Soldier meditating, symbolizing PTSD resilience through heart and mind.

Combatting PTSD: Can Resilience Training Make a Difference?

Nico Varela in Health & Wellness November 2025 • 4 min read.

"Explore how heart rate variability and cognitive bias feedback interventions are reshaping PTSD prevention for military personnel."

Post-traumatic stress disorder (PTSD) remains a significant concern for military personnel, with rates varying from 5.5% to 13.2% post-deployment. The need for effective pre-deployment strategies is clear, as historical efforts have had limited success. Recent research explores innovative resilience training interventions to mitigate the impact of deployment-related stress and trauma.

Heart rate variability biofeedback (HRVB) and cognitive bias modification for interpretation (CBM-I) training have emerged as promising mechanisms for building resilience. HRVB focuses on enhancing self-regulation through improved heart rate variability, while CBM-I aims to modify negative thought patterns associated with deployment scenarios. These approaches seek to bolster both physiological and cognitive resilience, offering new avenues for PTSD prevention.

The Warriors Achieving Resilience (WAR) study, a randomized controlled trial, investigated the effectiveness of HRVB and CBM-I training in Army National Guard soldiers preparing for deployment. By examining PTSD symptom severity at pre-deployment, 3-month, and 12-month intervals, the study aimed to determine whether resilience training could lead to lower post-deployment PTSD symptoms compared to a control group. This innovative approach holds promise for reshaping how the military addresses PTSD prevention.

Decoding HRVB and CBM-I: How Do They Work?

Soldier meditating, symbolizing PTSD resilience through heart and mind.

Heart Rate Variability Biofeedback (HRVB) is rooted in the understanding that a higher heart rate variability is linked to better self-regulation and cognitive control. This method involves identifying a breathing frequency that maximizes an individual's HRV, typically achieved by slowing the respiration rate. Participants then use a breath-pacing app to practice this frequency regularly. By regulating the stress response, HRVB aims to prevent PTSD symptoms.

Cognitive Bias Modification for Interpretation (CBM-I) takes a different approach, targeting negative thought patterns that can develop in response to stressful events. CBM-I training presents individuals with ambiguous deployment-related scenarios, gradually increasing the proportion of neutral or non-negative interpretations. This technique aims to promote less negative appraisals of post-event retrospections, reducing the likelihood of developing PTSD.

HRVB: Enhances self-regulation through optimized breathing techniques.
CBM-I: Modifies negative thought patterns related to deployment scenarios.
Combined Goal: Improve physiological and cognitive resilience to combat deployment-related stress.

Both HRVB and CBM-I interventions were delivered through self-paced training sessions on laptop computers, followed by individual practice using dedicated iPod apps. Participants were encouraged to practice at least three times per week, even for brief periods, to reinforce resilience-building skills. This approach aimed to seamlessly integrate resilience training into pre-deployment routines.

The Future of Resilience: What's Next?

While the WAR study provides valuable insights, it also highlights the need for further research and refinement. Future studies should focus on maintaining frequent contact with participants during deployment to ensure proper use of resilience training apps. Additionally, exploring the differential effectiveness of interventions based on individual characteristics and deployment experiences could lead to more tailored and impactful PTSD prevention strategies. By continuing to innovate and adapt, the military can better equip its personnel with the tools they need to navigate the challenges of deployment and protect their mental well-being.

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This article is based on research published under:

DOI-LINK: 10.1093/milmed/usy171, Alternate LINK

Title: Heart Rate Variability And Cognitive Bias Feedback Interventions To Prevent Post-Deployment Ptsd: Results From A Randomized Controlled Trial

Subject: Public Health, Environmental and Occupational Health

Journal: Military Medicine

Publisher: Oxford University Press (OUP)

Authors: Jeffrey M Pyne, Joseph I Constans, John T Nanney, Mark D Wiederhold, Douglas P Gibson, Timothy Kimbrell, Teresa L Kramer, Jeffery A Pitcock, Xiaotong Han, D Keith Williams, Don Chartrand, Richard N Gevirtz, James Spira, Brenda K Wiederhold, Rollin Mccraty, Thomas R Mccune

Published: 2018-07-18

Everything You Need To Know

What is Heart Rate Variability Biofeedback (HRVB)?

Heart Rate Variability Biofeedback (HRVB) is a technique designed to improve self-regulation by optimizing heart rate variability, which is linked to better cognitive control. Participants learn to identify and practice a breathing frequency that maximizes their HRV, typically by slowing their respiration rate. The goal is to regulate the stress response and prevent PTSD symptoms by enhancing physiological resilience.

Can you explain Cognitive Bias Modification for Interpretation (CBM-I) training?

Cognitive Bias Modification for Interpretation (CBM-I) training is a method that targets and modifies negative thought patterns that can arise in response to stressful events. It involves presenting individuals with ambiguous, deployment-related scenarios and gradually increasing the proportion of neutral or non-negative interpretations. By promoting less negative appraisals of post-event experiences, CBM-I aims to reduce the likelihood of developing PTSD by improving cognitive resilience.

What is the purpose of the Warriors Achieving Resilience (WAR) study?

The Warriors Achieving Resilience (WAR) study is a randomized controlled trial that examined the effectiveness of Heart Rate Variability Biofeedback (HRVB) and Cognitive Bias Modification for Interpretation (CBM-I) training in Army National Guard soldiers preparing for deployment. The study tracked PTSD symptom severity at pre-deployment, 3-month, and 12-month intervals to determine if resilience training could reduce post-deployment PTSD symptoms compared to a control group. It sought to reshape military PTSD prevention strategies through innovative approaches.

Why are Heart Rate Variability Biofeedback (HRVB) and Cognitive Bias Modification for Interpretation (CBM-I) important?

Heart Rate Variability Biofeedback (HRVB) is significant because it enhances self-regulation through optimized breathing techniques, promoting physiological resilience. Cognitive Bias Modification for Interpretation (CBM-I) is equally important as it modifies negative thought patterns related to deployment scenarios, fostering cognitive resilience. Both interventions aim to improve soldiers' ability to cope with deployment-related stress, ultimately reducing the risk of developing PTSD.

What should future studies focus on to improve resilience training?

Future research should focus on maintaining frequent contact with participants during deployment to ensure the continued use of resilience training apps. Additionally, it's important to explore the differential effectiveness of Heart Rate Variability Biofeedback (HRVB) and Cognitive Bias Modification for Interpretation (CBM-I) interventions based on individual characteristics and specific deployment experiences. Tailoring strategies could lead to more impactful and personalized PTSD prevention approaches. Additional types of interventions may include pharmacological and other types of therapies.