Understanding Stress Through HRV Biofeedback
For many years, in my work as a psychologist, I have used a range of psychological assessment tools to understand stress, anxiety, emotional regulation and the impact these difficulties can have on a person’s daily life.
Questionnaires, clinical interviews and psychological formulations remain very important because they help us understand the person’s perceived stress — how they experience stress, how they make sense of it, and how it affects their sleep, relationships, work, confidence and overall wellbeing. These tools are based largely on what the person reports, which is clinically very valuable, but it can sometimes be influenced by how aware the person is of their own stress, how easy they find it to describe their feelings, or whether they tend to minimise their difficulties. Biofeedback adds a more objective physiological measurement, allowing us to observe how the body is responding to stress in real time.
More recently, I have started using biofeedback, particularly Heart Rate Variability Biofeedback, as part of my clinical work. For me, this has added a very helpful and objective dimension to the assessment and treatment process.
HRV stands for Heart Rate Variability. It refers to the natural variation in time between heartbeats. A healthy nervous system does not keep the heart beating like a machine at exactly the same rhythm. Instead, the heart naturally speeds up and slows down depending on breathing, emotions, physical state, stress and recovery.
HRV is closely linked to the balance between two parts of the body’s automatic nervous system. The sympathetic nervous system is the part that prepares the body for action. It becomes more active when we are stressed, anxious, under pressure, frightened or physically active. It is often linked with the “fight or flight” response and can increase heart rate, alertness and body tension. The parasympathetic nervous system works more like the body’s calming and recovery system. It helps slow the heart rate, regulate breathing, support digestion, promote relaxation and restore emotional balance after stress.
In simple terms, the sympathetic system activates the body, while the parasympathetic system helps the body calm down and recover. HRV can therefore give us useful information about how flexibly the body moves between these two states.
When someone is under stress, their body may remain in a state of physiological activation even when they are trying to relax. Psychological questionnaires and clinical interviews can tell us how the person feels and how they describe their difficulties, but HRV biofeedback allows us to observe how the body is responding in real time. This means that we can compare the client’s reported experience with objective physiological information, such as heart rhythm, breathing patterns and the body’s ability to return to a calmer state.
I find this particularly helpful for people who are not always sure how they feel, or who may find it difficult to describe their internal experience for different reasons. Some clients may struggle to recognise the early signs of stress. Others may minimise their distress, may not have the words to explain what is happening in their body, or may say that they feel “fine” while their physiological responses suggest that their nervous system is still highly activated. In these situations, HRV biofeedback can provide a clearer and more objective picture of stress, helping both the client and therapist understand what is happening and identify the most helpful strategies for regulation.
During HRV biofeedback, sensors are used to monitor heart rhythm while the client is guided through breathing and regulation exercises. The client can see their physiological responses on a screen. This makes the connection between breathing, emotional state and nervous system regulation much easier to understand. Over time, the person learns how to influence their own physiological state by using slower, more regulated breathing and other calming strategies.
One of the main benefits of biofeedback is that treatment becomes more personalised and measurable. Rather than relying only on what the client reports, we can also observe how their nervous system responds during sessions, how quickly they recover after stress, and which strategies appear to be most effective for them. This can help guide treatment planning, including stress-management strategies, emotional regulation work, relaxation training, neurofeedback planning and home practice.
In my private practice, HRV biofeedback has become a reliable and helpful tool. Many clients find it reassuring to see that stress is not “just in their mind”, but something that can be observed, understood and gradually regulated. It also supports a more collaborative approach, where the client can actively see progress and develop practical skills for managing stress in daily life.
HRV biofeedback does not replace psychological assessment or therapy. Instead, it complements them by bringing together the client’s personal experience and objective physiological information. In my view, this combination allows for a more complete understanding of stress and helps create treatment plans that are practical, evidence-informed and tailored to the individual.
Dr Nistor Becia
Clinical Psychologist