Skip to main content
SpringerLink
Log in

A Pilot Study on the Effects of Heart Rate Variability Biofeedback in Patients with Depression and in Healthy Subjects

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Abstract

Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in patients with depression. It was aim of the present study to assess the feasibility of using heart rate variability (HRV) biofeedback to treat moderate to severe depression. This was an open-label study in which 14 patients with different degrees of depression (13 f, 1 m) aged 30 years (18–47; median; range) and 12 healthy volunteers attended 6 sessions of HRV biofeedback over two weeks. Another 12 healthy subjects were observed under an active control condition. At follow up BDI was found significantly decreased (BDI 6; 2–20; median 25%–75% quartile) as compared to baseline conditions (BDI 22;15–29) in patients with depression. In addition, depressed patients had reduced anxiety, decreased heart rate and increased HRV after conduction of biofeedback (p < 0.05). By contrast, no changes were noted in healthy subjects receiving biofeedback nor in normal controls. In conclusion, HRV biofeedback appears to be a useful adjunct for the treatment of depression, associated with increases in HRV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Agelink, M. W., Boz, C., Ullrich, H., & Andrich, J. (2002). Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychological Research, 113(1–2), 139–149. doi:10.1016/S0165-1781(02)00225-1.

    Google Scholar 

  • Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    PubMed  Google Scholar 

  • Bennaroch, E. E. (Ed.). (1997). Central autonomic network: functional organization and clinical correlations. Armonck, NY: Futura Publishing Company, Inc.

    Google Scholar 

  • Carney, R. M., Freedland, K. E., Miller, G. E., & Jaffe, A. S. (2002). Depression as a risk factor for cardiac mortality and morbidity. A review of potential mechanisms. Journal of Psychosomatic Research, 53, 897–902. doi:10.1016/S0022-3999(02)00311-2.

    Article  PubMed  Google Scholar 

  • Catipovic-Veselica, K., Galic, A., Jelik, K., et al. (2007). Relation between major and minor depression and heart rate, heart-rate variability, and clinical characteristics of patients with acute coronary syndrome. Psychological Reports, 100(3 Pt2), 1245–1254. doi:10.2466/PR0.100.3.1245-1254.

    Article  PubMed  Google Scholar 

  • Cohen, H., Gibson, G., & Alderman, M. H. (2000a). Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. The American Journal of Medicine, 108(1), 2–8. doi:10.1016/S0002-9343(99)00301-0.

    Article  PubMed  Google Scholar 

  • Cohen, H., Kotler, M., Matar, M., & Kaplan, Z. (2000b). Normalization of heart rate variability in post-traumatic stress disorder patients following fluoxetine treatment: preliminary results. The Israel Medical Association Journal, 2(4), 296–301.

    PubMed  Google Scholar 

  • Del Pozo, J. M., Gevirtz, R. N., Scher, B., & Guarneri, E. (2004). Biofeedback treatment increases heart rate variability in patients with coronary artery disease. American Heart Journal, 147(3), E11. doi:10.1016/j.ahj.2003.08.013.

    Article  PubMed  Google Scholar 

  • Glassman, A. H., Bigger, J. T., Gaffney, M., & Van Zyl, L. T. (2007). Heart rate variability in acute coronary syndrome patients with major depression: influence of sertraline and mood improvement. Archives of General Psychiatry, 64(9), 1025–1031. doi:10.1001/archpsyc.64.9.1025.

    Article  PubMed  Google Scholar 

  • Hassett, A. L., Radvanski, D. C., Vaschillo, E. G., et al. (2007). A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Applied Psychophysiology and Biofeedback, 32, 1–10. doi:10.1007/s10484-006-9028-0.

    Article  PubMed  Google Scholar 

  • Karavidas, M. K., Leherer, P. M., Vaschillo, E., et al. (2007). Preliminary results of an open lable study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback, 32, 19–30. doi:10.1007/s10484-006-9029-z.

    Article  PubMed  Google Scholar 

  • Krittayaphong, R., Cascio, W., Light, K., et al. (1997). Heart rate variability in patients with coronary artery disease: Differences in patients with higher and lower depression scores. Psychosomatic Medicine, 59, 231–235.

    PubMed  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant breathing biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback, 25(3), 177–191. doi:10.1023/A:1009554825745.

    Article  PubMed  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., Vaschillo, B., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805. doi:10.1097/01.PSY.0000089200.81962.19.

    Article  PubMed  Google Scholar 

  • McCraty, R., Atkinson, M., & Tomasino, D. (2003). Impact of a work-place stress reduction program on blood pressure and emotional health in hypertensive employees. The Journal of Complementary and Alternative Medicine, 9(3), 355–369. doi:10.1089/107555303765551589.

    Article  Google Scholar 

  • Mück-Weymann, M. (2002). Die Variabilität der Herzschlagfolge - Ein globaler Indikator für Adaptivität in bio-psycho-sozialen Funktionskreisen. Praxis Klinische Verhaltensmedizin und Rehabilitation, 60, 324–330.

    Google Scholar 

  • Mück-Weymann, M., & Beise, R. (2005). Herzkohärenztraining – eine moderne Form der Stressbewältigung. Forum Stressmedizin, I, 1–5.

    Google Scholar 

  • Mück-Weymann, M., Loew, T., & Hager, D. (1996). Multiparametrisches Bio-Monitoring mit einem computerunterstützten System für psychophysiologische Diagnostik, psychophysiologisch gesteuerte Therapie und Biofeedback. Psycho, 5, 378–384.

