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NCT03458910: HRV-ER

Heart Rate Variability and Emotion Regulation

Terminated NA Results posted Last updated 23 July 2025
What this trial tests

NA trial testing HRV training in Heart Rate Variability in 193 participants. Terminated before completion.

Timeline
14 February 2018
Primary endpoint
13 March 2020
5 May 2020

Quick facts

Lead sponsorUniversity of Southern California
PhaseNA
StatusTerminated
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposebasic science
Enrollment193
Start date14 February 2018
Primary completion13 March 2020
Estimated completion5 May 2020
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

University of Southern California

Who can join

Adults 18 to 80, any sex, with Heart Rate Variability. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

mPFC-right Amygdala Resting-state Functional Connectivity for Younger Adults (ANOVA) Primary · Time 1 (Baseline), Time 2 (5 weeks)

The strength of resting-state functional connectivity was measured by correlation coefficients. Values represent the correlation of BOLD time-series between mPFC and the right amygdala. Higher values indicate greater connectivity.

Time 1
GroupValue95% CI
Younger HRV-increase Group0.104± 0.105
Younger HRV-decrease Group0.086± 0.015
Time 2
GroupValue95% CI
Younger HRV-increase Group0.116± 0.015
Younger HRV-decrease Group0.090± 0.015
mPFC-right Amygdala Resting-state Functional Connectivity for Older Adults (ANOVA) Primary · Time 1 (Baseline), Time 2 (5 weeks)

The strength of resting-state functional connectivity was measured by correlation coefficients. Values represent the correlation of BOLD time-series between mPFC and the right amygdala. Higher values indicate greater connectivity.

Time 1
GroupValue95% CI
Older HRV-increase Group0.109± 0.045
Older HRV-decrease Group0.140± 0.046
Time 2
GroupValue95% CI
Older HRV-increase Group0.125± 0.046
Older HRV-decrease Group0.095± 0.047
mPFC-right Amygdala Resting-state Functional Connectivity for Younger Adults (Post-Pre) Primary · Time 1 (Baseline), Time 2 (5 weeks)

The strength of resting-state functional connectivity between mPFC and the right amygdala was measured by correlation coefficients. The difference in functional connectivity between the two time points (Time 2 - Time 1) was calculated. Higher values indicate greater connectivity at Time 2 than Time 1 (or post- than pre-intervention).

GroupValue95% CI
Younger HRV-increase Group0.011± 0.022
Younger HRV-decrease Group-0.016± 0.024
mPFC-right Amygdala Resting-state Functional Connectivity for Older Adults (Post-Pre) Primary · Time 1 (Baseline), Time 2 (5 weeks)

The strength of resting-state functional connectivity between mPFC and the right amygdala was measured by correlation coefficients. The difference in functional connectivity between the two time points (Time 2 - Time 1) was calculated. Higher values indicate greater connectivity at Time 2 than Time 1 (or post- than pre-intervention).

GroupValue95% CI
Older HRV-increase Group0.016± 0.072
Older HRV-decrease Group-0.045± 0.046
Emotion Regulation in Younger Adults (Behavior) Secondary · Time 1 (Baseline), Time 2 (5 weeks)

Emotional intensity ratings, which participants reported during the emotion regulation task inside MRI scanner before and after intervention. The ratings ranged from 1 through 4, and 4 represents strongest intensity.

