Matteo Campagna
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Heart rate variability biofeedback reduces the anxiety of people who have to perform

2 studies

ForContextAgainst20142016201820202022202420262018, for2018, against2018, context2014, context
Each circle is a study: its position gives the year, its row whether it is for, against or context, its size how many participants it measured. Light circles are studies on other populations or without archers.

There are no studies on archers, and almost everything there is comes from a 2018 systematic review of slow breathing which, among its fifteen papers, counts five on biofeedback, read here only for the healthy participants. The only one in which anxiety falls concerns precisely people who have to perform: dance conservatoire students who after ten sessions had lower anxiety than a group with no intervention, with heart rate variability rising only in those doing biofeedback. In the others anxiety does not fall, even when the heartbeat changes: in healthy young adults biofeedback done before bed raises high frequency power during sleep over the next two nights without changing state anxiety, in another study six sessions change neither variability nor the anxiety questionnaires in the healthy participants, and among the staff of an elite sporting environment five sessions raise variability without touching their strategies for regulating emotion. Biofeedback therefore changes the heartbeat fairly reliably and anxiety only sometimes, and the favourable case is a single study, outside archery and never on the anxiety of a competition.

Also phrased as: "hrv biofeedback for competition nerves"; "training heart rate variability to stay calm"; "biofeedback breathing before competing"; "resonance breathing and performance anxiety"; "heart rate variability training for anxiety"

In practice

Archers are advised to practise slow breathing for a few weeks with a heart rate strap and a biofeedback app, on the grounds that this teaches them to keep competition-day nerves in check.

Evidence

  • 2014
    Context General population Published later

    A review of mechanisms, with no sample of its own. It reports a controlled study from the authors' group: 12 people with four biofeedback sessions against 13 with muscle biofeedback and relaxation. SDNN rises only in the first group, and only there does the heartbeat evoked potential recorded on the scalp change. It is the mechanism by which biofeedback might work, not a measure of anxiety.

    Heart rate variability biofeedback: how and why does it work? · Paul M. Lehrer, Richard Gevirtz

  • 2018
    For General population Published later

    Study reported in the review (Gruzelier and colleagues, 2014): dance conservatoire students, ten biofeedback sessions against a group with no intervention. The standard deviation of the intervals between beats (SDNN) rises only in the biofeedback group and anxiety measured on the DASS scale falls relative to controls, while the creativity tests do not change. It is the only study in the review on people who have to perform, and the only one in which anxiety falls.

    How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing · Andrea Zaccaro, Andrea Piarulli, Marco Laurino, Erika Garbella, Danilo Menicucci, Bruno Neri, Angelo Gemignani

  • 2018
    Against General population Published later

    Study reported in the review (Sakakibara and colleagues, 2013): healthy young adults split between biofeedback, autogenic training and no treatment, with three twenty-minute sessions before bed, according to the review's table. High frequency heart rate power rises during sleep only in the biofeedback group, and stays higher on both following nights, but state anxiety does not differ between the three groups.

    How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing · Andrea Zaccaro, Andrea Piarulli, Marco Laurino, Erika Garbella, Danilo Menicucci, Bruno Neri, Angelo Gemignani

  • 2018
    Against General population Published later

    Study reported in the review (Siepmann and colleagues, 2008): six biofeedback sessions against an active control condition. In the healthy participants neither heart rate variability nor the questionnaires, the State-Trait Anxiety Inventory included, change significantly. The study also included people with depression, who are left out here.

    How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing · Andrea Zaccaro, Andrea Piarulli, Marco Laurino, Erika Garbella, Danilo Menicucci, Bruno Neri, Angelo Gemignani

  • 2018
    Context General population Published later

    Study reported in the review (Gross and colleagues, 2016): support staff and managers in an elite sporting environment, five sessions compared with the baseline measure. Total variability power, SDNN and low frequency power rise; lifestyle habits and the emotion regulation strategies measured with the ERQ do not change, while the habitual use of bodily strategies increases. Anxiety is not measured.

    How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing · Andrea Zaccaro, Andrea Piarulli, Marco Laurino, Erika Garbella, Danilo Menicucci, Bruno Neri, Angelo Gemignani

  • 2018
    Context General population Published later

    Study reported in the review (Lehrer and colleagues, 2003): ten 30-minute sessions with breathing held between 5.4 and 6 breaths a minute. Total variability power stays high in the rest that follows the session, once breathing is free again, and in the last five minutes of each session it is significantly higher than in the first five. It says the effect on the heartbeat outlasts the exercise, not that anxiety falls.

    How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing · Andrea Zaccaro, Andrea Piarulli, Marco Laurino, Erika Garbella, Danilo Menicucci, Bruno Neri, Angelo Gemignani

Status history

  1. 2014 Not studied A review by two leading researchers in biofeedback describes the mechanism: breathing at around six breaths a minute brings the cardiovascular system into resonance, and in a controlled study from their group four sessions were enough to raise heart rate variability, which muscle relaxation alone did not do. It explains how biofeedback changes the heartbeat, but it measures nobody's anxiety, and there is nothing on archers: the question still has no evidence.
  2. 2018 Contradicted A systematic review lines up the biofeedback studies on healthy people, and the picture comes out scattered. Ten sessions reduce anxiety in dance conservatoire students who have to perform; but in healthy young adults biofeedback done before bed raises high frequency power during sleep without changing anxiety, six sessions in another study change nothing in either the physiology or the questionnaires, and among the staff of an elite sporting environment five sessions raise variability without touching emotional regulation. No archers, and every study is read through the review: only one points the way of the claim, two run against it. What evidence there is leans against, and it is indirect: contradicted.

Related

Related articles

Research lines

Cite
APA

Campagna, M. (2026). Heart rate variability biofeedback reduces the anxiety of people who have to perform (Version 2). In Evidence Registry. Retrieved 16 October 2026, from https://matteocampagna.com/en/registry/mind/hrv-biofeedback-performance-anxiety

BibTeX
@misc{campagna2026_biofeedbackhrvansia,
  author = {Campagna, Matteo},
  title = {Heart rate variability biofeedback reduces the anxiety of people who have to perform},
  year = {2026},
  howpublished = {Evidence Registry, matteocampagna.com},
  url = {https://matteocampagna.com/en/registry/mind/hrv-biofeedback-performance-anxiety},
  note = {Version 2; accessed 2026-10-16}
}

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