Heart rate variability biofeedback and implications for tinnitus, PTSD and chronic pain in veterans: a scoping review

A small veteran evidence base suggests HRV biofeedback may be useful as a supportive approach for some PTSD or chronic-pain symptoms. The review found no veteran study of HRV biofeedback for tinnitus and cannot establish it as a stand-alone treatment.

Mainville MO, Lacasse-Rioux É, Noreña AJ, Vallet GT, Fournier P.
Frontiers in Audiology and Otology · Publication date: 2026-09-24
Added to site: 2026-09-27
DOI: 10.3389/fauot.2026.1917408

Original publication date verified from the publisher and Crossref. This source date is separate from the site's addition date.

Modalities

HRV biofeedback, Biofeedback

Clinical focus

Veterans, PTSD, Chronic pain, Tinnitus

Population

Veteran-only studies addressing PTSD symptoms, chronic pain or related chronic symptoms; no eligible tinnitus study was found

Sample

69 records screened and 5 studies included; the review did not report a pooled participant denominator

Intervention / method

Systematic searches of PubMed, Embase and CINAHL for HRV biofeedback alone or combined with standard care or another non-pharmacological intervention

Comparator

Heterogeneous study designs and controls across five included studies; no pooled effect estimate

Clinician summary

Four studies addressed PTSD, with two reporting overall symptom improvement and one an intrusion-only reduction. One chronic-pain study reported lower perceived pain. No included study tested tinnitus, and none linked change in HRV metrics statistically to change in clinical symptoms.

How to interpret the findings

Only five small, heterogeneous studies qualified. Designs, devices, HRV metrics, sampling rates, intervention formats and outcomes varied, some analyses did not clearly test treatment-control differences, only one study assessed longer-term effects, and methodological quality limited causal interpretation. Absence of reported negative effects is not a substitute for systematic safety assessment.

Equipment and disclosures

Devices and HRV acquisition methods varied across included studies, including ECG and pulse-based approaches; the review emphasizes that they are not interchangeable without measurement caveats.

Supported by the Chronic Pain Centre of Excellence for Canadian Veterans and the Mitacs Accelerate program; funders reportedly had no role in the work. The authors declared no commercial or financial conflicts and disclosed Microsoft Copilot use for language editing.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Electroencephalographic gamma correlates with pain intensity attenuation in a prospective longitudinal study using an AI-powered digital device for pain self-management · Mixed
• A Randomized Controlled Study of Neurofeedback for Chronic PTSD. · Positive with limitations
• Combining neurofeedback with source estimation: Evaluation of an sLORETA neurofeedback protocol for chronic tinnitus treatment. · Mixed
• Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury. · Positive with limitations