Breathe and Let Be : Improving Posttraumatic Stress and Neurobiological Dysregulation with Game-Based Meditation Therapy among Traumatized Adolescents in Residential Care

The aim of the current dissertation is three-fold. First, we aimed to provide insight with regard to the alterations of traumatized youths’ neurobiological stress systems (PART I). We investigated sympathetic, parasympathetic, and HPA axis parameters among traumatized adolescents in residential care and a nontraumatized comparison sample. Both basal activity during rest and reactivity to acute social stress were evaluated. The outcomes of this study are described in Chapter 2.

The second aim of this thesis was to address methodological issues in neurobiological research in two ways: (1) by evaluating the validity of a wearable wristband to assess autonomic nervous system parameters, and (2) by making use of a new method to assess long-term cortisol exposure that has been validated, but not previously used in a clinical population of traumatized adolescents in residential care. We aimed to evaluate the accuracy and predictive value of a wearable wristband to measure heart rate variability parameters in traumatized adolescents. While devices such as the VU-AMS are a valid way to monitor physiology, sensor application to the chest and back can be invasive for vulnerable, clinical populations. Simpler and less invasive monitoring systems, such as wearable wristbands, yield high expectations but are not extensively validated. Chapter 3 describes a comparison of the Empatica E4 wristband and the VU-AMS as a gold standard reference. Two studies in this dissertation included outcomes on hair cortisol in traumatized adolescents. In these studies, we assessed hair cortisol levels as a measure of long-term cortisol exposure. The outcomes on hair cortisol are included in Chapter 2 and Chapter 7.

Our third and final aim was to rigorously test game-based meditation therapy as an intervention for traumatized youths in residential care. We started by conducting a feasibility study that evaluated three game-based meditations interventions that incorporated either bio- or neurofeedback. We assessed the potential of these interventions to teach youths how to successfully regulate their physiological stress, user satisfaction, as well as the interventions’ preliminary effects on posttraumatic symptoms, stress, anxiety, and aggression. Chapter 4 presents the results of this study. The intervention that was positively evaluated in all outcomes was Muse. The feasibility study extended to an RCT on the effectiveness of Muse compared with treatment as usual (TAU). Chapter 6 describes the main outcomes of this RCT, including effects on posttraumatic symptoms and stress (primary outcomes), as well as on anxiety, depression, and aggression (secondary outcomes). As a next step, we investigated the potential of Muse to normalize alterations of neurobiological stress systems after trauma. Outcome effects on SNS, PNS, and HPA axis parameters that were measured during rest and while performing a social stress task (all secondary outcomes) are described in Chapter 7.

Lastly, Chapter 8 presents a summary and general discussion of the main findings of these studies. Following these discussions, limitations, clinical implications, and directions for future research on trauma and neurobiology, wearable recording devices, and game-based meditation interventions are examined.