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Research Library

Neurophysiological Approach by Self‑Control of Your Stress‑Related Autonomic Nervous System with Depression, Stress and Anxiety Patients

    • Published: 2021
    • Kees Blase1, Eric Vermetten2, Paul Lehrer3, and Richard Gevirtz4
    • Int. J. Environ. Res. Public Health 2021, 18, 3329. DOI: National Centre Stress Management, Innovational and Educational Centre HartFocus, Loosdrecht, The Netherlands.2. Department Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.3. Rutgers Medical School, Rutgers University, Monmouth Junction, NJ, USA.4. California School of Professional Psychology, Alliant International University, San Diego, CA, USA.
    • Download the complete paper, click here.



Heart Rate Variability Biofeedback (HRVB) is a treatment in which patients learn self-regulation of a physiological dysregulated vagal nerve function. While the therapeutic approach of HRVB is promising for a variety of disorders, it has not yet been regularly offered in a mental health treatment setting.


To provide a systematic review about the efficacy of HRV-Biofeedback in treatment of anxiety, depression, and stress related disorders.


Systematic review in PubMed and Web of Science in 2020 with terms HRV, biofeedback, Post- Traumatic Stress Disorder (PTSD), depression, panic disorder, and anxiety disorder. Selection, critical appraisal, and description of the Random Controlled Trials (RCT) studies. Combined with recent meta-analyses.


The search resulted in a total of 881 studies. After critical appraisal, nine RCTs have been selected as well as two other relevant studies. The RCTs with control groups treatment as usual, muscle relaxation training and a "placebo"-biofeedback instrument revealed significant clinical efficacy and better results compared with control conditions, mostly significant. In the depression studies average reduction at the Beck Depression Inventory (BDI) scale was 64% (HRVB plus Treatment as Usual (TAU) versus 25% (control group with TAU) and 30% reduction (HRVB) at the PSQ scale versus 7% (control group with TAU). In the PTSD studies average reduction at the BDI-scale was 53% (HRV plus TAU) versus 24% (control group with TAU) and 22% (HRVB) versus 10% (TAU) with the PTSD Checklist (PCL). In other systematic reviews significant effects have been shown for HRV-Biofeedback in treatment of asthma, coronary artery disease, sleeping disorders, postpartum depression and stress and anxiety. Conclusion: This systematic review shows significant improvement of the non-invasive HRVB training in stress related disorders like PTSD, depression, and panic disorder, in particular when combined with cognitive behavioral therapy or different TAU. Effects were visible after four weeks of training, but clinical practice in a longer daily self-treatment of eight weeks is more promising. More research to integrate HRVB in treatment of stress related disorders in psychiatry is warranted, as well as research focused on the neurophysiological mechanisms.