The Efficacy of an Evidence-Based Biofeedback Intervention to Reduce Anxiety in College Students

Abstract

This study employed a randomized control repeated measures design to determine the effectiveness of a 2-week paced breathing intervention in reducing anxiety symptoms. I randomly assigned 35 healthy college students into the paced breathing group (n = 17) and the control group (n = 18). Participants completed the State-Trait Anxiety Inventory (STAI) and baseline heart rate variability (HRV) during Session-1 and Session-2. Participants in the paced breathing group were trained using HRV biofeedback training (HRV-BT) during both sessions and then practiced at home using a free smartphone application. At baseline, both groups had similar State Anxiety (S-Anxiety) scores and HRV, evidenced by the outcome standard deviation of the NN intervals (SDNN; a measure of HRV). Within-group analyses demonstrated a significant reduction in S-Anxiety for the paced breathing group during Session-1 (Time-1 vs. Time-2) and Session-2 (Time-3 vs. Time-4), p = 0.02 and p [less-than] 0.001, respectively; however, the control group did not. Between-group analyses comparing the paced breathing and control group at baseline (Time-1) to Session-2 (Time-3) did not reveal a significant S-Anxiety reduction; similarly, between-group changes for SDNN were not significant. Lastly, a moderated mediation model explored if the changes in S-Anxiety over time were influenced by participants' Trait Anxiety (T-Anxiety) scores at Time-1 for the participants randomly assigned to the paced breathing or control group. However, the results did not support the overall moderated mediation model using the index of moderated mediation. However, I found that participants with higher levels of T-anxiety at baseline had higher S-Anxiety after the 2-week intervention. In conclusion, the HRV-BT and paced breathing at home for 2 weeks participants significantly reduced short-term anxiety, but the long-term effects were not significant. Furthermore, interventions such as HRV-BT or paced breathing may be an effective coping mechanism for college students to reduce short-term anxiety symptoms.