Evidence map›Paper›PMID 42558150›Full record

ReviewJournal of medical extended reality2025

Media-Dependent Effects in Heart Rate Variability Biofeedback: A Systematic Review of Extended Reality and Screen-Based Training Approaches.

Nathan Miner, Karmen Gill, Casper Harteveld, Christopher Bono, Darshan H Mehta

Abstract readReview
In one paragraph

Review in Journal of medical extended reality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Nathan MinerDepartment of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0003-2440-8521
Karmen GillDepartment of Biology, Union College, Schenectady, New York, USA.
Casper HarteveldCollege of Arts, Media and Design, Northeastern University , Boston, Massachusetts, USA.
Christopher BonoDepartment of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.
Darshan H MehtaBenson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Heart rate variability (HRV) is an indicator of autonomic nervous system function and cardiovascular health. Through biofeedback (BF), individuals can increase their HRV, which is ideal, by using audiovisual cues to monitor and adjust their breathing. HRV-BF training has demonstrated effectiveness in alleviating stress and anxiety, enhancing cardiac autonomic function, and supporting psychological treatments for conditions, such as depression and chronic pain. Despite their benefits, traditional HRV-BF approaches are limited by the need for frequent clinical visits, specialized equipment, and trained personnel, limiting accessibility and scalability. Extended reality (XR) technologies, including virtual reality, augmented reality, and mixed reality, offer a promising alternative by creating immersive, interactive environments that can deliver HRV-BF without traditional constraints. This review examines the available literature on reported differences in user experience (UX), HRV metrics, psychological outcomes, and BF performance, which are documented by research comparing HRV-BF using XR media to traditional screen-based methods. We searched PubMed, PsycINFO, Embase, Cochrane, Science Direct, ACM, and IEEE databases. Our search yielded 382 results. Four studies met our review criteria. Using HRV-BF research reporting guidelines, we extracted and summarized study objectives, design strategies, hypotheses, and related outcomes to evaluate the evidence for media-dependent effects. Findings indicate that both XR and screen-based implementations of HRV-BF positively affect HRV physiology. Furthermore, XR-based HRV-BF implementations showed more pronounced effects on outcomes for psychological and UX variables. These studies suggest that XR media can offer advantages in terms of user engagement and psychological benefits (e.g., stress relief, relaxation) over traditional screen-based modalities. Improvements in UX and psychological outcomes stem from the relaxing, immersive contexts created in XR, supporting user motivation and attentional control during XR-based HRV-BF training. However, design-based inquiries and longitudinal studies are needed to understand the role of design and the potential of the specific mechanisms contributing to these results.

Indexed as

augmented realitybiofeedbackextended realityhealth applicationsheart rate variabilitymixed realitysystematic reviewvirtual realitywearable sensors

Identifiers

PMID42558150
PMCPMC13387249

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.