EXPERT SERIES 1 In this interview, Dr. Don Moss and Dr. Fred Shaffer bring the insights that they have acquired through their many years of research and Variability Training practice to other health profession- als and introduce some of the key techniques being used in Heart Rate Variability (HRV) Donald Moss, Ph.D., is adjunct graduate training. The body’s autonomic faculty in Health Psychology at Saybrook nervous system (ANS) governs Graduate School in San Francisco, California, many of the body’s internal func- and a partner in three outpatient behavioural tions, through its two branches: the sympathetic branch of this ANS health clinics in western Michigan. He is activates or increases the heart’s Editor of the Biofeedback Magazine, Associ- action, while the parasympathetic ate Editor for Applied Psychophysiology and branch acts as a brake slowing the Biofeedback, and Consulting Editor for the action of the heart. The vagus nerve plays a role in the parasympathetic Journal of Neurotherapy and the Journal of braking action. The balance be- Phenomenological Psychology. Dr. Moss has tween this throttle and brake system over 50 publications in the fields of psycho- produces an ongoing oscillation, an physiology, biofeedback, and mind-body orderly increase and decrease in Donald Moss, Ph.D. heart rate. These autonomic inputs therapies, including an edited book (Hand- are mediated by two “pacemakers” book of Mind Body Medicine for Primary in the heart, the sinoatrial (SA) and Care, Sage, 2003). atrioventricular (AV) nodes, which are responsible for heart rhythms. The SA node initiates an electrical Fred Shaffer, Ph.D. is Professor of Psychol- signal which begins each cycle of ogy at Truman State University and founded the heart’s pumping action. This an innovative biofeedback and applied psy- signal passes through the AV node chophysiology program in 1977. He was a which spreads the electrical current through the ventricles of the heart. A 2005 recipient of the AAPB Sheila Adler variety of factors, including breath- Distinguished Service Award. He is the ing, pressure sensors (barore- producer and author of Biofeedback Tutor, a ceptors) in the arteries, the body’s multimedia training program developed for the thermal regulation, and anxious thinking, increase specific rhythms BCIA General Examination in Biofeedback. in heart activity. The overall process His research interests focus on heart rate of heart function is the end product variability and respiratory self-regulation. of these component rhythms. Higher Fred Shaffer, Ph.D. heart rate variability seems to indicate an optimal cooperation between the sympathetic and What is Heart Rate Variability? parasympathetic nervous system. By variability we mean changes in the interval or distance between one beat of the heart and the next. The interbeat interval (IBI) is the time The Biofeedback Foundation of Europe is a non-profit organization between one R-wave (or heart beat) and the next, in milliseconds. The IBI located in the Netherlands. For is highly variable within any given time period. Multiple biological rhythms more information on the BFE overlay one another to produce the resultant pattern of variability. “Foundation for Learning” initiative, Interbeat interval variations, or heart rate variability, have relevance for conferences, workshops, protocols and online education opportunities physical, emotional, and mental function. Many people confuse Heart please visit www.bfe.org. Rate with Heart Rate Variability. The human heart is a bio-electrical pump beating at an ever changing rate: it is not like a clock that beats at a steady, unchanging rate. This variability in heart rate is an adaptive quality in a healthy body.

How is Heart Rate Variability measured? One measure of heart rate variability is the difference between the highest heart rate and the lowest heart rate within each cardiac cycle, measured in beats per minute. This index is called “HR Max – HR Min.” A second index of Heart Rate Variability, the trainee learns to widely used in medical research recognize and pro- is the of the duce the smooth N-to-N interval. The N-to-N sinusoidal wave interval is the “normalized” beat- forms (RSA wave- to-beat interval. The SDNN is forms) in which the standard deviation of those respiration and heart intervals, a measure of their rate co-vary in a variability. The SDNN is ex- near-phase or pressed in milliseconds (ms). complete phase Finally, a third index of variability, relationship. HRV more reliable in the short term, is biofeedback can called pNN50. This index meas- reinforce breathing ures what percent of the in the 5-7 breaths Interbeat Intervals differ from per minute range, neighboring intervals by 50 and reinforce the milliseconds or more. The production of a pNN50 is expressed in percent- dominant spike in ages. HRV at around 0.1 Photo Courtesy of the Biofeedback Tutor Hz. “The human heart is a Is there any current or on- Current research suggests that going research to support HRV bio-electrical pump each individual has a “resonant biofeedback? beating at an ever frequency” at which heart rate Psychophysiological research variability is the greatest, and this changing rate: it is not suggests that these frequency resonant frequency can be meas- like a clock that beats ranges reflect different biological ured by biofeedback instruments. at a steady, unchang- influences. The high frequency While there is no uniform “ideal range is associated with ing rate.” value” for all persons, this resonant parasympathetic pathways, the frequency is most frequently influences of respiration in normal Can we train individuals to produced by persons in a relaxed frequencies on . The increase the variability of their mental state, with a positive emo- low frequency range is associ- Heart Rate and is there an tional tone, breathing ated with the influence of blood ideal value for HRV? diaphragmatically at a rate of about pressure () on heart Scientific study of the variability 5-7 breaths per minute. Relaxed rhythms, and meditative/slow in heart rate is fairly recent, and breathing at around six breaths per breathing augments this range. only in the past ten years did it minute produces a spike of heart The very low frequency range is become possible to train human rate variability at around 0.1 Hz. associated with sympathetic beings to change the variability in Remember that one tenth of a activation, or more probably the heart rhythms. Biofeedback hertz equals one tenth of a cycle withdrawal of parasympathetic practitioners have found that per second, so that 0.1 Hz equals braking, and also the influences biofeedback training can in- six cycles per minute. The other of visceral and thermal regulation. crease HRV, through several measures of HRV also tend to Rumination and worry augment parallel training pathways. The maximize when heart rate change this range. Finally, the ultra low practitioner initially guides the is dominated by rhythms in this frequency range is associated subject to acquire three basic Low Frequency range. In this way, with the slower-acting biological skills: 1) relax physically and a trainee in HRV biofeedback can influences. Several clinical emotionally, 2) reduce anxious be directly reinforced for increasing findings show the importance of thoughts and negative emotions, one of the variability indices (HR the heart’s variability. Changes in and 3) engage in smooth full Max – HR Min, SDNN, or pNN50). the rhythms of the heart occur diaphragmatic breathing. Next, before a fetus goes into distress, EXPERT SERIES 1 and may predict sudden infant death. Lower variability in heart rate predicts a greater risk for death after a heart attack and death from all causes in adults, especially sudden death. Stud- ies have also shown that clinical depression lowers heart rate variability.

