Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment (Preprint)

BACKGROUND Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. OBJECTIVE This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. METHODS We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. RESULTS We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. CONCLUSIONS Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency.