Does HRV Biofeedback Work as Treatment for PTSD?

In the United States, post-traumatic stress disorder (PTSD) affects approximately 3.5 percent of adults every year; an estimated one in 11 people will be diagnosed with PTSD in their lifetime. As a non-invasive treatment of various stress-related disorders, heart rate variability biofeedback (HRVB) has been gaining significant attention from researchers in recent years; will it prove to be efficient in trauma treatment settings?

It is a condition that develops in some people who have experienced a shocking, scary, or dangerous event: PTSD. During and after a traumatic situation, fear comes naturally. In order to help our bodies defend themselves against, or to avoid, danger, fear triggers a “fight-or-flight” response, explains the UK’s National Institute of Mental Health. Following a trauma, most individuals will experience a range of reactions; however, the majority of cases is characterized by natural recovery from symptoms. Individuals who continue to feel stressed or frightened, even when they are not in danger, may be diagnosed with PTSD.

Symptoms usually begin within about three months of the traumatic incident; in some cases, they only emerge after years. In order to be considered PTSD, symptoms must last more than a month and be severe enough to interfere with relationships or work. Whereas some people recover within six months, others experience longer-lasting symptoms. In some patients, the condition becomes chronic.

Diagnosing PTSD

To be diagnosed with PTSD, adults will, for a minimum of one month, need to have at least: one re-experiencing symptom; one avoidance symptom; two arousal and reactivity symptoms; as well as two cognition and mood symptoms. Anyone can develop PTSD at any age; children and teens can also have extreme reactions to trauma, but some of their symptoms may be different from adults. 

Researchers are looking into risk factors which include experiencing dangerous events, getting hurt, and mental illness or substance abuse. Support from friends and family and coping strategies are among the factors which may promote recovery. Thanks to research going on in genetics and neurobiology, it may be possible at some time in the future to predict who is likely to develop PTSD and how to prevent it. 

Treatments and Therapies

PTSD treatment aims at helping individuals regain a sense of control over their lives. While primary treatment is psychotherapy, it is often combined with medication. Combining these treatments can help improve your symptoms by teaching patients useful skills to address symptoms, induce positive thinking, communicating ways to cope if symptoms return, and treating other problems often related, in particular depression, anxiety, or misuse of alcohol or drugs. 

Psychotherapeutic approaches include cognitive therapy. This talk therapy helps individuals recognize the ways of thinking that are keeping you stuck, e.g. negative beliefs about themselves and the risk of traumatic things recurring. 

Exposure therapy helps patients safely face situations as well as memories they find frightening so that individuals can learn to cope with them effectively. This behavioral therapy has been particularly helpful in cases of flashbacks and nightmares. 

Eye movement desensitization and reprocessing (EMDR) is a further treatment option. It combines exposure therapy with guided eye movements, aiming to help patients process traumatic memories and change how they react.

Heart Rate Variability Enabling a Treatment Option

Heart rate variability (HRV) is measured by the variation in time between each heartbeat. Greater variability indicates greater ability of the autonomic nervous system to regulate itself. This measure of the functioning of the autonomic nervous system reflects an individual’s ability to adaptively cope with stress. As a non-invasive treatment, heart rate variability biofeedback (HRVB) helps patients to self-regulate a physiological dysregulated vagal nerve. 

In an example, a study analyzed whether veterans with combat-related PTSD would show significantly different HRV prior to an intervention at baseline compared to controls. It aimed at determining whether the HRV among veterans experiencing PTSD is more depressed than that among veterans without PTSD. The study also assessed the feasibility, acceptability, and potential efficacy of providing HRVB as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. 

Somewhat more recently, researchers looked into the efficacy of HRVB as an additional psychophysiological treatment for depression and PTSD. A selection from 789 studies showed that, despite an obvious popularity of HRV in literature, HRVB had not really been reviewed systematically. According to the researchers, significant outcomes from six randomized studies indicate there may be a clinical improvement when HRVB training is integrated into treatment of PTSD and depression. This holds true in particular when combined with psychotherapy. More research, study authors underline, needs to be done with larger groups, and further efforts are needed to integrate HRVB into treatment of stress-related disorders. Future research also needs to focus on the psychophysiological mechanisms involved.

The debate about efficacy may be ongoing. Already today, however, patients can use their smartphones to measure HRV. This convenient option provides innovative support of HRVB therapy as an additional psychophysiological treatment for PTSD.