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Articles & Research

HAT® Research: Completed and in-progress:

November 2017: For the past 2 years the research team at the University of Arizona has been laying the groundwork for highly sophisticated study of HAT and the HAT components. Several pilot studies have yielded exciting results pertaining to the influence of heart-breaths on heart and brain interactions! More information on the emerging data will be forthcoming.

December 2013: Study of the "Health Effects of Heart Assisted Therapy®-SR (HAT-SR)" is currently under way.  The research team of John H. Diepold, Jr., Ph.D. (Psychologist), Elisabeth A. Siegert, MD (Physician), and Maria E. Pfrommer, Ph.D., APN-C, RN, CNE (Nurse Practitioner, Nurse Educator) are evaluating the changes in physical and psychological health of residents in a Continuing Care Retirement Community after a six week pilot study using HAT-SR.  Heart Assisted Therapy®-SR is an abbreviated, three-step protocol for self-regulation (SR) for personal use by non-clinicians, which was derived from several components found in the HAT® model of psychotherapy. The participating residents are assigned randomly to either one of two treatment protocols and participate in pre and post treatment assessments.

September 2015: Data analysis has been completed.  

Diepold, J. H., Jr., Pfrommer, M., Siegert, E., & Thompson, J. A. (2015). The health effects of Heart Assisted Therapy-SR. Unpublished manuscript.

In a 6-week pilot study of HAT-SR conducted at the Evergreens Continuing Care Retirement Community, randomized geriatric subjects (n=19) were assigned to an intervention or control group and administered pre and post surveys. The Cognitive and Affective Mindfulness Scale–Revised (CAMS-R) (Feldman et al, 2007) was used to measure four aspects of trait mindfulness, including attention, awareness, acceptance, and present-focus. Separate paired t-tests were conducted to compare CAMS-R scores pre- and post-intervention for the placebo and intervention groups. Results revealed a statistically significant increase from pre- (M = 36.75 ± 6.90) to post-intervention (M=38.76 ± 6.59) in CAMS scores for the intervention group, t (N=7) = -2.43, p < .05, but not for the control group, t (N=6) = .47, p = .65. 


After conducting the above referenced pilot study, the authors gained additional knowledge on the benefits of HAT-SR and were inspired to move forward with teaching caregivers of patients with dementia about stress reduction and the HAT-SR mindfulness enhancing technique.  The primary aim of this project was to teach HAT-SR to long-term care staff in a continuing care retirement community (CCRC) and evaluate the effectiveness of HAT-SR as an intervention to benefit staff and improve care for patients with dementia. The authors’ secondary aim was to assess baseline knowledge related to mindfulness and caregiver challenges and to evaluate the effectiveness of the HAT-SR teaching session at increasing the participant’s awareness of these two aspects of dementia care. 

Pfrommer, M., McConnell, E.S., Diepold, Jr. J. H., Siegert, E.A., & Thompson, J.A. (2015).  Heart Assisted Therapy-Self-Regulation (HAT-SR) for caregivers of persons with dementia. Manuscript in review for publication.

Results: Mean scores were slightly improved (M=39.00 pre to  M=39.73 post) after practicing HAT-SR for just one week, however, these results were not statistically significant. The End of Educational Activity survey revealed 100% of participants increased their knowledge base regarding mindfulness, 86% reported the educational activity was helpful in identifying the challenges faced by caregivers of patients with cognitive impairments, and over 85% of participants responded favorably to using HAT-SR as a tool to promote calm and relaxation and to improve their practice. 

(Now for the exciting subjective data!):

Thirty-four participants were taught HAT-SR and asked to practice HAT-SR for one week.  Of the 34 participants, 16 chose to practice HAT-SR and returned survey tools. All participants were eligible to receive 1 CEU after the educational session and then received an additional CEU for turning in their post surveys.  Of the 34 participants, 13 agreed to practice HAT-SR for one week and completed the post-CAMS–R and the End of Educational Activity Evaluation. Of the 34 participants there were 32 females and 2 males. Occupations represented included Registered Nursing (20%), Licensed Practical Nurses (9%), Certified Nursing Assistance (32%), Physicians (6%), Physical Therapist (6%), Administration (6%), Advanced Practice Nurse (3%), Coordinator, (3%) Activities Director (3%), and Housekeeper (3%)

Primary outcome

Qualitative analysis of the End of Educational Survey revealed a majority of positive response to all questions on the survey. Table 1 depicts the questions and common responses to the questions in the survey.

