Combining Biofeedback with Stress Management Interventions: A Systematic Review of Physiological and Psychological Effects

  • Nele A. J. De WitteEmail author
  • Inez Buyck
  • Tom Van Daele


Current mental healthcare systems experience difficulties meeting the challenges of a growing population with elevated stress symptoms. Outpatient stress management interventions have already proven to be effective in routine care and recent technological advances now allow to expand such interventions, for example by adding a physiological component like biofeedback. Adding biofeedback to stress management interventions appears promising, but there is a lack of insight into the general conceptualization and evaluation of the resulting interventions, both in relation to psychological and physiological stress indicators. A comprehensive literature search was performed to investigate stress management interventions with a biofeedback component. This systematic review provides an overview of these interventions and explores to what extent they can improve both physiological and psychological indicators of stress. Fourteen RCTs were included. A large diversity was observed in intervention design and effectiveness. Nevertheless, there is preliminary evidence that the use of biofeedback can improve both physiological and psychological indicators of stress. Biofeedback could provide an accessible and low-cost addition to stress interventions. Further research into the effectiveness of different components of biofeedback interventions is needed.


Biofeedback Stress reduction mHealth Effectiveness Heart rate variability 



This work was written within the Carewear project, funded by a VLAIO TETRA grant (Grants IWT.150614 and HBC.2016.0099).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Expertise Unit Psychology, Technology & SocietyThomas More University of Applied SciencesAntwerpBelgium
  2. 2.LUCAS, Centre for Care Research and ConsultancyKU LeuvenLeuvenBelgium

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