Graduation Year


Document Type


Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)


Occupational Therapy


Background: People who acquire Covid 19 may have symptoms lasting over three months, called Long Covid. It is estimated that one in five people in the United States has Long Covid. Unpleasant symptoms of Long Covid are many including anxiety. People with Long Covid have a difficult time engaging in everyday activities and have a poor quality of life. Occupational therapy practitioners using heart rate variability (HRV) biofeedback may help decrease anxiety in the Long Covid population. There is limited research on occupational therapy and HRV biofeedback.

Purpose: The problem the study addressed was to investigate the use of HRV biofeedback therapy delivered by an occupational therapy practitioner and its effectiveness to decrease anxiety levels in people with Long Covid. The research aimed to discover if HRV biofeedback decreased anxiety and increased the quality of life in persons with Long Covid.

Methods: This study was quasi-experimental in the form of a pre-test-post-test design. Each participant was administered two pre-tests/posttests, the Generalized Anxiety Disorder (GAD) and the Quality of Life Scale (QOLS). Each participant received eight biofeedback sessions.

Results: The results of this study found that HRV biofeedback demonstrated potential in decreasing anxiety and improving quality of life in persons with Long Covid. This study yielded a low sample size; therefore, more data needs to be collected in order to determine if the results are statistically significant. A minimal clinical difference of a 4-point change is considered clinically meaningful. Ten out of eleven participants in this study reported a decrease in anxiety based on the post-test outcome measures of the GAD-7 which is considered clinically meaningful. An increase of 8-9 points in the QOLS is considered a 60% improvement in quality of life. Nine out of eleven participants reported an improvement in their quality of life and as a group mean score, which was found to be clinically meaningful.

Conclusions: The results of this pilot study appear promising for the use of HRV biofeedback to reduce anxiety and improve QOLS in persons with Long Covid. The study will continue to collect data until there are sufficient participants to perform paired-sample t-tests to determine the statistical significance of pre-test/post-test scores for both the GAD-7 and the QOLS.

Faculty Mentor

Dr. Cindy Hayden

Department Affiliation

Occupational Therapy

Committee Member

Dr. Julie Duckart

Department Affiliation

Occupational Therapy

Department Affiliation

Occupational Therapy

IRB Approval Number (if applicable)