Biofeedback
Can Biofeedback Help With Stress and Anxiety?
Possibly, though the evidence concerns mainly one type. A 2017 meta-analysis of 24 studies found that heart rate variability biofeedback was associated with a large reduction in self-reported stress and anxiety, though its authors say more well-controlled studies are needed. An independent 2019 evidence map could not include any review of biofeedback for anxiety that met its quality standards. For an anxiety disorder, start with a doctor.
Which kind of biofeedback is used for stress?
Several signals can be trained. The meta-analysis below concerns heart rate variability (HRV) biofeedback, in which you watch your heart rate rise and fall with each breath while breathing slowly. Other forms track skin conductance, muscle tension or breathing directly.
What did the 2017 meta-analysis find?
The meta-analysis by Goessl and colleagues, published in Psychological Medicine, pooled 24 studies with 484 participants. According to its abstract:
- Size of the effect: large, both from before to after training and compared with control groups.
- Consistency: the effect did not depend on the year of the study, its risk of bias, the share of women, the number of sessions, or whether participants had an anxiety disorder.
- What was measured: self-reported stress and anxiety.
- The authors’ caution: more well-controlled studies are needed.
Why isn’t the question settled?
Because the independent evidence is thin. The 2019 evidence map in the Journal of General Internal Medicine, which included only good-quality systematic reviews, found none on biofeedback for anxiety that met its criteria. The Association for Applied Psychophysiology and Biofeedback, a professional association, lists biofeedback as efficacious for anxiety; the map’s authors note that some conditions the association lists did not reach the same level in their findings or were excluded because of weak review methods.
Two further limits apply to the 2017 results. The outcomes were people’s own ratings of their stress and anxiety, with no objective measure reported in the abstract. And the analysis covers HRV biofeedback, not every type.
Is it a treatment for an anxiety disorder?
Not as a first step. For generalized anxiety disorder, the NHS names talking therapies, usually cognitive behavioral therapy, and medicines as the main treatments, and says a GP will usually suggest talking therapy before medicine. Biofeedback may sit alongside that care if your clinician agrees, not in place of it.
When to see a doctor
The NHS advises seeing a GP if you think you might have generalized anxiety disorder, or if you have been diagnosed and treatment is not helping. The same page notes that most people feel anxious sometimes and that it does not always mean you have the disorder. If anxiety is shaping your days, a diagnosis comes before any device.
This article is general information, not medical or psychological advice; talk with a licensed clinician about your own situation.