TYPE Hypothesis and Theory

PUBLISHED 29 September 2023

DOI 10.3389/fnrgo.2023.1245946

Using the Research Domain

OPEN ACCESS Criteria as a framework to
integrate psychophysiological
EDITED BY
Martin O. Mendez,
Universidad Autónoma de San Luis
Potosí, Mexico

REVIEWED BY
findings into stress management
Richard Harvey,
San Francisco State University, United States
Mariateresa Sestito,
and psychotherapy interventions
Independent Researcher, Long Beach, CA,
United States
Patrick R. Steffen*
*CORRESPONDENCE
Patrick R. Steffen Department of Psychology, Brigham Young University, Provo, UT, United States
steffen@[Link]
RECEIVED 24 June 2023
ACCEPTED 11 September 2023 Research on the psychophysiology of stress is expanding rapidly, but the
PUBLISHED 29 September 2023
field lacks a clear integrative framework to help translate research findings
CITATION
Steffen PR (2023) Using the Research Domain
into empirically supported stress interventions. The Research Domain Criteria
Criteria as a framework to integrate (RDoC) is an excellent candidate to explore as a framework to integrate stress
psychophysiological findings into stress research. The RDoC framework is a dimensional, multi-modal approach to
management and psychotherapy interventions.
Front. Neuroergon. 4:1245946.
psychopathology proposed as an alternative to categorical approaches used by
doi: 10.3389/fnrgo.2023.1245946 the International Classification of Diseases (ICD) and the Diagnostic and Statistical
COPYRIGHT
Manual (DSM). The goal of this paper is to explore the RDoC as a framework
© 2023 Steffen. This is an open-access article to integrate psychophysiology research into therapeutic interventions for stress.
distributed under the terms of the Creative The RDoC consists of six domains: negative valence systems, positive valence
Commons Attribution License (CC BY). The use,
distribution or reproduction in other forums is systems, cognitive systems, social processes systems, arousal/regulatory systems,
permitted, provided the original author(s) and and sensorimotor systems, and provides an excellent structure for integrating
the copyright owner(s) are credited and that information from multiple levels of functioning including physiology, behavior,
the original publication in this journal is cited, in
accordance with accepted academic practice. and self-report, as well as genes, molecules, cells, and brain circuits. Integrating
No use, distribution or reproduction is psychophysiological research on stress using the RDoC framework can direct and
permitted which does not comply with these amplify stress management and psychotherapeutic interventions. First, the RDoC
terms.
provides a clear foundation for conceptualizing the stress response in terms of
important concepts such as allostasis and adaptation. In this perspective, the terms
“allostatic response” or “adaptation response” are more descriptive terms than
“stress response” in understanding bodily responses to life threats and challenges.
Second, psychophysiological approaches can be used in the context of modalities
such as biofeedback and mindfulness to both collect psychophysiological data
and then integrate that data into a broader therapeutic framework. Heart rate
variability (HRV) biofeedback is being used more frequently as part of a therapeutic
intervention package with stress management and psychotherapy, and HRV data is
also used to provide outcome evidence on the efficacy of treatment. Mindfulness
practices are commonly used in combination with stress management and
psychotherapy, and psychophysiological data (HRV, EEG, blood pressure, etc.) is
often collected to explore and understand mind/body relationships. In conclusion,
the lack of a clear framework to assess and understand mind/body functioning
limits current stress research and interventions. The RDoC provides a strong
framework to assess and integrate physiological and psychological data and
improve stress interventions.

KEYWORDS

stress, Research Domain Criteria, interventions, assessment, biofeedback, mindfulness

