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Research Library

Relationship Between the Proficiency Level and Anxiety‑Reducing Effect in a One‑Time Heart Rate Variability Biofeedback – A Randomized Controlled Trial

    • Published: 2021
    • Ryuji Saito, M.S.1, Daisuke Sawamura, Ph.D.2, Kazuki Yoshida, Ph.D.2, and Shinya Sakai, Ph.D.2
    • Medicine 2021; 100:45.1. Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.2. Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
    • Download the complete paper, click here.



Previous studies have reported that the proficiency level of heart rate variability biofeedback (HRVBF) contributes significantly to the anxiety-reducing effects in continuous HRVBF interventions. Meanwhile, anxiety-reducing effects have been confirmed in one-time HRVBF interventions as well as continuous HRVBF; however, no study has analyzed the relationship between the proficiency level of a one-time HRVBF and its anxiety-reducing effects. To pursuit the effectiveness of a one-time HRVBF intervention, it is necessary to clarify whether the proficiency level is an important predictor of anxiety-reducing effects from a doseresponse relationship between these 2 variables. The purpose of this study was to examine the dose-response relationship between the proficiency level and anxiety-reducing effects of a one-time HRVBF.


This study was a single-blinded, randomized, controlled trial with stratification based on trait anxiety of the State-Trait Anxiety Inventory-JYZ. In total, 45 healthy young males aged 20 to 30years were allocated to the HRVBF or control group with simple breathing at rest. The intervention was performed for 15 minute in each group. The state anxiety score of the State-Trait Anxiety Inventory-JYZ was measured to evaluate the anxiety-reducing effect before and after training.


The results showed no significant linear relationship between the proficiency level and anxiety-reducing effect, and variations in the proficiency level were observed post-intervention in the HRVBF group. A significant anxiety-reducing effect was only observed in the HRVBF group (P=.001, effect size r=0.62).


These results suggest that there is no close relationship between the proficiency level and anxiety-reducing effect in one-time HRVBF and that HRVBF is effective in reducing anxiety regardless of individual differences in the proficiency level. Therefore, a one-time HRVBF may be a useful breathing technique for reducing state anxiety without specific education and breathing techniques.