The Promise of Heart Rate Variability Biofeedback: Evidence-Based Applications

Introduction Heart rate variability biofeedback (HRVB) has enjoyed a good deal of popularity in recent years. A number of commercial products have been introduced ranging in price from $80 (MyCalmBeat by Brain Resourcet) to over $200 (Alivee by Somatic Vision, Inc.). The advertising for these products claims efficacy for a large number of disorders and, in fact, we are quite optimistic about the potential for these techniques, especially when combined with mindfulness-based interventions (Khazan, 2013). In this article, I will review the state of the empirical literature for the use of HRVBwith and without other clinical components. Wheat and Larkin (2010) reviewed some of the HRVB literature and concluded that ‘‘Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear’’ (p. 229). A substantial number of studies have appeared since that review. As developed in the early 1980s, HRVBwas conceived as an intervention that would target the parasympathetic nervous system (PNS) in contrast to other peripheral techniques that focused the sympathetic nervous system (SNS) ormuscles (see Lehrer, this issue for a history).Wenowthinkof the training as affecting cardiovascular homeostatic reflexes so as to increase flexibility and recovery from fight/flight adaptive situations. In addition, we are now investigating the vagal afferent pathways that may explain some of the central effects described below (MacKinnon, Gevirtz, McCraty, & Brown, 2013). A third pathway has been described by Tracey (2002) and involves the cholinergic or parasympathetic systems regulating the inflammatory response. The following review is organized by these possible mechanisms of action. Much more research will be necessary to elucidate these and other mechanisms, but the trend to organize treatments by mechanistic pathways has become useful in many areas of science.