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Introduction noting that “therefore stress, in addition to being itself and the
result of itself, is also the cause of itself ” (Roberts, 1950). To define
Stress significantly impacts health and wellbeing and national the concept of stress more clearly, Selye (1976) defined stressor as
stress surveys indicate that stress remains at high levels following a cause of stress and emphasized the terms distress and eustress
the pandemic (Schneiderman et al., 2005; Cohen et al., 2007; to help delineate negative and positive forms of stress. Selye was
American Psychological Association, 2023). Therefore, effective not a native English speaker and later wished he had used another
stress interventions are of vital importance. Although there is term besides the word stress to describe the body’s response to
a large and growing body of psychophysiological research on life challenges.
stress, the field lacks an accepted overarching framework to Today it is still argued that the word stress is too ambiguous
integrate psychophysiological stress research findings into stress to be useful, being more of an impediment to research than
interventions. The biopsychosocial model is frequently used a help (Ader, 1980; Koolhaas et al., 2011; Kagan, 2016). Most
as a general model to conceptualize the interactions between researchers, however, do continue to use the word stress, with
biological, psychological, and social factors in health (Searight, stress researchers arguing that the remedy to this problem
2016; Smith, 2021). The biopsychosocial approach, however, has is increased specificity in how the word stress is used to
focused only on general concepts and has not provided a specific maximize clarity in what is meant, and broader conceptual
framework for integrating information across factors. Cohen models that integrate biological, psychological, sociological, and
et al. (2016) note that there are multiple traditions in studying epidemiological approaches (Cohen et al., 2016; Slavich and
stress, from epidemiological to psychological and biological, with Shields, 2018; Croswell and Lockwood, 2020; Croswell et al., 2022).
each using different methods to study stress and even have For example, to help clarify stress terms, instead of just using the
different conceptualizations of stress. Definitions of stress used by word stress, use the word stressor to define the event and chronic
researchers, as well as by people who are not specialists, are often stress to help clarify time period.
vague and lack clarity, with some experts arguing that the word Given that researchers struggle with word “stress”, it is not
stress should not used at all (Ader, 1980; Koolhaas et al., 2011; surprising that lay people who do not have specialized knowledge
Kagan, 2016). about stress have difficulties understanding as well. Lay people
The Research Domain Criteria (RDoC) approach provides a still typically emphasize stress as a negative event or experience;
promising framework within which to conceptualize stress and even the Oxford dictionary defines stress using primarily negative
integrate current stress research findings into stress interventions words. This is in spite of repeated attempts by researchers and
(Craske, 2012; Cuthbert and Kozak, 2013; Kozak and Cuthbert, professionals to have a broader definition of stress, emphasizing
2016). The RDoC consists of six domains (negative and positive that stress can have positive as well as negative effects. Selye (1976)
valence systems, cognitive systems, social processes systems, emphasized positive stress with his concept of eustress. Hanson
arousal systems, and sensorimotor systems) that are impacted (1986) book, “The Joy of Stress,” emphasized the positive side of
by environment and development and are studied using a stress and was well-received and lauded. And in 2013, McGonigle
multi-modal approach, from genes to broad social factors (2013) presented a famous TED talk about making stress our friend,
(Vaidyanathan et al., 2020). Having a clearly delineated framework emphasizing the positive side of stress. None of these have seemed
can facilitate the integration of research into interventions by to make a dent in the overall negative view of stress. Given the
mapping out specifically the domains to cover, environmental and confusion over the use of the word stress, when working with
developmental factors that impact these domains, and the multiple patients and people it may be more helpful to focus on the process
dimensions to consider in a comprehensive stress assessment. of coping with life challenges and use more descriptive terms
This paper begins by reviewing how stress has been defined instead of using the word stress.
and understood over the years, the RDoC approach is then Perhaps most importantly, the concept of stress is really
presented, and then an integrative method is considered using HRV a metaphor that incompletely addresses the physiological and
biofeedback and mindfulness as specific approaches to guide both psychological processes that occur during challenge and threat
assessment and interventions. (Thibodeau and Boroditsky, 2011; Taylor and Dewsbury, 2018).
The problem with metaphors being taken literally is that no
metaphor completely maps onto reality. People are not bridges
made of concrete and steel withstanding physical strain; people
Understanding stress are biological, psychological, and social organisms that grow,
adapt, and change over time (Lazarus, 1993; Thibodeau and
In the 1950′ s, Selye’s extensive work on stress significantly Boroditsky, 2011; Taylor and Dewsbury, 2018). People can be
impacted how the word began to be used in everyday language negatively impacted by chronic stress over time, but the process
(Selye, 1956; Lazarus, 1993; Becker, 2013). Up until at least 1949, is psychological and social as well as biological. To make things
dictionaries defined stress only as the action of external forces (e.g., even more complicated, two people can perceive the exact same
a natural disaster) that people endured, or the physical strain placed event in diametrically opposite ways. As a simple example, some
on an object such as a bridge. Selye’s research made it clear that people love rollercoasters and some people fear them, with the
stress has significant internal physiological impacts, and that stress same experience leading to very different physiological responses.
is an internal event as well as an external one. Problems arose, Bridges do not perceive, respond, or grow as humans do. This is
however, with the vagueness of the word stress, with one critic where taking the metaphor of stress too literally causes problems,

