Heart rate variability biofeedback and other psychophysiological procedures as important elements in psychotherapy

Lang's distinction of psychophysiological, behavioral, and cognitive domains in psychological problems and therapies provides a useful heuristic for guiding psychotherapy. Much psychotherapy practice emphasizes the cognitive domain, but behavioral and psychophysiological interventions show at least equivalent effectiveness for some kinds of problems. Most descriptions of cognitive behavior therapy emphasize cognitive procedures, although most CBT approaches also incorporate behavioral interventions such as social skills training, exposure, and behavior activation. The contribution of psychophysiological methods is often underemphasized. Muscle relaxation and breathing interventions, particularly heart rate variability biofeedback, have been shown to have clinically significant therapeutic effects for a variety of problems. Although used more sporadically in the West, similar methods are part of traditional medical practice in Eastern countries. Examples are given for how these methods can be integrated into more generic psychotherapy practice, using Lang's distinctions, for a variety of psychological problems. •Psychophysiological, cognitive, and behavioral manifestations of emotional problems are partially independent from each other.•Psychophysiological interventions are downplayed in psychotherapy.•Psychophysiological interventions have documented effects for a variety of problems.