Heart Rate Variability Biofeedback Based on Slow-Paced Breathing With Immersive Virtual Reality Nature Scenery
Open accessAbstract
This study investigated the benefits of using a virtual nature environment to administer immersive heart rate variability biofeedback (HRV-BF) based on slow-paced breathing. We compared the virtual reality (VR)-based HRV-BF with a standard implementation in a randomized controlled experiment with 60 healthy employees. After a cognitive stress induction, the participants performed a single-session of HRV-BF before repeating the cognitive stressor task. VR-based versus standard HRV-BF was comparable in terms of biofeedback performance (cardiac coherence and cardiac vagal tone). However, the VR-based implementation buffered perceived stress in the subsequent stressor task, increased relaxation self-efficacy more, reduced mind wandering, helped participants focus on the present moment, and helped preserve attentional resources. Potential long-term effects and generalizability need to be assessed in future research.
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Research on VR for related techniques such as mindfulness is at the very early stages with predominantly single case studies and typically involves populations of adults without a mental health condition.
“However, this research is at the very early stages with predominantly single case studies and typically involves populations of adults without a mental health condition.”
From A Virtual Reality–Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study. (2025) · cites this paper as [33]
The Introduction discusses VR-assisted mindfulness, and the Limitations and Future Research section calls this an early attempt at VR-based HRV biofeedback. The paper studied healthy employees, but its randomized controlled experiment involved 60 participants—not a single case—and it does not establish that VR research on related techniques consists predominantly of single-case studies or typically excludes people with mental health conditions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA small number of studies have examined the use of VR for related techniques such as mindfulness, with preliminary evidence of positive outcomes.
“A small number of studies have also examined the use of VR for related techniques such as mindfulness [31-34], with preliminary evidence of positive outcomes.”
From A Virtual Reality–Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study. (2025) · cites this paper as [33]
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(1970) · Cited by 24,983 · see citing works
Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use
Electrophysiology, T. F. O. T. E. S. O. C. T. N. A. (1996) · Circulation · doi:10.1161/01.cir.93.5.1043 · Cited by 17,159 · see citing works
The restorative benefits of nature: toward an integrative framework
Kaplan, S. (1995) · Journal of Environmental Psychology · doi:10.1016/0272-4944(95)90001-2 · Cited by 6,923 · cited 6× · see citing works
“…resources of an observer can be restored by involuntary attention toward an environment that provides a feeling of being away from daily routines, that is expansive and coherent , that elicits soft fascination , and that is compatible with the observer’s preferences and goals (Kaplan, 1995).”
BackgroundMethodInfluentialHalf a century of research on the Stroop effect: An integrative review.
MacLeod, C. M. (1991) · Psychological Bulletin · doi:10.1037/0033-2909.109.2.163 · Cited by 5,500 · cited 1× · see citing works
“To objectively assess attentional resources, we used a computerized modified Stroop task (c.f., MacLeod, 1991).”
MethodHeart rate variability: origins, methods, and interpretive caveats
BERNTSON, G. G., THOMAS BIGGER, J., ECKBERG, D. L., GROSSMAN, P., KAUFMANN, P. G., MALIK, M., NAGARAJA, H. N., PORGES, S. W., SAUL, J. P., STONE, P. H., et al. (1997) · Psychophysiology · doi:10.1111/j.1469-8986.1997.tb02140.x · Cited by 3,962 · cited 2× · see citing works
“…for cognitive, affective, social, and health-related self-regulatory mechanisms [Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology (Task Force), 1996; Berntson et al., 1997; Porges, 2007; Thayer et al., 2009; Laborde et al., 2017, 2018].”
BackgroundMethodSelf-Efficacy Beliefs of Adolescents
Pajares, F., & Urdan, T. (2006) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-60752-750-3 · Cited by 3,544 · see citing works
Porges, S. W. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2006.06.009 · Cited by 3,415 · cited 2× · see citing works
“…for cognitive, affective, social, and health-related self-regulatory mechanisms [Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology (Task Force), 1996; Berntson et al., 1997; Porges, 2007; Thayer et al., 2009; Laborde et al., 2017, 2018].”
BackgroundThayer, J. F., Åhs, F., Fredrikson, M., Sollers, J. J., & Wager, T. D. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2011.11.009 · Cited by 3,224 · cited 1× · see citing works
“By contrast, high levels of HRV are associated with cardiovascular health and resilience (Thayer et al., 2012; Walker et al., 2017).”
BackgroundCrawford, J. R., & Henry, J. D. (2004) · British Journal of Clinical Psychology · doi:10.1348/0144665031752934 · Cited by 2,957 · cited 1× · see citing works
“Instruments that explicitly assess different aspects of affect and mood (e.g., Positive and Negative Affect Scale, Crawford and Henry, 2004; Multidimensional Mood Questionnaire, Steyer et al., 1997) might have revealed more.”
BackgroundHeart rate variability: A review
Rajendra Acharya, U., Paul Joseph, K., Kannathal, N., Lim, C. M., & Suri, J. S. (2006) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-006-0119-0 · Cited by 2,820 · cited 1× · see citing works
“Functionally, HRV allows the organism to adapt to changing exogenous and endogenous demands (for an overview, see Acharya et al., 2006; Shaffer et al., 2014).”
BackgroundKubios HRV–heart rate variability analysis software.
Tarvainen, M. P., Niskanen, J.-P., Lipponen, J. A., Ranta-aho, P. O., & Karjalainen, P. A. (2014) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2013.07.024 · Cited by 2,720 · see citing works
Laborde, S., Mosley, E., & Thayer, J. F. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00213 · Cited by 2,336 · cited 5× · see citing works
“As HRV data are often non-normally distributed and may require log-transformation (Laborde et al., 2017), we checked for normal distribution within all experimental cells.”
BackgroundMethodInfluentialThayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2009.09.543 · Cited by 2,276 · see citing works
Methods for dealing with reaction time outliers.
Ratcliff, R. (1993) · Psychological Bulletin · doi:10.1037/0033-2909.114.3.510 · Cited by 2,142 · cited 1× · see citing works
“For each participant, we aggregated the reaction times of the correctly answered trials (Ratcliff, 1993), excluding the few control items to ensure equal numbers of congruent and incongruent trials.”
MethodA systematic review of evidence for the added benefits to health of exposure to natural environments
Bowler, D. E., Buyung-Ali, L. M., Knight, T. M., & Pullin, A. S. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-456 · Cited by 1,993 · cited 1× · see citing works
“Even short exposure to nature has been shown to reduce stress and restore productivity (Kaplan, 1995; Bowler et al., 2010; Berto, 2014; Ohly et al., 2016).”
BackgroundThayer, J. F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009) · Annals of Behavioral Medicine · doi:10.1007/s12160-009-9101-z · Cited by 1,872 · cited 4× · see citing works
“According to the neurovisceral integration model (Thayer et al., 2009; Smith et al., 2017), cardiac vagal tone is positively associated with the performance of executive functions.”
BackgroundMethodInfluentialShaffer, F., McCraty, R., & Zerr, C. L. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01040 · Cited by 1,866 · cited 2× · see citing works
“Functionally, HRV allows the organism to adapt to changing exogenous and endogenous demands (for an overview, see Acharya et al., 2006; Shaffer et al., 2014).”
BackgroundFrom presence to consciousness through virtual reality.
Sanchez-Vives, M. V., & Slater, M. (2005) · Nature reviews. Neuroscience · doi:10.1038/nrn1651 · Cited by 1,831 · see citing works
How Immersive Is Enough? A Meta-Analysis of the Effect of Immersive Technology on User Presence
Cummings, J. J., & Bailenson, J. N. (2016) · Media Psychology · doi:10.1080/15213269.2015.1015740 · Cited by 1,749 · cited 1× · see citing works
“In a VR-based HRV-BF, the user is confronted with immersive virtual stimuli capable of inducing a sense of presence , that is the feeling of actually being inside the virtual environment (Sanchez-Vives and Slater, 2005; Cummings and Bailenson, 2016).”
MethodKemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.12.012 · Cited by 1,286 · cited 1× · see citing works
“…low HRV is associated with an increased overall mortality risk (Thayer and Lane, 2007; Thayer et al., 2010) and various psychological disorders (Kemp et al., 2010; Kemp and Quintana, 2013; Chalmers et al., 2014) and has been suggested as a transdiagnostic biomarker of psychopathology…”
BackgroundGrossman, P., & Taylor, E. W. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2005.11.014 · Cited by 1,133 · cited 2× · see citing works
“From a physiological point of view, cardiac coherence is beneficial because it makes the autonomic nervous system work most efficiently (see also the biological behavioral model, Grossman and Taylor, 2007).”
BackgroundAffective interactions using virtual reality: the link between presence and emotions
Riva, G., Mantovani, F., Capideville, C. S., Preziosa, A., Morganti, F., Villani, D., Gaggioli, A., Botella, C., & Alcañiz, M. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2006.9993 · Cited by 1,111 · see citing works
Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis
Chalmers, J. A., Quintana, D. S., Abbott, M. J.-A., & Kemp, A. H. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00080 · Cited by 1,067 · cited 1× · see citing works
“…with an increased overall mortality risk (Thayer and Lane, 2007; Thayer et al., 2010) and various psychological disorders (Kemp et al., 2010; Kemp and Quintana, 2013; Chalmers et al., 2014) and has been suggested as a transdiagnostic biomarker of psychopathology (Beauchaine and Thayer, 2015).”
BackgroundThe role of vagal function in the risk for cardiovascular disease and mortality
Thayer, J. F., & Lane, R. D. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2005.11.013 · Cited by 1,033 · cited 1× · see citing works
“In line with that, low HRV is associated with an increased overall mortality risk (Thayer and Lane, 2007; Thayer et al., 2010) and various psychological disorders (Kemp et al., 2010; Kemp and Quintana, 2013; Chalmers et al., 2014) and has been suggested as a transdiagnostic biomarker of…”
BackgroundOhly, H., White, M. P., Wheeler, B. W., Bethel, A., Ukoumunne, O. C., Nikolaou, V., & Garside, R. (2016) · Journal of Toxicology and Environmental Health, Part B · doi:10.1080/10937404.2016.1196155 · Cited by 961 · see citing works
Directed Attention as a Common Resource for Executive Functioning and Self-Regulation
Kaplan, S., & Berman, M. G. (2010) · Perspectives on Psychological Science · doi:10.1177/1745691609356784 · Cited by 905 · cited 1× · see citing works
“Second, research on the Attention Restoration Theory (Kaplan, 1995; Kaplan and Berman, 2010) has shown that nature exposition helps regain concentration and acts as an antidote to attentional fatigue (for a review, see Ohly et al., 2016).”
BackgroundHeart rate variability biofeedback: how and why does it work?
Lehrer, P. M., & Gevirtz, R. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.00756 · Cited by 883 · cited 4× · see citing works
“…influence of different ratios in the context of our study, given that evidence suggests a longer exhalation than inhalation when targeting increases in cardiac vagal tone (Lehrer et al., 2000; Strauss-Blasche et al., 2000; Vaschillo et al., 2006; Allen and Friedman, 2012; Lehrer and Gevirtz, 2014).”
BackgroundInfluentialHeart rate variability as a transdiagnostic biomarker of psychopathology
Beauchaine, T. P., & Thayer, J. F. (2015) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.08.004 · Cited by 870 · cited 1× · see citing works
“…with an increased overall mortality risk (Thayer and Lane, 2007; Thayer et al., 2010) and various psychological disorders (Kemp et al., 2010; Kemp and Quintana, 2013; Chalmers et al., 2014) and has been suggested as a transdiagnostic biomarker of psychopathology (Beauchaine and Thayer, 2015).”
BackgroundBerto, R. (2014) · Behavioral Sciences · doi:10.3390/bs4040394 · Cited by 842 · cited 1× · see citing works
“Even short exposure to nature has been shown to reduce stress and restore productivity (Kaplan, 1995; Bowler et al., 2010; Berto, 2014; Ohly et al., 2016).”
BackgroundZaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00353 · Cited by 820 · cited 1× · see citing works
“Slow-paced breathing provides an accessible way of increasing HRV as well as improving psychological well-being and emotion regulation (Zaccaro et al., 2018).”
BackgroundAnnerstedt, M., Jönsson, P., Wallergård, M., Johansson, G., Karlson, B., Grahn, P., Hansen, Å. M., & Währborg, P. (2013) · Physiology & Behavior · doi:10.1016/j.physbeh.2013.05.023 · Cited by 647 · cited 1× · see citing works
“This also applies to virtual substitutes of nature (Villani and Riva, 2012; Annerstedt et al., 2013; Gromala et al., 2015; Serrano et al., 2016; Andersen et al., 2017; Anderson et al., 2017).”
BackgroundLehrer, P. M., Vaschillo, E. G., & Vaschillo, B. (2000) · Applied Psychophysiology and Biofeedback · doi:10.1023/a:1009554825745 · Cited by 636 · cited 1× · see citing works
“…influence of different ratios in the context of our study, given that evidence suggests a longer exhalation than inhalation when targeting increases in cardiac vagal tone (Lehrer et al., 2000; Strauss-Blasche et al., 2000; Vaschillo et al., 2006; Allen and Friedman, 2012; Lehrer and Gevirtz, 2014).”
BackgroundThe effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis
Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017) · Psychological Medicine · doi:10.1017/s0033291717001003 · Cited by 632 · cited 1× · see citing works
“The effectiveness of HRV-BF in treating stress-related disorders and symptoms has been established in reviews and meta-analyses (Wheat and Larkin, 2010; Gevirtz, 2013; Goessl et al., 2017; Kennedy and Parker, 2018; Yu et al., 2018).”
BackgroundKemp, A. H., & Quintana, D. S. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.06.018 · Cited by 538 · cited 1× · see citing works
“…with an increased overall mortality risk (Thayer and Lane, 2007; Thayer et al., 2010) and various psychological disorders (Kemp et al., 2010; Kemp and Quintana, 2013; Chalmers et al., 2014) and has been suggested as a transdiagnostic biomarker of psychopathology (Beauchaine and Thayer,…”
BackgroundThe hierarchical basis of neurovisceral integration
Smith, R., Thayer, J. F., Khalsa, S. S., & Lane, R. D. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.02.003 · Cited by 523 · cited 1× · see citing works
“According to the neurovisceral integration model (Thayer et al., 2009; Smith et al., 2017), cardiac vagal tone is positively associated with the performance of executive functions.”
MethodState Mindfulness Scale (SMS): Development and initial validation.
Tanay, G., & Bernstein, A. (2013) · Psychological Assessment · doi:10.1037/a0034044 · Cited by 486 · cited 1× · see citing works
“Focus on the present moment was assessed via the State Mindfulness Scale (SMS; Tanay and Bernstein, 2013), which comprises the 15-item mindfulness of mind subscale (sample item: “I felt closely connected to the present moment”) and the six-item mindfulness of body subscale (sample item: “I clearly…”
MethodEmotions and respiratory patterns: review and critical analysis
Boiten, F. A., Frijda, N. H., & Wientjes, C. J. E. (1994) · International Journal of Psychophysiology · doi:10.1016/0167-8760(94)90027-2 · Cited by 462 · cited 1× · see citing works
“Negative feedback might be perceived as a stressor that triggers distracting associations and impedes proper breathing (c.f., Boiten et al., 1994).”
BackgroundCharacteristics of Resonance in Heart Rate Variability Stimulated by Biofeedback
Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-006-9009-3 · Cited by 431 · see citing works
Relaxation with immersive natural scenes presented using virtual reality
Anderson, A. P., Mayer, M. D., Fellows, A. M., Cowan, D. R., Hegel, M. T., & Buckey, J. C. (2017) · Aerospace Medicine and Human Performance · doi:10.3357/amhp.4747.2017 · Cited by 419 · cited 2× · see citing works
“Research on the use of simulated environments for stress reduction and relaxation has demonstrated the feasibility of virtual reality (VR; i.e., computer-generated) nature environments (de Kort et al., 2006; Anderson et al., 2017; Liszio et al., 2018; White et al., 2018).”