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as many people conceptualize stress as something that happens The Research Domain Criteria as an
to them as if they were merely an object being acted upon, not integrative framework for stress
recognizing that their perception of the event plays a key role in
the stress response. Interestingly, perception is typically a key focus The RDoC approach provides an excellent framework for
of stress interventions (Pretzer and Beck, 2007). integrating psychophysiological research into psychotherapy and
Modern views of stress emphasize challenge or threat to stress management interventions (Craske, 2012; Cuthbert and
homeostasis, the person’s perception of stress, and their perceived Kozak, 2013; Kozak and Cuthbert, 2016; Vaidyanathan et al., 2020).
ability to cope (McEwen, 2000; Goldstein and Kopin, 2007; Although definitions of stress are becoming clearer and assessments
McEwen and Akil, 2020). The process of maintaining balance of stress are becoming more refined, stress research lacks an agreed
between internal needs and external demands is at the heart of the upon overarching framework for integrating knowledge across
stress response. A person’s perception of their ability to cope with theory, assessment, and intervention, and providing a clear way to
life challenges directly impacts this balance. This process is well- translate research into practice. In particular, stress interventions
described by the concept of allostasis (McEwen, 2000). Allostasis, often focus on the symptoms without considering the underlying
or maintaining stability through change, is a broader term than causes. Having a clear, organized framework that integrates
homeostasis focusing on interdependence of bodily systems in research knowledge across theory, assessment, and intervention has
response to life’s challenges (McEwen, 2000). Bodily systems need the potential to improve how stress interventions are conducted
to work together as an integrated whole to effectively deal with to improve allostasis and adaptation. There are other frameworks
life challenges. Allostatic load, or the cost of chronic exposure to being developed in addition to the RDoC that may be useful
significant life challenges, can negatively impact system functioning for integrating research, particularly the Hierarchical Topology of
over time leading to increased morbidity and early mortality Psychopathology (HiTOP), and Michelini et al. (2021) provide an
(McEwen and Akil, 2020). Selye (1946) concept of “diseases of interesting integration of RDoC and HiTOP approaches. For this
adaptation” also maps well with the ideas of allostasis and allostatic article the focus is exclusively on the RDoC as a beginning point to
load. Maintaining healthy allostasis is basically healthy adaptation. explore possibilities.
Instead of using the term “stress response” with people, the The RDoC approach provides an excellent framework for
terms “allostatic response” or “adaptation response” are both more integrating stress research and stress interventions for four key
accurate and more descriptive of what people experience during life reasons. First, the RDoC takes a dimensional approach being
challenges (McEwen, 2000) (see Table 1). created as a dimensional alternative to the DSM categorical
Psychophysiological research emphasizes the importance approach. Depressive symptoms, for example, occur along a
of balance and coping (Lang et al., 1990, 2017; McEwen, continuum with many possible levels; to categorize people as
2000; McEwen and Akil, 2020), and an understanding of either depressed or not depressed is to lose vital information.
psychophysiological responses to life challenges provides a Similarly, stress is not an either/or proposition with people either
strong foundation for stress interventions. The brain integrates having a lot of stress or none at all. Stress also occurs along a
information about life challenges and decides on appropriate continuum from low to high with many possible levels. Second,
action, and the endocrine and peripheral nervous systems provide the RDoC takes current environments into account and focuses on
communication highways throughout the body preparing the the development of distress over time. The current stress context is
body for that action. Cortisol and adrenaline (epinephrine) are key not independent of previous developmental factors, and assessing
chemical messengers of these two respective systems. Although these factors may have significant benefit for interventions.
they are often called “stress hormones”, it is more helpful to think Third, the RDoC takes a multilevel assessment approach, ranging
of them as “hormones involved in the stress response” because their from self-report and interviews to assessing organ systems,
primary purpose is to assist in metabolism and energy regulation
brain circuits, cells, and chemical messengers. Taking a broad,
regardless of stress levels. They are more than just stress hormones,
integrative multilevel approach to assessment enables a thorough
they help regulate normal, day to day activities. Given that energy
representation of stress to be constructed. Fourth, the RDoC
utilization is often a key part of the stress response, cortisol and
is a developing framework, continually integrating new research
adrenaline also play a central role in the stress response as well.
discoveries over time. The seven pillars of the RDoC approach
Excessively high levels of cortisol and adrenaline over time are
(e.g., the RDoC is flexible and dynamic to accommodate
associated with dysregulation of the cardiovascular, immune,
research advances, focuses on constructs with solid evidence, and
and gastrointestinal systems, as well as with the central nervous
uses reliable and valid measures) emphasize this approach to
system itself. An effective framework for understanding stress and
continual development (see Table 2).
conducting stress interventions needs to consider the different
The RDoC dimensional, developmental/environmental, and
organ systems involved in stress, the multiple physiological levels
in stress (i.e., chemical messengers, cells, brain circuits, organs and multilevel assessment approach is measured across six domains:
organ systems), the environmental and social contexts in which negative valence systems, positive valence systems, cognitive
they occur, and how all of these interact together over time in systems, social systems, arousal systems, and sensorimotor systems.
processes of development and change. Each of these domains will be discussed in turn.