Time 1: down-regulation
GroupValue95% CI
Younger HRV-increase Group1.841± 0.080
Younger HRV-decrease Group1.822± 0.085
Time 1: viewing
GroupValue95% CI
Younger HRV-increase Group2.073± 0.084
Younger HRV-decrease Group2.309± 0.089
Time 1: up-regulation
GroupValue95% CI
Younger HRV-increase Group3.141± 0.072
Younger HRV-decrease Group3.271± 0.076
Time 2: down-regulation
GroupValue95% CI
Younger HRV-increase Group1.861± 0.075
Younger HRV-decrease Group1.959± 0.080
Time 2: viewing
GroupValue95% CI
Younger HRV-increase Group1.964± 0.078
Younger HRV-decrease Group2.427± 0.083
Time 2: up-regulation
GroupValue95% CI
Younger HRV-increase Group3.269± 0.070
Younger HRV-decrease Group3.395± 0.074
Emotion Regulation in Older Adults (Behavior) Secondary · Time 1 (Baseline), Time 2 (5 weeks)

Emotional intensity ratings, which participants reported during the emotion regulation task inside MRI scanner before and after intervention. The ratings ranged from 1 through 4, and 4 represents strongest intensity.

Time 1: down-regulation
GroupValue95% CI
Older HRV-increase Group2.059± 0.085
Older HRV-decrease Group1.973± 0.119
Time 1: viewing
GroupValue95% CI
Older HRV-increase Group2.586± 0.096
Older HRV-decrease Group2.511± 0.134
Time 1: up-regulation
GroupValue95% CI
Older HRV-increase Group3.117± 0.087
Older HRV-decrease Group3.022± 0.121
Time 2: down-regulation
GroupValue95% CI
Older HRV-increase Group2.115± 0.087
Older HRV-decrease Group2.061± 0.122
Time 2: viewing
GroupValue95% CI
Older HRV-increase Group2.668± 0.116
Older HRV-decrease Group2.695± 0.162
Time 2: up-regulation
GroupValue95% CI
Older HRV-increase Group3.279± 0.069
Older HRV-decrease Group3.155± 0.097
Left Amygdala BOLD Activity During Emotion Regulation in Younger Adults Secondary · Time 1 (Baseline), Time 2 (5 weeks)

We measured percent changes (%) in BOLD activity in the left amygdala region during emotion down-regulation, viewing, and up-regulation before and after intervention. The viewing condition was used as a baseline during the task. The change is represented by %.

Time 1: down-regulation
GroupValue95% CI
Younger HRV-increase Group0.032± 0.022
Younger HRV-decrease Group0.024± 0.023
Time 1: viewing
GroupValue95% CI
Younger HRV-increase Group0.029± 0.023
Younger HRV-decrease Group0.048± 0.035
Time 1: up-regulation
GroupValue95% CI
Younger HRV-increase Group0.107± 0.026
Younger HRV-decrease Group0.095± 0.028
Time 2: down-regulation
GroupValue95% CI
Younger HRV-increase Group0.027± 0.021
Younger HRV-decrease Group0.021± 0.022
Time 2: viewing
GroupValue95% CI
Younger HRV-increase Group0.018± 0.019
Younger HRV-decrease Group-0.020± 0.021
Time 2: up-regulation
GroupValue95% CI
Younger HRV-increase Group0.121± 0.027
Younger HRV-decrease Group0.074± 0.029
Left Amygdala BOLD Activity During Emotion Regulation in Older Adults Secondary · Time 1 (Baseline), Time 2 (5 weeks)

We measured percent changes (%) in BOLD activity in the left amygdala region during emotion down-regulation, viewing, and up-regulation before and after intervention. The viewing condition was used as a baseline during the task. The change is represented by %.

Time 1: down-regulation
GroupValue95% CI
Older HRV-increase Group-0.069± 0.041
Older HRV-decrease Group-0.028± 0.043
Time 1: viewing
GroupValue95% CI
Older HRV-increase Group-0.092± 0.039
Older HRV-decrease Group-0.006± 0.040
Time 1: up-regulation
GroupValue95% CI
Older HRV-increase Group-0.043± 0.052
Older HRV-decrease Group0.067± 0.053
Time 2: down-regulation
GroupValue95% CI
Older HRV-increase Group-0.068± 0.037
Older HRV-decrease Group-0.035± 0.038
Time 2: viewing
GroupValue95% CI
Older HRV-increase Group-0.004± 0.030
Older HRV-decrease Group-0.013± 0.031
Time 2: up-regulation
GroupValue95% CI
Older HRV-increase Group-0.013± 0.031
Older HRV-decrease Group0.036± 0.032
Right Amygdala BOLD Activity During Emotion Regulation in Younger Adults Secondary · Time 1 (Baseline), Time 2 (5 weeks)

We measured percent changes (%) in BOLD activity in the right amygdala region during emotion down-regulation, viewing, and up-regulation before and after intervention. The viewing condition was used as a baseline during the task. The change is represented by %.