BackgroundIs virtual reality emotionally arousing? Investigating five emotion inducing virtual park scenarios
Felnhofer, A., Kothgassner, O. D., Schmidt, M., Heinzle, A.-K., Beutl, L., Hlavacs, H., & Kryspin‐Exner, I. (2015) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2015.05.004 · Cited by 385 · see citing works
Bradley, R. T., Tomasino, D., Atkinson, M., & McCraty, R. (2009) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 363 · see citing works
Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise
GILLINOV, S., ETIWY, M., WANG, R., BLACKBURN, G., PHELAN, D., GILLINOV, A. M., HOUGHTALING, P., JAVADIKASGARI, H., & DESAI, M. Y. (2017) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001284 · Cited by 345 · see citing works
The strength model of self-regulation: conclusions from the second decade of willpower research
Baumeister, R. F., Tice, D. M., & Vohs, K. D. (2018) · Perspectives on Psychological Science · doi:10.1177/1745691617716946 · Cited by 338 · see citing works
Hayano, J., Yasuma, F., Okada, A., Mukai, S., & Fujinami, T. (1996) · Circulation · doi:10.1161/01.cir.94.4.842 · Cited by 332 · cited 1× · see citing works
“This effect, called respiratory sinus arrhythmia (RSA), is one of the main components of HRV (Hayano et al., 1996) and is most present with low respiratory frequencies (Song and Lehrer, 2003).”
BackgroundPlews, D. J., Scott, B., Altini, M., Wood, M., Kilding, A. E., & Laursen, P. B. (2017) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2016-0668 · Cited by 323 · see citing works
A review of research and a meta-analysis of the seductive detail effect
Rey, G. D. (2012) · Educational Research Review · doi:10.1016/j.edurev.2012.05.003 · Cited by 318 · cited 1× · see citing works
“Likewise, the rich virtual environment did not impair participants’ concentration on the task, indicating that the design of the virtual environment succeeded in avoiding a seductive details effect (c.f., Rey, 2012).”
BackgroundWhat's wrong with virtual trees? Restoring from stress in a mediated environment
de Kort, Y. A. W., Meijnders, A. L., Sponselee, A.-M. A.-M. G., & IJsselsteijn, W. A. (2006) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2006.09.001 · Cited by 314 · cited 1× · see citing works
“Research on the use of simulated environments for stress reduction and relaxation has demonstrated the feasibility of virtual reality (VR; i.e., computer-generated) nature environments (de Kort et al., 2006; Anderson et al., 2017; Liszio et al., 2018; White et al., 2018).”
BackgroundLaborde, S., Mosley, E., & Mertgen, A. (2018) · Frontiers in Neuroscience · doi:10.3389/fnins.2018.00458 · Cited by 305 · cited 4× · see citing works
“The most recent among those theories is the Vagal Tank Theory (Laborde et al., 2018).”
BackgroundInfluentialThe effects of specific respiratory rates on heart rate and heart rate variability
Song, H.-S., & Lehrer, P. M. (2003) · Applied Psychophysiology and Biofeedback · doi:10.1023/a:1022312815649 · Cited by 292 · cited 1× · see citing works
“This effect, called respiratory sinus arrhythmia (RSA), is one of the main components of HRV (Hayano et al., 1996) and is most present with low respiratory frequencies (Song and Lehrer, 2003).”
BackgroundImmersive Virtual Reality for Pediatric Pain
Won, A., Bailey, J., Bailenson, J., Tataru, C., Yoon, I., & Golianu, B. (2017) · Children · doi:10.3390/children4070052 · Cited by 286 · see citing works
Navarro-Haro, M. V., López-del-Hoyo, Y., Campos, D., Linehan, M. M., Hoffman, H. G., García-Palacios, A., Modrego-Alarcón, M., Borao, L., & García-Campayo, J. (2017) · PLoS ONE · doi:10.1371/journal.pone.0187777 · Cited by 262 · see citing works
Cognitive interference: Situational determinants and traitlike characteristics.
Sarason, I. G., Sarason, B. R., Keefe, D. E., Hayes, B. E., & Shearin, E. N. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.1.215 · Cited by 249 · cited 1× · see citing works
“To measure mind wandering during the treatment, we used the Cognitive Interference Questionnaire (CIQ; Sarason et al., 1986).”
MethodBiofeedback of Heart Rate Variability and Related Physiology: A Critical Review
Wheat, A. L., & Larkin, K. T. (2010) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-010-9133-y · Cited by 240 · see citing works
A prescription for “nature” – the potential of using virtual nature in therapeutics
White, M. P., Yeo, N. L., Vassiljev, P., Lundstedt, R., Wallergård, M., Albin, M. C., & Lõhmus, M. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s179038 · Cited by 233 · cited 1× · see citing works
“This mechanism has been utilized to help overcome acute, procedural, and chronic pain (Won et al., 2017) and to help practice mindfulness meditation (Gromala et al., 2015; Kosunen et al., 2016; Navarro-Haro et al., 2017).”
MethodThe Promise of Heart Rate Variability Biofeedback: Evidence-Based Applications
Gevirtz, R. (2013) · Biofeedback · doi:10.5298/1081-5937-41.3.01 · Cited by 225 · cited 1× · see citing works
“The effectiveness of HRV-BF in treating stress-related disorders and symptoms has been established in reviews and meta-analyses (Wheat and Larkin, 2010; Gevirtz, 2013; Goessl et al., 2017; Kennedy and Parker, 2018; Yu et al., 2018).”
BackgroundECG artifacts and heart period variability: Don't miss a beat!
Berntson, G. G., & Stowell, J. R. (1998) · Psychophysiology · doi:10.1111/1469-8986.3510127 · Cited by 223 · cited 1× · see citing works
“…to be reliable in most conditions (Gillinov et al., 2017; Plews et al., 2017), it does not allow for precise artifact correction via visual inspection of the ECG signal to understand whether artifacts are due to technical or physiological issues (Berntson and Stowell, 1998; Laborde et al., 2017).”
BackgroundIn the search for integrative biomarker of resilience to psychological stress
Walker, F. R., Pfingst, K., Carnevali, L., Sgoifo, A., & Nalivaiko, E. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.003 · Cited by 211 · cited 1× · see citing works
“Furthermore, these properties of VR-based HRV-BF are beneficial as they help maintain sustained concentration as well as motivation and may thus influence biofeedback success (e.g., Khazan, 2015; Weerdmeester et al., 2017).”
BackgroundBiofeedback for Everyday Stress Management: A Systematic Review
Yu, B., Funk, M., Hu, J., Wang, Q., & Feijs, L. M. G. (2018) · Frontiers in ICT · doi:10.3389/fict.2018.00023 · Cited by 185 · cited 1× · see citing works
“Slow-paced breathing provides an accessible way of increasing HRV as well as improving psychological well-being and emotion regulation (Zaccaro et al., 2018).”
BackgroundPrinsloo, G. E., Rauch, H. G. L., Lambert, M. I., Muench, F., Noakes, T. D., & Derman, W. E. (2011) · Applied Cognitive Psychology · doi:10.1002/acp.1750 · Cited by 183 · see citing works
Serrano, B., Baños, R., & Botella, C. (2015) · Computers in Human Behavior · doi:10.1016/j.chb.2015.08.007 · Cited by 175 · cited 1× · see citing works
“This also applies to virtual substitutes of nature (Villani and Riva, 2012; Annerstedt et al., 2013; Gromala et al., 2015; Serrano et al., 2016; Andersen et al., 2017; Anderson et al., 2017).”
BackgroundThe Effect of Heart Rate Variability Biofeedback on Performance Psychology of Basketball Players
Paul, M., & Garg, K. (2012) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-012-9185-2 · Cited by 158 · cited 1× · see citing works
“HRV-BF in general may increase trainees’ relaxation self-efficacy because success in producing the target behavior is immediately fed back and thus perceivable (e.g., Giardino et al., 2004; Paul and Garg, 2012; Teufel et al., 2013).”
