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Updated: Aug 7, 2026
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The use of Biofeedback in Clinical Virtual Reality: The INTREPID Project
Published on: November 12, 2009
Media-Dependent Effects in Heart Rate Variability Biofeedback: A Systematic Review of Extended Reality and
Nathan Miner1,2, Karmen Gill3, Casper Harteveld2
1Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.
Journal of Medical Extended Reality
|August 6, 2026
Summary
Extended reality (XR) biofeedback (BF) training shows improved psychological outcomes and user experience compared to traditional methods. This approach enhances heart rate variability (HRV) training by leveraging immersive technology for better stress relief and engagement.
Area of Science:
- Integrative Medicine and Health Technologies
- Psychophysiology and Biofeedback Applications
- Human-Computer Interaction in Health
Background:
- Heart rate variability (HRV) biofeedback (BF) is a validated technique for improving autonomic function and psychological well-being.
- Traditional HRV-BF methods face limitations in accessibility and scalability due to reliance on clinical settings and specialized equipment.
- Extended reality (XR) technologies present an innovative medium for delivering immersive and accessible HRV-BF interventions.
Purpose of the Study:
- To systematically review and compare the efficacy of XR-based HRV-BF versus traditional screen-based HRV-BF.
- To evaluate differences in user experience (UX), physiological HRV metrics, and psychological outcomes between XR and screen-based modalities.
- To assess the potential of XR to enhance engagement and therapeutic benefits in HRV-BF training.
Main Methods:
- A comprehensive literature search was conducted across major scientific databases (PubMed, PsycINFO, Embase, Cochrane, Science Direct, ACM, IEEE).
- Four studies meeting the review criteria were selected for analysis, focusing on comparisons between XR and screen-based HRV-BF.
- Data extraction followed HRV-BF research reporting guidelines, summarizing objectives, design, hypotheses, and outcomes to identify media-dependent effects.
Main Results:
- Both XR and screen-based HRV-BF implementations demonstrated positive effects on HRV physiology.
- XR-based HRV-BF interventions yielded more significant improvements in psychological outcomes and user experience (UX) compared to screen-based methods.
- Enhanced user engagement and psychological benefits, such as stress reduction and relaxation, were observed with XR modalities, attributed to immersive contexts.
Conclusions:
- XR-based HRV-BF offers a promising, potentially more effective alternative to traditional methods, particularly for enhancing psychological well-being and user engagement.
- The immersive and relaxing nature of XR environments appears to contribute to improved motivation and attentional control during HRV-BF training.
- Further research, including design-focused inquiries and longitudinal studies, is necessary to fully elucidate the mechanisms and optimize the application of XR in HRV-BF.
