Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder

Int J Psychophysiol. 2018 Sep;131:96-101. doi: 10.1016/j.ijpsycho.2018.01.001. Epub 2018 Jan 5.


Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD.

Keywords: Biofeedback; Heart rate variability; Major depressive disorder; Psychotherapy.

MeSH terms

  • Adolescent
  • Adult
  • Baroreflex / physiology
  • Biofeedback, Psychology / methods*
  • Depressive Disorder, Major / physiopathology*
  • Depressive Disorder, Major / rehabilitation*
  • Female
  • Follow-Up Studies
  • Heart Rate / physiology*
  • Humans
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Treatment Outcome
  • Young Adult