The influence of heart rate variability biofeedback on cardiac regulation and functional brain connectivity

Abstract

Background Heart rate variability (HRV) biofeedback has beneficial influence on perceived stress and emotion regulation. In this study, we aimed to investigate the effect of an HRV-biofeedback intervention on resting functional brain connectivity in healthy subjects. Methods The 8-week HRV biofeedback training was carried out in five sessions per week using a mobile app. A control group played jump‘n’run games instead of the training. Functional magnetic resonance imaging was conducted before and after the intervention in both groups. To compute resting state functional connectivity (RSFC), we defined regions of interest in the ventral medial prefrontal cortex (VMPFC) and a total of 260 independent anatomical regions for network-based analysis. Additionally, we estimated co-variations of dynamic functional connectivity of the VMPFC and temporal changes of HRV during the resting state recording in all participants before the intervention. Results Temporal changes of HRV co-varied with dynamic changes of prefrontal connectivity, especially to the middle cingulate cortex, left anterior insula, right amygdala, supplementary motor area, dorsal and ventral lateral prefrontal regions. The biofeedback group showed a drop in heart rate by 5.5 beats/min and an increased HRV by 33% after the intervention. Functional connectivity of the VMPFC increased mainly to the right anterior insula, the dorsal anterior cingulate cortex and the dorsolateral prefrontal cortex after biofeedback intervention when compared to changes in the control group. Network-based statistic showed that biofeedback had an influence on a broad functional network of brain regions. Conclusion Our results demonstrate that increased vagal modulation induced by HRV-biofeedback is accompanied by changes in functional brain connectivity during resting state.

Breathing out dental fear: A feasibility crossover study on the effectiveness of diaphragmatic breathing in children sitting on the dentist's chair

“…83 Neuroimaging data support the view that slow breathing acts via vagal pathways by increasing the functional connectivity between prefrontal and limbic networks involved in the emotion regulation. 84,85 Well-replicated evidence now exists, suggesting that increased parasympathetic control of the heart is associated with a reduction in perceived stress, depression, anxiety and fear. [34][35][36][37] It should be noted, however, that in this study, the lack of significant effects on HF-HRV points to a decrease in sympathetic activation (lower LF/HF) rather than pointing to an increase in parasympathetic activation.…”

Heart Rate Variability Covaries with Amygdala Functional Connectivity During Voluntary Emotion Regulation

“…Whilst our study augments prior findings which have heavily relied on associations between HRV and functional connectivity during rest by assessing heart-brain function in an active emotion regulatory context, the current study and the majority of prior work have typically relied on relatively static functional connectivity techniques. Although a few studies have examined transient HRV changes and functional connectivity using dynamic functional connectivity (dFC) techniques such as the sliding window approach (Chand et al, 2020; Chang et al, 2013; Schumann et al, 2021a), this method is limited by its reliance on arbitrary selection of truncated time windows to assess both functional connectivity and HRV, with the latter particularly affected by the shorter duration of the measurement period (Shaffer & Ginsberg, 2017; TaskForce, 1996). It would therefore be fruitful for future research to employ novel and alternative dFC methods that overcome existing constraints (e.g., co-activation pattern analysis; Liu et al, 2013, 2018) to determine associations between HRV and dynamic neural networks underlying adaptive and flexible regulation across the lifespan.…”

“…A growing body of neuroimaging research lends support for the NIM and the link between HRV and emotion regulation-related brain function (Mather & Thayer, 2018; Sakaki et al, 2016; Schumann et al, 2021a; Steinfurth et al, 2018). Consistent with the notion that HRV serves as a measure of effective, inhibitory cortical-subcortical connectivity, individuals with higher HRV exhibit stronger resting medial prefrontal cortex (mPFC)-amygdala functional connectivity (Nashiro et al, 2022; Sakaki et al, 2016).…”

“…Relatedly, a study conducted by Kumral et al (2019) found that young adults with higher resting HRV exhibited stronger bilateral ventromedial prefrontal cortex (vmPFC) connectivity, with this vmPFC seed demonstrating further extended functional connectivity with several CAN regions. Increasing HRV via biofeedback (e.g., slow breathing, Lehrer & Gevirtz, 2014) has also been shown to elevate resting-state functional connectivity of the prefrontal cortex to neural regions implicated in emotional processing (Schumann et al, 2021a). Specifically, increasing HRV via an 8-week HRV biofeedback intervention was reported to enhance resting-state functional connectivity between the vmPFC and various regions outlined in the NIM, including the amygdala, middle cingulate cortex, anterior insula, and lateral PFC (Schumann et al, 2021a).…”

“…Increasing HRV via biofeedback (e.g., slow breathing, Lehrer & Gevirtz, 2014) has also been shown to elevate resting-state functional connectivity of the prefrontal cortex to neural regions implicated in emotional processing (Schumann et al, 2021a). Specifically, increasing HRV via an 8-week HRV biofeedback intervention was reported to enhance resting-state functional connectivity between the vmPFC and various regions outlined in the NIM, including the amygdala, middle cingulate cortex, anterior insula, and lateral PFC (Schumann et al, 2021a). Interestingly, only a few studies to date have assessed HRV and associated neural activity during tasks that require emotional or self-regulatory processes.…”