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Principles and Methods of Heart Rate Variability Biofeedback

The document provides an overview of heart rate variability biofeedback (HRVB), detailing its definition, methods, and benefits. HRVB is a technique that helps individuals alter physiological responses through feedback mechanisms, promoting mental and physical well-being. Key components include biofeedback systems, protocols for training, and the physiological importance of heart rate variability in regulating stress and health outcomes.

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Presentation by Dr. Saran A K on HRV Biofeedback, defining key concepts and overview.

Biofeedback is a process for improving health by changing physiological activity, aiding relaxation and stress reduction.

Description of a biofeedback system, differentiating between various types of physiological information.

The objectives of biofeedback training and various types including HRV, EMG, and EEG.

HRV represents heartbeat interval changes, vital for cardiovascular response and related to health outcomes.

Detailed methods for analyzing HRV through time and frequency domain measures.

HRV biofeedback involves synchronizing heart rate data with breathing to maximize health benefits.

Explains mechanisms that enhance HRV during feedback practices focusing on phase relationships.

Explains the role of baroreflex and resonant frequencies in enhancing HRV and maintaining stability.

Differences between spontaneous and slow-paced breathing in eliciting HRV and physiological responses.

Cumulative benefits of HRV biofeedback include stress reduction, cardiovascular improvement, and enhanced performance.

Links HRV biofeedback with cognition, meditation, anxiety reduction, and management of chronic pain.

Highlights the importance of HRV biofeedback in self-regulation and patient empowerment.

Citations for the content presented, underscoring the research backing HRV biofeedback.

Closure of the presentation thanking the audience.