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TABLE 1 Definitions of stress.

Concept Definition
Stress The perceived demands of a situation exceed or threaten to exceed the perceived resources of the individual. Selye conceptualized stress
as the effects of anything that threatens homeostasis.

Stressor Situations or events that are perceived as threatening or challenging.

Stress response Attempts to cope with and reduce stress. There are significant individual differences in how people perceive and respond to stressful
situations.

Eustress Positive stress

Allostasis Maintaining stability through change. The major goal of allostasis is to promote adaptation.

Allostatic load The cumulative burden of chronic exposure to stress that may cause physiological dysregulation and promote disease.

Adaptation response The ability to cope with external environmental conditions while maintaining necessary internal functioning required for life (oxygen,
glucose, etc.)

TABLE 2 The seven pillars and six domains of the Research Domain Criteria.

Pillar Definition
Translational perspective Understanding based on basic science, including basic systems such as neural, behavioral, cognitive, etc.

Dimensional approach Constructs are dimensional and not categorical

Reliable, valid measures Constructs assessed using measures with demonstrated reliability and validity

Novel research designs New research designs and strategies are needed to aid in new discoveries

Integrative methods Emphasis on integrating multiple types of measures to better study constructs

Platform for research Goal is to have a platform for research based on solid evidence, and not tied to any one approach

Flexible, dynamic to accommodate Help free researchers from constraints of any given diagnostic system to help push understanding forward
research advances

Domain Definition
Negative valence Responses to threat or harm through self-protection and avoidance

Positive valence Responsiveness to rewards and approach behavior

Cognitive Attention, perception, memory, and effortful cognitive control

Social Affiliation and attachment, social communication, self-perception and understanding, and other-perception and
understanding

Arousal Arousal, circadian rhythms, sleep-wakefulness

Sensorimotor Control and execution of motor behaviors, agency and ownership, habit, innate motor patterns

RDoC negative and positive valence acting survival circuits that motivate and guide behavior. Fear,
systems on the other hand, is the conscious awareness of our survival
response. The goal of negative valence systems is to be vigilant
Avoidance of harm and approaching needed resources are key and ready to respond quickly to danger. How can the negative
to survival. From a psychophysiological perspective, we are guided valence systems go wrong during chronic stress? Because safety
by the two core motives of approach and avoidance, with affect and survival are paramount, human beings have a natural tendency
guiding our strategic orientation toward the world (Lang et al., to err on the side of protection, with the stress response being
1990, 2017). Our current valence, the balance between our current the default response until safety is certain (Brosschot et al., 2018;
negative and positive affect, provides a background framework for Van den Bergh et al., 2021). If a significant threat is missed, the
the interactions between ourselves and our various environments. results could be disastrous. If life is chronically uncertain, then
This is also termed core affect which represents the integration of the stress response becomes chronic and continually engaged to
information indicating how we are doing each moment in time be ready just in case, even when no stressors actually occur.
(Russell, 2003; Duncan and Barrett, 2007). From this perspective prolonged stress responses can occur in
Negative valence systems direct our responses to threat or common situations, situations in which no current stressors are
harm through self-protection and avoidance. To survive and occurring, such as loneliness, low social status, or early life
thrive, negative valence systems help us to effectively cope with adversity. Therefore, a person does not need to be currently
life threats and challenges as they occur. LeDoux (2012, 2021) experiencing stress for a stress response to occur, merely feeling
argues that we do not have fear circuits, rather we have fast unsafe is enough to trigger a stress response (Brosschot et al., 2018).

