Current Evidence on Heart Rate Variability Biofeedback as a Complementary Anticraving Intervention

J Altern Complement Med. 2018 Nov;24(11):1039-1050. doi: 10.1089/acm.2018.0019. Epub 2018 May 21.


Background: The limited success of conventional anticraving interventions encourages research into new treatment strategies. Heart rate variability biofeedback (HRVB), which is based on slowed breathing, was shown to improve symptom severity in various disorders. HRVB, and certain rates of controlled breathing (CB), may offer therapeutic potential as a complementary drug-free treatment option to help control substance craving.

Methods: This review evaluated current evidence on the effectiveness of HRVB and CB training as a complementary anticraving intervention, based on guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies that assessed a cardiorespiratory feedback or CB intervention with substance craving as an outcome were selected. Effect sizes were calculated for each study. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to evaluate the quality of each study reviewed.

Results: A total of eight articles remained for final review, including controlled studies with or without randomization, as well as noncontrolled trials. Most studies showed positive results with a variety of methodological quality levels and effect size. Current HRVB studies rated moderately on methodological rigor and showed inconsistent magnitudes of calculated effect size (0.074-0.727) across populations. The largest effect size was found in a nonclinical college population of high food cravers utilizing the most intensive HRVB training time of 240 min.

Conclusions: Despite the limitations of this review, there is beginning evidence that HRVB and CB training can be of significant therapeutic potential. Larger clinical trials are needed with methodological improvements such as longer treatment duration, adequate control conditions, measures of adherence and compliance, longitudinal examination of craving changes, and more comprehensive methods of craving measurement.

Keywords: anticraving intervention; complementary; craving; heart rate variability biofeedback; substance use disorder.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Biofeedback, Psychology*
  • Craving / physiology
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Substance-Related Disorders / therapy*
  • Young Adult