Impact of a brief HRV-biofeedback intervention on emotion regulation following a real-life stressful event: A randomized controlled study

BACKGROUND Although studies indicate that Heart Rate Variability Biofeedback (HRV-BFB) interventions seem to increase physiological regulation, their effects on broader aspects of emotion regulation during stress recovery remain inconsistent. The aim of the current study was to investigate the effect of a brief 6-min HRV-BFB intervention on different aspects of emotion regulation and well-being after exposure to a real-life stressor. METHOD For this purpose, a randomized, parallel-group (1:1), controlled and monocentric trial was conducted following exposure to a naturalistic stressor in medical students. This trial investigated the impact of a 6-min HRV-BFB intervention (n = 122), compared to a control intervention (n = 118), on psychophysiological markers of emotion regulation (i.e. cardiac coherence score), psychological well-being (integrating stress, emotional valence, and self-confidence dimensions), and state rumination using linear models. RESULTS The HRV-BFB group showed significant increases in cardiac coherence score across time, confirming the effectiveness of HRV-BFB for enhancing physiological regulation. Compared to the control group, the HRV-BFB group showed slight improvements in psychological well-being. Further analysis revealed that HRV-BFB might buffer against decreases in self-confidence. No significant effect on state rumination was observed. CONCLUSION This study extends prior findings by demonstrating the effectiveness of a brief HRV-BFB intervention in improving physiological regulation and well-being in a naturalistic stress context. In contrast to what theoretical frameworks would suggest, no significant effect on state rumination was found. These findings contribute to understanding how HRV-BFB can be applied in real-world settings to enhance emotion regulation and mental health. Clinical trial registered at clinicaltrials.gov (NCT05136586).