The Impact of a Seven-Week Heart Rate Variability Biofeedback Protocol on Skin Severity, Quality of Life, and Mental Health in a Proof-of-Concept Clinical Case Series of Individuals with Psoriasis

Abstract

Abstract Background Psoriasis is a common psychocutaneous disorder, frequently associated with reduced quality of life (QoL) and psychiatric comorbidities, including anxiety and mood disorders. Although pharmacological interventions and phototherapy may provide effective, albeit temporary, relief in the skin, they frequently fail to address the psychological impact of the disease. Heart rate variability biofeedback (HRVB) is a specific mind-body therapy that provides real-time visual feedback on an individual’s autonomic functioning in order to modify their physiological stress response through diaphragmatic, paced breathing. Objective To explore the impact of a seven-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and to determine whether the effects, if any, can be maintained after the intervention has concluded. Methods This was a single-arm, proof-of-concept clinical case series conducted at Bastyr University Clinic in San Diego, California. Five participants were recruited through flyers and referrals and were screened for eligibility prior to undergoing a seven-week HRVB protocol. SS was assessed by both the participant and clinician using the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL was assessed using the Cardiff Dermatology Life Quality Index (DLQI), and MH was measured using the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). These outcomes were collected at baseline (T1), post-protocol (T2), and follow-up (T3) between June 2022 to December 2022. Results There were significant differences in scores between T1 and T2 for PASI-P, DLQI, and GAD-7. There was also a significant difference between T1 and T3 for GAD-7. PASI-C and PHQ-9 had no significant difference between any time points. All scales were non-significant for T2 and T3. PASI-P, PASI-C, DLQI, and PHQ-9 were non-significant between T1 to T3. Linear regressions for each participant showed a majority decreasing rate of change. Conclusion In this real-life setting, HRVB was associated with significant improvements in participant perception of SS, QoL, and anxiety over a seven-week period. Future studies should include a larger cohort with more variation in SS, QoL, and MH scores at T1 and compare the HRVB protocol against a control group. NCT05506644, retrospectively registered on 16 August 2022. Trial registration ClinicalTrials.gov