(PS10-53) Changes in Heart Rate Variability During Neurostimulation as a Predictive Biomarker of Emotional Dysregulation and General Psychopathology

Recent findings show that active neurostimulation, such as repetitive transcranial magnetic stimulation (rTMS), can influence heart rate variability (HRV) to enhance prefrontal regulatory functions. However, the extent to which these changes influence treatment outcomes in transdiagnostic samples remains underexplored, and findings on the role of baseline HRV in neurostimulation outcomes are inconsistent. To address this gap, we combined data from three studies (two completed and one ongoing) to investigate how HRV at baseline and during active neurostimulation predicts changes in emotional dysregulation and psychopathology in transdiagnostic clinical adults.

In a sample of 96 participants, we compared active (n = 60) and sham (n = 30) neurostimulation.  HRV was continuously monitored during a 2-minute baseline and a 10-minute session of left or right 10HZ rTMS (120% MT). Previous studies have demonstrated that right and left rTMS have equivalent effects on HRV during stimulation. We assessed difficulties with emotion regulation and general psychopathology at baseline, 1-week, and 1-month after a one-time neurostimulation intervention.

Mixed model analyses of variance showed that a higher increase in HRV from baseline during active stimulation [F(1,106.98) =4.65, p= .033] predicted lower psychopathology at follow-up whereas sham stimulation had no significant effect [F(1,62.69) =0.37, p=.54]. Moreover, higher HRV change in both active [F(1,108.88)= 10.116, p= .002] and sham [F(1,62.99)= 4.59, p= .036] conditions predicted lower emotional dysregulation at follow-up. Baseline HRV did not significantly predict either outcome (ps > .12).

These findings suggest that HRV during neurostimulation could serve as a valuable biomarker for predicting treatment success, with greater HRV increases correlating to significant predictions in psychopathology and emotional dysregulation. Future research should explore whether real-time monitoring of changes in inter-beat intervals may provide a cost-effective way to personalize stimulation protocols and optimize therapeutic outcomes. Leveraging HRV as a biomarker represents a critical advancement in precision medicine for the treatment of emotional disorders, offering a scalable method to tailor interventions to individual patient physiology.