A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder

Donna L Schuman; Karen A Lawrence; Ian Boggero; Peter Naegele; J P Ginsberg; Ashley Casto; Debra K Moser

doi:10.1007/s10484-022-09565-z

A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder

Appl Psychophysiol Biofeedback. 2023 Mar;48(1):51-65. doi: 10.1007/s10484-022-09565-z. Epub 2022 Nov 4.

Authors

Donna L Schuman¹, Karen A Lawrence², Ian Boggero³, Peter Naegele⁴, J P Ginsberg^{5

6}, Ashley Casto⁷, Debra K Moser⁸

Affiliations

¹ School of Social Work, University of Texas at Arlington, 211 South Cooper St, Box 19129, Arlington, TX, USA. donna.schuman@uta.edu.
² College of Social Work, University of Kentucky, Lexington, KY, USA.
³ College of Dentistry, University of Kentucky, Lexington, KY, USA.
⁴ Department of Psychology, Oberlin College, Oberlin, OH, USA.
⁵ Saybrook University, Pasadena, CA, USA.
⁶ College of Medicine, University of Virginia, Charlottesville, VA, USA.
⁷ Lexington VA Health Care System, Lexington, KY, USA.
⁸ College of Nursing, University of Kentucky, Lexington, KY, USA.

PMID: 36331685
DOI: 10.1007/s10484-022-09565-z

Abstract

Many veterans do not complete traditional trauma treatments; others may continue to struggle with posttraumatic stress disorder (PTSD) even after completing a full course of therapy (Blasé et al., in Int J Environ Res Public Health 18(7):Article 3329, https://doi.org/10.3390/ijerph18073329 , 2016). Heart rate variability (HRV) biofeedback (HRVB) is a non-invasive, non-pharmacological, breathing-based cardiorespiratory training technique that can reduce trauma symptoms and improve HRV parameters. Prior studies have demonstrated HRVB is well-tolerated by veterans with PTSD symptoms (Tan et al., in Appl Psychophysiol Biofeedback 36(1):27-35, 10.1007/s10484-010-9141-y, 2011; Schuman and Killian, in Appl Psychophysiol Biofeedback 44(1):9-20, https://doi.org/10.1007/s10484-018-9415-3 , 2019). This randomized wait-list controlled pilot study tested a short mobile app-adapted HRVB intervention in combination with treatment as usual for veterans with military-related PTSD to determine if further investigation was warranted. We assessed veterans' military-related PTSD symptoms, depression symptoms, and HRV time and frequency domain measures at baseline, after three clinical sessions, and one month later. This study combined clinical training and home biofeedback with a smartphone app and sensor to reinforce training and validate adherence. In the intervention group, depression and SDNN significantly improved, and we observed marginally significant improvements for PTSD Cluster B (intrusion) symptoms, whereas no significant improvements were observed in the control group. In addition, the brief protocol was acceptable to veterans with PTSD with over 83% of participants completing the study. However, adherence to home practice was low. Findings suggest brief HRVB interventions can decrease comorbid depression and improve overall autonomic function in veterans with PTSD; however, additional research on home biofeedback is necessary to determine the best strategies to increase adherence and which veterans would benefit from brief HRVB interventions.

Keywords: Biofeedback; Depression; Heart rate variability; Posttraumatic stress disorder; Veterans.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Biofeedback, Psychology / methods
Heart Rate / physiology
Humans
Pilot Projects
Stress Disorders, Post-Traumatic* / therapy
Veterans*