Research Supporting Biofeedback
Biofeedback Research supports a wide array of conditions.
Click the “+” to view the abstracts/summaries for each article.
Biofeedback for
Anxiety & Stress
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Introduction: Vagally mediated heart rate variability is an index of autonomic nervous system activity that is associated with a large variety of outcome variables including psychopathology and self-regulation. While practicing heart rate variability biofeedback over several weeks has been reliably associated with a number of positive outcomes, its acute effects are not well known. As the strongest association with vagally mediated heart rate variability has been found particularly within the attention-related subdomain of self-regulation, we investigated the acute effect of heart rate variability biofeedback on attentional control using the revised Attention Network Test.
Discussion: The results point to acute beneficial effects of heart rate variability biofeedback on cognitive performance in highly stressed individuals. Although promising, the results need to be replicated in larger or more targeted samples in order to reach stronger conclusions about the effects.
DOI 10.3389/fpsyg.2023.1292983
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Objective: Some evidence suggests that heart rate variability (HRV) biofeedback might be an effective way to treat anxiety and stress symptoms. To examine the effect of HRV biofeedback on symptoms of anxiety and stress, we conducted a meta-analysis of studies extracted from PubMed, PsycINFO, and the Cochrane Library.
Methods: The search identified 24 studies totaling 484 participants who received HRV biofeedback training for stress and anxiety. We conducted a random-effects meta-analysis.
Results: The pre-post within-group effect size (Hedges’ g) was 0.81. The between-groups analysis comparing biofeedback to a control condition yielded Hedges’ g = 0.83. Moderator analyses revealed that treatment efficacy was not moderated by study year, risk of study bias, percentage of females, number of sessions, or presence of an anxiety disorder.
Conclusions: HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety. Although more well-controlled studies are needed, this intervention offers a promising approach for treating stress and anxiety with wearable devices.
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Abstract
Previous research studies have indicated that biofeedback treatment and relaxation techniques are effective in reducing psychological and physical symptoms (Hammond, 2005; Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E., 2008). However, dearth of studies has compared heart rate variability (HRV) biofeedback treatment and relaxation training to reduce trait anxiety. The objective of this study was to determine the effect of HRV biofeedback treatment and relaxation training in reducing trait anxiety compared to control group without any treatment using students in a science and engineering university of South Korea. For the present study, a total of 15 graduate students with moderate level of trait anxiety were recruited for 4 individual sessions every two weeks. They were randomly assigned into three groups: biofeedback treatment (n = 5), relaxation training (n = 5), and no treatment control group (n = 5). Our results revealed significant difference in change score of trait anxiety between the HRV biofeedback treatment and the no treatment control group. However, no significant difference was found between the relaxation training group and the no treatment control group. In addition, there was no significant difference between the HRV biofeedback treatment and the relaxation training. Results of the present study indicate that there is potential benefit in utilizing HRV biofeedback treatment for stress management programs and/or anxiety reduction treatment
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Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies.
Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analyzed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI = − 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity.
Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being.
Biofeedback &
Sleep Improvement
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Abstract The present study was designed to examine the effect of heart rate variability (HRV) biofeedback on the cardiorespiratory resting function during sleep in daily life. Forty-five healthy young adults were randomly assigned to one of three groups: HRV biofeedback, Autogenic Training (AT), and no-treatment control. Participants in the HRV biofeedback were instructed to use a handheld HRV biofeedback device before their habitual bedtime, those in the AT were asked to listen to an audiotaped instruction before bedtime, and those in the control were asked to engage in their habitual activity before bedtime. Pulse wave signal during sleep at their own residences was measured continuously with a wristwatch-type transdermal photoelectric sensor for three time points. Baseline data were collected on the first night of measurements, followed by two successive nights for HRV biofeedback, AT, or control. Cardiorespiratory resting function was assessed quantitatively as the amplitude of highfrequency
(HF) component of pulse rate variability, a surrogate measure of respiratory sinus arrhythmia. HF component increased during sleep in the HRV biofeedback group, although it remained unchanged in the ATand control groups. These results suggest thatHRVbiofeedback before sleep may improve cardiorespiratory resting function during sleep.
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Background: Patients with coronary heart disease (CHD) who experience depressed mood or psychological stress exhibit decreased vagal control of heart rate (HR), as assessed by spectral analysis of HR variability (HRV). Myocardial infarction and sudden cardiac death are independently associated with depression and stress, as well as impaired vagal HR control. This study examined whether a behavioral neurocardiac intervention to reduce stress or depression can augment cardiovagal modulation in CHD patients. We hypothesized that (1) cognitive-behavioral training with HRV biofeedback would augment vagal recovery from acute stress, and (2) vagal regulation of HR would be inversely associated with stress and depression after treatment.
