Enhancing Wellness: A Systematic Review of Biofeedback Interventions for Healthcare Professionals

Elisa Cantone^1,2Antonio Urban^3,4Alessandra Perra²Giulia Cossu²Massimo Tusconi^5,6*Serdar M Dursun⁷Mauro Giovanni Carta²

• ¹PhD Course Capacities Building for Global Health, University of Cagliari, Cagliari, Italy
• ²Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042, Cagliari, Italy
• ³PhD Course Capacities Building for Global Health, Cagliari, Italy
• ⁴University Hospital of Cagliari, Cagliari, Italy
• ⁵University of Cagliari, Cagliari, Italy
• ⁶University Hospital of Cagliari, 09042 Cagliari, Cagliari, Italy
• ⁷Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada

Background/Objectives: Healthcare professionals are routinely exposed to high psychosocial and physiological demands, placing them at elevated risk for stress-related disorders, including burnout, anxiety, and impaired autonomic regulation. Biofeedback has emerged as a promising non-pharmacological approach to enhance self-regulation and resilience. This systematic review aimed to evaluate the effectiveness of biofeedback-based interventions in improving psychological and physiological outcomes among healthcare workers. Methods: A systematic search was conducted across PubMed, Cochrane, Embase, PsycINFO, and grey literature (December 2023–January 2024), following PRISMA guidelines and a registered PROSPERO protocol (CRD42024544687). Eligible studies included randomized controlled trials, quasi-experimental designs, and pre-post studies involving adult healthcare workers exposed to work-related stress. Primary outcomes comprised stress, burnout, anxiety, depression, resilience, and physiological indices such as heart rate variability (HRV), respiratory rate, and skin conductance. Data were synthesized narratively due to methodological heterogeneity. Results: Twelve studies met inclusion criteria. HRV-biofeedback and respiratory sinus arrhythmia training demonstrated consistent improvements in perceived stress, anxiety, depressive symptoms, emotional regulation, and resilience. Physiological benefits included increased HRV, decreased sympathetic arousal, and improved autonomic balance. Interventions integrating breathing or mindfulness techniques exhibited the strongest effects. However, non-randomized designs and small samples limited the robustness of findings. Discussion/Conclusions: Biofeedback represents a feasible and potentially effective strategy for mitigating occupational stress and enhancing psychophysiological well-being in healthcare professionals. Despite promising results, evidence remains 2 preliminary due to heterogeneity, limited methodological rigor, and scarce long-term follow-up. Future large-scale randomized trials with standardized protocols are needed to strengthen the evidence base and support implementation in occupational health settings.