BackgroundRelative Timing Of Inspiration And Expiration Affects Respiratory Sinus Arrhythmia
Strauss‐Blasche, G., Moser, M., Voica, M., McLeod, D., Klammer, N., & Marktl, W. (2000) · Clinical and Experimental Pharmacology and Physiology · doi:10.1046/j.1440-1681.2000.03306.x · Cited by 149 · see citing works
Lin, I. M., Tai, L. Y., & Fan, S. Y. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.12.006 · Cited by 145 · cited 1× · see citing works
“An inhalation to exhalation ratio of 5:5 with no pause between the breathing phases was chosen in accordance with prior research findings indicating that HRV is most increased when inhalation and exhalation phases are equal in length (Lin et al., 2014).”
MethodGiardino, N. D., Chan, L. E., & Soo Borson, B. (2004) · Applied Psychophysiology and Biofeedback · doi:10.1023/b:apbi.0000026638.64386.89 · Cited by 129 · see citing works
Sampling frequency of the RR interval time series for spectral analysis of heart rate variability
Singh, D., Vinod, K., & Saxena, S. (2004) · Journal of Medical Engineering & Technology · doi:10.1080/03091900410001662350 · Cited by 108 · cited 2× · see citing works
“…a Hann-Window was applied (tapering the amplitudes of the end points of the data series to prevent leakage and improve the time resolution, c.f., Singh et al., 2004); and a forward Fast-Fourier transformation was performed, which yields estimates of power spectral densities of different…”
MethodLiszio, S., Graf, L., & Masuch, M. (2018) · Annual review of Cybertherapy and Telemedicine · Cited by 93 · see citing works
Biofeedback as a stress management tool: a systematic review
Kennedy-Metz, L. R., & Parker, S. H. (2018) · Cognition Technology & Work · doi:10.1007/s10111-018-0487-x · Cited by 86 · cited 1× · see citing works
“The effectiveness of HRV-BF in treating stress-related disorders and symptoms has been established in reviews and meta-analyses (Wheat and Larkin, 2010; Gevirtz, 2013; Goessl et al., 2017; Kennedy and Parker, 2018; Yu et al., 2018).”
BackgroundDoes Interactive Media Enhance the Management of Stress? Suggestions from a Controlled Study
Villani, D., & Riva, G. (2011) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2011.0141 · Cited by 76 · see citing works
Heart rate variability biofeedback, executive functioning and chronic brain injury
Kim, S., Zemon, V. M., Cavallo, M. M., Rath, J. F., McCraty, R., & Foley, F. W. (2013) · Brain Injury · doi:10.3109/02699052.2012.729292 · Cited by 71 · cited 1× · see citing works
“The duration was chosen following previous research on short-duration HRV-BF (e.g., Prinsloo et al., 2011; Kim et al., 2013).”
MethodTeufel, M., Stephan, K., Kowalski, A., Käsberger, S., Enck, P., Zipfel, S., & Giel, K. E. (2013) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-013-9223-8 · Cited by 55 · see citing works
Reaction times and other skewed distributions: problems with the mean and the medianPreprint
Rousselet, G. A., & Wilcox, R. R. (2018) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/383935 · Cited by 51 · cited 1× · see citing works
“…distributions are typically skewed, we used the median as an aggregator instead of the arithmetic mean because it is more robust against outliers and asymmetrical distributions (Rousselet and Wilcox, 2018), which has also been empirically demonstrated with the Stroop task (Singh and Göritz, 2019).”
MethodExploring the Role of Self-efficacy in Biofeedback Video Games
Weerdmeester, J., van Rooij, M. M. J. W., Harris, O., Smit, N., Engels, R. C. M. E., & Granic, I. (2017) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3130859.3131299 · Cited by 38 · see citing works
Pin, F., Minero, V. G., Penna, F., Muscaritoli, M., TULLIO, R. D., Baccino, F. M., & Costelli, P. (2017) · Frontiers in Physiology · doi:10.3389/fphys.2017.00213 · Cited by 30 · see citing works
Positive emotion reduces dyspnea during slow paced breathing
Allen, B., & Friedman, B. H. (2012) · Psychophysiology · doi:10.1111/j.1469-8986.2011.01344.x · Cited by 29 · cited 1× · see citing works
“…influence of different ratios in the context of our study, given that evidence suggests a longer exhalation than inhalation when targeting increases in cardiac vagal tone (Lehrer et al., 2000; Strauss-Blasche et al., 2000; Vaschillo et al., 2006; Allen and Friedman, 2012; Lehrer and Gevirtz, 2014).”
BackgroundA preliminary study of users' experiences of meditation in virtual reality
Andersen, T., Gintare, A., Christiansen, A., Hussein, M., Carol, L., Nielsen, T. B., Rafferty, E. I., Nilsson, N. C., Nordahl, R., & Serafin, S. (2017) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr.2017.7892317 · Cited by 26 · see citing works
Revisiting Ego Depletion: Moderators and Measurement
Singh, R. K., & Göritz, A. S. (2018) · Basic and Applied Social Psychology · doi:10.1080/01973533.2018.1530671 · Cited by 20 · cited 2× · see citing works
“…distributions are typically skewed, we used the median as an aggregator instead of the arithmetic mean because it is more robust against outliers and asymmetrical distributions (Rousselet and Wilcox, 2018), which has also been empirically demonstrated with the Stroop task (Singh and Göritz, 2019).”
BackgroundMethodSelf-citationMindfulness- and Acceptance-Based Biofeedback
Khazan, I. (2015) · Biofeedback · doi:10.5298/1081-5937-43.3.08 · Cited by 12 · cited 1× · see citing works
“Furthermore, these properties of VR-based HRV-BF are beneficial as they help maintain sustained concentration as well as motivation and may thus influence biofeedback success (e.g., Khazan, 2015; Weerdmeester et al., 2017).”
BackgroundVARIABLE ACCURACY OF COMMERCIALLY AVAILABLE WEARABLE HEART RATE MONITORS
Gillinov, A. M., Etiwy, M., Gillinov, S. M., Wang, R., Blackburn, G. G., Phelan, D. M. J., Houghtaling, P. L., Javadikasgari, H., & Desai, M. Y. (2017) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(17)33725-7 · Cited by 10 · cited 2× · see citing works
“Next, although assessing HRV via a chest strap has been found to be reliable in most conditions (Gillinov et al., 2017; Plews et al., 2017), it does not allow for precise artifact correction via visual inspection of the ECG signal to understand whether artifacts are due to technical or…”
MethodSathiyakumar, V., Golozar, A., Lazo, M., Quispe, R., Güallar, E., Blumenthal, R. S., Jones, S. R., & Martin, S. S. (2017) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(17)35086-6 · Cited by 4 · see citing works
Flagged first, then by citations
1 of the 81 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Gromala D. Tong X. Choo A. Karamnejad M. Shaw C. D. (2015). The virtual meditative walk: virtual reality therapy for chronic pain management. Paper presented at the 33rd Annual ACM Conference on Human Factors in Computing Systems New York, NY: ACM pp. 521– 524.
- Kosunen I. Salminen M. Järvelä S. Ruonala A. Ravaja N. Jacucci G. (2016). RelaWorld: neuroadaptive and immersive virtual reality meditation system. Paper presented at the 21st International Conference on Intelligent User Interfaces New York, NY: ACM pp. 208– 217.
- Peek C. J. (2017). “ A primer of traditional biofeedback instrumentation” in Biofeedback. A practitioner’s guide. 4th Edn. eds. Schwartz M. S. Andrasik F. (New York, NY: Guilford Press), 35– 67.
Cited by
Sorted by citations
Browning, M. H. E. M., Mimnaugh, K. J., van Riper, C. J., Laurent, H. K., & LaValle, S. M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02667 · Cited by 507 · see citing works
Virtual immersion in nature and psychological well-being: A systematic literature review
Frost, S., Kannis‐Dymand, L., Schaffer, V., Millear, P. M. R., Allen, A., Stallman, H. M., Mason, J., Wood, A. P., & Atkinson-Nolte, J. (2022) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2022.101765 · Cited by 168 · see citing works
Halbig, A., & Latoschik, M. E. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.694567 · Cited by 166 · see citing works
Virtual, mixed, and augmented reality: a systematic review for immersive systems research
Liberatore, M. J., & Wagner, W. P. (2021) · Virtual Reality · doi:10.1007/s10055-020-00492-0 · Cited by 161 · see citing works
A Narrative Review of Mindfulness-Based Interventions Using Virtual Reality
Arpaia, P., D’Errico, G., De Paolis, L. T., Moccaldi, N., & Nuccetelli, F. (2022) · Mindfulness · doi:10.1007/s12671-021-01783-6 · Cited by 122 · see citing works
“In Blum et al. (2019), the advantages of implementing heart rate variability (HRV) biofeedback in a virtual scenario are shown.”
