ABSTRACT Alcohol use disorder (AUD) and acute intoxication have a salient precipitous effect on intimate partner violence (IPV). Conversely, IPV negatively impacts AUD treatment and increases risk for relapse. Despite intense scientific inquiry regarding behavioral mechanisms underlying this link, there remains a critical unmet need to identify complex multimodal mechanisms and develop effective treatments to reduce alcohol-facilitated IPV. Mitigating maladaptive physiological reactivity in the form of respiratory sinus arrhythmia measure of heart rate variability (HRV) is one promising pathway to achieve this goal. HRV is an autonomic biomarker of sympathetic dominance and emotional over-arousal relevant to AUD pathophysiology. Our team’s promising laboratory research also suggests that HRV is an emerging mechanism underlying alcohol-facilitated IPV. However, a critical step to achieve clinical translation is to extend these findings to naturalistic settings. The primary objective of the proposed project is to use wearable technology to develop proof-of-concept of HRV as a biomarker of alcohol-facilitated IPV in vivo. Our secondary objective is to examine the preliminary usability, feasibility, and acceptability of a remote, self-administered HRV biofeedback (HRV-B) intervention. To accomplish this, we will utilize discreet, low cost wearable technology in an innovative 28-day micro-longitudinal design. Participants (N=50 couples, 100 total participants) will complete ecological momentary assessment (EMA; 4 times daily plus optional event-triggered reports) of alcohol use, couple conflict including IPV, and affect via smartphone. Both partners within each dyad will be assigned to the same assessment schedule, and we will use geolocation to further contextualize our primary outcomes. During days 21-28, participants will also receive once-daily prompts to complete 10 minutes of HRV-B in a non-randomized, open-label approach. This study will also leverage our team’s established remote participation procedures from ongoing AUD trials. Participants will have the option to complete the study remotely using electronic informed consent, mailing of study materials, and interviews, surveys, and direct observation of biologic sample data using HIPAA-compliant platforms. These findings will be used to refine and optimize our methodology, statistical power, and HRV-B dose and timing in preparation for a collaborative R01 application proposing a randomized controlled trial of the efficacy of HRV-B delivered remotely in a “just-in-time” fashion. The proposed study directly addresses the mission of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in that will identify real-time physiological and behavioral antecedents and sequelae of alcohol-facilitated IPV in naturalistic settings. Our findings will provide critical new information to advance the mechanistic science and accelerate clinical prevention and intervention efforts in the area of alcohol-related IPV, which is an urgent national health priority.

PROJECT NARRATIVE The primary objective of this study is to develop proof-of-concept of respiratory sinus arrhythmia measure of heart rate variability as a biomarker of alcohol-facilitated intimate partner violence (IPV) in naturalistic settings. We will accomplish this goal by employing a novel combination of ecological momentary assessment with physiological monitoring and geolocation using wearable technology. These critical methodological innovations will address an urgent public health priority, significantly advance the mechanistic science in this area, and take a critical translational step to reduce the prevalent, deleterious, and costly effects of alcohol-facilitated IPV.