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Research Library

Heart Rate Variability Biofeedback and Executive Functioning in Individuals with Chronic Traumatic Brain Injury

    • Published: 2011 IND
    • Sonya Kim, Ph.D.
    • Dissertation Ferkauf Graduate School of Psychology, Albert Einstein School of Medicine, Yeshiva University, June 2011.
    • Download the complete paper, click here.


This study sought to determine if individuals with neurological damage can be trained to regulate their emotions through psychophysiological processes and thereby can learn to improve executive functioning and enhance clear thinking. Participants were drawn from AHRC, a community-based structured day program in New York City that provides long-term rehabilitation services for individuals with severe brain injuries who are past the post-acute phase of rehabilitation. Contrary to commonly held beliefs that further rehabilitation or recovery is impossible for such a population, one key premise of this study is that given appropriate training, people with chronic brain injury can continue to make substantial improvements in their functioning. This study used a non-randomized experimental design with repeated measures at 3-time-points. The primary training tool was HeartMath Institute’s heart rate variability (HRV) PC—emWave. This study provides one of the first empirical demonstrations of psychophysiological self-regulation training applied to individuals with severe brain injuries who were on the average 24 years post-injury. Because this study provides empirical evidence that the brain and emotions are connected in the body – as opposed to operating in the separate domains created by the traditional mind/body divide – it also presents the possibility that this connection could be used to train individuals with brain injury to better self-regulate their behavior and thereby control disinhibition and impulsivity. Evidence is also presented that even individuals who sustained severe brain injuries and are long past the post-acute phase of rehabilitation can learn new techniques, respond to biofeedback, and greatly increase coherence in heart rate variability. The results show that the participants made dramatic improvements in the heart rate variability indices, even though neither functional improvements nor improvements in neuropsychological testing were observed. However, the results of this experiment show that HRV may hold promise as being an effective neuropsychological tool that can offer guidance on how to assess and treat behavior.