Key result
Psychotherapy shows mixed effects on HRV but consistently links HRV to a positive working alliance.
Why the study?
Evidence concerning the role of vagal tone indexed by heart rate variability in psychotherapy was limited, and no review had summarized these findings.
Does heart rate variability predict clinical outcomes or change in response to psychotherapy?
Systematic Review (n=960)
Does heart rate variability predict clinical outcomes or change in response to psychotherapy?
HRV shows mixed results as a predictor of psychotherapy outcomes but is consistently associated with a positive working alliance, suggesting its potential as a marker of psychophysiological resources.
HRV should not yet guide psychotherapy outcome predictions; leaves open its consistent working alliance association for prospective trials.
Vagal tone is a psychophysiological construct indexed by heart rate variability (HRV) that is associated with emotion regulation, interpersonal abilities, and mental health in non-clinical and clinical populations. However, the evidence concerning its role in psychotherapy is still limited and no review summarizing the obtained results has been reported to date. The present study aims to fill this gap by presenting a systematic review of psychotherapy studies that evaluate patients’ vagal tone regarding process variables and therapy outcomes. The databases SSCI (WoS), EBSCO, and Psychology (ProQuest) database were searched, yielding a total of 23 studies that were qualitatively analyzed. Results showed mixed evidence regarding the predictive value of HRV for clinical outcomes (e.g., symptom level), as well as the effects of psychotherapy on HRV. The association between HRV and working alliance has shown to be consistently positive, although in a smaller number of investigations. Findings are discussed considering HRV assessment conditions and study designs, highlighting the potential value of HRV to inform about the level of psychophysiological resources and autonomic flexibility that individuals bring to therapy.
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Dufey et al. (2023) conducted a systematic review in Various mental health conditions (anxiety, depression, PTSD, somatoform disorders) (n=960). Psychotherapy vs. Control conditions or other therapies was evaluated on Predictive value of HRV for clinical outcomes, effects of psychotherapy on HRV, and association between HRV and working alliance. The systematic review found mixed evidence regarding the predictive value of HRV for clinical outcomes and the effects of psychotherapy on HRV, but a consistently positive association between HRV and working alliance.
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