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. 2023 May 10:14:1147260.
doi: 10.3389/fphys.2023.1147260. eCollection 2023.

Assessing effectiveness of heart rate variability biofeedback to mitigate mental health symptoms: a pilot study

Thais Castro Ribeiro  1   2 , Pau Sobregrau Sangrà  3 , Esther García Pagès  2 , Llorenç Badiella  4 , Beatriz López-Barbeito  5 , Sira Aguiló  5 , Jordi Aguiló  1   2
Affiliations

Assessing effectiveness of heart rate variability biofeedback to mitigate mental health symptoms: a pilot study

Thais Castro Ribeiro et al. Front Physiol. .

Abstract

Introduction: The increasing burden on mental health has become a worldwide concern especially due to its substantial negative social and economic impact. The implementation of prevention actions and psychological interventions is crucial to mitigate these consequences, and evidence supporting its effectiveness would facilitate a more assertive response. Heart rate variability biofeedback (HRV-BF) has been proposed as a potential intervention to improve mental wellbeing through mechanisms in autonomic functioning. The aim of this study is to propose and evaluate the validity of an objective procedure to assess the effectiveness of a HRV-BF protocol in mitigating mental health symptoms in a sample of frontline HCWs (healthcare workers) who worked in the COVID-19 pandemic. Methods: A prospective experimental study applying a HRV-BF protocol was conducted with 21 frontline healthcare workers in 5 weekly sessions. For PRE-POST intervention comparisons, two different approaches were used to evaluate mental health status: applying (a) gold-standard psychometric questionnaires and (b) electrophysiological multiparametric models for chronic and acute stress assessment. Results: After HRV-BF intervention, psychometric questionnaires showed a reduction in mental health symptoms and stress perception. The electrophysiological multiparametric also showed a reduction in chronic stress levels, while the acute stress levels were similar in PRE and POST conditions. A significant reduction in respiratory rate and an increase in some heart rate variability parameters, such as SDNN, LFn, and LF/HF ratio, were also observed after intervention. Conclusion: Our findings suggest that a 5-session HRV-BF protocol is an effective intervention for reducing stress and other mental health symptoms among frontline HCWs who worked during the COVID-19 pandemic. The electrophysiological multiparametric models provide relevant information about the current mental health state, being useful for objectively evaluating the effectiveness of stress-reducing interventions. Further research could replicate the proposed procedure to confirm its feasibility for different samples and specific interventions.

Keywords: effectiveness of interventions; electrophysiological model; healthcare workers; heart rate variability biofeedback; mental health; stress; stress objective assessment.

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Conflict of interest statement

Since 16th June 2022, the co-author PSS has been employed by Frontiers Media SA. PSS declared his/her affiliation with Frontiers, and the handling Editor states that the process nevertheless met the standards of a fair and objective review. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Scheme of the 5-session experimental protocol. The colors identify the different steps in each of the sessions. Those marked in gray represent the biofeedback training.
FIGURE 2
FIGURE 2
Schematic procedure for physiological response measurement PRE- and POST-intervention.
FIGURE 3
FIGURE 3
Severity classification of subjects based on the psychometrics cut-off points at PRE- and POST-intervention. (A) Stress perception with the Visual Analog Stress Scale (VASS), (B) risk to develop PTSD with Posttraumatic Stress Disorder Checklist for DSM-5 (PCL5), (C) perceived stress with the Perceived Stress Scale (PSS), (D) anxiety state with State Anxiety Inventory (STAI-S), (E) anxiety trait with Trait Anxiety Inventory (STAI-T), and (F) depression with Patient Health Questionnaire-9 (PHQ9).
FIGURE 4
FIGURE 4
Chronic stress level at PRE- and POST-intervention measured by the multiparametric chronic stress model (ESBSm). Key: p < 0.05.
FIGURE 5
FIGURE 5
Boxplot of HRV parameters: (A) HR, (B) SDNN, (C) LF, and (D) PAT over the stages and conditions. Key: Light gray boxes show the significant differences between stages for each condition. (#) Differences between BM and the other stages (SE or RM). (+) Differences between RM and SE stages. p < 0.05.
FIGURE 6
FIGURE 6
Boxplot of EDA and ST parameters: (A) Tonic, (B) Phasic, (C) EDASymp, and (D) TGradient, over the stages and conditions. Key: Light gray boxes show the significant differences between stages for each condition. (#) Differences between BM and the other stages (SE or RM). (+) Differences between RM and SE stages. p < 0.05.
FIGURE 7
FIGURE 7
Boxplot of (A) respiratory rate (RR) and (B) ES3 acute stress model over the stages and conditions. Key: p < 0.05.
See this image and copyright information in PMC

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