Short-Term Biofeedback Therapies Lead to Alleviation of Certain Long COVID Symptoms


The investigators seek to replicate the data in a future randomized control trial, and they hope to compare biofeedback to different therapies such as pulmonary rehabilitation.

Natacha D. Emerson, PhD

Credit: UCLA Psychiatry & Biobehavioral Sciences

Natacha D. Emerson, PhD

Credit: UCLA Psychiatry & Biobehavioral Sciences

Certain individuals living with long COVID-19 may see some alleviation of their symptoms following the use of short-term biofeedback therapy, according to recent findings led by investigators at UCLA.1

The conclusions of this study were published in the Journal of Psychosomatic Research. The research team addressed patients’ self-regulation of their autonomic functions through the use of breathwork practices as well as relaxation activities alongside visual feedback.

Natacha D. Emerson, PhD, from UCLA Psychiatry & Biobehavioral Sciences at the David Geffen School of Medicine, led this new research. Emerson and colleagues noted that recent analyses had shown that long-COVID 19 symptoms have a relationship with cardiovascular dysfunction among sufferers through persistent effects on their endothelial functions.2

“Taking into consideration the effects of SARS-CoV-2 on long-term cardiovascular dysfunction and reduced vascular reactivity, this study examined the efficacy of a six-session intervention that combined HRV and temperature biofeedback in alleviating chronic somatic symptoms of patients diagnosed with long COVID,” Emerson and colleagues wrote.1

Background and Methods

The investigators made contact with the study participants and the group was given a telephone screening to determine their eligibility for the research. The research team’s criteria for subject inclusion consisted of subjects with long COVID being English-proficient, being 18 years or older, reporting specific somatic symptoms, and receiving psychosocial distress connected to the noted symptom.1

The team excluded those with severe psychiatric conditions such as psychosis or dementia. Prior to the 6-meeting biofeedback intervention done in the study, those participating gave to the investigators several pieces of information on their current symptoms and recent healthcare usage.

The investigators ended up recruiting 20 adult participants with diverse long COVID symptoms who were in the age range of 22 - 63 years, with the average age being 44.1 years. The research team used a single-arm study, with 16 out of the 20 subjects involved being able to successfully finish all 6 biofeedback sessions and 14 completing the team’s assessments at the 3-month follow-up meeting occurring post-treatment.

The aforementioned surveys were immediately filled out once more following the subjects’ completion of the 6 weekly single-hour sessions. The sessions themselves involved a combination of heart rate variability and temperature biofeedback, with the overall goal being to improve participants’ somatic complaints, mood, and disturbances in their sleep.


Overall, the research team reported that the subjects showed substantial improvements in somatic, anxiety, and depressive symptoms, as well as quality of sleep, quality of life, and the reduction in so-called ‘bad days.’ These improvements were observed by the team immediately following the intervention’s conclusion as well as in the 3 months following.

In a notable finding, the investigators showed at the 3-month mark there had been a decrease in medical visits (ES = 0.85), in addition to improvements in subjects’ emotional well-being (ES = 0.97) and a diminished use of prescription drugs (odds ratio = 0.33). Generally speaking, the study’s participants were able to improve their occupational and social involvement to manage long COVID symptoms.

The team did note, however, that some of the participants were also concurrently given psychotherapy and other treatments such as acupuncture, potentially influencing the noted improvements. So despite the positive findings, the investigators addressed such limitations in their research, highlighting as well the lack of a comparison group, smaller sample size, and a within-subject design that may have limited the trial’s generalizability.

“Our biggest hope is that we’ve identified a way to alleviate chronic physical symptoms that are not successfully treated by standard biomedical approaches, and that we did so with a short-term, non-pharmacological model that is easily scalable,” Emerson said in a statement, later adding. “It is important to underscore that…patients with long COVID are not in control of their symptoms and are not faking or exaggerating what they report to their doctors.”


  1. Emerson ND, Lavretsky H, Pittman WQ, Viswanathan N, Siddarth P. An open trial of biofeedback for long COVID. J Psychosom Res. Published online February 23, 2024. doi:10.1016/j.jpsychores.2024.111625.
  2. Kar M. Vascular Dysfunction and Its Cardiovascular Consequences During and After COVID-19 Infection: A Narrative Review. Vasc Health Risk Manag. 2022;18:105-112
  3. Houston W. Long COVID patients report improvements following self-regulation therapy, study finds. UCLA Health. March 13, 2024. Date accessed: March 28, 2024.
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