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In terms of stress interventions, the question then is not what causes RDoC arousal and sensorimotor systems
a prolonged stressor but what stops it, what contributes to a sense
of safety? The arousal and sensorimotor systems are in a sense broader
The positive valence systems consist of responsiveness to level systems that encompass the other systems (Cuthbert and
rewards and approach behavior. To survive we need to be able Kozak, 2013; Kozak and Cuthbert, 2016). Arousal involves
to obtain needed resources such as food. How can the positive sensitivity to external and internal stimuli and facilitating
valence systems go wrong during chronic stress? The positive interaction with the environment according to context, which
valence systems can go wrong as people approach substances or can be impacted by anxiety and depression (Lang et al., 2016;
activities that can have a negative impact, such as using addictive Olbrich et al., 2016; Zambrano-Vazquez et al., 2017). Circadian
substances or chronic gambling. Initially, these activities can rhythms play an important role in homeostasis, along with the
lead to positive feelings and increased desire to continue using. sleep/wakefulness cycle which plays an important restorative role
Over time, they can lead to addiction as people engage in these (Gunzler et al., 2020; Pingeton et al., 2023). This system can go
activities to increase their sense of positivity. Eventually, tolerance wrong when homeostasis is disrupted due to chronic stress or
develops as more and more use is required to obtain positive lack of quality sleep over time. The sensorimotor system involves
feelings, and use begins to be about avoiding the negative feelings control and execution of motor behaviors, engaging plans, and
of withdrawal. matching internal and external constraints to achieve goals. It
also involves our sense of agency, the sense that we are initiating,
executing and in control of our actions, the sense that our body
belongs to ourselves, and general self-awareness. This system can
also go wrong during prolonged chronic stress, particularly when
RDoC cognitive and social systems early life adversity disrupts normal development, leading to a
disrupted sense of self (Brosschot et al., 2018; Van den Bergh et al.,
As with the negative and positive valence systems, the 2021).
central goal of the cognitive and social systems is survival.
According to Bowlby’s theory of “environment of evolutionary
adaptedness”, humans’ successful evolution over hundreds of
Integrating current
thousands of years was based on increased cognitive abilities
and strong social connections (Bowlby, 1980). We have cognitive psychophysiological research findings
processes such as problem solving, planning, effective decision into stress interventions
making, etc., because they are highly adaptive. We have
social relationships because there is strength and protection The RDoC approach provides a promising framework for
in numbers, we can accomplish more together than alone, integrating current psychophysiological research findings into
and we need parents to make it out of infancy. When stress interventions. Being able to assess stress across the
our cognitive and social systems are doing well, we are six domains at multiple levels of functioning from chemical
doing well. messengers such as cortisol to measures of social factors in health
The cognitive valence systems consist of attention, perception, allows a thorough evaluation to be conducted. Drawing from
memory, and effortful cognitive control. By attending to and a RDoC guided stress evaluation, stress interventions can be
being aware of our current situation we can more successfully tailored specifically to the needs of the individual. Perhaps most
respond to emerging needs. Our brains are geared to predict importantly, the thorough assessment helps to ensure that key
coming need to be ready for whatever changes, good or bad, might aspects of stress and health have been covered and this information
arise. How can cognitive systems go wrong with chronic stress? is carefully integrated into the stress intervention to enhance the
Our attention and perception are impacted by our motivation adaptative and allostatic abilities of the person.
and affective state (Lang et al., 1990, 2017). The perseverative Compassion Focused Therapy (CFT) is an excellent example
cognition hypothesis argues that worry and rumination are of how psychophysiological research and psychophysiological
common responses to stress that lead to prolonged physiological interventions can be integrated with psychotherapy and stress
activation and stress related health problems (Verkuil et al., management using the RDoC as an integrative framework.
2011). The foundational principles of CFT emphasize how negative
The social processes domain includes affiliation and emotion and stress occur when people lack self-compassion
attachment, social communication, self-perception and and interventions focus on activating positive emotions and
understanding, and other-perception and understanding. This engagement with the self and others to decrease stress. CFT also
system can go wrong when do not experience safety as part of a emphasizes mindful breathing exercises to directly impact heart
group. This is similar to the generalized unsafety theory of stress rate variability and stress and encourages the measurement of heart
discussed in the negative valence systems, with compromised social rate variability as a part of the intervention process (Steffen et al.,
contexts, isolation and loneliness, low social status and minority 2021). The RDoC framework provides an excellent framework
standing, unpredictable social contexts, and early negative learning for conceptualizing and integrating this information. The negative
all priming us to experience chronic stress (Bowlby, 1980; valence system aligns with the work on negative emotion and
Baumeister and Leary, 1995; Brosschot et al., 2018; Hogan and the positive valence system aligns with the work on building
Sherman, 2020; Van den Bergh et al., 2021). positive emotions. The cognitive system aligns with addressing how

