{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T07:08:35Z","timestamp":1783840115940,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006379","name":"Medical University - Varna","doi-asserted-by":"publisher","award":["21004"],"award-info":[{"award-number":["21004"]}],"id":[{"id":"10.13039\/501100006379","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Medical education is a high\u2010demand environment where stress may disrupt autonomic and HPA\u2010axis regulation. We examined symptom trajectories and adaptation during heart rate variability biofeedback (HRV\u2010BF) in an academic setting. Forty\u2010seven students were followed for ~3\u2009months. The intervention group completed HRV\u2010BF twice weekly (~30\u2009min\/session). Psychological outcomes (PSS, SAS, BAI, BDI) were assessed at baseline and follow\u2010up, with clinically meaningful improvement defined as a \u2265\u200920% reduction. HRV\/coherence indices were analyzed with mixed\u2010effects models, and cortisol and secretory IgA were measured around Maastricht Acute Stress Test before and after training. Within the HRV\u2010BF group, perceived stress, anxiety, and depression declined by May (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001;\n                    <jats:italic>d<\/jats:italic>\n                    \u22481.28\u20131.86), although between\u2010group differences converged. Meaningful improvement was more frequent in HRV\u2010BF group across scales. Acute sessions increased coherence and inter\u2010beat interval and reduced heart rate (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009\u2264\u20090.015), while RMSSD and inter\u2010beat interval gains plateaued after ~14 sessions. Cortisol responses to stress differed after training, whereas sIgA showed no between\u2010group effects. In this nonrandomized study, HRV\u2010BF was associated with clinically meaningful improvement by follow\u2010up and autonomic adaptation; however, because the group was not matched on baseline distress severity and no sham comparator was used, reductions in anxiety and depression cannot be attributed definitively to the intervention.\n                  <\/jats:p>","DOI":"10.14814\/phy2.70949","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:39:36Z","timestamp":1780637976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physiological adaptation during heart rate variability biofeedback in young adults: A survival analysis in high\u2010stress academic environments"],"prefix":"10.14814","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1404-8884","authenticated-orcid":false,"given":"Gabriela","family":"Panayotova","sequence":"first","affiliation":[{"name":"Division of Physiology, Department of Physiology and Pathophysiology Medical University of Varna  Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Velikova","sequence":"additional","affiliation":[{"name":"Division of Physiology, Department of Physiology and Pathophysiology Medical University of Varna  Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jfmk9020093"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.14455"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/\/0022\u2010006x.56.6.893"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1961.01710120031004"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227721"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359\u2010025\u201003041\u2010z"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102023\u2010082910"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.02172"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1147260"},{"key":"e_1_2_12_11_1","volume-title":"StatPearls","author":"Chu B.","year":"2026"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2307\/2136404"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19095693"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/sports10100146"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717001003"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2008.10.026"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010025\u201008053\u20102"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009034"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484\u2010023\u201009582\u20106"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484\u2010020\u201009466\u2010z"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2014.00756"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/2032057"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484\u2010020\u201009483\u2010y"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/mi.2011.41"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.7453\/gahmj.2014.073"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/1980\u2010220X\u2010REEUSP\u20102022\u20100078en"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00301"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033\u20102909.133.1.25"},{"key":"e_1_2_12_29_1","unstructured":"Moore K. 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