BackgroundVirtual nature, psychological and psychophysiological outcomes: A systematic review
Spano, G., Theodorou, A., Reese, G., Carrus, G., Sanesi, G., & Panno, A. (2023) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2023.102044 · Cited by 140 · see citing works
Access to Nature via Virtual Reality: A Mini-Review
Li, H., Zhang, X., Wang, H., Yang, Z., Liu, H., Cao, Y., & Zhang, G. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.725288 · Cited by 108 · see citing works
Enable, Reconnect and Augment: A New ERA of Virtual Nature Research and Application
Litleskare, S., Macintyre, T. E., & Calogiuri, G. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17051738 · Cited by 103 · see citing works
“This type of IVN can achieve relatively high levels of realism, and has been found to elicit psychological and cognitive restoration [60,101].”
BackgroundVirtual Reality Biofeedback in Health: A Scoping Review
Lüddecke, R., & Felnhofer, A. (2021) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-021-09529-9 · Cited by 129 · see citing works
“, 2014) projects performed ground work in the field, new research mostly emerges out of one research group located in Freiburg, Germany (Blum et al., 2019; Rockstroh et al., 2019, 2020, 2021) and several research groups in The Netherlands (Bossenbroek et al.”
BackgroundResultInfluentialMitsea, E., Drigas, A. S., & Skianis, C. (2022) · Technium Social Sciences Journal · doi:10.47577/tssj.v29i1.6145 · Cited by 176 · see citing works
Measures and modalities in restorative virtual natural environments: An integrative narrative review
Nukarinen, T., Rantala, J., Korpela, K., Browning, M. H. E. M., Istance, H. O., Surakka, V., & Raisamo, R. (2021) · Computers in Human Behavior · doi:10.1016/j.chb.2021.107008 · Cited by 93 · see citing works
Virtual reality and immersive technologies to promote workplace wellbeing: a systematic review
Riches, S., Taylor, L., Jeyarajaguru, P., Veling, W., & Valmaggia, L. (2023) · Journal of Mental Health · doi:10.1080/09638237.2023.2182428 · Cited by 90 · see citing works
A mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing
Rockstroh, C., Blum, J., & Göritz, A. S. (2021) · Virtual Reality · doi:10.1007/s10055-020-00471-5 · Cited by 83 · see citing works
“Additionally, blocking unwanted external audiovisual stimuli and replacing them with desired and task-relevant stimuli reduces distraction and supports a sustained focus on the biofeedback task (Blum et al. 2019).”
BackgroundSelf-citationKnaust, T., Felnhofer, A., Kothgassner, O. D., Höllmer, H., Gorzka, R.-J., & Schulz, H. (2021) · Virtual Reality · doi:10.1007/s10055-021-00595-2 · Cited by 77 · see citing works
“Physiologically, HR can be innervated both sympathetically (inspiration) and parasympathetically (expiration; Blum et al. 2019; Schwartz and Andrasik 2017; Wang et al. 2018).”
BackgroundMethodVirtual reality biofeedback interventions for treating anxiety
Kothgassner, O. D., Goreis, A., Bauda, I., Ziegenaus, A., Glenk, L. M., & Felnhofer, A. (2022) · Wiener klinische Wochenschrift · doi:10.1007/s00508-021-01991-z · Cited by 70 · see citing works
“Furthermore, keeping up focused attention during the training sessions has been identified as another challenge in biofeedback training [6].”
BackgroundMethodInfluentialNaylor, M., Ridout, B., & Campbell, A. (2020) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2019.0287 · Cited by 60 · see citing works
“Anderson et al., 38 Blum et al., 44 and Liszio et al. 48 all have the words ‘‘immersive’’ and ‘‘nature’’ or ‘‘natural’’ in their titles and as part of the focus of the studies.”
Crisis and extended realities: remote presence in the time of COVID-19
Matthews, B., See, Z. S., & Day, J. J. (2020) · Media International Australia · doi:10.1177/1329878x20967165 · Cited by 54 · see citing works
“VR in particular has proven useful in improving mental wellness, where it has clear relevance to those facing complex challenges such as people with a physical disability (Blum et al., 2019; Roche et al., 2019; Valtchanov et al., 2010).”
BackgroundDevelopment and Pilot Test of a Virtual Reality Respiratory Biofeedback Approach
Blum, J., Rockstroh, C., & Göritz, A. S. (2020) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-020-09468-x · Cited by 60 · see citing works
Self-citationIntegrating Breathing Techniques Into Psychotherapy to Improve HRV: Which Approach Is Best?
Steffen, P. R., Bartlett, D., Channell, R., Jackman, K. N., Cressman, M., Bills, J., & Pescatello, M. S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.624254 · Cited by 56 · see citing works
“As noted previously, exposure to nature and to nature videos has been related to improvements in HRV in some studies but not all (Ulrich et al., 1991; Blum et al., 2019; Rockstroh et al., 2019).”
BackgroundVirtual reality environments for stress reduction and management: a scoping review
Ladakis, I., Filos, D., & Chouvarda, I. (2024) · Virtual Reality · doi:10.1007/s10055-024-00943-y · Cited by 52 · see citing works
“Ten studies implemented breathing techniques as the main stress recovery method, while seven used some type of bio-feedback (mainly based on breathing, but there were two studies that utilized HRV biofeedback (Blum et al. 2019; Rockstroh et al. 2019)).”
Breath Tools: A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running
Harbour, E. T., STÖGGL, T. L., Schwameder, H., & Finkenzeller, T. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.813243 · Cited by 53 · see citing works
Weibel, R. P., Kerr, J. I., Naegelin, M., Ferrario, A., Schinazi, V. R., Marca, R. L., Hölscher, C., Nater, U. M., & von Wangenheim, F. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107607 · Cited by 52 · see citing works
Machine learning in biosignals processing for mental health: A narrative review
Sajno, E., Bartolotta, S., Tuena, C., Cipresso, P., Pedroli, E., & Riva, G. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1066317 · Cited by 50 · see citing works
“…its maximum level with 6 complete breaths per minute, where resonance between respiration and HR oscillations is reached (called Cardiac Coherence; van Ravenswaaij-Arts et al., 1993; Blum et al., 2019) Slow-paced respiration boosts HRV and could be used for increasing relaxation Blum et al. (2019).”
BackgroundMitsea, E., Drigas, A. S., & Skianis, C. A. (2024) · Electronics · doi:10.3390/electronics13122253 · Cited by 44 · see citing works
Hu, M., Simon, M., Fix, S. T., Vivino, A. A., & Bernat, E. M. (2021) · Scientific Reports · doi:10.1038/s41598-021-85210-9 · Cited by 42 · see citing works
Velana, M., Sobieraj, S., Digutsch, J., & Rinkenauer, G. (2022) · Applied Sciences · doi:10.3390/app12147309 · Cited by 42 · see citing works
“In addition, one research experiment applied a double-blind, randomized, laboratory procedure [47].”
BackgroundMethodInfluentialThörel, E., Pauls, N., & Göritz, A. S. (2022) · Organizational Psychology Review · doi:10.1177/20413866221116309 · Cited by 47 · see citing works
“…activity (Posada-Quintero & Chon, 2020; Rockstroh et al., 2020a), hair cortisol (Fendel et al., 2020; Staufenbiel et al., 2013), heart parameters (Blum et al., 2019; Kim et al., 2018), keyboard typing (Freihaut & Göritz, 2021; Vizer et al., 2009), breathing patterns (Rockstroh et al., 2020b;…”
BackgroundSelf-citationCrosswell, A. D., Mayer, S. E., Whitehurst, L. N., Picard, M. A., Zebarjadian, S., & Epel, E. S. (2023) · Psychological Review · doi:10.1037/rev0000453 · Cited by 41 · see citing works
“Past work on paced breathing practices have shown bene fi ts on mental and physical health, including down-shifting sympathetic arousal and increasing parasympathetic activity, without any other didactic or psychos-piritual components (Blum et al., 2019; Harada et al., 2014; Laborde et al., 2019).”
