Beyond the Breath: Improving Interoceptive Awareness & Autonomic Regulation through Trauma-Informed Biofeedback for Veterans

Posttraumatic stress disorder (PTSD) may be conceptualized as a condition of autonomic nervous system (ANS) imbalance and hyperreactivity, as multiple symptoms are indicative of ANS imbalance (e.g., hypervigilance, exaggerated startle response, etc.). Several meta-analyses found hyperreactivity of the sympathetic nervous system (SNS), reduced basal parasympathetic nervous system (PNS) activity, and exaggerated PNS withdrawal. Additionally, evidence-based psychotherapies (EBPs) for PTSD do not always improve this ANS imbalance, nor the negative health consequences associated with it (i.e., hypertension). As such, providing adjunctive interventions that target this may be beneficial, such as Heart Rate Variability Biofeedback (HRVB). Yet, there is limited research on how adding Trauma Informed HRVB (T-HRVB) may affect HRV and secondary mechanisms of change, such as interoceptive awareness (i.e., awareness of one’s internal responses and their use in self-regulation). The current study aimed to fill this gap by examining the effectiveness of Trauma Informed HRVB (T-HRVB) among outpatient and residential veterans engaged in PTSD programming. Thirty-seven veterans completed T-HRVB while participating in either outpatient or residential treatment. HRV and self-report measures were collected at the beginning and end of T-HRVB. Improvements in both HRV and interoceptive awareness were hypothesized and confirmed, with several HRV variables (e.g., Standard Deviation of Normal to Normal, etc.) significantly increasing, as well as interoceptive listening, trusting, and self-regulation. Thus, these findings provide initial evidence of the impact of implementing biofeedback in active treatment for PTSD. However, future studies should compare T-HRVB to other active approaches.