The efficacy of a new self-training program of Heart Rate Variability Biofeedback and Thought Field Therapy to improve anxiety, insomnia, and quality of life


Ayame Morikawa, PhD, Naoko Okamoto, PhD, and Iwao Yokuda, MA


This study investigated improvements and impact of our new self-training program using Thought Filed Therapy (TFT) and Heart Rate Variability Biofeedback (HRVB) with HeartMath techniques designed to reduce anxiety and insomnia and improve quality of life. The program includes five two-hour workshops for two months and TFT and biofeedback self-training between the workshops. Ten participants with symptoms of anxiety or panic attacks attended the program. Trait anxiety ratings on the post-intervention administration of the State-Trait Anxiety Inventory (STAI) showed significant reduction in participants’ anxiety levels compared to pre-intervention ratings (P<0.01). Insomnia and Happiness Scale measures also indicated significant pre- and post-intervention changes (P<.05). Results of STAI administered at the two and a half months follow-up (n=8) indicated that improvements were maintained overtime. The researchers suggested that the new training may be a cost effective and time saving program for improving symptoms of anxiety, panic attacks, insomnia, and quality of life.


Those who suffer from anxiety and panic attacks are increasing in Japan and are likely to depend on medication. Even though some are willing to have drug-free life, they may in fact depend on medication to alleviate anxiety about going outside, taking a train, and even terminating medication.

Thought Field Therapy (TFT) (Callahan, 1995) is an evidence-based approach to treat negative emotions and symptoms including trauma, depression, and anxiety by tapping on the meridian points of the body. The preliminary meta-analysis (Edwards & Vanchu-Orosco, 2017) showed significant improvements in trauma or PTSD symptoms across studies (Johnson, Shala, Sejdijaj, Odell, & Dabishevci, 2001; Folks, 2002; Sakai, Connolly, & Oas, 2010), including controlled studies (Connolly & Sakai, 2011; Connolly, Roe-Sepowitz, Sakai, & Edwards, 2013; Robson, Robson, Ludwig, Mitabu, & Phillips, 2016). Irgens and colleagues, in their randomized controlled study, suggested that TFT may have enduring anxiety-reducing effect (Irgens et al., 2012). In their study, they compared Cognitive Behavioral Therapy (CBT) and TFT on effectiveness in treating agoraphobia and concluded that TFT as an alternative approach may be a more predictable and more time-efficient therapy than CBT.

Heart Rate Variability Biofeedback (HRVB) is accompanied by slowed respiration at a rate of 0.1Hz, which is thought to induce physiological coherence among the heart rate, blood pressure, and vascular tone (Vaschillo, Lehrer, Rishe, & Konstantinov, 2002; Vaschillo, Vaschilo, & Lehrer, 2004). HRVB has been shown to significantly improve not only medical conditions such as asthma, congestive heart failure, and hypertension but also posttraumatic stress disorder (PTSD), depression, anxiety, fibromyalgia, and insomnia (McCraty & Childre, 2010; Siepmann, Aykac, Unterdorfer, Petrowski, & Mueck-Weymann, 2008).

As a part of their research at HeartMath Institute, McCraty and Zayas (2014) reported that positive emotions are independently associated with psychophysiological coherence which improves optimal cognitive functioning, emotional stability, and self-regulation. HeartMath technique is programed through the use of heart rate variability and heart rhythm coherence feedback training. Edwards (2015) emphasized that regular HeartMath practice enhances awareness of energy depletion, renewal and resilience in preparing for challenges as well as shifting and resetting feelings after challenges.


Through our clinical practice, we observed that an integrated approach of eliminating negative emotions and enhancing positive emotions, resilience, and self-regulation skills is effective for clients in overcoming anxiety and panic attacks. Based on our observations, we developed a new self-training program for those who want to be able to ride a train without panic symptoms. This new program utilizes a smartphone app and an ear sensor, offering self-help training in TFT tapping and HeartMath breathing techniques that help clients treat or alleviate their anxiety and any other associated symptoms by themselves. TFT is characterized by alleviating negative emotions and symptoms instantly and HeartMath program enhances individual’s resilience and positive emotions. Moreover, both self-help trainings may improve psychophysiological self-regulation. The objective of this study is to examine the efficacy of our new program.


