Skip to main content
SpringerLink
Log in

Heart Rate Variability (HRV) and Posttraumatic Stress Disorder (PTSD): A Pilot Study

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Abstract

Exposure to combat experiences is associated with increased risk of developing Post Traumatic Stress Disorder. Prolonged exposure therapy and cognitive processing therapy have garnered a significant amount of empirical support for PTSD treatment; however, they are not universally effective with some patients continuing to struggle with residual PTSD symptoms. Heart rate variability (HRV) is a measure of the autonomic nervous system functioning and reflects an individual’s ability to adaptively cope with stress. A pilot study was undertaken to determine if veterans with PTSD (as measured by the Clinician-Administered PTSD Scale and the PTSD Checklist) would show significantly different HRV prior to an intervention at baseline compared to controls; specifically, to determine whether the HRV among veterans with PTSD is more depressed than that among veterans without PTSD. The study also aimed at assessing the feasibility, acceptability, and potential efficacy of providing HRV biofeedback as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. Veterans with combat-related PTSD displayed significantly depressed HRV as compared to subjects without PTSD. When the veterans with PTSD were randomly assigned to receive either HRV biofeedback plus treatment as usual (TAU) or just TAU, the results indicated that HRV biofeedback significantly increased the HRV while reducing symptoms of PTSD. However, the TAU had no significant effect on either HRV or symptom reduction. A larger randomized control trial to validate these findings appears warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akselrod, S., Gordon, D., Ubel, F., Shannon, D., Barger, A. C., & Cohen, R. J. (1981). Power spectral analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control. Science, 213, 220–222.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed., text revision). Washington, DC: Author.

  • Appelhans, B. M., & Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10, 229–240.

    Article  Google Scholar 

  • Biosignal Analysis and Medical Imaging Group. (2008). Biosignal Analysis Program.

  • Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214–227.

    Article  PubMed  Google Scholar 

  • Cohen, H., Kotler, M., Matar, M., Kaplan, Z., Miodownik, H., & Cassuto, Y. (1997). Power spectral analysis of heart rate variability in posttraumatic stress disorder patients. Biological Psychiatry, 41, 627–629.

    Article  PubMed  Google Scholar 

  • Cohen, H., Matar, M., Kaplan, Z., & Kotler, M. (1999). Power spectral analysis of heart rate variability in psychiatry. Psychotherapy and Psychosomatics, 68, 59–66.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194–200.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic memories, therapist guide. New York: Oxford University Press.

    Google Scholar 

  • Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive behavioral therapy for PTSD. New York: Guilford Press.

    Google Scholar 

  • Freed, M. C., Yeager, D., Liu, Xian., Gore, K., Engel, C., et al. (2009). Preference-weighted health status of PTSD among veterans: Outcome for cost-effectiveness analysis using clinical data. Psychiatric Services, 60, 1230–1238.

    Article  PubMed  Google Scholar 

  • Friedman, M. J. (2004). Acknowledging the psychiatric cost of war. New England Journal of Medicine, 351, 75–77.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 4, 621–632.

    Article  Google Scholar 

  • Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13–22.

    Article  PubMed  Google Scholar 

  • Kang, H. K., Natelson, B. H., Mahan, C. M., Lee, K. Y., & Murphy, F. M. (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: A population based survey of 30, 000 veterans. American Journal of Epidemiology, 157, 141–148.

    Article  PubMed  Google Scholar 

  • Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., et al. (2007). Preliminary results of an open-label study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback, 32, 19–30.

    Article  PubMed  Google Scholar 

  • Keppel, G., & Wickens, T. (2004). Design and analysis: A researchers’ handbook. Upper Saddle River, NJ: Pearson/Prentice Hall.

    Google Scholar 

  • Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61, 4–12.

    PubMed  Google Scholar 

  • Lehrer, P., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rational and manual for training. Applied Psychophysiology and Biofeedback, 25, 177–191.

    Article  PubMed  Google Scholar 

  • Litz, B. T., Orsillo, S., Kaloupek, D., & Weathers, F. W. (2000). Emotional-processing in PTSD. Journal of Abnormal Psychology, 109, 26–39.

    Article  PubMed  Google Scholar 

  • Milliken, C. S., Auchterlonie, M. S., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA, 298, 2141–2148.

