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Research Library

Reducing Anxiety and Social Stress in Primary Education: A Breath‑Focused Heart Rate Variability Biofeedback Intervention

    • Published: 2022
    • Ainara Aranberri-Ruiz1, Aitor Aritzeta1, Amaiur Olarza1, Goretti Soroa2, and Rosa Mindeguia1
    • Int. J. Environ. Res. Public Health 2022, 19, 10181. DOI: Department of Basic Psychological Process and Development, University of the Basque Country, Gipuzkoa, Spain.2. Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country, Gipuzkoa, Spain.
    • Download the complete paper, click here.


Primary school students suffer from high levels of anxiety and stress. Having emotional regulation abilities can help them to manage challenging emotional situations. Conscious and slow breathing is a physiological, emotional regulation strategy that is feasible for primary school students to learn. Following Polyvagal Theory and PMER Theory, this research presents the results of a breathfocused heart rate variability biofeedback intervention. The intervention aimed to reduce anxiety and physiological and social stress in primary school children. A total of 585 students (46.4% girls and 53.6% boys) from the same public school, aged between 7 and 12 years (M = 8.51; SD = 1.26), participated in this study. To assess the impact of training, a mixed design was used with two groups (Treatment and Control groups), two evaluation phases (Pretest and Post-test), and three educational cycles (first, second and third cycles). To examine heart rate variability, emWave software was used and anxiety and social stress were measured by the BASC II test. The results showed that after the intervention, the students learned to breathe consciously. Moreover, they reduced their levels of anxiety (M(SD)pretest = 12.81(2.22) vs. M(SD)posttest = 13.70(1.98)) and stress (M(SD)pretest = 12.20(1.68) vs. M(SD)posttest = 12.90(1.44)). The work also discusses the limitations and benefits of this type of intervention in primary schools.