Biofeedback Volume 41: Issue 1

Introduction to the Special Issue

The cover photo shows Dana Schneeberger, a member of the Cleveland Clinic heart transplant research team, going to the operating room to recover an explanted failing heart to be used in laboratory research. The cover article by Christine S. Moravec and Michael G. McKee of the Cleveland Clinic describes how their research on patients awaiting heart transplant has raised hope that biofeedback may benefit patients with chronic heart failure. (My thanks to the Cleveland Clinic for the photo.)

This Special Issue explores “The Promise of Cardio-Plasticity.” The meaning of cardio-plasticity is best understood by the

The Biofeedback Certification International Alliance (BCIA) has developed a certificate of completion program to establish education and training standards for the exciting modality of heart rate variability (HRV) biofeedback. HRV represents the beat-to-beat changes in the intervals between consecutive heartbeats. A growing list of HRV biofeedback applications has earned ratings from possibly efficacious to probably efficacious. BCIA's expert-designed Blueprint of Knowledge and exam promise to increase the academic rigor of didactic HRV biofeedback courses and enhance the knowledge of providers who incorporate this modality into their practice.

Autonomic imbalance is a therapeutic target in heart failure patients. Overactivation of the sympathetic branch of the autonomic nervous system has for years been treated with beta-adrenergic blocking drugs, although it cannot be long before invasive therapies such as renal sympathetic denervation, currently being tested for resistant hypertension, make their way to the heart failure arena. Insufficient parasympathetic input to the heart is already being augmented with implanted vagal nerve stimulators. It is our contention that biofeedback training could provide much of the same benefit as these more invasive therapies in improving autonomic imbalance, with the added advantage of increasing patient self-efficacy. This article describes a pilot study of biofeedback training in patients with end-stage heart failure awaiting heart transplantation. It was our goal to show not only that patients would appreciate this training and benefit from it but also that patient-controlled autonomic modulation could actually reverse the cellular and molecular markers of heart failure, or remodel the failing heart, similar to what we had previously shown for other types of heart failure therapy such as the left ventricular assist device. To our knowledge, this is the first study to demonstrate changes in the biology of the failing heart in response to a psychophysiologic intervention.

Heart rate variability (HRV) is generated by the interaction of multiple regulatory mechanisms that operate on different time scales. This article examines the regulation of the heart, the meaning of HRV, Thayer and Lane's neurovisceral integration model, the sources of HRV, HRV frequency and time domain measurements, Porges's polyvagal theory, and resonance frequency breathing. The medical implications of HRV biofeedback for cardiovascular rehabilitation and inflammatory disorders are considered.

Special Issue: The Promise of Cardio-Plasticity: Psychophysiological Approaches to Cardiovascular Rehabilitation

Introduction to the Special Issue

BCIA Launches a Heart Rate Variability Biofeedback Certificate of Completion

Psychophysiologic Remodeling of the Failing Human Heart

Heart Rate Variability Anatomy and Physiology

How Does Heart Rate Variability Biofeedback Work? Resonance, the Baroreflex, and Other Mechanisms

The Nerve of That Disease: The Vagus Nerve and Cardiac Rehabilitation

Heart Disease: From Psychosocial to Pathophysiological to Treatment with Biofeedback—An Overview

ABSTRACTS: Abstracts of Papers Presented at the 54th Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback

ABSTRACTS: Abstracts of Posters Presented at the 54th Annual Scientific Meeting of AAPB

MEMORIAL: Eleanor Criswell-Hanna, 1938–2024

SPECIAL ISSUE: Lessons Learned: A Pilot Study on the Feasibility of Using Biofeedback Monitoring in a Remote Setting with Special Forces Veterans in Saipan

SPECIAL ISSUE: The ACT of Biofeedback—Training for Psychological Flexibility