Interoceptive mechanisms of a mobile heart rate variability biofeedback app for eating disorder symptoms
Proof-of-concept findings
Bibliographic Data
| ID | 7754357 |
|---|---|
| Authors | Janell L Mensinger (0000-0001-7675-8879, Nova Southeastern University, corresponding author) |
| Year | 2026 |
| Volume | 60 |
| Pages | 102060 |
| Publication date | 2026-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Eating Behaviors (JOURNAL) |
| Journal identifiers | ISSN: 1471-0153 • E-ISSN: 1873-7358 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.eatbeh.2025.102060 |
| PMID | 41319396 |
| OpenAlex | W4416662298 |
| Language | EN |
| References cited | 67 |
INTRODUCTION: Recent US-based datasets (Ns > 1000) show over 1-in-4 adults suffer from clinically significant eating disorder (ED) symptoms. Methods for preventing subthreshold problems from becoming full-threshold EDs are needed. An 8-week, single-arm feasibility study of a mobile heart rate variability biofeedback (HRVB) app supported strong acceptability and preliminary efficacy for reducing ED symptoms. The present study investigated potential mechanisms of change from pre- to post-intervention. METHOD: Participants were 24 healthcare workers recruited during the COVID-19 pandemic who scored in the clinically significant range on the Loss of Control Eating Scale-Brief (LOCES-Brief) (92 % female, 83 % non-Hispanic white, Mean age = 42; SD = 11.8). Measures included the eight subscales from the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) for interoceptive sensibility, and the Eating Disorder Examination-Questionnaire 7-item Short (EDE-Q7) and LOCES-Brief for ED symptoms. Mediation analyses were conducted using the MEMORE macro for repeated measures, with indirect effects evaluated via 95 % Monte Carlo confidence intervals. RESULTS: Significant indirect effects on EDE-Q7 scores were found for MAIA-2 'noticing', 'attention-regulation', 'emotional-awareness', 'self-regulation', and 'body-listening' subscales. 'Not-worrying', 'not-distracting', and 'trusting' did not significantly mediate EDE-Q7 changes. For LOCES-Brief, significant indirect effects were found for 'trusting'. No other MAIA-2 subscales showed statistically significant indirect effects for LOCES-Brief. CONCLUSION: Findings suggest HRV biofeedback may reduce ED symptoms by enhancing interoceptive skills. These results support further investigation into biofeedback as a low-cost, scalable intervention for populations at risk for EDs. Future studies should evaluate fully powered controlled efficacy trials of mobile HRVB as a preventive strategy for eating and body-related mental health concerns
Biofeedback · Eating disorders · Heart rate · Heart rate variability · Mental health · mHealth · Eating Disorders and Behaviors · Heart Rate Variability and Autonomic Control · Virtual Reality Applications and Impacts
The Multidimensional Assessment of Interoceptive Awareness (Maia)
The mental health of healthcare workers in the Covid-19 pandemic
Estimating and testing mediation and moderation in within-subject designs.
Two-condition within-participant statistical mediation analysis
On the embodiment of emotion regulation
Causes of Eating Disorders
The Multidimensional Assessment of Interoceptive Awareness, Version 2 (Maia-2)
Effect size measures for mediation models
Calculating and reporting effect sizes to facilitate cumulative science
A comparison of methods to test mediation and other intervening variable effects.
Does emotion regulation mediate the relationship between interoception/alexithymia and co-morbid depression/anxiety? Evidence from two independent samples
Disentangling the role of interoceptive sensibility in alexithymia, emotion dysregulation, and depression in healthy individuals
Eating Pathology and Interoceptive Sensibility Using the Brief Multidimensional Assessment of Interoceptive Awareness-2
Required Sample Size to Detect the Mediated Effect
Perceptual and Conceptual Disturbances in Anorexia Nervosa
Acute Stress Disorder Among Frontline Health Professionals During the Covid-19 Outbreak
Heart Rate Variability Measurement through a Smart Wearable Device
General versus hunger/satiety-specific interoceptive sensibility in predicting disordered eating
The association between alexithymia and eating behavior in children and adolescents
Emotional eating during Covid-19 in the United Kingdom
Increased emotional eating during Covid-19 associated with lockdown, psychological and social distress
| Citation velocity | historical |
|---|---|
| Highly cited | No |