BackgroundAffective Visualization in Virtual Reality: An Integrative Review
Pinilla, A., Garcia, J. A., Raffe, W. L., Voigt‐Antons, J., Spang, R. P., & Möller, S. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.630731 · Cited by 39 · see citing works
Rutkowski, S., Szary, P., Sacha, J., & Casaburi, R. H. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.702266 · Cited by 40 · see citing works
Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review
Pittara, M., Matsangidou, M., & Pattichis, C. S. (2023) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/47114 · Cited by 35 · see citing works
Prabhu, V. G., Stanley, L., Morgan, R., & Shirley, B. (2023) · Aging & Mental Health · doi:10.1080/13607863.2023.2270442 · Cited by 37 · see citing works
“Finally, our findings are supported by research with VR and biofeedback for other patient outcomes, including stress and depression (Blum et al., 2019; Kothgassner et al., 2022).”
MethodWeerdmeester, J., van Rooij, M. M. J. W., Maciejewski, D. F., Engels, R. C. M. E., & Granic, I. (2021) · Technology Mind and Behavior · doi:10.1037/tmb0000028 · Cited by 33 · see citing works
A Scoping Review of the Health Benefits of Nature-Based Physical Activity
Christiana, R. W., Besenyi, G. M., Gustat, J., Horton, T. H., Penbrooke, T. L., & Schultz, C. L. (2021) · Journal of Healthy Eating and Active Living · doi:10.51250/jheal.v1i3.25 · Cited by 34 · see citing works
ARCADIA: A Gamified Mixed Reality System for Emotional Regulation and Self-Compassion
Soler-Dominguez, J. L., Medrano, S. N., & Pons, P. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642123 · Cited by 33 · see citing works
“Blum et al. [12] have explored the use of cardiac biofeedback to improve breathing patterns and enhance relaxation in a VR scenario that emulates nature.”
Backgroundde Zambotti, M., Yüksel, D., Kiss, O., Barresi, G., Arra, N., Volpe, L., King, C. D., & Baker, F. C. (2022) · Digital Health · doi:10.1177/20552076221107887 · Cited by 34 · see citing works
Pizzoli, S. F. M., Monzani, D., Vergani, L., Sanchini, V., & Mazzocco, K. (2021) · Current Psychology · doi:10.1007/s12144-021-02158-9 · Cited by 31 · see citing works
Slow Breathing Exercise with Multimodal Virtual Reality: A Feasibility Study
Lan, K.-C., Li, C.-W., & Cheung, Y. (2021) · Sensors · doi:10.3390/s21165462 · Cited by 29 · see citing works
“While common implementations of biofeedback make use of numerical indicators and charts to present the feedback parameters, some prior studies [12,13] have shown, by providing”
MethodCuneo, A. Z., Yang, R., Zhou, H., Wang, K., Goh, S., Wang, Y., Raiti, J., Krashin, D., & Murinova, N. (2023) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000001114 · Cited by 22 · see citing works
Bolouki, A., McAnirlin, O., Browning, M. H. E. M., & Maynard, A. (2024) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2024.2338327 · Cited by 26 · see citing works
Cortez-Vázquez, G., Adriaanse, M. C., Burchell, G. L., Ostelo, R., Panayiotou, G., & Vlemincx, E. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09611-4 · Cited by 31 · see citing works
“All five parallel-group RCTs raised some concerns of bias (see Fig.”
BackgroundMethodInfluentialBrelet, L., & Gaffary, Y. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.900970 · Cited by 25 · see citing works
Virtual Reality and Stress Management: A Systematic Review
Meshkat, S., Edalatkhah, M., Luciano, C. D., Martin, J., Kaur, G., Lee, G. H., Park, H., Torres, A., Mazalek, A., Kapralos, B., et al. (2024) · Cureus · doi:10.7759/cureus.64573 · Cited by 24 · see citing works
Nasri, M. (2025) · ACM Conference on User Modeling, Adaptation and Personalization (UMAP) · doi:10.1145/3699682.3727575 · Cited by 24 · see citing works
“Some studies adjust difficulty dynamically to maintain engagement by modifying complexity [5, 11, 19].”
Aritzeta, A., Ruiz, A. A., Soroa, G., Mindeguia, R., & Olarza, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095475 · Cited by 34 · see citing works
“The high HRV generated through voluntary breathing is a suitable emotional self-regulation measure [43,44].”
BackgroundMiller, N., Stepanova, E. R., Desnoyers-Stewart, J., Adhikari, A., Kitson, A., Pennefather, P. P., Quesnel, D. T., Brauns, K., Friedl-Werner, A., Stahn, A. C., et al. (2023) · Designing Interactive Systems Conference · doi:10.1145/3563657.3595998 · Cited by 23 · see citing works
“…of relaxation [3, 102, 107], stress reduction [3, 16, 145], pain reduction [45, 92], mindfulness cultivation [45, 78], evoked connection to nature [ 2, 69, 113, 117, 120], reduced anxiety during medical procedures [107, 139], improved attentional capacity [8, 145], and arousal of awe [20, 99].”
BackgroundExcite-O-Meter: Software Framework to Integrate Heart Activity in Virtual Reality
Quintero, L., Muñoz, J. E., de Mooij, J., & Gaebler, M. (2021) · Proceedings - International Symposium on Mixed and Augmented Reality, ISMAR · doi:10.1109/ismar52148.2021.00052 · Cited by 21 · see citing works
Connelly, M. A., Boorigie, M. E., & McCabe, K. M. (2023) · Children · doi:10.3390/children10020329 · Cited by 21 · see citing works
“Biofeedback (including neurofeedback) has a well-established evidence base for improving headache outcomes, but young patients may struggle to remain sufficiently motivated and engaged with traditional biofeedback training to achieve success [12,45,46].”
BackgroundKerr, J. I., Weibel, R. P., Naegelin, M., Ferrario, A., Schinazi, V. R., Marca, R. L., Hölscher, C., Nater, U. M., & von Wangenheim, F. (2023) · BMC Digital Health · doi:10.1186/s44247-023-00042-z · Cited by 24 · see citing works
“Blum et al. [65] found that using an HMD for an HRV-BF session led to significantly higher levels of mindfulness and attention resources and reduced mind-wandering than using a two-dimensional screen.”
MethodResultCho, Y., Kim, H., Seong, S., Park, K., Choi, J., Kim, M., Kim, D., & Jeon, H. J. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.031 · Cited by 21 · see citing works
Bell, C. N., George, R. S., Honan, C. A., Bell, L. J., Jolly, A. T. W., & Matthews, A. J. (2025) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2025.102632 · Cited by 25 · see citing works
Bögge, L., Colás-Blanco, I., & Piolino, P. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.791498 · Cited by 14 · see citing works
“6) as HRVB affects CVC very strongly in young healthy adults (Lehrer et al., 2003; Prinsloo et al., 2013; Blum et al., 2019; Rockstroh et al., 2019) whereas effects in the control group were expected to be at best modest (Krygier et al.”
BackgroundResultChittaro, L., Serafini, M., & Vulcano, Y. (2024) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2024.103275 · Cited by 20 · see citing works
Ma, H., Bian, Y., Wang, Y., Zhou, C., Geng, W., Zhang, F., Liu, J., & Yang, C. (2021) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2021.103721 · Cited by 17 · see citing works
Pratviel, Y., Bouny, P., & Deschodt‐Arsac, V. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2024.1358981 · Cited by 20 · see citing works
Mindfulness for Anxiety Management and Happiness: The Role of VR, Metacognition, and Hormones
Mitsea, E., Drigas, A. S., & Skianis, C. (2022) · Technium BioChemMed · doi:10.47577/biochemmed.v3i3.7343 · Cited by 19 · see citing works
Kampa, M., Finke, J. B., Stalder, T., Bucher, L., Klapperich, H., Mertl, F., Zimmer, C., Geiger, C., Hassenzahl, M., & Klucken, T. (2022) · Trials · doi:10.1186/s13063-022-06307-8 · Cited by 16 · see citing works
“VR relaxation interventions led to reduced subjective stress [16], anxiety, and depression [15, 20, 21], as well as reduced negative affect [8, 18, 19], increased state relaxation [8, 21] and relaxation self-efficacy [13], increased recreation [19], and enhanced positive affect [12, 19].”
