Heart Rate Variability Biofeedback in Substance Use Disorder: Emerging Evidence from a Randomized Clinical Trial and Contextual Review

MedXY Editorial Team•Oct 6, 2025•Clinical Updates

Second-generation wearable HRVB reduced negative affect and craving, and lowered alcohol and other drug (AOD) use by 64% compared with usual care in a robust randomized clinical trial of adults with SUD.
HRVB disrupted the typical craving-AOD use cascade, moderating within-person risk of relapse following craving episodes, indicating a mechanistic pathway for clinical benefit.
Complementary studies support HRVB’s efficacy in mitigating craving, anxiety, and depression across substance types (e.g., methamphetamine, alcohol) and populations, with additional benefits on autonomic function and sleep quality.
Limitations include modest sample sizes in prior studies and heterogeneity in intervention duration and technologies; however, the latest phase 2 trial underscores feasibility and impact of second-generation, outpatient HRVB delivered virtually.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Second-generation wearable HRVB reduced negative affect and craving, and lowered alcohol and other drug (AOD) use by 64% compared with usual care in a robust randomized clinical trial of adults with SUD.
HRVB disrupted the typical craving-AOD use cascade, moderating within-person risk of relapse following craving episodes, indicating a mechanistic pathway for clinical benefit.
Complementary studies support HRVB’s efficacy in mitigating craving, anxiety, and depression across substance types (e.g., methamphetamine, alcohol) and populations, with additional benefits on autonomic function and sleep quality.
Limitations include modest sample sizes in prior studies and heterogeneity in intervention duration and technologies; however, the latest phase 2 trial underscores feasibility and impact of second-generation, outpatient HRVB delivered virtually.