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people think about themselves and the social system aligns with stress response and using that awareness to cope better with
working on compassionate relationships. Finally, the arousal and their stress.
modulatory systems are impacted by engaging in exercises that People also practice resonance frequency breathing at home,
affect heart rate variability. Using the RDoC framework can also learning how to be in resonance without the aid of a computer
help in the design of research studies, focusing on measuring each screen, developing better breathing habits. Training sessions only
of the domains in reliable and valid ways. require 15–20 min of time and are not difficult. A number of smart
General approaches that can be integrated into psychotherapy phone apps have been developed as well as portable biofeedback
or stress management interventions using the RDoC framework devices which makes home practice easy and effective. Because
include heart rate variability (HRV) biofeedback and mindfulness biofeedback involves developing new habits, regular practice is
(Steffen et al., 2017). Both modalities effectively reduce stress and required to achieve full benefit. In addition to using HRV as part
have been integrated into basic stress management interventions as of an intervention strategy, HRV data is collected over time to
well as psychotherapy, and both fit well within an RDoC framework assess change in baseline HRV as people practice and improve in
because they directly impact the negative and positive valence breathing. HRV biofeedback is also frequently used in combination
systems as well as the arousal and modulatory system (Khoury et al., with mindfulness practices, progressive muscle relaxation, and
2015; Steffen et al., 2022). And both modalities are frequently used autogenic training (Lehrer et al., 2007; Khazan, 2013). Autogenic
to collect psychophysiological data in order to understand the stress training has also been shown to improve heart rate variability as
response to help guide stress interventions, as well as being a part a standalone intervention (Miu et al., 2009; Lim and Kim, 2014;
of the intervention itself. HRV is a psychophysiological measure Stanton et al., 2018).
of particular interest in assessing both mental and physical health.
HRV, a measure of the change in time intervals between heart beats,
is considered a measure of positive adaptability and health. Higher
HRV is associated with better adaptability and health and lower Mindfulness
HRV is associated with worse adaptability and health. Because both
HRV biofeedback and mindfulness effectively increase HRV they As with HRV biofeedback, mindfulness also often begins with
are being used more frequently in stress interventions (Steffen et al., a breathing focus. Mindfulness consists of sustained moment-to-
2017; Steffen and Bartlett, 2022). moment awareness in an open and non-judgmental way, accepting
whatever one is experiencing (Grossman, 2010). Most people are
not typically aware of their immediate experience, with many
different thoughts occurring in the mind at any given moment,
Biofeedback and with many of those thoughts being about the past or the
future and not present focused. A key assumption of mindfulness
Biofeedback is an interactive process where people are taught practice is that anyone can learn to become more mindful and
how to become more aware of and then alter their physiological more present focused. Because mindfulness develops over time, it
activity (Lehrer et al., 2007). Sensors are attached that allow a is recommended that people practice most days (if not daily), with
persons’ physiological signals (heart rate, respiration, etc.) to be beginners spending about 20 min each day.
measured in real time and shown to the person on a computer There are a number of different ways to approach mindfulness,
screen, allowing them to see the impact of their practice on with breath focus being just one, but it is focused on here for ease
their physiology in real time. People are also given homework of presentation. Mindfulness of breath exercises are relatively easy
assignments where they practice physiological exercises learned in and straightforward to practice. People can practice in groups with
session, such as breathing, in order to develop the skill more fully. A a teacher and there are numerous audio-based exercises that are
key goal of biofeedback is to help people learn to self-regulate their available for individual practice. Mindful breathing exercises have
physiological responses, especially during times of stress. people focus on their breathing, just being with the breath, noticing
HRV biofeedback has been shown to be particularly effective the process of breathing. Interestingly, experienced meditators will
at regulating the stress response (Lehrer et al., 2007). HRV naturally gravitate toward a resonance frequency breathing rate
biofeedback involves measuring heart rate and respiration and without consciously trying to. It appears that people naturally learn
showing the combined information to the client on a computer to recognize the calm state of resonance frequency breathing, spend
screen (Lehrer et al., 2013). People are taught to breathe at their more time in this breathing state, and derive benefits similar to
personal resonance frequency rate, typically between 4.5 and 7 HRV biofeedback, such as improved mood (negative and positive
breaths per minute. Breathing instructions emphasize breathing valence systems) and healthier physiological functioning (arousal
“low and slow”, breathing low into the diaphragm and slowing the and modulatory systems). Mindfulness is an effective approach to
rate of breathing to the resonance frequency rate. Using feedback managing stress and improving overall wellbeing (Hofmann et al.,
from the computer screen, people learn to recognize when they 2010; Khoury et al., 2015; Steffen et al., 2020).
are in resonance, and then practice spending more time at their Using mindfulness and HRV biofeedback together can be
personal resonance frequency breathing rate. Synchronizing heart an especially powerful approach to building an effective stress
rate and breathing increases breathing efficiency and significantly intervention, especially when integrated with general stress
increases HRV and parasympathetic activity (Lehrer and Gevirtz, management and psychotherapeutic principles (Khazan, 2013).
2014; Caldwell and Steffen, 2018). HRV biofeedback helps people Conceptualizing this intervention in a RDoC framework, we
learn to self-regulate by being more aware of their physiological would first do a thorough assessment. Each of the domains