What is the relationship be- tween Heart Rate Variability and Biofeedback? Heart Rate Variability Biofeed- back, or HRV biofeedback, is a new technique for training human beings to change the variability and dominant rhythms in their trainees for shifting their overall As human beings age or suffer heart activity. The use of HRV heart rate variability into the LF illness, the total variability in biofeedback began in Russia, range. heart rate is reduced, and the where it was applied to the risk of illness and death in- treatment of asthma and many Can you tell me a little about creases. Twenty year olds often other conditions. Research is your BFE Suite on HRV Training show a swing of twenty or more now going on in many sites and what makes it so useful to points between the high and low within the United States, applying professionals that want to work points in their heart rates. Per- HRV biofeedback to a variety of with Heart Rate Variability Bio- sons over 50 often show medical and psychiatric condi- feedback? changes of ten beats or less. tions, including: anger, anxiety The Suite has been designed to Persons who are more physi- disorders, asthma, cardiovascu- help newcomers to the field to cally active show a wider range lar conditions, chronic obstructive apply what has been demonstrated between their maximal and pulmonary disorder, irritable by both research and experience. minimal heart rate. HRV bio- bowel syndrome, chronic fatigue, It includes specialized software feedback can enable the indi- and chronic pain. display screens to support a variety vidual to increase this variability of convergent training strategies to in heart rate, sometimes produc- Biofeedback training can teach produce increased heart rate ing a range of fifty beats a patients to increase the percent- variability. One of the things we minute during training. HRV age of total HRV in specific are most pleased about with the biofeedback training can focus frequency ranges. To date, it suite is that it also includes a on increasing the HR Max –HR appears optimal to increase the clinical guide that clinicians can Min index. amount of heart rate change in use to get started right away in this the Low Frequency Range. exciting field. The software and Evgeny Vaschillo, a Russian documentation in the suite teach physiologist, hypothesizes that “Heart Rate Variability the techniques necessary for there is a “resonant frequency,” Biofeedback is a new increasing heart rate variability. native to each organism, which is HRV biofeedback can be of par- technique for training optimal for overall health. For ticular value to psychologists and human beings to most persons that resonant other health practitioners and frequency involves a dominance change the variability therapists. of heart rate change in the Low and dominant Frequency (LF) range, around Does Heart Rate Variability rhythms in their heart 0.1 Hz. HRV biofeedback can change with age? activity.” therefore guide and reinforce NEW Physiology Suite features: • Skin-conductance driven relaxation script with audio induction track • User-defined pre-labelled event-markers (hot key activated) • Real-time epoch statistics for instant trend graphing

The Physiology Suite contains a complete set of standard biofeedback tools to get a total physiological perspective on your client’s sympathetic and parasympathetic processes, including: Temperature, Skin Conduct- ance, Surface EMG, Respiration and Heart rate variability (HRV).

The Physiology suite contains more than 80 screens and over 14 scripts, and provides you with advanced tools for assessment and follow-up: • Pre/post baseline assessment • SC verbal Relaxation exercise • Training scripts (10 x 1 min trials) • A 7 activity assessment script that takes your client through a sequence of stress/relax cycles and generates a report to rapidly identify hyper- or hypo-reactivity in each modality.

The Suite offers 17 new animations, 15 MP3 (music & ambiance), 20 MIDI songs and many other new multimedia feedback options: • DVD (4 action control: shrink, zoom, pause & sound) • Morphing animation sequences, 3 stage puzzles • Nature sound audio tracks • MIDI splitter

Thought Technology Ltd. 2180 Belgrave Avenue Montreal, QC, H4A 2L8, Canada Tel: 1-800-361-3651 • 514-489-8251 Fax: 514-489-8255 http://www.thoughttechnology.com Distributed courtesy of an educational grant by Thought Technology Ltd. MAR803-00