Ten participants included 8 females and 2 males, ranging from 31 to 67 years of age (M=49.8, SD=9.98). Among 10 participants, five were diagnosed with the panic disorder, three presented with anxiety, one was diagnosed with generalized anxiety disorder, and one with depression. Two of them also presented with obsessive compulsive symptoms. Six of them were taking anti-anxiety and/or other medication prescriptions. The program was designed for two months, during which all participants were required to attend five two-hour workshops, where they learned TFT and HRVB step by step, shared their experiences and feelings and were able to ask questions and receive feedback. The participants were also engaged in self-training and exercises between the workshops. The instructor monitored their biofeedback data online and gave advice when necessary. The STAI (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), the Athens Insomnia Scale (Soldatos, Dikeos, & Paparrigopoulos, 2000), and the Happiness Scale (Sato et al., 1995) were administered to all participants in a pre- and post-intervention design to evaluate the effect of our new training program on their wellbeing. After two and a half months, STAI levels were assessed again as a follow-up measure.


The trait anxiety levels on STAI post-intervention measure showed significant reduction from a pre-intervention mean of 52.8 (SD=9.3) to 40.7(SD=9.6), with the large effect size of 0.715 (Cohen’s d at P<.01). The results on both Insomnia and Happiness Scale indicated significant changes at 5% levels with medium effect sizes, d =0.46 and d =0.45 respectively. Insomnia ratings indicated significant symptom reduction from a mean of 8.8 (SD=3.2) to 3.9 (SD=2.6). The Happiness Scale results showed improvement in quality of life reports from a mean of 43.0 (SD=8.7) to 49.3 (SD=6.0). The STAI follow-up after two and a half months (n=8) revealed significant improvement compared to pre-intervention, from a mean of 54 (SD=9.2) to 41.6 (SD=7.1) (p<.01).There were no significant differences between post-intervention and the follow-up results on the STAI measure, means of 43 (SD=9.3) and 41.6 (SD=7.1) respectively.


The findings of this study revealed that our new program is significantly effective in each of the dependent variables: trait anxiety, insomnia, and quality of life. As indicated by the results of STAI at the two and a half months follow-up, improvements in anxiety levels were maintained. Self-reports during interviews revealed that those who used anti-anxiety drugs prior to intervention successfully reduced or terminated the medication intake. One of the participants was successfully able to take a flight overseas without medication. Similarly, all of those who had been taking medication could get on busy subways in Tokyo with reduced medication or completely terminated medication regiment. The program is designed for the participants to explore their ability to change their psychophysiological states in workshops and to continue working on them at home with the biofeedback app as their personal trainer. The participants are able to continue their self-training after the program is over. The program may be time-saving and cost effective for both clients and therapists.


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Ayame Morikawa, Ph.D., is a psychologist and a chairperson of the Japanese Association for Thought Field Therapy (JATFT). She is a Voice Technology therapist and a Thought Field Therapy (TFT) trainer and the author of three books on TFT self-help. She is a Certified HeartMath Trainer and teaches Heart Rate Variability (HRV) biofeedback program. She has offered TFT training to more than 2,000 professionals and has been engaged in disaster assistance after earthquake, flood, and gun shooting in Japan. Dr. Morikawa started TFT Partner, the new program of humanitarian assistance using Community Reinforcement Approach. She received the Humanitarian Award of 2016 from ACEP. She also serves on the United Nations World Human Facility (WHF).


Naoko Okamoto, Ph.D., is a professor at the faculty of Comprehensive Psychology at Ritsumeikan University. She is a licensed clinical psychologist, art therapist, developmental psychologist, TFT advanced therapist, TFT trainer, and a certified HRV Breathing Coach. She is the author of numerous articles such as “A study on self-expression and interchange with others in group psychotherapy through group finger painting for university students“ and “The proposal for the notion of Dramism in psychotherapy as a key to seeking therapeutic meaning of expression”. She also is the author of many books such as “The meaning of drama in the context of clinical psychology” and “The standard of psychology”. Dr. Okamoto has an extensive clinical experience working at elementary, junior high, and senior high school levels as well as in a psychiatric hospital as a psychotherapist.


Iwao Yokuda, M.A., is a professor of Osaka Yuhigaoka Gakuen junior college. He is a licensed clinical psychologist, TFT advanced therapist, TFT trainer, and a certified HRV Breathing Coach. He is the author of numerous articles such as “A case study of bullying solved by cooperation with concerned teachers and the second grade junior high-school boy with problem behavior”. Mr. Yokuda has rich experience in the field of education and welfare, including provision of services as a psychological evaluator at a child guidance center, a school counselor at junior high and elementary school levels, and delivering counseling to students at a university. Currently, he teaches at the junior college and provides counseling to university students.

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