Heart rate variability biofeedback increased autonomic activation and improved symptoms of depression and insomnia among patients with major depression disorder
I-Mei Lin 1, 2, Sheng-Yu Fan 3, Cheng-Fan Yen 4, 5, Yi-Chun Yeh 4, 5, Tze‐Chun Tang 4, 6, Mei-Feng Huang 4, 5, Tai Ling Liu 4, 5, Peng-Wei Wang 4, Huang-Chi Lin 4, Hsin-Yi Tsai 1, Yu-Che Tsai 1*
1Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, Taiwan, 2Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan, 3Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan, 4Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan, 5Graduate Institute of Medicine, and Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan , 6Dr. Tang's Psychiatric Clinic and Mind Center, Taiwan
Received: April 7, 2018; Revised: June 3, 2018; Accepted: June 4, 2018; Published online: June 4, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: Autonomic imbalance is considered a psychopathological mechanism underlying major depressive disorder (MDD). Heart rate variability (HRV) is an index for autonomic activation. Poor sleep quality is common among patients with MDD. HRV biofeedback (BF) has been used for regulating autonomic balance among patients with physical illness and mental disorders. The purpose of present study was to examine the effects of HRV-BF on depressive symptoms, sleep quality, pre-sleep arousal, and HRV indices, in patients with MDD and insomnia.
Methods: In this case-controlled study, patients with MDD and Pittsburgh Sleep Quality Index (PSQI) score higher than 6 were recruited. The HRV-BF group received weekly 60-min protocol for 6 weeks, and the control group who have matched the age and sex received medical care only. All participants were assessed on Beck Depression Inventory II, Back Anxiety Inventory, PSQI, and Pre-Sleep Arousal Scale. Breathing rates and electrocardiography were also performed under resting state at pre-testing, and post-testing conditions and for the HRV-BF group, also at 1-month follow-up.
Results: In the HRV-BF group, symptoms of depression and anxiety, sleep quality, and pre-sleep arousal were significantly improved, and increased HRV indices, compared with the control group. Moreover, in the HRV-BF group, significantly improved symptoms of depression and anxiety, decreased breathing rates, and increased HRV indices were detected at post-testing and at 1-month follow-up, compared with pre-testing values.
Conclusions: This study confirmed that HRV-BF is a useful psychosocial intervention for improving autonomic balance, baroreflex, and symptoms of depression and insomnia in MDD patients.
Keywords: heart rate variability biofeedback, major depressive disorder, insomnia


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