BackgroundBarton, A. C., Do, M., Sheen, J. A., & Byrne, L. K. (2024) · Virtual Reality · doi:10.1007/s10055-023-00916-7 · Cited by 16 · see citing works
“In line with prior research (Blum et al. 2019; Lymeus et al. 2017; Niksirat et al. 2019), we theorise that exposure to a restorative environment helped offset the cognitive demands of the focused attention exercise.”
InfluentialEvaluating the Role of Breathing Guidance on Game-Based Interventions for Relaxation Training
Gummidela, V. N. C., Silva, D. R. D. C., & Gutiérrez‐Osuna, R. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.760268 · Cited by 16 · see citing works
“Blum et al. (45) conducted a study comparing VR and standard (non-VR) HRV biofeedback in terms of skill transfer, self-regulation, focus, and attentional resources.”
Manchón, F. D. A. M., & Šimunić, A. (2023) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2023.2235122 · Cited by 14 · see citing works
“…of a physiological measurement instrument to assess the level of stress and the state of relaxation in an objective manner such as, for example, heart rate variability (Blum et al., 2019), electrodermal activity (Browning et al., 2020) or the amount of cortisol in saliva (Annerstedt et al., 2013).”
D’Errico, G., Barba, M. C., Gatto, C., Nuzzo, B. L., Nuccetelli, F., Luca, V. D., & Paolis, L. T. D. (2023) · Lecture notes in computer science · doi:10.1007/978-3-031-43401-3_32 · Cited by 14 · see citing works
Enhancing interoceptive sensibility through exteroceptive–interoceptive sensory substitution
Goral, O., Wald, I. Y., Maimon, A., Snir, A., Golland, Y., Goral, A., & Amedi, A. (2024) · Scientific Reports · doi:10.1038/s41598-024-63231-4 · Cited by 15 · see citing works
Wagner, M., & Wieczorek, A. (2024) · Scientific Reports · doi:10.1038/s41598-024-68043-0 · Cited by 16 · see citing works
Fusaro, M., Lisi, M. P., Era, V., Porciello, G., Candidi, M., Aglioti, S. M., & Boukarras, S. (2025) · Topoi · doi:10.1007/s11245-025-10216-1 · Cited by 20 · see citing works
“…monitored during a stressful VR scenario, allowing the virtual environment to adapt in real time by introducing calming visuals and soothing sounds (Blum et al. 2019) or provided coupled to a virtual body or a virtual body part to increase vicarious ownership (Aspell et al. 2013; Suzuki et al.…”
Bolin, L. P., Saul, A. D., Scroggs, L. L. B., & Horne, C. E. (2022) · Clinical Hypertension · doi:10.1186/s40885-021-00185-z · Cited by 14 · see citing works
Guo, F., Li, M., Lin, G., & Zhang, D. (2025) · Tourism Management · doi:10.1016/j.tourman.2025.105178 · Cited by 14 · see citing works
Makaracı, Y., Makaracı, M., Zorba, E., & Lautenbach, F. (2023) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09589-z · Cited by 13 · see citing works
“…auditory pacer since the HRV is most increased when the two phases of breathing (inhalation and exhalation) are of equal length (Lin et al., 2014; Blum et al., 2019) Besides, the BFB device software displayed a personal information to optimise HRV by synchronizing breathing and heart rates (HR)…”
MethodYoon, H., & Jeon, J. Y. (2024) · Virtual Reality · doi:10.1007/s10055-024-01087-9 · Cited by 14 · see citing works
“Physiologically, virtual natural environments have been shown to reduce stress, as evidenced by heart rate variability (HRV) indicators (Blum et al. 2019; Rockstroh et al. 2020; Kim et al. 2021; Weibel et al. 2023).”
Breathing in virtual reality for promoting mental health: a scoping review
Pancini, E., Natale, A. F. D., & Villani, D. (2025) · Virtual Reality · doi:10.1007/s10055-024-01096-8 · Cited by 13 · see citing works
“…et al. 2014; Schrempf et al. 2022; Soyka et al. 2016; Stromberg et al. 2015; Tinga et al. 2019; Weibel et al. 2023), heart rate variability (HRV) (Blum et al. 2019, 2020; de Zambotti et al. 2022 ; Kniffin et al. 2014; Russel et al. 2014; Shiban et al. 2017; Soyka et al. 2016; Tinga et al. 2019;…”
InfluentialWeerdmeester, J., van Rooij, M. M. J. W., & Granic, I. (2022) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2022.0030 · Cited by 12 · see citing works
“Some evidence shows that biofeedback can influence self-efficacy 21,22 ; however, which specific aspects of biofeedback interventions are linked to this change has not been explored.”
Jyskä, I., Turunen, M., Maleki, A. C., Karppa, E., Palmu, S. A., Mäkelä, J., & Puura, K. (2023) · Healthcare · doi:10.3390/healthcare11243129 · Cited by 12 · see citing works
Frigione, I., Massetti, G., Girondini, M., Etzi, R., Scurati, G. W., Ferrise, F., Chirico, A., Gaggioli, A., & Gallace, A. (2022) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2021.0162 · Cited by 11 · see citing works
“EDA, HR, and respiration rate (RR) were recorded as measures of sympathetic nervous system arousal 7,11,17,23–25 through the ProComp 5 Infiniti (cid:2) system (Thought Technology, Montreal, QC, Canada) and a desktop computer.”
Humbert, A., Kohls, E., Baldofski, S., Epple, C., & Rummel‐Kluge, C. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1271702 · Cited by 10 · see citing works
Jyskä, I., Turunen, M., Maleki, A. C., Karppa, E., Palmu, S. A., Viik, J., Mäkelä, J., & Puura, K. (2023) · Healthcare · doi:10.3390/healthcare11243140 · Cited by 11 · see citing works
Baldini, A., Patron, E., Gentili, C., Scilingo, E. P., & Greco, A. (2024) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2024.3352424 · Cited by 13 · see citing works
“For example, it has been reported that visual feedback is often too abstract or lacks meaningful engagement for the user, potentially leading to boredom [14], [21], [22].”
BackgroundImmersive virtual reality as tool to reduce anxiety during embryo transfer
Guardo, F. D., & Palumbo, M. A. (2022) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2021.1995855 · Cited by 11 · see citing works
Data-Driven Spatio-Temporal Analysis via Multi-Modal Zeitgebers and Cognitive Load in VR
Liao, H., Xie, N., Li, H., Li, Y., Su, J., Jiang, F., Huáng, W., & Shen, H. T. (2020) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr46266.2020.00068 · Cited by 11 · see citing works
Inward VR: Toward a Qualitative Method for Investigating Interoceptive Awareness in VR
Haley, A. C., Thorpe, D., Pelletier, A., Yarosh, S., & Keefe, D. F. (2023) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2023.3247074 · Cited by 11 · see citing works
“Biofeedback could potentially play a role in increasing interoceptive awareness, but VR applications designed for biofeedback tend to focus on objective outcome measures of task performance, such as slowing the heart rate or lowering respiration rate (e.g., [3]).”
BackgroundMoon, D. U., Lütt, A., Kim, H., Seong, S., Park, K. R., Choi, J., Kim, M., & Jeon, H. J. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.04.047 · Cited by 10 · see citing works
Rockstroh, C., Blum, J., Hardt, V., & Göritz, A. S. (2020) · Frontiers in Virtual Reality · doi:10.3389/frvir.2020.598282 · Cited by 10 · see citing works
“This seems to be especially true for sophisticated and immersive simulations, for example via HMDs (de Kort et al., 2006; Villani and Riva, 2012; Liszio et al., 2018; Blum et al., 2019; Rockstroh et al., 2019, 2020).”
