub 2009 Sep 14. PMID: 19751259.
  42. Zhu FF, Lin Z, Lin L, Wang MF. Changes in quality of life during biofeedback for people with puborectalis dyssynergia: generic and disease-specific measures. J Adv Nurs. 2011 Jun;67(6):1285-93. doi: 10.1111/j.1365-2648.2010.05593.x. Epub 2011 Feb 17. PMID: 21323980.
  43. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017 May 1;32(5):1075-1091. doi: 10.1093/humrep/dex044. PMID: 28333286.

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