1. Heart Rate Variability Biofeedback Part 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 100 th 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? 4

5. Electrocardiograph Heart Rate Variability (HRV)

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. 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) Heart Rate Variability (HRV) Why is it important?

9. 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). Heart Rate Variability (HRV) Why is it important?

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

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

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 Tone Definition 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 Resting HR 70 BPM Maximum HR 200 BPM Intrinsic HR 100 BPM Potential HRV - 30 SNS Activation PNS Vagus Nerve

21. AGEIHR MAX Heart Rate 20106.7194 30101.0187 4095.3180 5089.6173 6083.9166 7078.2159 8072.5152 Maximal/Intrinsic HR and Age

22. BPM AGE

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

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

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 ACCInsula Amyg Brain Stem Sympathetic Activation Parasympathetic Suppression Inhibits/down-regulates Activation

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

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

30. Oscillations-Heart Rate Variability Heart Rate Breathing 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