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of negative and positive valence systems, cognitive and social and mindfulness to collect psychophysiological data that can
systems, and arousal and sensorimotor systems, are reviewed then be integrated into a broader therapeutic framework for
within current environmental contexts and historical development. conducting stress interventions. Overall, the RDoC provides
The RDoC framework recommends using a multi-modal approach a strong framework to assess and integrate physiological and
to collecting data, from the very basic level such as chemical psychological data and thereby improve stress interventions.
messengers, to the broadest levels of social context. To use
this multi-modal approach, the assessment could begin with
an interview and self-report questionnaires to examine stress, Data availability statement
wellbeing, and social functioning. Physiological data can be
collected during biofeedback on heart rate and respiration. The original contributions presented in the study are included
Additionally, cortisol can be collected via saliva. Ideally, this data in the article/supplementary material, further inquiries can be
will be collected at home as well as in the clinic at the beginning directed to the corresponding author.
of the intervention, during the intervention, and at the end of
the intervention. This thorough data assessment will allow change
and progress to be examined and can be used as feedback for Author contributions
intervention participants to better understand their personal stress
response, realize what gains they have made, and where to best The author confirms being the sole contributor of this work and
focus their efforts in the future. has approved it for publication.

Conflict of interest
Conclusions
The author declares that the research was conducted in the
The RDoC is a promising framework for integrating
absence of any commercial or financial relationships that could be
psychophysiological research into psychotherapy and stress
construed as a potential conflict of interest.
management interventions. The RDoC framework is a
dimensional, multi-modal approach that allows for integration of
information from multiple levels of functioning in the context of Publisher’s note
environments and development. Integrating psychophysiological
research on stress using the RDoC framework can direct and All claims expressed in this article are solely those of the
amplify stress management and psychotherapeutic interventions. authors and do not necessarily represent those of their affiliated
The RDoC provides a clear foundation for conceptualizing the organizations, or those of the publisher, the editors and the
stress response in terms of important concepts such as allostasis reviewers. Any product that may be evaluated in this article, or
and adaptation. Psychophysiological approaches can be used claim that may be made by its manufacturer, is not guaranteed or
in the context of modalities such as biofeedback, Autogenics, endorsed by the publisher.

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