Time 1: down-regulation
GroupValue95% CI
Younger HRV-increase Group0.019± 0.021
Younger HRV-decrease Group0.018± 0.023
Time 1: viewing
GroupValue95% CI
Younger HRV-increase Group0.032± 0.021
Younger HRV-decrease Group0.039± 0.022
Time 1: up-regulation
GroupValue95% CI
Younger HRV-increase Group0.054± 0.024
Younger HRV-decrease Group0.074± 0.025
Time 2: down-regulation
GroupValue95% CI
Younger HRV-increase Group0.076± 0.026
Younger HRV-decrease Group0.017± 0.028
Time 2: viewing
GroupValue95% CI
Younger HRV-increase Group0.073± 0.027
Younger HRV-decrease Group-0.003± 0.029
Time 2: up-regulation
GroupValue95% CI
Younger HRV-increase Group0.106± 0.025
Younger HRV-decrease Group0.068± 0.027
Right Amygdala BOLD Activity During Emotion Regulation in Older Adults Secondary · Time 1 (Baseline), Time 2 (5 weeks)

We measured percent changes (%) in BOLD activity in the right amygdala region during emotion down-regulation, viewing, and up-regulation before and after intervention. The viewing condition was used as a baseline during the task. The change is represented by %.

Time 1: down-regulation
GroupValue95% CI
Older HRV-increase Group-0.058± 0.052
Older HRV-decrease Group-0.014± 0.053
Time 1: viewing
GroupValue95% CI
Older HRV-increase Group0.005± 0.029
Older HRV-decrease Group-0.027± 0.030
Time 1: up-regulation
GroupValue95% CI
Older HRV-increase Group0.041± 0.045
Older HRV-decrease Group0.062± 0.047
Time 2: down-regulation
GroupValue95% CI
Older HRV-increase Group-0.038± 0.031
Older HRV-decrease Group-0.004± 0.032
Time 2: viewing
GroupValue95% CI
Older HRV-increase Group-0.005± 0.027
Older HRV-decrease Group0.001± 0.027
Time 2: up-regulation
GroupValue95% CI
Older HRV-increase Group0.006± 0.038
Older HRV-decrease Group0.024± 0.039
Decision-making for Younger Adults at Post Intervention (Behavior) Secondary · one time point: at study completion, which is the end of 5-week training

The decision-making ability was measured by multiple-choice responses during a computer-based task. Median percentage of acceptance of unfair offers and fair offers were calculated. A higher percentage of accepted both unfair and fair offers points toward more rational decision-making and likely better emotion regulation. This task was administered only at post-intervention (but not pre-intervention).

percentage of acceptance of fair offers
GroupValue95% CI
Younger HRV-increase Group100100 – 100
Younger HRV-decrease Group100100 – 100
percentage of acceptance of unfair offers
GroupValue95% CI
Younger HRV-increase Group33.335.56 – 72.22
Younger HRV-decrease Group33.335.72 – 80.21
Decision-making for Younger Adults (fMRI) Secondary · one time point: at study completion, which is the end of 5-week training

We measured percent changes (%) in BOLD activity in the dorsal anterior cingulate cortex and anterior insula during a computer-based decision-making task. Higher values indicate greater activity.

