Heart rate variability biofeedback: an investigation into its adoption and benefit in people with autistic spectrum disorder

  • Helen Coulter

Student thesis: Doctoral Thesis


Autistic spectrum disorder (ASD) is a complex neurodevelopmental disorder associated with high levels of anxiety. This study assessed the feasibility of using a complex investigation in a healthcare environment by testing the adoption and usability of heart rate variability (HRV) biofeedback as an intervention to help people with ASD manage anxiety. The first phase entailed patient and public involvement of key stakeholders to develop the study protocol. The second phase involved a small-scale pilot trial with participants with ASD who had been attending mental health services (n = 20, 13- 24 years; 16 males; 4 females; IQ>70). Participants were randomly allocated to an immediate biofeedback group, or a waiting list group who then also received the biofeedback intervention after a 6 week wait. Participants were allocated to one of two different home trainer HRV biofeedback devices (StressEraser or Inner Balance). All participants were offered training and were provided with a biofeedback device for home use over a 12-week intervention period. Pre and post levels of anxiety and depression were measured using questionnaires, whilst HRV was measured using single lead ECG. Pre-post participant reports indicated a significant reduction in anxiety in children (p = 0.04; d = 0.96) and adults (p = 0.006; d =1.39) but no change in depression over the course of the intervention. Pre-post ECG monitoring indicated no change in HRV indices and a significant increase in heart rate (p = 0.01; d = 0.73) during a stress profile assessment. Surveys and usability ratings were collected to assess acceptability of the intervention. The majority of participants were able to use HRV biofeedback devices with reported benefit, however some participants had difficulties using a fingertip sensor device. The feasibility of using HRV biofeedback to manage anxiety in this population in a larger trial was found to be acceptable.
Date of AwardDec 2018
Original languageEnglish
SponsorsPublic Health Agency Northern Ireland
SupervisorGeorge Kernohan (Supervisor) & Mark Donnelly (Supervisor)


  • heart rate variability
  • biofeedback

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