Heart rate variability biofeedback and implications for tinnitus, PTSD and chronic pain in veterans: a scoping review

Introduction Tinnitus, post-traumatic stress disorder (PTSD), and chronic pain are prevalent chronic conditions among veterans and frequently co-occur. These conditions have been associated with alterations in autonomic nervous system (ANS) functioning. Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention intended to modulate autonomic regulation. This scoping review aimed to identify HRVB interventions used for tinnitus, PTSD, and chronic pain in veterans and evaluate the extent and characteristics of the existing evidence in this population. Materials and methods A systematic search of PubMed, Embase, and CINAHL was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies examining the effects of HRVB, alone or in combination with other non-pharmacological interventions, on chronic symptoms in veteran-only populations were included. Results Of 69 records identified, five studies met inclusion criteria. Four studies examined HRVB in relation to PTSD symptoms, with mixed findings: two reported improvements in overall PTSD symptoms, while one reported reduction limited to intrusion symptoms. One study also reported improvements in depressive symptoms. A single study examined chronic pain outcomes and reported reductions in perceived pain following HRVB training. No studies investigated HRVB in relation to tinnitus. Across studies, small sample sizes, methodological heterogeneity, and variability in HRV measurement approaches limited comparability and interpretation of findings. Conclusion Current evidence on HRVB in veterans is limited and does not allow conclusions regarding its efficacy as a standalone intervention for PTSD or chronic pain, although it may have potential as an adjunctive or supportive approach. Notably, no studies have examined HRVB in relation to tinnitus in veterans. These findings highlight the need for rigorously designed studies to evaluate the feasibility, safety, and potential relevance of HRVB in well-characterized veteran populations, including those with tinnitus and co-occurring conditions.