The effects of biofeedback training on athletes’ mental health and performance: a systematic review and Bayesian meta-analysis
Open accessAbstract
Background: Biofeedback and neurofeedback are increasingly used in sports psychology, yet their overall effectiveness for athletes’ mental health, athletic performance, and cognitive performance remains unclear. Methods: We conducted a systematic review of randomized controlled trials across eight databases and performed Bayesian random-effects meta-analyses. Study selection used ASReview with the SAFE rule; full-text screening was done in Covidence; risk of bias followed Cochrane guidance; certainty of evidence was appraised with GRADE. Results: Forty-one studies met inclusion. Pooled effects were statistically significant across domains: mental health µ(SMD)=0.76 (95% CrI 0.44–1.09), athletic performance µ(SMD)=0.88 (0.69–1.05), and cognitive performance µ(SMD)=0.81 (0.48–1.14). Conclusion: Biofeedback and neurofeedback benefit athletes across mental, athletic, and cognitive outcomes. Given heterogeneity and sample sizes, further rigorous trials are warranted to refine the estimates. Systematic review registration: PROSPERO registration CRD420251015094.
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HRV biofeedback may improve autonomic regulation via resonant frequency breathing, counteracting sympathetic hyperactivity associated with anxiety.
“HRV biofeedback may improve autonomic regulation via resonant frequency breathing, counteracting sympathetic hyperactivity associated with anxiety [25].”
From The Effect of Different Psychological Interventions on Athletes' Competitive Anxiety: A Systematic Review and Bayesian Network Meta-Analysis. (2026) · cites this paper as [25]
The Introduction (page unavailable) links HRV biofeedback to resonance-frequency training and increased parasympathetic activation. The Discussion (page unavailable) links parasympathetic dominance to anxiety reduction and describes breathing adjustments, but does not specifically say that the intervention counteracts sympathetic hyperactivity associated with anxiety. (LLM, conf=0.82)
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“…these findings, showing that biofeedback can effectively help athletes cope with anxiety and stress (Donghai et al., 2024a; Dziembowska, 2015; Tirinnanzi, 2022), By fostering greater interoceptive awareness and top down control over stress reactivity, Biofeedback helps athletes shift from…”
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“HRV biofeedback may improve autonomic regulation via resonant frequency breathing, counteracting sympathetic hyperactivity associated with anxiety [25].”
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“SMR training has also been associated with better decision-making and tactical processing in female youth players [12], aligning with broader findings that modulation of alpha and SMR frequencies can improve attention, working memory, and cognitive flexibility [25].”
Dergaa, I., Dhahbi, W., Dergaa, M. A., Razzak, M., Ceylan, H. İ., Ștefănică, V., Muntean, R. I., & Guelmami, N. (2026) · Sports · doi:10.3390/sports14080360
“A 2025 Bayesian meta-analysis [34] reported that HRV biofeedback produces moderate effects for anxiety reduction and performance, operating through better self-regulation and interoceptive awareness.”
Li, L., Zhao, Z., Li, X., & Yi, Y. (2026) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-026-01888-2
“Finally, advances in virtual reality (VR) and biofeedback have introduced innovative training approaches, including VR-based eye-tracking feedback, neurofeedback combined with VR, and VR interventions that simulate competitive situations [78–80].”
- Authors
- Zhang, X., Chang, Z., Zhao, S., & Ning, Z.
- Affiliations
- Macao Polytechnic University (MO)
- Lanzhou University (CN)
- Corresponding author
- Chang, Zhizhao
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2025-10-21
- Volume
- 16
- Pages
- 1662868-1662868
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC12583207
- OpenAlex
- W4415388121
- Cited by
- 5
- References
- 67
- Citations by year
- 2026: 5
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- biofeedback, neurofeedback, athletes, mental health, athletic performance, cognitive performance, sport psychology
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