BackgroundSelf-citationJerath, R., & Beveridge, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.645289 · Cited by 10 · see citing works
“More recently, VR has been integrated with biofeedback with promising results (76, 77).”
BackgroundZi, S.-S., Ledger, S., Goodman, L., Matthews, B., Jones, D., Fealy, S., Ooi, W. H., & Amin, M. (2023) · Journal of Information Technology Education Innovations in Practice · doi:10.28945/5121 · Cited by 10 · see citing works
“XR applications have also been explored in terms of how they can be used in a variety of therapeutic, well - being, and social good contexts ( Blum et al., 2019; Guil-lén et al., 2018; Roche et al., 2019 ; Rose et al., 2018; Valtchanov et al., 2010).”
BackgroundVirtual Nature and Psychological Outcomes: A Systematic ReviewPreprint
Spano, G., Theodorou, A., Reese, G., Carrus, G., Sanesi, G., & Panno, A. (2022) · doi:10.31219/osf.io/8ux9a · Cited by 10 · see citing works
Scale for time and space experience in anxiety (STEA): Phenomenology and its clinical relevance
Lu, C.-J., Goheen, J., Wolman, A., Angeletti, L. L., Arantes-Gonçalves, F., Hirjak, D., Wolff, A., & Northoff, G. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.04.099 · Cited by 9 · see citing works
Kramer, A. C., Neubauer, A. B., & Schmiedek, F. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2084743 · Cited by 9 · see citing works
“In addition, another difference between the present study and most of the studies supporting relaxing effects of slow-paced diaphragmatic breathing (Blum et al., 2019; Prinsloo et al., 2013) is the use of biofeedback.”
BackgroundResultBarclay, E. G. (2023) · The Open Review · doi:10.47967/tor2022col/vol8.13 · Cited by 8 · see citing works
Mulvaney, P., Rooney, B., Friehs, M. A., & Leader, J. F. (2024) · Virtual Reality · doi:10.1007/s10055-024-00941-0 · Cited by 8 · see citing works
“These findings have motivated the development and study of the efficacy of a series of immersive nature environments, particularly for therapeutic applications (Appel et al. 2020; Blum et al. 2019; Kim et al. 2017).”
An EEG-Based Positive Feedback Mechanism for VR Mindfulness Meditation to Improve Emotion Regulation
Wang, Q., Liu, F., Yang, B., Yang, Z., Huang, J., Xu, Y., Zheng, C., She, Y., Cai, H., & Tian, F. (2025) · IEEE Transactions on Computational Social Systems · doi:10.1109/tcss.2025.3557711 · Cited by 8 · see citing works
“The subtle changes of VR elements achieves a synchronized visualization of the user’s emotional state, allowing for more intuitive self-awareness and fostering motivation and focus [51], [52], [53].”
Mechanisms of Virtual Reality-Based Relaxation in Older Adults: A Scoping Review
Cieślik, B. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176126 · Cited by 9 · see citing works
“…in early studies has improved autonomic indices and psychological outcomes such as relaxation self-efficacy, attentional focus, and engagement [92]; and (iii) VR-based biofeed-back using EEG, galvanic skin response, respiratory feedback, or mindfulness prompts, with preliminary reductions…”
Extended reality interactive wall: User experience design research-creation
See, Z. S., Matthews, B., Goodman, L., Jones, D., Hight, C., Egglestone, P., Amin, M., & Ooi, W. H. (2020) · Virtual Creativity · doi:10.1386/vcr_00030_1 · Cited by 8 · see citing works
Lotfinia, S., Yaseri, A., Jamshidmofid, P., Nazari, F., Shahkaram, H., Yaztappeh, J. S., & Kianimoghadam, A. S. (2024) · Brain and Behavior · doi:10.1002/brb3.70084 · Cited by 7 · see citing works
“These relaxation effects can be detected through physiological indices (e.g., heart rate variability, electrodermal activity, and saliva cortisol) and self-reportedquestionnaires(e.g.,thePositiveandNegativeAffect Schedule and the State-Trait Inventory) (Blum, Rockstroh, and Goritz 2019; Browning et al. 2020).”
BackgroundRobbemond, L. M., Noordzij, M. L., van Driel, C. M. G., & Veling, W. (2026) · Stress and Health · doi:10.1002/smi.70164 · Cited by 9 · see citing works
“…serial subtraction (H. I. Jo et al. 2022), summing random numbers (Jin et al. 2023), the Stroop task which requires colour‐word conflict resolution (Blum et al. 2019; Naylor et al. 2019), the Letter Detection Test, involving rapid visual scanning (Manaf et al. 2021), and the digit span task with…”
InfluentialKang, J., Hong, J., & Lee, Y.-H. (2021) · Asian Nursing Research · doi:10.1016/j.anr.2021.12.002 · Cited by 7 · see citing works
Virtual Reality in Physical Education
Petil, E. D., Florece, M. E. A., Gomez, M. G. A., Villaruel, K. B., Fernandez, H. G. C. Q., Cruz, C. M. B. D., & Ferrer-Rafols, R. B. (2024) · Advances in educational technologies and instructional design book series · doi:10.4018/979-8-3693-3952-7.ch005 · Cited by 7 · see citing works
Howatson, G., Russell, S., Pedlar, C. R., & Halson, S. L. (2025) · Sports Medicine · doi:10.1007/s40279-025-02246-x · Cited by 6 · see citing works
Silva, T. C. A., Bandeira, P. M., Ranzatto, A. D. D. S., Meziat‐Filho, N., Nogueira, L. A. C., Júnior, O. F., & dos Reis, F. J. J. (2020) · Brazilian Journal Of Pain · doi:10.5935/2595-0118.20200187 · Cited by 6 · see citing works
Virtual reality hypnosis diminishes experimental cold pain and alters autonomic responses
Terzulli, C., Chauvin, C., Liberti, C. C.-D., Faisan, S., Goffin, L., Gianesini, C., Graff, D., Dufour, A., Laroche, É., Salvat, É., et al. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1237090 · Cited by 6 · see citing works
“Heart rate variability (HRV), measured as changes in standard deviation from normal to normal (SDNN) and root mean square of successive differences (RMSSD), have been shown to be modulated by VR (26 – 29).”
BackgroundImmersive VR as a Promising Technology for Computer-Supported Mindfulness
De Paolis, L. T., Arpaia, P., D’Errico, G., Gatto, C., Moccaldi, N., & Nuccetelli, F. (2021) · Lecture notes in computer science · doi:10.1007/978-3-030-87595-4_12 · Cited by 5 · see citing works
Grosprêtre, S., Mathiot, J., Eon, P., & Ruffino, C. (2025) · Experimental Brain Research · doi:10.1007/s00221-025-07015-w · Cited by 7 · see citing works
“Previous studies have demonstrated the importance of this factor to the observed effects of VR (Blum et al. 2019).”
Seong, S., Kim, H., Cho, Y., Kim, M., Park, K. R., Choi, J., Lee, S., Kim, D. J., Kim, S. J., & Jeon, H. J. (2025) · Journal of Medical Internet Research · doi:10.2196/65772 · Cited by 5 · see citing works
“Moreover, minimal apparent side effects associated with VR-based BF position it as a safe and innovative intervention for addressing sleep disturbances, particularly for individuals with depressive and anxiety symptoms [11,12,41].”
Influential
- Authors
- Blum, J., Rockstroh, C., & Göritz, A. S.
- Affiliations
- University of Freiburg (DE)
- Corresponding author
- Blum, Johannes
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2019-09-20
- Volume
- 10
- Pages
- 2172-2172
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC6763967
- OpenAlex
- W2973709831
- Cited by
- 183
- References
- 81
- Citations by year
- 2026: 24 · 2025: 32 · 2024: 25 · 2023: 37 · 2022: 24 · 2021: 24 · 2020: 17
- FWCI
- 11.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OPUS (Augsburg University) (submittedVersion, cc-by)
- Funders
- German Research Foundation
- University of Freiburg
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- heart rate variability biofeedback, slow-paced breathing, immersive virtual reality, perceived stress, mind wandering, attentional resources, cardiac coherence, cardiac vagal tone, workers
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