Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta
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Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis Paul Lehrer1 · Karenjot Kaur2 · Agratta Sharma3 · Khushbu Shah4 · Robert Huseby1 · Jay Bhavsar5 · Yingting Zhang1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We performed a systematic and meta analytic review of heart rate variability biofeedback (HRVB) for various symptoms and human functioning. We analyzed all problems addressed by HRVB and all outcome measures in all studies, whether or not relevant to the studied population, among randomly controlled studies. Targets included various biological and psychological problems and issues with athletic, cognitive, and artistic performance. Our initial review yielded 1868 papers, from which 58 met inclusion criteria. A significant small to moderate effect size was found favoring HRVB, which does not differ from that of other effective treatments. With a small number of studies for each, HRVB has the largest effect sizes for anxiety, depression, anger and athletic/artistic performance and the smallest effect sizes on PTSD, sleep and quality of life. We found no significant differences for number of treatment sessions or weeks between pretest and post-test, whether the outcome measure was targeted to the population, or year of publication. Effect sizes are larger in comparison to inactive than active control conditions although significant for both. HRVB improves symptoms and functioning in many areas, both in the normal and pathological ranges. It appears useful as a complementary treatment. Further research is needed to confirm its efficacy for particular applications. Keywords Applied physiology · Rehabilitation · Emotional dysregulation · Disease · Performance This review focuses on heart rate variability biofeedback (HRVB), a method that has become increasingly popular in recent years among psychophysiologically-minded psychotherapists (Kaur et al. 2016; Lehrer 2016, 2018). A growing body of literature has consistently shown that organized variability in heart rate (HR) may be a reasonable index of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10484-020-09466-z) contains supplementary material, which is available to authorized users. * Paul Lehrer [email protected] 1
Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
2
Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
3
St. George’s University School of Medicine, True Blue, W.I., Grenada
4
Richmond University Medical Center, Staten Island, NY, USA
5
Reid Health, Richmond, IN, USA
general health, both physical and emotional (Joyce and Barrett 2019; Kristal-Boneh et al. 1995; McCraty and Shaffer 2015; Perna et al. 2019; Sessa et al. 2018; Young and Benton 2018), and that biofeedback as a method to increase heart rate variability has widespread beneficial effects. The pattern of heart rate variability is complex, but, in the healthy hear
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