Combining Motivational Interviewing with HRV Biofeedback: A Feasibility Study

Background/Hypotheses Heart rate variability biofeedback (HRVB) improves HRV. Clinicians generally assume that home practice plays a significant role in HRVB, but little is known about the relationship between home practice and HRV outcomes. Motivational Interviewing (MI) is an approach that increases intrinsic motivation for health behaviors. We assessed whether brief, targeted training could help undergraduate research assistants reach moderate MI fidelity. We also hypothesized that improved MI fidelity would be associated with increased home practice, and increased practice would lead to increased baseline HRV. These latter hypotheses were exploratory due to the lack of a control group. Methods Forty-nine college students (51% female) completed five HRVB sessions with trained research assistants. Research assistants used MI techniques at the start and end of each session to support home practice. We assessed MI fidelity using the Motivational Interviewing Skill Code (MISC). Practice data came from the Inner Balance ^TM app; HRV was recorded via a 3-lead ECG. Results Research assistants achieved moderate MI fidelity (1.06 reflections/questions, 70% open questions, 98% MI consistent responses, 65% client change talk, MI spirit 5.15/7) after training with deliberate practice. Mixed models demonstrated no relationship between research assistants’ MI fidelity and client home practice, except that MI spirit was slightly associated with reduced practice. We did not find any associations between practice time or quality and changes in baseline HRV. Conclusions It is feasible to train undergraduate students to administer MI in conjunction with HRVB. Extrinsic motivators like class credit may have reduced the effect of MI on home practice. An upcoming randomized controlled study will examine MI’s effects on HRVB practice and additional outcome measures in a community sample.