Dorsal anterior cingulate cortex activation
GroupValue95% CI
Younger HRV-increase Group0.1073± 0.0221
Younger HRV-decrease Group0.0177± 0.0278
Anterior insula activation
GroupValue95% CI
Younger HRV-increase Group0.0740± 0.0214
Younger HRV-decrease Group0.0135± 0.0229

Sponsor's own description

Previous research suggests that heart rate variability (HRV) biofeedback aimed at increasing HRV can reduce anxiety and stress. However, some mental quiescence practices that reduce HRV during the practice sessions also lead to positive emotional outcomes. Thus, it is not obvious that the benefits of HRV-biofeedback accrue due to increasing HRV during the session. An alternative possibility is that the benefits arise from engaging prefrontal control over heart rate. In this study, the investigators will test two possible mechanisms of the effects of HRV on emotional health by comparing two groups. In one group, participants will be asked to engage in daily training to decrease HRV using the HRV biofeedback device. In the other group, participants will be asked to engage in daily training to increase HRV using the HRV biofeedback device. This will allow analyses to pit two possible mechanisms against each other: 1. Mechanism 1: engaging prefrontal control over heart rate is the critical factor that allows HRV biofeedback to help improve well-being. In this case, well-being should increase over time in both groups, as both training should engage prefrontal cortex to implement self-directed control over heart rate. Strengthening prefrontal control mechanisms may help improve emotion regulation in everyday life. 2. Mechanism 2: increased HRV during the training sessions leads to greater functional connectivity among brain regions associated with emotion regulation during the high HRV state. In this case, improved well-being would be specifically associated with having time each day during which there were very high HRV states, and so improved well-being should be seen only in the group in which participants get biofeedback to increase HRV.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Increasing coordination and responsivity of emotion-related brain regions with a heart rate variability biofeedback randomized trial.
    Nashiro K, Min J, Yoo HJ, Cho C, et al · · 2023 · cited 42× · PMID 36109422 · DOI 10.3758/s13415-022-01032-w
  2. Heart rate variability (HRV) changes and cortical volume changes in a randomized trial of five weeks of daily HRV biofeedback in younger and older adults.
    Yoo HJ, Nashiro K, Min J, Cho C, et al · · 2022 · cited 28× · PMID 36030986 · DOI 10.1016/j.ijpsycho.2022.08.006
  3. Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults.
    Min J, Rouanet J, Martini AC, Nashiro K, et al · · 2023 · cited 27× · PMID 36894565 · DOI 10.1038/s41598-023-30167-0
  4. Emotion Downregulation Targets Interoceptive Brain Regions While Emotion Upregulation Targets Other Affective Brain Regions.
    Min J, Nashiro K, Yoo HJ, Cho C, et al · · 2022 · cited 27× · PMID 35193926 · DOI 10.1523/jneurosci.1865-21.2022
  5. Daily heart rate variability biofeedback training decreases locus coeruleus MRI contrast in younger adults in a randomized clinical trial.
    Bachman SL, Cole S, Yoo HJ, Nashiro K, et al · · 2023 · cited 23× · PMID 37647944 · DOI 10.1016/j.ijpsycho.2023.08.014
  6. Changes in Medial Prefrontal Cortex Mediate Effects of Heart Rate Variability Biofeedback on Positive Emotional Memory Biases.
    Cho C, Yoo HJ, Min J, Nashiro K, et al · · 2023 · cited 17× · PMID 36658380 · DOI 10.1007/s10484-023-09579-1
  7. Multimodal neuroimaging data from a 5-week heart rate variability biofeedback randomized clinical trial.
    Yoo HJ, Nashiro K, Min J, Cho C, et al · · 2023 · cited 15× · PMID 37516756 · DOI 10.1038/s41597-023-02396-5
  8. Sex Differences in Neural Correlates of Emotion Regulation in Relation to Resting Heart Rate Variability.
    Min J, Koenig J, Nashiro K, Yoo HJ, et al · · 2023 · cited 13× · PMID 37353651 · DOI 10.1007/s10548-023-00974-9

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