Physiological regulation strategies can be effective in reducing anxiety. However, while these strategies are often learned and practised under low-stress conditions, they are more likely to be required under conditions of high stress. We created virtual reality (VR) biofeedback games to both teach participants a breathing technique and then practise that technique under stress. We present two studies: the first provides a proof of concept, demonstrating that participants can apply the breathing technique during stress, with a significant lowering of both respiration rate and increase in heart rate variability (HRV) under stress (p < .001). The second study explicitly evaluated the effectiveness of training by comparing trained and untrained groups. Training was associated with a significantly greater HRV (p = .008) under stress. In within-group comparisons of HRV during stress compared to a baseline stressor presented before training, the trained group showed a significantly greater increase compared to untrained controls (p = .025). Our results show the feasibility and potential effectiveness of VR-based games for biofeedback training under experimentally applied stress. This may offer the opportunity for clinical techniques to more closely reflect the circumstances under which those techniques will be required.
Keywords: anxiety; biofeedback; heart rate variability; interoception; respiration; stress.
© 2024 The Author(s). Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.