Early HRV Biofeedback for Child Emotion Regulation: A Longitudinal Study Proposal

Emotion regulation in childhood is a foundational skill for developmental resilience, influencing social, academic, and mental health outcomes across the lifespan (Gross, 2015; Aldao et al., 2010). Heart rate variability (HRV) biofeedback is a non-invasive intervention aimed at enhancing autonomic self-regulation and vagal tone, with evidence suggesting potential benefits for improving emotional regulation and reducing psychopathological risk (Lehrer et al., 2020; Goessl et al., 2017). The objective of this proposed research is to examine whether HRV biofeedback training enhances emotion regulation and decreases internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., conduct problems, ADHD traits) from early childhood into emerging adulthood. The study is designed as a randomized controlled longitudinal trial, recruiting children aged five years and following them through multiple developmental stages until age 25. Participants will be randomly assigned to an HRV biofeedback intervention or a control group. Assessments include physiological metrics of HRV (e.g., RMSSD, SDNN, HF-HRV), age-appropriate measures of emotion regulation such as the Difficulties in Emotion Regulation Scale (DERS), and standardized measures of psychopathology (e.g., IDAS-II). Planned analyses involve multilevel modeling to examine within- and between-person changes over time and to explore whether changes in emotion regulation mediate effects on psychopathology. It is hypothesized that children who participate in HRV biofeedback training will demonstrate increased HRV indices, alongside improvements in emotion regulation and reductions in internalizing and externalizing symptoms compared to the control group. These results are expected to clarify how early modulation of physiological self-regulation may cascade into longer-term psychological benefits, shedding light on developmental mechanisms underlying resilience and risk. Moreover, the study aims to provide preliminary evidence supporting HRV biofeedback as a feasible, non-invasive preventive intervention to promote mental health from early childhood through emerging adulthood.