What the Research Actually Says About Heart Rate Variability Biofeedback

Heart Rate Variability (HRV) biofeedback is becoming an increasingly popular tool in both clinical and community settings. With the rise of wearable smart devices, access to this technology is greater than ever. But what does the science actually say about its efficacy?

In my recent analysis of the literature, I reviewed four key peer-reviewed studies to understand how HRV biofeedback impacts mental and physical health. The consensus is clear: this tool plays a crucial role in emotion regulation and stress reduction. However, looking closer at how these studies are conducted reveals a significant gap in our understanding.

Who Benefits from HRV Biofeedback?

The research shows that HRV biofeedback is incredibly versatile. It isn't just for one type of patient; it supports emotional and physiological self-regulation across diverse populations. Here are three distinct groups that have shown significant improvement:

• Healthcare Workers: A randomized controlled trial by Lee et al. (2024) focused on healthcare workers experiencing high stress during the COVID-19 pandemic. The results were powerful: participants showed significant decreases in anxiety, depression, and PTSD symptoms. Physiologically, they improved their "HRV coherence," which is a key indicator of autonomic nervous system regulation.

• Veterans: Schuman and Killian (2019) conducted a pilot study with veterans suffering from PTSD. Using a single biofeedback session paired with a smartphone app for home practice, veterans reported decreased hyperarousal and emotional numbing. This highlights the practical value of the intervention it is something clients can take home with them.

• Athletes: On the performance side, Kim et al. (2024) studied athletes dealing with severe competition anxiety. When combined with cognitive restructuring, HRV biofeedback helped athletes reduce physical anxiety symptoms and gain greater control over their emotional responses.

The Clash of Paradigms: "One Truth" vs. "Lived Experience"

One of the most interesting aspects of this research is the philosophical divide in how we study it.

Most of the research on HRV biofeedback is quantitative. This makes sense because HRV is inherently numerical, it measures the variations between heartbeats. These studies align with a "Positivist" tradition, which assumes there is a single, objective reality that we can measure (DePoy & Gitlin, 2016). We like this approach because it provides exact evidence that we can generalize to large populations.

However, there is another side to the story.

A study by Field et al. (2022) took a qualitative approach, researching the lived experiences of individuals with gastrointestinal disorders using HRV biofeedback. Rather than just looking at heart rates, they looked at how it felt to use the intervention. Participants reported feeling "enhanced self-awareness" and "empowerment," describing a deeper mind-body-spirit connection.

This aligns with a "Constructivist" paradigm, which argues that individuals create their own subjective realities. It suggests that the "truth" of the intervention isn't just in the numbers, but in the meaning the patient assigns to it.

The Missing Piece

My key takeaway from reviewing this literature is that we have a data imbalance. It was extremely hard to find qualitative studies.

While we have plenty of charts proving that HRV biofeedback calms the nervous system, we lack studies that capture the subjective perspectives, cultural nuances, and identity-related meaning-making of the people using it. We know that it works, but we are listening less to how it is experienced.

For HRV biofeedback to reach its full potential, especially in underserved populations, we need to bridge this gap. We need research that values the empirical data and the interpretive depth of the human story.

References

• DePoy, E., & Gitlin, L. N. (2016). Introduction to Research: Understanding and Applying Multiple Strategies (5th ed.). Elsevier Mosby.

• Field, L., et al. (2022). “The tonic’s not always in a bottle”: A qualitative study investigating a heart rate variability biofeedback coherence intervention for individuals with gastrointestinal disorders. Journal of Complexity In Health Sciences.

• Kim, B., Hwang, S., & Kang, H. (2024). Heart rate variability biofeedback and cognitive restructuring for self-regulation: A case study. International Journal of Disability Sports and Health Science.

• Lee, D., et al. (2024). Addressing mental health symptoms among COVID-19 healthcare workers: A heart-rate-variability biofeedback pilot study. Stress and Health.

• Schuman, D. L., & Killian, M. O. (2019). Pilot study of a single-session heart-rate-variability biofeedback intervention on veterans’ post-traumatic stress symptoms. Applied Psychophysiology and Biofeedback.