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Research Library

Cognitive Behavioral Therapy with Heart Rate Variability Biofeedback for Adults with Persistent Noncombat‑Related Posttraumatic Stress Disorder

    • Published: 2018
    • Shawn R. Criswell, M.A., Ph.D., L.P.C.1, Richard Sherman, M.S., Ph.D.2, and Stanley Krippner, M.S., Ph.D.3
    • The Permanente Journal, 2018; 22:17-207. DOI: 10.7812/TPP/17-207.1. Mental Health Therapist, Department of Mental Health, Kaiser Permanente Northwest, Portland, OR. 2. Chair of the Department of Psychophysiology, Saybrook University, Oakland, CA; Director of Behavioral Medicine Research and Training Foundation, Port Angeles, WA. 3. Instructor of Psychology, College of Social Sciences; Department of Humanistic and Clinical Psychology, Saybrook University, Oakland, CA.
    • Download the complete paper, click here.



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.


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.


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).


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.