A randomized-controlled trial of heart rate variability biofeedback for psychotic symptoms
Abstract
Arousal and the way it is coped with are relevant to the emergence of psychotic symptoms. Heart rate variability (HRV) stems from autonomic responses to environmental demands such as stress and is an index of physiological arousal, adaptability, and homeostatic reflexes forming autonomic balance. A randomized-controlled between-subjects trial that compared HRV-biofeedback (BF) to an active relaxation and to a waiting control condition was conducted in a sample with attenuated subclinical psychotic symptoms (N = 84). A 20-min intervention was preceded and followed by repeated assessments of stress responses. Change scores of the post-stress periods were analyzed using ANOVAs for HRV, subjective stress, perceived control, and state paranoia. As expected, BF participants showed greater improvements in perceived control than waiting controls (p = 0.006). However, no group differences occurred in HRV, paranoid symptoms or subjective stress. In exploratory analyses in a subset of participants who were breathing per protocol, the expected effects were found for total HRV and state paranoia. Thus, this trial of HRV-BF for people with attenuated psychotic symptoms indicates that the intervention may hold potential if conducted per protocol. To reach this, longer training might be inevitable. Future studies are needed to further elucidate efficacy and applicability of HRV-BF in clinical samples.
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Such programs may also be helpful for people suffering from psychotic symptoms, who have been found to benefit from increased HF-HRV control in a biofeedback study.
“Such programs may also be helpful for people suffering from psychotic symptoms, who have been found to benefit from increased HF-HRV control in a biofeedback study86.”
From Voluntary upregulation of heart rate variability through biofeedback is improved by mental contemplative training (2019) · cites this paper as [86]
Brief biofeedback sessions have the potential to induce short-term benefit; however, longer interventions are required to properly engage breathing and stimulate the baroreflex.
“This indicates that brief biofeedback sessions have the potential to induce short-term benefit; however, longer interventions are required to properly engage breathing and stimulate the baroreflex.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [107]
In one randomized controlled trial of short 20-min HRV-biofeedback for psychotic symptoms, participants with subclinical symptoms were trained in diaphragmatic breathing and taught about its application for increasing HRV.
“For example, in one randomized controlled trial of short 20-min HRV-biofeedback for psychotic symptoms, participants with subclinical symptoms were trained in diaphragmatic breathing and taught about its application for increasing HRV107.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [107]
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- Authors
- Clamor, A., Koenig, J., Thayer, J. F., & Lincoln, T. M.
- Affiliations
- Universität Hamburg (DE)
- Heidelberg University (DE)
- The Ohio State University (US)
- Corresponding author
- Clamor, Annika
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 87
- Pages
- 207-215
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2530637998
- Cited by
- 40
- References
- 54
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 8 · 2020: 6 · 2019: 2 · 2018: 6 · 2017: 2
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Universität Heidelberg
- Universität Hamburg
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- heart rate variability biofeedback, attenuated psychotic symptoms, subclinical psychosis, physiological arousal, perceived control, stress response, autonomic regulation, relaxation training
- MeSH terms
- Adult, Female, Heart Rate, Humans, Male, Psychotic Disorders, Relaxation Therapy, Stress, Psychological, Treatment Outcome, Feedback, Physiological, Young Adult, Prodromal Symptoms
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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