Applied Psychophysiology and Biofeedback

, Volume 42, Issue 2, pp 139–146 | Cite as

Resonance Frequency Breathing Biofeedback to Reduce Symptoms of Subthreshold PTSD with an Air Force Special Tactics Operator: A Case Study

  • Lorene M. PettaEmail author


The prevalence rates of post-traumatic stress disorder (PTSD) have been estimated to be several times higher in military populations compared to the national average. Special Tactics operators are a group that is more likely to avoid seeking psychological care due to the stigma and other consequences the diagnosis may have on their military careers. There is a need for more effective and less stigmatizing interventions to treat this population. Psychophysiological methods have been proven to be efficacious in treating PTSD, yet have received less attention as an adjunctive intervention. Resonance frequency (RF) biofeedback is a form of cardiorespiratory intervention that has shown promise as an effective treatment. The current case study examined the use of RF biofeedback in combination with other physiological and evidence-based methods as part of a comprehensive treatment approach. The client showed a significant drop from his initial scores on a screening assessment by the end of treatment, and demonstrated continued progress despite a 3-month break from the therapy. This author proposed that the synergistic effects of the multi-phased treatment approach contributed to the client’s progress. Furthermore, a case was made for using multiple techniques when treating subthreshold PTSD and related symptoms within a treatment resistant population.


Resonance frequency breathing biofeedback Heart rate variability Post traumatic stress disorder Stellate ganglion block Special tactics operator 



This author would like to thank the wing and unit level command psychologists for their support and guidance throughout the process of publishing this case study. A special thanks is also extended to the unit Commander. His genuine desire to help the men and women, and their families, in this unit provided the command level support that made this project possible.


Consent to publish this case study was obtained from the client and his spouse.

Compliance with Ethical Standards

Conflict of interest

The author declares that the author has no conflict of interest.


  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  2. Bliese, P. D., Wright, K. M., Adler, A. B., Cabrera, O., Castrol, C. A., & Hoge, C. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272–281.CrossRefPubMedGoogle Scholar
  3. Hickey, A. H., Navaie, M., Stedje-Larsen, E. T., Lipov, E. G., & McLay, R. N. (2013). Stellate ganglion block for the treatment of posttraumatic stress disorder. Psychiatric Annals, 43(2), 87–92.CrossRefGoogle Scholar
  4. Hines, L. A., Sundin, J., Rona, R. J., Wesseley, S., & Fear, N. T. (2014). Posttraumatic stress disorder post Iraq and Afghanistan: Prevalence among military subgroups. Canadian Journal of Psychiatry, 59(9), 468–479.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Institute of Medicine of the National Academies. (2014). Treatment for posttraumatic stress disorder in military and veteran populations. Washington DC: National Academy of Sciences.Google Scholar
  6. Lehrer, P. M. (2007). Biofeedback training to increase heart rate variability. In P. M. Lehrer, R. L. Woolfolk & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed.). (pp 227–248). New York: Guilford Press.Google Scholar
  7. Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 1–9.CrossRefGoogle Scholar
  8. Lipov, E. G., Joshi, J. R., Sanders, S., & Slavin, K. V. (2009). A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical Hypotheses, 72(6), 657–661.CrossRefPubMedGoogle Scholar
  9. Litz, B. T., & Schlenger, W. E. (2009). PTSD in service members and new veterans of the Iraq and Afghanistan wars: A bibliography and critique. PTSD Research Quarterly, 20(1), 1–8.Google Scholar
  10. McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: A review of evidence and dissemination. Expert Review of Neurotherapeutics, 11(8), 1151–1163.CrossRefPubMedGoogle Scholar
  11. Morin, C. M., Belleville, G., Belanger, L., & Ivers, H. (2011). The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601–608.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Mulvaney, S. W., Lynch, J. H., Hickey, M. J., Rawlins, T. R., Schroeder, M., Kane, S., & Lipov, E. (2014). Stellate ganglion block used to treat symptoms associated with combat-related posttraumatic stress disorder: A case series of 166 patients. Military Medicine, 179(10), 1133–1140.CrossRefPubMedGoogle Scholar
  13. Polak, A. R., Witteveen, A. B., Denys, D., & Olff, M. (2015). Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: A pilot study. Applied Psychophysiology & Biofeedback, 40, 25–31.CrossRefGoogle Scholar
  14. Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133, 725–746.CrossRefPubMedGoogle Scholar
  15. Porges, S. (2011). The polyvagal theory. New York: Norton.Google Scholar
  16. Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, posttraumatic stress disorder, and health outcomes. Advances in Mind-Body Medicine, 20, 18–29.PubMedGoogle Scholar
  17. Shanker, T., & Oppel, A. (2014). War’s elite tough guys, hesitant to seek healing. The New York Times. Retrieved June 5, 2014 from
  18. Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Psychophysiology & Biofeedback, 36, 27–35.CrossRefGoogle Scholar
  19. Tan, G., Wang, P., & Ginsberg, J. (2013). Heart rate variability and posttraumatic stress disorder. Biofeedback, 41(3), 131–135.CrossRefGoogle Scholar
  20. Weathers, F. W., Huska, J. A., Keane, T. M., (1991). PCL-M for DSM-IV. Boston: National Center for PTSD- Behavioral Science Division.Google Scholar
  21. Yucha, C. & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: Association for Applied Psychophysiology & Biofeedback.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Air Force Special Operations CommandFort BraggUSA

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