Table 1.
Features of Studies Investigating Heart Rate Variability Biofeedback and Substance Craving
| Reference | Sample | Substance/diagnosis | HRVB training | Control | Craving measure | Findings |
|---|---|---|---|---|---|---|
| Eddie et al.39 | 20–25 years 100% male 28-day intensive inpatient United States |
Polysubstance SUD + Co-occurring Axis-I and Axis-II diagnoses |
n = 20; one 60–75 min session/week over 3 weeks (Total: 180–225 min) Handheld emWave device (20 min twice daily practice) |
n = 21 Rehabilitative treatment as usual (TAU) |
Adjusted PACS | HRVB intervention vs. control comparison Larger mean craving reduction (35.8% vs. 27.3%; t(39) = 0.99, p > 0.05) No chronic HRV changes at post-treatment baseline HRVB dose–response effect was not reported |
| Meule et al.18 | 18–40 years 11% male Nonclinical University setting Germany |
None; High food cravers selected |
n = 14; Twelve 20-min sessions over 4 weeks (Total: 240 min) No home practice |
Non-craving-control (NCC; n = 28) Craving-control (CC; n = 14) No treatments provided |
FCQ-T | HRVB intervention vs. control comparison Larger mean craving reduction in the HRVB group (13%; t(13) = 2.81, p < 0.05) vs. the NCC (7%; t(27) = 2.90, p < 0.01). No changes in CC. Stronger standard effect sizes in HRVB group (0.95) than in CC (0.01) and NCC (0.32) Vagal-cardiac control: No changes in HRVB group vs. decrease in CC |
| Penzlin et al.40 | 25–59 years 71% male Inpatient rehabilitation Germany |
Alcohol use disorder |
n = 24; Three 20-min sessions/week over 2 weeks (Total: 120 min) No home practice |
n = 24 Rehabilitative TAU |
OCDS | HRVB intervention vs. control comparison Larger mean craving reduction at week 2 (37.2%, p < 0.05 vs. nonsignificant change), smaller craving reduction at week 3 (45.2% vs. 68.9%; p < 0.05) and week 6 (44.5% vs. 72.4%; p < 0.05) Nonsignificant trend toward increase in CVNN following HRVB compared to baseline and control |
| Zucker et al.66 | 18–60 years 55% male Urban residential program (6 months to 1 year); United States |
Polysubstance SUD + elevated PTSD symptoms |
n = 19; 30-min StressEraser device training preintervention 20 min daily home practice over 4 weeks |
n = 19; Progressive Muscle Relaxation (PMR) 20 min daily over 4 weeks |
1 item (10-point scale); no craving to extreme craving | HRVB intervention vs. control comparison Larger mean craving reduction trend (40.9% vs. −1.6%; F(1, 34) = 2.52, p = 0.2) Increases in SDNN* at postintervention baseline (t(15) = −2.4, p = 0.03) vs. no changes in PMR group No dose–response effect found with no differences between high and low users of the StressEraser |
CC, craving-control; CVNN, coefficient of variation of normal-to-normal intervals; FCQ-T, food craving questionnaire-trait; HRV, heart rate variability; HRVB, heart rate variability biofeedback; NCC, non-craving-control; OCDS, obsessive compulsive drinking scale; PACS, Pennsylvania alcohol craving scale; PMR, Progressive Muscle Relaxation; SDNN, standard deviation of normal-to-normal intervals; SUD, substance use disorder; TAU, treatment as usual.