A Pilot Controlled Crossover Trial of Transcutaneous Auricular Vagus Nerve Stimulation and Breath-Focused Biofeedback in Adolescents: Feasibility and Psychophysiological Outcomes

A Pilot Controlled Crossover Trial of Transcutaneous Auricular Vagus Nerve Stimulation and Breath-Focused Biofeedback in Adolescents: Feasibility and Psychophysiological Outcomes | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 27 January 2026 V1 Latest version Share on A Pilot Controlled Crossover Trial of Transcutaneous Auricular Vagus Nerve Stimulation and Breath-Focused Biofeedback in Adolescents: Feasibility and Psychophysiological Outcomes Authors : Ainara Aranberri Ruiz [email protected] , Andrea Lebeña 0000-0003-0067-4390 , and Unai Liberal Graña Authors Info & Affiliations https://doi.org/10.22541/au.176951748.80330498/v1 151 views 85 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background/Objectives: The vagus nerve is a key neurophysiological pathway connecting the brain and body. Its functional state—vagal tone—is typically indexed by heart-rate variability (HRV) and inversely reflects physiological stress. Adolescents often exhibit reduced vagal tone and heightened stress reactivity. Schools offer a strategic setting for delivering stress-reduction interventions. This pilot study assessed the feasibility, safety, and preliminary efficacy of a school-based program combining HRV biofeedback with transcutaneous auricular vagus nerve stimulation (taVNS). Methods : Seventeen Vocational Education and Training (VET) students (ages 15–17) from AZITAIN-IFMPB (Eibar, Spain) completed six weekly 30-minute sessions. Each session included paced-breathing biofeedback (emWave®) combined with taVNS (Parasym™). Feasibility was assessed via recruitment, retention, acceptability, and adverse events. Physiological outcomes included HRV (analysed with Kubios) and hair cortisol concentration. State anxiety was assessed using the State–Trait Anxiety Inventory (STAI). Assessments were conducted at baseline, post-intervention, and at 7-week follow-up . Results: Recruitment reached 50%; retention in the second cohort was 75%. The intervention was well tolerated, with 80% acceptability and one mild adverse event. taVNS significantly increased parasympathetic activity (PNS index; F(1, 11) = 5.26, p = .043, η 2 p = 0.32), and reduced state anxiety (STAI; F(1, 13) = 6.79, p = .022, η 2 p = 0.34). Hair cortisol rose post-intervention (F(1, 12) = 11.75, p = .005, η 2 p = 0.49), but declined below baseline at follow-up. Conclusions : This pilot study demonstrated the feasibility of implementing the intervention in adolescents and provided preliminary estimates of its effects on stress-related outcomes, which will inform the design of a larger, controlled trial. Supplementary Material File (figures and images.docx) Download 122.79 KB File (paper tavns+biofeedback 2.docx) Download 217.07 KB Information & Authors Information Version history V1 Version 1 27 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Ainara Aranberri Ruiz [email protected] Universidad del Pais Vasco Departamento de Procesos Psicologicos Basicos y su Desarrollo View all articles by this author Andrea Lebeña 0000-0003-0067-4390 Linköping University View all articles by this author Unai Liberal Graña Universidad del Pais Vasco Departamento de Procesos Psicologicos Basicos y su Desarrollo View all articles by this author Metrics & Citations Metrics Article Usage 151 views 85 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ainara Aranberri Ruiz, Andrea Lebeña, Unai Liberal Graña. A Pilot Controlled Crossover Trial of Transcutaneous Auricular Vagus Nerve Stimulation and Breath-Focused Biofeedback in Adolescents: Feasibility and Psychophysiological Outcomes. Authorea . 27 January 2026. DOI: https://doi.org/10.22541/au.176951748.80330498/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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