Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis

Early Interv Psychiatry. 2018 Aug;12(4):694-701. doi: 10.1111/eip.12368. Epub 2016 Aug 29.


Aim: Anxiety is a common presenting concern for individuals at clinical high risk (CHR) for psychosis. Treatment for CHR is still in the early stages and has focused on transition to psychosis and positive symptom reduction, but little is known about what may be effective in reducing anxiety for these young people. One treatment that may be effective for anxiety is heart rate variability (HRV) biofeedback. The aim of this study was to test the efficacy and feasibility of using HRV biofeedback to reduce anxiety and distress in those at CHR.

Methods: Twenty participants who met minimum scores for anxiety and distress completed 4 weeks of an HRV biofeedback intervention and received pre- and post-intervention assessments. Repeated measures were used to examine changes in scores over time.

Results: There was a significant decrease in impaired ability to tolerate normal stressors (P ≤ 0.001) and dysphoric mood (P ≤ 0.001) over time. There was no change on self-reported measures of anxiety and distress. However, when two outliers were removed there was a trend towards improvement in self-reported anxiety (P = 0.07). These results were not impacted by including usage time as a covariate. Feedback and adherence were significant.

Conclusions: HRV biofeedback may be a feasible treatment option for individuals at CHR who have concerns with impaired stress tolerance and dysphoric mood. Future studies with a randomized controlled trial design will be necessary to further determine efficacy.

Keywords: anxiety; biofeedback; clinical high risk; heart rate variability; psychosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety / complications
  • Anxiety / therapy*
  • Biofeedback, Psychology / physiology*
  • Female
  • Heart Rate / physiology
  • Humans
  • Male
  • Pilot Projects
  • Prodromal Symptoms*
  • Psychotic Disorders / complications
  • Psychotic Disorders / prevention & control*
  • Self Report
  • Young Adult