Heart Rate Variability Biofeedback Part 1 Background and Research

1. Heart Rate VariabilityBiofeedbackPart 1 Background and Research Presented to GGSC Meet-up July 10, 2013 By Linda Hartstrom

2. “If I’d known I was going to live this long, I’d have taken better care of myself” US comedian Eubie Blake on his 100th birthday

3. Outline of Presentation • Heart Facts • Heart Rate Variability • Why is it important • Vagal Tone • Respiratory Sinus Arrhythmia • Cardiac Coherence • Heart Rate Variability Biofeedback

4. The Heart Just the facts… What is a heart rate? What determines heart rate? What is Heart Rate Variability?

5. 2 1.5 76 BPM 83 BPM 70 BPM m Volts 1 .793 sec. .726 sec. .859 sec. 0.5 0 -0.5 0 1 2 2.5 seconds of heartbeat data Heart Rate Variability (HRV) Electrocardiograph

6. High vs Low HRV

7. Heart Rate Variability (HRV)Why is it important? • Higher levels of resting HRV have been associated with: • Well balanced ANS • Greater overall health • Greater emotion regulation • Effective stress coping strategies • Increased resilience under stress • Increased attention control

8. Heart Rate Variability (HRV)Why is it important? • Low HRV predicts worsening: • Coronary heart disease • Atherosclerosis (Wennerblom, et al 2000) • Elevated triglycerides (Jensen-Urstad M, et al 1998) • Low HRV Correlates with: • Diabetes (Laitinen T, et al 1999) • Obesity (Karason K, et al 1999) • Multiple metabolic syndrome (Liao D, et al: 1998) • Hypertension (Schroeder EB, et al 2003)

9. Heart Rate Variability (HRV)Why is it important? • Low HRV linked with: • Depression (Carney RM et al. 2001) • Social isolation (Hughes JW et al. 2000) • Suppressed anger (Inmaculada L et al. 2009) • Increased risk of mortality (Framington Heart Study: Singh et al., 1998).

10. Heart Rate Variability (HRV)Intervention Results • Reduced blood pressure in hypertension (McConville, 2012) • Improved asthma (Lehrer, 2000) • Reduced symptoms of stress (Nolan RP, 2005) • Increased calmness and well-being (Friedman, 2000) • Increased emotional stability (McCraty, 2001) • Improved cognitive performance (McCraty, 2001) • Improves hormonal balance (McCraty, 1998) • PTSD symptom reduction (Zucker et al. 2009)

11. Heart Rate Variability • Influences • Extrinsic • Physical Activity • Physical Stress • Mental/Psychological Stress • Intrinsic • Respiratory Sinus Arrhythmia (breathing) • Baroreceptor reflex (blood pressure) • Hormones

12. Heart Rate Variability (HRV) 100 90 80 70 60 50 40 30 20 10 0 HEART RATE (BPM) 8 10 12 14 16 18 20 22 24 Seconds

13. Heart Rate Variability (HRV) 100 – 90 – 80 – 70 – 60 – 50 – Incoherence: Impairs Performance— Drains Energy InhibitsBrain Function(Incoherence) HEART RATE 100 – 90 – 80 – 70 – 60 – 50 – Coherence: Promotes Optimal Performance—Builds Resilience FacilitatesBrain Function(coherence) HEART RATE 1 50 100 150 200 TIME (SECONDS) 13

14. Heart Rate Variability- Typical Day

15. A Police Officer HRV During a High-Speed Pursuit Scenario

16. A Police Officer HRV During a Domestic Violence Scenario

17. Vagal ToneDefinition • Vagal • Referring to the action of the vagus nerve; the 10th cranial nerve, which relays information between the brainstem and most of the internal organs • Tone • Tone is a term commonly used to refer to systems in continuous and partial states activity, such as “muscle tone” • In this context it means something similar to “tension” or “strength”

18. Low Vagal Tone • Linked to high inflammation (Thayer & Sternberg, 2006) and; • Forecasts higher risk for myocardial infarction and decreased odds of survival after heart failure (Bibevski & Dunlap, 2011).

19. High Vagal Tone • Is associated with superior abilities to regulate emotions (Thayer, Hansen, Saus-Rose, & Johnson, 2009) • Show greater positive emotionality (Oveis, Cohen, Gruber, Shiota, Haidt, & Kelther, 2009) and; • Show greater gains over time in their positive emotions (Kok & Fredrickson, 2010).

20. Vagal Tone Physiology Maximum HR 200 BPM SNS Activation Intrinsic HR 100 BPM PNS Vagus Nerve Potential HRV - 30 Resting HR 70 BPM

21. Maximal/Intrinsic HR and Age

22. Maximal/Intrinsic HR and Age BPM AGE

23. Maximal/Intrinsic HR and Age BPM Resting Heart Beat AGE

24. Maximal/Intrinsic HR and Age BPM 36 8 Resting Heart Beat AGE

25. Improving HRV • Lifestyle adjustments: • Exercise • Omega-3 intake • Yoga/qigong • Acupuncture • Emotional self- management (positive emotions) • Breathing practices (resonant frequency breathing) • HRV Biofeedback • Wine

26. Heart Rate Variability • HRV 3 domains • Sympathetic component; • Parasympathetic component coupled with respiration (RSA) … bottom-up; • Parasympathetic component independent from respiration… top-down cortex influence

27. Top Down Central Autonomic Network (CAN) PFC Inhibits/down-regulates Activation ACC Insula Amyg Brain Stem Sympathetic Activation Parasympathetic Suppression

28. Tides Breathing Exhale Exhale Exhale Inhale Inhale Inhale Bottom Up Respiratory Sinus Arrhythmia (RSA) Oscillations

29. Inhale Inhale Exhale Exhale Respiratory Sinus Arrhythmia(RSA) • Respiratory = Breath Oscillations • Sinus = Sinus node Oscillations • Arrhythmia = Heart Rate Changes

30. Oscillations-Heart Rate Variability Breathing Heart Rate Blood Pressure

31. What is Resonant Frequency? • Current research suggests that every individual has a “resonant frequency” at which heart rate variability is the greatest.

32. Cardiac Coherence

33. 12 breaths per minute

34. 7 breaths per minute

35. 5 breaths per minute

36. Heart Rate Variability Biofeedback Part 2 Demonstration