Method: This randomized controlled trial enrolled 46 CHD patients from 3 clinics of CHD risk reduction in Toronto and Vancouver, Canada. Subjects were randomized to five 1.5-hoursessions of HRV biofeedback or an active control condition. Outcome was assessed by absolute and normalized high-frequency spectral components (0.15-0.50 Hz) of HRV, and by the Perceived Stress Scale and Centre for Epidemiologic Studies in Depression scale.
Results: Both groups reduced symptoms on the Perceived Stress Scale (P = .001) and Centre for Epidemiologic Studies in Depression scale (P = .004). Hierarchical linear regression determined that improved psychological adjustment was significantly associated with the high-frequency index of vagal HR modulation only in the HRV biofeedback group. Adjusted R was as follows: HRV biofeedback group, 0.86 for stress (P = .02) and 0.81 for depression (P= .03); versus the active control group, 0.04 (P = .57) and 0.13 (P = .95), respectively.
Conclusion: A novel behavioral neurocardiac intervention, HRV biofeedback, can augment vagal HR regulation while facilitating psychological adjustment to CHD.
Biofeedback Improves
Emotional & Physical Performance
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Abstract
We performed a systematic and meta analytic review of heart rate variability biofeedback (HRVB) for various symptoms and human functioning. We analyzed all problems addressed by HRVB and all outcome measures in all studies, whether or not relevant to the studied population, among randomly controlled studies. Targets included various biological and psychological problems and issues with athletic, cognitive, and artistic performance. Our initial review yielded 1868 papers, from which 58 met inclusion criteria. A significant small to moderate effect size was found favoring HRVB, which does not differ from that of other effective treatments. With a small number of studies for each, HRVB has the largest effect sizes for anxiety, depression, anger and athletic/artistic performance and the smallest effect sizes on PTSD, sleep and quality of life.
We found no significant differences for number of treatment sessions or weeks between pretest and post-test, whether the outcome measure was targeted to the population, or year of publication. Effect sizes are larger in comparison to inactive than active control conditions although significant for both. HRVB improves symptoms and functioning in many areas, both in the normal and pathological ranges. It appears useful as a complementary treatment. Further research is needed to confirm its efficacy for particular applications.
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In recent years there has been substantial support for heart rate variability biofeedback (HRVB) as a treatment for a variety of disorders and for performance enhancement (Gevirtz,2013). Since conditions as widely varied as asthma and depression seem to respond to this form of cardiorespiratory feedback training, the issue of possible mechanisms becomes more salient. The most supported possible mechanism is the strengthening of homeostasis in the baroreceptor (Vaschilloetal.,2002;Lehreretal.,2003). Recently, the effect on the vagal afferent pathway to the frontal cortical areas has been proposed. In this article, we review these and other possible mechanisms that might explain the positive effects of HRVB.
doi: 10.3389/fpsyg.2014.00756
Biofeedback for
Post Traumatic Stress Disorder (PTSD)
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ABSTRACT
Objective: To test the effectiveness of a mental health therapy designed to reduce noncombat-related persistent posttraumatic stress disorder (PTSD) symptoms in 30 adult outpatients with a diagnosis of PTSD. The individual treatment offered modules to address PTSD nightmare distress, dissociation, general core skills, alterations in arousal and reactivity, avoidance, intrusion, and negative alternations in cognitions and mood. The therapeutic approach centered on cognitive behavioral therapy and heart rate variability biofeedback.
Methods: The study had 2 components: The quality improvement project that performed the treatment within a standard care environment, and a retrospective medical chart review process that analyzed the results. The Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual, Fifth Edition, was used to confirm the initial PTSD diagnosis and was the primary measure used to monitor change in the diagnosis following treatment.
Results: None of the patients who completed the PTSD treatment met criteria for a PTSD diagnosis in the posttreatment assessment. A 1-sample test of proportions, with a 95% confidence interval and a significance level of p < 0.05, showed p = 0.0008, and that the proportion of patients who would not have PTSD if the study was repeated would be 86.77% to 100.00%. The treatment dropout rate was 13% (4 patients).
Conclusion: The study findings suggest that this intervention is an effective treatment for helping adult patients, including those with a history of childhood abuse, remit their PTSD diagnosis.
Biofeedback for Depression
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Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB + psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD.
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Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive
symptoms, a common mental health issue, which is often comorbid with other psychopathological
and medical conditions. The aim of the present meta-analysis is to test whether and to what extent
HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search
on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies.
Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed
to further test whether publication year, the questionnaire used to assess depressive symptoms, or
the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analyzed 14 RCTs
with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38
[95% CI = 0.16, 0.60; 95% PI = − 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant,
QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The
year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65,
p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall,
results showed that HRVB improves depressive symptoms in several psychophysiological conditions in
adult samples and should be considered as a valid technique to increase psychological well-being.