    Article  PubMed  Google Scholar 

  • Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907.

    Article  PubMed  Google Scholar 

  • Nishith, P., Resick, P. A., & Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886.

    Article  PubMed  Google Scholar 

  • Nolan, R. P., Jong, P., Barry-Bianchi, S. M., Tanaka, T. H., & Floras, J. S. (2008). Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review. European Journal of Cardiovascular Prevention & Rehabilitation, 15, 386–396.

    Article  Google Scholar 

  • O’Donnell, M. L., Creamer, M., Elliott, P., & Atkin, C. (2005). Health costs following motor vehicle accidents: The role of posttraumatic stress disorder. Journal of Traumatic Stress, 18, 557–561.

    Article  PubMed  Google Scholar 

  • Orr, S. P., & Roth, W. T. (2000). Psychophysiological assessment: Clinical applications for PTSD. Journal of Affective Disorder, 61, 225–240.

    Article  Google Scholar 

  • Pitman, R. K., Orr, S. P., Forgue, D. F., de Jong, J. B., & Claiborn, J. M. (1987). Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Archives of General Psychiatry, 44, 970–975.

    PubMed  Google Scholar 

  • Pole, N. (2007). The psychophysiology of post traumatic stress disorder: a meta-analysis. Psychological Bulletin, 133, 725–746.

    Article  PubMed  Google Scholar 

  • Resick, P. A., Galovski, T. E., Uhlmansiek, M., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258.

    Article  PubMed  Google Scholar 

  • Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748–756.

    Article  PubMed  Google Scholar 

  • Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric properties of the PTSD Checklist-civilian version. Journal of Traumatic Stress, 16, 495–502.

    Article  PubMed  Google Scholar 

  • Schlenger, W. E., Kulka, R. A., Fairbank, J. A., Hough, R. L., Jordan, B., Marmar, C., et al. (1992). The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder. Journal of Traumatic Stress, 5, 333–363.

    Article  Google Scholar 

  • Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Advances in Mind-Body Medicine, 20, 18–29.

    PubMed  Google Scholar 

  • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17, 354–381.

    Google Scholar 

  • Thought Technology .com. (2009). Thought technology infiniti system. Available at: www.thoughttechnology.com. Retrieved July 1, 2009.

  • Van Der Kolk, B. A. (2006). Clinical implications of neuroscience research in PTSD. Annals of the New York Academy of Sciences, 1071, 277–293.

    Article  PubMed  Google Scholar 

  • Vaschillo, E., Lehrer, P., Rishe, N., & Konstantinov, M. (2002). Heart rate variability biofeedback as a method for assessing baroreflex function: A preliminary study of resonance in the cardiovascular system. Applied Psychophysiology and Biofeedback, 27, 1–27.

    Article  PubMed  Google Scholar 

  • Weathers, F. W., & Litz, B. T. (1994). Psychometric properties of the Clinician-Administered PTSD Scale, CAPS-1. PTSD Research Quarterly, 5, 2–6.

    Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.

  • Zucker, T. L., Samuelson, K. W., Muench, F., Greenberg, M. A., & Gevirtz, R. N. (2007). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study. Applied Psychophysiology and Biofeedback, 34, 134–156.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Michael E. DeBakey Veterans Affair Medical Center, Houston, TX, USA

    Gabriel Tan, Lorie Farmer & Roy John Sutherland

  2. University of Houston, 491 Farish Hall, Houston, TX, 77004, USA

    Tam K. Dao & Roy John Sutherland

  3. Baylor College of Medicine, Houston, TX, USA

    Gabriel Tan, Tam K. Dao & Roy John Sutherland

  4. Alliant International University, San Diego, CA, USA

    Richard Gevirtz

Authors
  1. Gabriel Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tam K. Dao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorie Farmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roy John Sutherland
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Gevirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tam K. Dao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, G., Dao, T.K., Farmer, L. et al. Heart Rate Variability (HRV) and Posttraumatic Stress Disorder (PTSD): A Pilot Study. Appl Psychophysiol Biofeedback 36, 27–35 (2011). https://doi.org/10.1007/s10484-010-9141-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-010-9141-y

Keywords

Search

Navigation