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A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder

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Abstract

Many veterans do not complete traditional trauma treatments; others may continue to struggle with posttraumatic stress disorder (PTSD) even after completing a full course of therapy (Blasé et al., in Int J Environ Res Public Health 18(7):Article 3329, https://doi.org/10.3390/ijerph18073329, 2016). Heart rate variability (HRV) biofeedback (HRVB) is a non-invasive, non-pharmacological, breathing-based cardiorespiratory training technique that can reduce trauma symptoms and improve HRV parameters. Prior studies have demonstrated HRVB is well-tolerated by veterans with PTSD symptoms (Tan et al., in Appl Psychophysiol Biofeedback 36(1):27-35, 10.1007/s10484-010-9141-y, 2011; Schuman and Killian, in Appl Psychophysiol Biofeedback 44(1):9–20, https://doi.org/10.1007/s10484-018-9415-3, 2019). This randomized wait-list controlled pilot study tested a short mobile app-adapted HRVB intervention in combination with treatment as usual for veterans with military-related PTSD to determine if further investigation was warranted. We assessed veterans’ military-related PTSD symptoms, depression symptoms, and HRV time and frequency domain measures at baseline, after three clinical sessions, and one month later. This study combined clinical training and home biofeedback with a smartphone app and sensor to reinforce training and validate adherence. In the intervention group, depression and SDNN significantly improved, and we observed marginally significant improvements for PTSD Cluster B (intrusion) symptoms, whereas no significant improvements were observed in the control group. In addition, the brief protocol was acceptable to veterans with PTSD with over 83% of participants completing the study. However, adherence to home practice was low. Findings suggest brief HRVB interventions can decrease comorbid depression and improve overall autonomic function in veterans with PTSD; however, additional research on home biofeedback is necessary to determine the best strategies to increase adherence and which veterans would benefit from brief HRVB interventions.

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Data Availability

The datasets generated by the survey research during and/or analyzed during the current study are available from the corresponding author upon request from other researchers.

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Acknowledgements

We would like to thank Amy Brown, LCSW and Christopher Mead, MSW for assistance with data collection and data management. We express our most sincere appreciation to the members of the Lexington VA Research and Development Team and the Lexington Biomedical Research Institute. We thank Pavleta Ognyanova, MA for proofreading the final manuscript.

Funding

This research was supported by the University of Kentucky Igniting Research Collaborations Grant. This material is the result of work supported with resources and the use of facilities at the Lexington VA Health Care System, Lexington, KY.

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Authors and Affiliations

  1. School of Social Work, University of Texas at Arlington, 211 South Cooper St, Box 19129, Arlington, TX, USA

    Donna L. Schuman

  2. College of Social Work, University of Kentucky, Lexington, KY, USA

    Karen A. Lawrence

  3. College of Dentistry, University of Kentucky, Lexington, KY, USA

    Ian Boggero

  4. Department of Psychology, Oberlin College, Oberlin, OH, USA

    Peter Naegele

  5. Saybrook University, Pasadena, CA, USA

    J. P. Ginsberg

  6. College of Medicine, University of Virginia, Charlottesville, VA, USA

    J. P. Ginsberg

  7. Lexington VA Health Care System, Lexington, KY, USA

    Ashley Casto

  8. College of Nursing, University of Kentucky, Lexington, KY, USA

    Debra K. Moser

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  1. Donna L. Schuman
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Correspondence to Donna L. Schuman.

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Schuman, D.L., Lawrence, K.A., Boggero, I. et al. A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder. Appl Psychophysiol Biofeedback 48, 51–65 (2023). https://doi.org/10.1007/s10484-022-09565-z

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