Question                            Number (N)                             Percentage (%)   Comments (or n/a)                                                                                      

1. This continuing education activity increased my knowledge base about HAT-SR and mindfulness enhancing techniques.       15         100% strongly agree/agree           n/a

2. This continuing education activity was helpful in identifying the challenges faced by caregivers of patients with cognitive impairments   15    86.67% strongly agreed/agreed   13.33% undecided          n/a

3. I am confident I will be able to perform the HAT-SR technique        15         85.7% strongly agreed/agreed      14.29% undecided         n/a

4. HAT-SR would be useful for caregivers to family members with cognitive impairments?          15         93.0 % strongly agreed/agreed     7% undecided        n/a

5.  What did you like best about this continuing education activity?    15         Open-ended:       “Breathing; it relaxed me; it is easy; learning a new technique to help myself and residents; the calm feeling you experience right after the exhale; ease of performance with immediate effect; self help; taking myself into a peaceful state; the relaxing quality; I like the acceptance statement in the activity; It made me feel better afterwards and made me real proud of who I really am; my head feels clear afterwards; quick and easy to learn; learning a skill that can be used in practice; and It helps people”.

6. What did you like least about this continuing education activity?       8        Open-ended:       “The phrase; remembering to do it (n=2); rushed education; nothing (n=2); the last set of heart breaths; Relaxing; and felt I should do it more”.

7. Would you recommend this continuing education activity to other healthcare professionals?”    14         86% strongly agreed/agreed  7.1% undecided  7.1% no     n/a

8. Do you have any prior knowledge of mindfulness practices? If so, can you please elaborate?      14         36% yes    64% no     Yoga (n=3), meditation, learned during labor training, 4-7 breathes technique, I have an interest in positive psychology, read an article

9. Do you think the HAT-SR exercise is something that enhanced your practice? If so, can you please elaborate?     11         73% yes   27% no           “Yes, I can do HAT in a shorter time frame; yes, because I think everyone needs an exercise such as mindfulness practice in our everyday lives as acceptance and mindful to others and especially to the residents; yes, thinking clearly increases caregiver acceptance of where the patient is right now in their disease process and; yes, taught my mom and to a patient.

10. Do you think the HAT-SR exercise is something that enhanced your compassion for your patients? If so, can you please elaborate?”   13   69% yes  31% no            “It let's me have more patience; I am more relaxed so I can see past my stress and empathize; no, I am always compassionate; help calm them down; I am always compassionate; keeping me calm and remembering to breath really helps; absolutely more compassionate and especially with combative/ resistive and verbal abusive residents and; the exercise helps diffuse my frustrations towards different patients”.

11. Do you think the HAT-SR exercise is something that has enhanced your ability to have more patience? If so, can you please elaborate?      13         77% yes   23% no           “Not really, already overly patient (n=2) HAT-SR relies me and makes me more aware of my feelings; make me think before I react; HAT-SR reminded me that it is okay as an employee to take a few moments to myself if needed; not really; in accepting them (residents) for who they are and more than happy to help them and leave a smile on their face every single day; more aware, we all have burdens; calmness and; yes, more aware, we all have burdens”

12. Do you think the HAT-SR exercise is something that has enhanced your ability to be more attentive to your patients? If so, can you please elaborate?          13         67% yes  25% no    8% maybe  “Yes, because I'm relaxed I am more aware; yes, in understanding them and be at their present moment and help to relate to how they feel; yes, gives me patience; it increased awareness of the stressors on caregivers and; no, I have always been hyper aware of others feelings”.

13.  What was the one most important thing you learned about yourself from practicing the HAT-SR technique?     13         Open-ended:       “Slow breathing to calm self; that I can control my emotions with this technique, less stress; calming my mind; I can control my thoughts, emotions, and feelings; facilitates relaxation when tense or tired; helps with stress; that I actually have patience somewhere inside of me; accepting my staff (more so even than myself and the residents); breathing is important; thinking clearly; I need to be able to calm myself; I need to make more time to take care of myself and;  I need to do it to be calm”

14. Do you plan to continue using this self-care exercise?        14         71% yes   7% no   7% undecided    7 % “ I will try”               n/a