The effects of cognitive-behavioural therapy (CBT) on heart rate variability (HRV) in people with depression and/or anxiety disorders: A systematic review and meta-analysis

CBT was associated with improvement in some HRV measures, including HF-HRV, LF-HRV and SDNN, but not RMSSD or several other indices. The review did not test HRV biofeedback and does not yet establish HRV as a clinical treatment-response marker.

Alkout A, Husaini AHBE, Kadan A, Parlatini V, Cortese S, Bellato A.
International Journal of Psychophysiology · Publication date: 2026-10-09
Added to site: 2026-10-12
DOI: 10.1016/j.ijpsycho.2026.113495

Published online October 9, 2026. Added to Neurofeedback.com October 12, 2026 after abstract review.

Modalities

Heart-rate variability measurement, Cognitive-behavioural therapy

Clinical focus

Depression, Anxiety disorders, Physiological treatment markers

Population

Adults with depression and/or anxiety disorders receiving cognitive-behavioural therapy

Sample

12 studies identified; five randomized controlled trials were meta-analyzed and seven studies were narratively reviewed because calculable effects were unavailable

Intervention / method

Embase, PsycINFO, PubMed and Web of Science were searched under PROSPERO protocol CRD420251040957; pooled pre-post effects were estimated with Hedges' g

Comparator

Control conditions in the five randomized trials; the remaining seven studies contributed narrative evidence

Clinician summary

Compared with control, CBT produced significantly greater pre-post increases in HF-HRV, LF-HRV and SDNN across the meta-analyzed randomized trials. LF/HF ratio, RMSSD and triangular index did not change significantly. The authors describe the evidence as emerging and call for higher-quality studies before clinical biomarker use.

How to interpret the findings

Only five randomized trials supplied calculable effects, seven additional studies could not be pooled, and the abstract does not report pooled effect sizes, heterogeneity, risk-of-bias judgments, adverse events or publication-bias analyses. HRV index findings were mixed, and physiological change should not be treated as proof of symptom improvement or biofeedback efficacy.

Equipment and disclosures

This review evaluated HRV measurement around CBT, not HRV biofeedback or a specific device. The checked abstract does not support any vendor attribution.

Funding and competing-interest statements were not available in the checked abstract and PubMed record. The review was registered as PROSPERO CRD420251040957.

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