Archive (2016–2006)

Heart Rate Variability Biofeedback Stress Relief Program for Depression

Journal: Methods of Information in Medicine
Subtitle: A journal stressing, for more than 50 years, the methodology and scientific fundamentals of organizing, representing and analyzing data, information and knowledge in biomedicine and health care
ISSN: 0026-1270
Issue: 2017 (Vol. 56): Issue 6 2017
Pages: 419-426
Ahead of Print: 2017-07-19

Heart Rate Variability Biofeedback Stress Relief Program for Depression

A Replicated Single-Subject Design

Focus theme - Original Article

Supplementary Material

B. M. A. Hartogs (1), A. Bartels-Velthuis (1, 2), K. Van der Ploeg (1), E. H. Bos (2)

(1) Lentis Mental Health Organizaion, Center for Integrative Psychiatry, Groningen, the Netherlands; (2) University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands


Depression, Heart rate variability, resilience, stress reduction


Background: Depressive disorders often have a chronic course and the efficacy of evidence-based treatments may be overestimated. Objective: To examine the effectiveness of the Heart Rate Variability Stress Reduction Program (SRP) as a supplement to standard treatment in patients with depressive disorders. Methods: The SRP was individually administered in eight weekly sessions. Seven participants completed the full protocol and were enrolled in a single-subject ABA multiple baseline experimental design. To perform interrupted time-series analyses, daily measures were completed in a diary (depression, resilience, happiness, heart coherence and a personalized outcome measure). Results: Five out of seven patients improved in depressed mood and/or a personalized outcome measure. The effect of treatment was reversed in four patients during the withdrawal phase. One patient reliably improved on depression, whereas two patients recovered on autonomy and one on social optimism. No consistent relationship was found between the heart rate variability-related level of coherence and self-reported mood levels. Conclusions: The SRP is beneficial in some domains and for some patients. A prolonged treatment or continued home practice may be required for enduring effects. The intervention had more clinical impact on resilience-related outcome measures than on symptoms. The small sample size does not permit generalization of the results. We recommend future investigation of the underlying mechanisms of the SRP.

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