    Google Scholar 

  • Mück-Weymann, M., Moesler, T., Joraschky, P., Rebensburg, M., & Agelink, M. W. (2002). Depression modulates autonomic cardiac control: A psyhopsychophysiological pathway linking depression and mortality? German Journal of Psychiatry, 5, 67–69.

    Google Scholar 

  • Mück-Weymann, M., & Rechlin, T. (1996). Reflexes of cutaneous microcirculation in amitriptyline and in fluoxetine treated patients. Psychopharmacology, 124(3), 241–244. doi:10.1007/BF02246663.

    Article  PubMed  Google Scholar 

  • Musselman, D. L., Evans, D. L., & Nemeroff, C. B. (1998). The relationship of depression to cardiovasucular disease. Epidemiology, biology and treatment. Archives of General Psychiatry, 55(7), 580–592. doi:10.1001/archpsyc.55.7.580.

    Article  PubMed  Google Scholar 

  • Nahshoni, E., Aravot, D., Aizenberg, D., et al. (2004). Heart rate variability in patients with major depression. Psychosomatics, 45(2), 129–134. doi:10.1176/appi.psy.45.2.129.

    Article  PubMed  Google Scholar 

  • Nemeroff, C. B., Musselman, D. L., & Evans, D. L. (1998). Depression and cardiac disease. Depression and Anxiety, 8(Suppl 1), 71–79. doi:10.1002/(SICI)1520-6394(1998)8:1+<71::AID-DA11>3.0.CO;2-X.

    Article  Google Scholar 

  • Nolan, R. P., Kamath, M. V., Floras, J. S., & Stanley, J. (2005). Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart control. American Heart Journal, 149(6), 1137. doi:10.1016/j.ahj.2005.03.015.

    Article  PubMed  Google Scholar 

  • Pergola, P. E., Kellogg, D. L., Jr., Johnson, J. M., et al. (1993). Role of sympathetic nerves in the vascular effects of local temperatue in human forearm skin. The American Journal of Physiology, 265(3 Pt 2), H785–H792.

    PubMed  Google Scholar 

  • Rechlin, T., Weis, M., Spitzer, A., & Kaschka, W. P. (1994). Are affective disorders associated with alterations of heart rate variability? Journal of Affective Disorders, 32(4), 271–275. doi:10.1016/0165-0327(94)90091-4.

    Article  PubMed  Google Scholar 

  • Rissanen, A., Naukkarinen, H., Virkunnen, M., Rawlings, R. R., & Linnoila, M. (1998). Fluoxetine normalizes increased cardiac vagal tone in bulimia nervosa. Journal of Clinical Psychopharmacology, 18(1), 26–32. doi:10.1097/00004714-199802000-00005.

    Article  PubMed  Google Scholar 

  • Sattler, H. D., Richter, P., Fritzsche, M., von Turner, A., & Barnett, W. (2000). Neurophysiologic tests during antidepressive treatment—an exploratory study. Pharmacopsychiatry, 33(6), 229–233. doi:10.1055/s-2000-8354.

    Article  PubMed  Google Scholar 

  • Siepmann, M., Grossmann, J., Mück-Weymann, M., & Kirch, W. (2003). Effects of sertraline on autnomic and cognitive functions in healthy volunteers. Psychopharmacology, 168(3), 293–298. doi:10.1007/s00213-003-1448-4.

    Article  PubMed  Google Scholar 

  • Siepmann, M., Joraschky, P., Rebensburg, M., et al. (2005). Is autonomic cardiac control disturbed in patients with depression and coronary artery disease? Zeitschrift für Klinische Psychologie und Psychotherapie, 34(4), 277–281. doi:10.1026/1616-3443.34.4.277.

    Article  Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (Eds.). (1970). State-trait anxiety inventory, manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologist Press.

    Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201–216. doi:10.1016/S0165-0327(00)00338-4.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Rao, K. A., Smitha, M. R., Pohl, R. B., Balon, R., & Srinivasan, K. (2002). Diminished chaos of heart rate time series in patients with major depression. Biological Psychiatry, 51(9), 733–744. doi:10.1016/S0006-3223(01)01347-6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The present work was part of a thesis. The authors are sincerely thankful to Mrs. E. Hempel, for her assistance in conducting the study.

Author information

Authors and Affiliations

  1. Clinic for Psychotherapy and Psychosomatic Medicine, Medical School, Technical University, Dresden, Germany

    Martin Siepmann, Katja Petrowski & Michael Mueck-Weymann

  2. Institute of Clinical Pharmacology, Medical Faculty, Technical University, Fiedlerstr. 27, 01307, Dresden, Germany

    Martin Siepmann, Volkan Aykac & Jana Unterdörfer

  3. Institute of Behavioural Medicine and Prevention, Medical Informatics and Technology, University for Health Sciences, Hall, Austria

    Michael Mueck-Weymann

Authors
  1. Martin Siepmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volkan Aykac
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jana Unterdörfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katja Petrowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Mueck-Weymann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Siepmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siepmann, M., Aykac, V., Unterdörfer, J. et al. A Pilot Study on the Effects of Heart Rate Variability Biofeedback in Patients with Depression and in Healthy Subjects. Appl Psychophysiol Biofeedback 33, 195–201 (2008). https://doi.org/10.1007/s10484-008-9064-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-008-9064-z

Keywords

Search

Navigation