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Lopez-Barbeito, BeatrizAuthor

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March 9, 2025
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Assessing effectiveness of heart rate variability biofeedback to mitigate mental health symptoms: a pilot study

Publicated to: Frontiers In Physiology. 14 1147260- - 2023-05-10 14(), DOI: 10.3389/fphys.2023.1147260

Authors:

Ribeiro, Thais Castro; Sangra, Pau Sobregrau; Pages, Esther Garcia; Badiella, Llorenc; Lopez-Barbeito, Beatriz; Aguilo, Sira; Aguilo, Jordi
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Affiliations

Autonomous Univ Barcelona, Appl Stat Serv, Barcelona, Spain - Author
Autonomous Univ Barcelona, Dept Microelect & Elect Syst, Barcelona, Spain - Author
Biomed Res Network Ctr Biogineering Biomat & Nanom, Madrid, Spain - Author
Hosp Clin Barcelona, Clin Fdn Biomed Res, Barcelona, Spain - Author
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain - Author
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Abstract

Introduction: The increasing burden on mental health has become a worldwide concern especially due to its substantial negative social and economic impact. The implementation of prevention actions and psychological interventions is crucial to mitigate these consequences, and evidence supporting its effectiveness would facilitate a more assertive response. Heart rate variability biofeedback (HRV-BF) has been proposed as a potential intervention to improve mental wellbeing through mechanisms in autonomic functioning. The aim of this study is to propose and evaluate the validity of an objective procedure to assess the effectiveness of a HRV-BF protocol in mitigating mental health symptoms in a sample of frontline HCWs (healthcare workers) who worked in the COVID-19 pandemic.Methods: A prospective experimental study applying a HRV-BF protocol was conducted with 21 frontline healthcare workers in 5 weekly sessions. For PRE-POST intervention comparisons, two different approaches were used to evaluate mental health status: applying (a) gold-standard psychometric questionnaires and (b) electrophysiological multiparametric models for chronic and acute stress assessment.Results: After HRV-BF intervention, psychometric questionnaires showed a reduction in mental health symptoms and stress perception. The electrophysiological multiparametric also showed a reduction in chronic stress levels, while the acute stress levels were similar in PRE and POST conditions. A significant reduction in respiratory rate and an increase in some heart rate variability parameters, such as SDNN, LFn, and LF/HF ratio, were also observed after intervention.Conclusion: Our findings suggest that a 5-session HRV-BF protocol is an effective intervention for reducing stress and other mental health symptoms among frontline HCWs who worked during the COVID-19 pandemic. The electrophysiological multiparametric models provide relevant information about the current mental health state, being useful for objectively evaluating the effectiveness of stress-reducing interventions. Further research could replicate the proposed procedure to confirm its feasibility for different samples and specific interventions.
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Keywords

DepressionEffectiveness of interventionsElectrodermal activityElectrophysiological modelHealthcare workersHeart rate variability biofeedbackMental healthStresStressStress objective assessmentToo

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Frontiers in Physiology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 24/85, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Physiology. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Physiology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.17. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-05, the following number of citations:

  • WoS: 4
  • Europe PMC: 3
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 54.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 54 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.
  • The number of mentions on the social network X (formerly Twitter): 4 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
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Awards linked to the item

This work was supported by the Fondo Supera COVID, funded by the Santander Bank, Conference of Rectors of Spanish Universities (CRUE) and Spanish National Research Council (CSIC).
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