EFFECTS OF GRATITUDE JOURNALING ON HEART RATE VARIABILITY AND INFLAMMATORY BIOMARKERS IN ASYMPTOMATIC HEART FAILURE PATIENTS

Introduction   Conclusions  

Results  

•  The field of Behavioral Cardiology is moving from mainly focusing on the impact of negative psychological factors such as anger, stress, and depression on cardiac health to investigating effects of positive psychological attributes such as gratitude, empathy and optimism.

•  Gratitude interventions are considered potentially useful for improving mental health and self-reported physical health, although the evidence base is lacking.

•  We examined whether a gratitude intervention could improve biomarkers of inflammation and autonomic control linked with CVD prognosis in patients with asymptomatic Stage B heart failure (HF).

Paul J. Mills PhD, Kathleen Wilson MS, Meredith A. Pung PhD, Kelly Chinh BS, Brook Henry PhD, J. Christopher Wells BS, Alex Wood PhD, Shamini Jain PhD, Barry Greenberg MD, Alan Maisel MD, Ottar Lunde MD,

Deepak Chopra MD, Laura Redwine, PhD Departments of Family Medicine & Public Health, Psychiatry, and Medicine, UC San Diego, La Jolla, CA

Department of Behavioral Science, University of Stirling, Stirling Scotland

Design  &  Patients  

•  Participants included 40 American College of Cardiology / American Heart Association Stage B asymptomatic HF (age 66.5 years ±10).

•  Patients were randomly assigned to an 8-week gratitude journaling plus usual care, or usual care alone.

•  Patients completed the Gratitude Questionnaire Six-Item Form (GQ-6) at pre- and post-intervention.

•  Heart rate variability (HRV) was assessed (Equivital) at pre-intervention and again after the 8‐week intervention. After the post-intervention period, both groups were asked to write about 3-5 things they were grateful for while HRV was assessed.

•  Circulating levels of inflammatory biomarkers IL-6 and sTNFR1 were assessed (ELISA) at rest at pre-intervention and after the 8-week intervention.

•  There was a group by time quadratic effect, with trait gratitude increased in the journaling group at mid intervention (p<.05) (FIGURE 1).

•  Reductions in plasma IL-6 and sTNFr1 were found in the gratitude intervention group compared to controls, with medium to large effect size differences (p < .05, d = 1.10;

p ≤ .05, d = 0.60, respectively) (FIGURE 2 shows IL-6).

•  For HRV (time, frequency and non‐linear domains), after adjusting for baseline resting HRV, group by time interactions and medium Cohen’s d effect size differences were found in response to the journaling task for RMSSD, HF, and SD1 (p = .005, d = .49; p = .038, d = .51; p = .005; d =0.47 respectively) (FIGURE 3 shows RMSDD).

•  Findings suggest that for Stage B HF patients there may be clinical benefits of gratitude journaling by improving autonomic control (suggested to reflect better cardiac function) and reducing inflammation.

•  Gratitude journaling is a low cost, easily implementable intervention that may have significant impact on enhancing physiological health and attenuating the progression of CVD. However, clinical implications for morbidity and mortality still need to be determined.

•  Efforts to increase gratitude in HF patients’ lives may be a treatment target for improving wellbeing and be of potential clinical value.

Assessments  

Fig 1. Gratitude Scores

Fig 2. IL-6

Fig 3. HRV