Building resilience with heart rate variability biofeedback (HRVB) in emergency department and ICU healthcare workers: a randomized controlled trial

Healthcare workers in emergency departments (EDs) and intensive care units (ICUs) are highly vulnerable to stress and burnout. Resilience training may mitigate these effects, but most programs are resource intensive and untested. Heart Rate Variability Biofeedback (HRVB) is a brief intervention (30-min introduction and self-practice 10 min twice daily) that shows promise, yet randomized controlled trials are limited. We randomized patient-facing healthcare workers (n = 37) from EDs and ICUs at a large Southwestern medical center to 4 weeks of HRVB or a waitlist (WL) control. After posttreatment assessment, WL participants crossed over to receive HRVB, and both groups were reassessed 4 weeks later. Resilience, stress, depression, and burnout were measured at pretreatment, posttreatment, and follow-up. Consistent with prediction, resilience (CD-RISC-10) increased significantly in the HRVB group relative to WL from pre- to posttreatment (d = .79, p = .003), and gains were maintained at follow-up. Contrary to prediction, reductions in stress, depression, and burnout were not significantly greater in HRVB than WL. Reliable Change Index analysis showed 21% of HRVB participants improved reliably at posttreatment and 24% at follow-up. Findings support HRVB as a feasible, individually delivered intervention to enhance resilience among ED and ICU healthcare providers.