Effects of heart rate variability (HRV) biofeedback on HRV and immune response in patients with panic disorder

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The aim of the present study is to analyse the effects of HRV biofeedback on HRV, symptom severity and cytokine concentration in patients diagnosed with panic disorder (PD). Patients with anxiety disorders, especially PD patients, exhibit reduced HRV indices (Friedman, 2007; Pittig, Arch, Lam, & Craske, 2013). First results suggest an association between PD and elevated levels of pro-inflammatory cytokines (Hoge et al., 2009). Prior studies showed that HRV biofeedback is effective in reducing symptoms of mental disorders associated with autonomic dysbalance (e. g. Karavidas et al., 2007; Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011). It has not been explored yet to what extent HRV biofeedback alone could be an effective treatment since most studies implemented HRV biofeedback in addition to treatment as usual. Further it is unknown if HRV biofeedback is capable of modulating cytokine production. Data will be obtained in 66 patients with PD randomly assigned to either HRV biofeedback or active control condition. Patients assigned to the experimental group pass one session of HRV biofeedback training per week over ten weeks. Patients assigned to the control group passed three sessions of an active control condition per week over 2 weeks. At follow-.up six weeks after the last training sessions, HRV, symptom severity and cytokine concentration will be analysed again. This study tests for the first time (1) if HRV biofeedback will be effective in the treatment of PD, and (2) if HRV biofeedback will positively modulate cytokine production.