Psychological and physiological changes following a mindfulness-based intervention integrating breathing training and HRV biofeedback in adults with anxiety disorders

Anxiety disorders are associated with psychological dysregulation and autonomic imbalance. Although mindfulness-based interventions and breathing training have shown potential benefits for anxiety management, evidence regarding their integrated psychological and physiological outcomes remains limited. To examine psychological and physiological changes following a four-week mindfulness-based intervention integrating structured breathing training and HRV biofeedback in adults with anxiety disorders.

A quasi-experimental one-group pretest–posttest design was employed. Thirty adults with anxiety disorders completed a four-week intervention. Anxiety was assessed using the State–Trait Anxiety Inventory (STAI), and heart rate variability (HRV; RMSSD and SDNN) was assessed immediately before and after each weekly session.

Paired-samples t tests examined aggregated pre–post changes, and linear mixed-effects models were used to analyze repeated HRV measurements across the four intervention sessions. State anxiety decreased from 43.83 to 35.87 (− 18.2%), and trait anxiety decreased from 51.27 to 45.37 (− 11.5%), with significant pre–post reductions in both measures (p ≤ .001). Aggregated mean post-session RMSSD and SDNN values were significantly higher than the corresponding mean pre-session values (both p < .001).

However, linear mixed-effects models showed no significant main effect of time or Week × Time interaction for either RMSSD or SDNN (all p > .05). The intervention was associated with significant pre–post reductions in state and trait anxiety. Although aggregated HRV measures showed significant pre–post differences, repeated-measures analyses did not demonstrate consistent changes in HRV across the four sessions.

These preliminary findings warrant confirmation in adequately powered randomized controlled trials. We thank all the participants in our study, without whom this research would not be possible. This research is funded by Taiwan Adventist Hospital.

Yi-Chun Lin and Chien-Chih Chen contributed equally to this work. Department of Psychosomatic Medicine & Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan Department of LOHAS Industry, Fo Guang University, Yilan, Taiwan Department of Health Administration, Tzu Chi University, Hualien, Taiwan The authors declare no competing interests. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Taiwan Adventist Hospital Institutional Review Board (approval number: 111-E-20).