Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression

Appl Psychophysiol Biofeedback. 2020 Jun;45(2):75-86. doi: 10.1007/s10484-020-09458-z.


A rise in the prevalence of depression underscores the need for accessible and effective interventions. The objectives of this study were to determine if the addition of a treatment component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-B ("enhanced") intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original ("standard") intervention. We used a quasi-experimental, non-equivalent (matched) groups design to compare changes in symptoms of depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = 48). Patients in the enhanced group completed a total average of 3.86 h of HRV-B practice across 25.8 sessions, and were more likely to report a clinically significant improvement in depressive symptom score post-intervention than participants in the standard group, even after adjusting for differences in demographics and engagement between groups (adjusted OR 3.44, 95% CI [1.28-9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, remote intervention for depression is feasible and may enhance treatment outcomes.

Keywords: Biofeedback; Depression; Digital health; Heart rate variability; Meditation; Mindfulness; Online intervention; Smartphone app; mHealth.

MeSH terms

  • Adult
  • Biofeedback, Psychology* / instrumentation
  • Biofeedback, Psychology* / methods
  • Cognitive Behavioral Therapy*
  • Feasibility Studies
  • Female
  • Heart Rate* / physiology
  • Humans
  • Male
  • Meditation*
  • Mindfulness / instrumentation
  • Mindfulness / methods
  • Mobile Applications
  • Outcome and Process Assessment, Health Care*
  • Patient Reported Outcome Measures
  • Telemedicine* / instrumentation
  • Telemedicine* / methods