Heart rate variability biofeedback: a meta-analysis (Lehrer 2020)

A meta-analysis of 58 randomized controlled studies found a significant small-to-moderate effect favouring heart rate variability biofeedback, not different from other effective treatments. Effects were larger against inactive than active controls, though significant for both.

A plain-language summary from binaural's reading notes, edited by Jude Mc. Last updated 10 November 2026. Not medical advice.

The question: Does heart rate variability biofeedback improve emotional and physical health and performance?

Summarised from the abstract; not read in full.

What it found

• There was a significant small-to-moderate effect favouring heart rate variability biofeedback, not different from other effective treatments.
• The largest effects, each based on a small number of studies, were for anxiety, depression, anger and athletic or artistic performance; the smallest were for PTSD, sleep and quality of life.
• Effects were larger against inactive than active controls, though significant for both.
• No dose effect was found for the number of sessions.
• The authors call it "useful as a complementary treatment".

Limits

• The largest effects each rest on a small number of studies.
• Effects are smaller against active controls than against inactive ones.
• The authors say further research is needed for particular applications.

Where this sits

More in the library on breathing and heart rate variability. For the wider picture, read Resonance breathing.

This is our plain-language reading of the paper. It is not medical advice, and one study rarely settles a question.