2024/01/25 by Jordan Kenemore, Grant Benham, Ruby Charak +2 · 14 citations
Medicine · Psychology · #Anxiety #Attrition #Biofeedback #Clinical psychology #Confidence interval #Emotion and Mood Recognition #Environmental health #Heart Rate Variability and Autonomic Control #Internal medicine #MEDLINE #Medicine #Meta-analysis #Population #PsycINFO #Psychiatry #Psychological intervention #Psychology #Psychosomatic Disorders and Their Treatments #Sample size determination
paper · doi:10.1093/milmed/usae003
published in Military Medicine 189(9-10), e1903-e1909 (Oxford University Press)
openalex publication_date 2024/01/25 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/26
INTRODUCTION: Emerging research has provided tentative support for the use of heart rate variability biofeedback (HRVB) as a treatment for several psychological disorders, with meta-analyses providing compelling evidence for HRVB as a promising treatment for anxiety, depression, and PTSD. Given the prevalence of PTSD in military veterans and the comparatively lower benefit and higher attrition rate of traditional psychological treatment for PTSD relative to civilian counterparts, it is important to examine complementary and alternative treatment approaches such as HRVB in this population. Although studies of HRVB for PTSD have been conducted with military veterans, they have involved relatively small sample sizes, limiting interpretation. To address this, the current article presents a comprehensive meta-analysis, consolidating existing literature to more accurately evaluate the efficacy of HRVB in reducing PTSD symptoms within military populations. MATERIALS AND METHODS: This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and our protocol was registered with PROSPERO to increase review transparency. A literature search of HRVB interventions was conducted using PubMed, PsycINFO, Military Database, PTSDPubs, and EBSCO's Psychological and Behavioral Sciences Collection. RESULTS: Five studies met eligibility criteria, providing a combined sample size of 95 military services members. For all studies, effect sizes were negative, indicating a reduction in PTSD symptoms. Effect sizes ranged from -1.614 to -0.414, resulting in an overall moderate to large mean effect for HRVB (Hedges's g = -0.557; 95% confidence interval = -0.818 to -0.296; P < .001). Additionally, cumulative attrition was 5.8%, significantly lower than commonly reported rates for evidence-based treatments (16%-36%). CONCLUSIONS: The present study is the first meta-analysis to examine HRVB as a treatment for military service members with PTSD. Results indicate that HRVB may be a viable treatment approach to reduce PTSD symptomatology. Low attrition rates, ease of accessibility, and favorable participant outlook serve as additional benefits for the use of HRVB.