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Principles and Methods of Heart Rate Variability Biofeedback (HRVB) Presenter : Dr. Saran A K Preceptors : Fourth Unit Faculty DM Seminar | 04 April 2024 1 DEPT. OF PHYSIOLOGY, AIIMS PATNA
DEPT. OF PHYSIOLOGY, AIIMS PATNA 2
3 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
Biofeedback is defined as a process that enables an individual to learn how to change physiologic activity for the purposes of improving health and performance. DEPT. OF PHYSIOLOGY, AIIMS PATNA 4
• Precise instruments measure physiologic activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. • Rapidly and accurately feed back information to the user. • In conjunction with changes in thinking, emotions, and behavior—supports desired physiologic changes. • Over time, desired changes without continued use of an instrument. DEPT. OF PHYSIOLOGY, AIIMS PATNA 5
• The most prominent use of biofeedback is to train individuals in physiologic relaxation and stress reduction. • It long has been known that yogis and others who practice eastern mind–body techniques can induce a state of relaxation sufficient to greatly slow their heart rate and influence other autonomic processes. DEPT. OF PHYSIOLOGY, AIIMS PATNA 6
A biofeedback system is composed of • input physiological information and • output sensorial stimuli information in a real time closed-loop process that allows patients to modulate target physiological (dys)function. 7 Components of a Biofeedback System DEPT. OF PHYSIOLOGY, AIIMS PATNA
8 DEPT. OF PHYSIOLOGY, AIIMS PATNA
A typical biofeedback loop consists of four components 1. A biosensing unit 2. A data transfer unit 3. A data processing unit 4. A feedback unit 9 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Biofeedback information can be classified into two types: • that reflecting a physiological process designed to assist in self regulation (performance feedback) • and that indicating the results of self-regulation training (result indices). 10 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Sakurai Y, Song K. Neural Operant Conditioning as a Core Mechanism of Brain-Machine Interface Control. Technologies. 2016; 4(3):26. https://doi.org/10.3390/technologies4030026 Operant Conditioning in Biofeedback DEPT. OF PHYSIOLOGY, AIIMS PATNA 11
Goals of Biofeedback 1. Patient education regarding connections between symptoms and his/ her physiology 2. Specific skills training in changing biofeedback signals corresponding to physiologic processes 3. Development of awareness of the internal states that are linked to the arousal and relaxation 4. Application of the skills training to include carry-over without the aid of instrumentation 5. Development of an overall sense of self-efficacy and empowerment for contributing to health and well being DEPT. OF PHYSIOLOGY, AIIMS PATNA 12
Types of biofeedback • EMG Biofeedback – Tension type headaches, Incontinence, fibromyalgia, anxiety disorders • Thermal Biofeedback – Stress and anxiety, Raynauds Syndrome • Galvanic Skin Response Biofeedback • EEG Biofeedback – ADHD, Anxiety disorders, PTSD • HRV Biofeedback – Depression and anxiety, Asthma, Cardiovascular diseases, Hypertension, Fibromyalgia, Musculoskeletal pain disorders DEPT. OF PHYSIOLOGY, AIIMS PATNA 13
14 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
• A healthy heart is not a metronome. • Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). • Allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges. • Depends on the balance between sympathetic and parasympathetic drives to myocardium. DEPT. OF PHYSIOLOGY, AIIMS PATNA 15 Heart Rate Variability
Generation of HRV • HRV has a complex structure, often referred to as “chaotic” • Involves various superimposed oscillation frequencies, non- linearly related to each other. • Some are known reflexes, modulatory functions, often controlled by different autonomic pathways. • Described as “negative feedback loops,” 16 DEPT. OF PHYSIOLOGY, AIIMS PATNA
DEPT. OF PHYSIOLOGY, AIIMS PATNA 17 They operate as closed loop system components that help maintain allostatic balance, while allowing adaptation to environmental demands (Lehrer and Eddie, 2013).
• HRV is mainly under the control of the vagal parasympathetic nervous system, given that the sympathetic outflow on the heart is too slow to elicit beat-to-beat changes • A higher vmHRV was found to be associated with higher life expectancy, greater cognitive flexibility, resilience to stress or resistance to temptation in dietary challenges • vmHRV is a relevant marker positively related to health, wellbeing, and self-regulation. 18 DEPT. OF PHYSIOLOGY, AIIMS PATNA
DEPT. OF PHYSIOLOGY, AIIMS PATNA 19 Signal Processing Steps in HRV Analysis
Time Domain Measures DEPT. OF PHYSIOLOGY, AIIMS PATNA 20 Kleiger RE, Stein PK, Bigger JT Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10(1):88-101.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 21 Frequency Domain Parameters
DEPT. OF PHYSIOLOGY, AIIMS PATNA 22 Karayannis, Georgios & Giamouzis, Gregory & Cokkinos, Dennis & Skoularigis, John & Triposkiadis, Filippos. (2012). Diabetic cardiovascular autonomic neuropathy: Clinical implications. Expert review of cardiovascular therapy. 10. 747-65. 10.1586/erc.12.53.
23 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
HRV Biofeedback A form of biofeedback therapy training that involves feeding back beat by beat heart rate data during slow breathing so that the breathing matches heart rate patterns. 24 DEPT. OF PHYSIOLOGY, AIIMS PATNA
25 DEPT. OF PHYSIOLOGY, AIIMS PATNA Gilbert, Christopher. (2014). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.. Biofeedback. 42. 130-132. 10.5298/1081-5937-42.3.05.
• Heart rate variability (HRV) biofeedback is the most common single-modal biofeedback technique for stress management. • Depression and anxiety, Asthma, Cardiovascular diseases, Hypertension, Fibromyalgia, Musculoskeletal pain disorders. 26 DEPT. OF PHYSIOLOGY, AIIMS PATNA
27 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Principle of HRV Biofeedback • The procedure consists of feeding back beat by beat heart rate data during slow breathing maneuvers. • The participant tries to maximize Respiratory Sinus Arrhythmia (RSA), create a sine wave like curve of peaks and valleys, and match RSA to heart rate patterns. • Maximizing HRV via Feedback • The participant uses a feedback or a breath pacing device to produce characteristic maximized RSA. 28 DEPT. OF PHYSIOLOGY, AIIMS PATNA
29 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Mechanisms of maximizing HRV during Biofeedback • During HRV biofeedback, the amplitude of heart rate oscillations grows to many times the amplitude at rest, while the pattern becomes simple and sinusoidal. • Temporal coherence of phases between respiratory, blood pressure, and cardiac oscillations, at the specific so-called resonant frequency. 30 DEPT. OF PHYSIOLOGY, AIIMS PATNA
The mechanism for this effect lies in a confluence of processes: 1. Phase relationships between heart rate oscillations and breathing at specific frequencies 2. Phase relationships between heart rate and blood pressure oscillations at specific frequencies 3. Activity of the baroreflex 4. Resonance characteristics of the cardiovascular system 31 DEPT. OF PHYSIOLOGY, AIIMS PATNA
1. Phase Relationship between heart rate oscillations and breathing at specific frequencies • Normal Spontaneous Breathing happens at a frequency of 0.15 and 0.4Hz or 9 to 24 breaths per minute. • Influences the SA Node resulting in Respiratory Sinus Arrythmia (RSA) • Spectral amplitude of HRV within 0.15-0.4 Hz (HF Band) - index of RSA. • At resting respiratory rates, the phase relationship between breathing and HR is asynchronous. 32 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Respiratory Sinus Arrythmia Serves important regulatory functions. 1. Regulates rate of gas exchange at the alveoli • The partial out-of-phase relationship between heart rate and breathing is not the most efficient pattern for gas exchange. • Maximization of RSA improves gas exchange efficiency. 33 DEPT. OF PHYSIOLOGY, AIIMS PATNA
2. Reflection of vagal activity • RSA is entirely controlled by vagus • Vagus acts only during exhalation • Greater vagal activity- greater RSA amplitude • HF HRV reflects cardiac vagal tone 34 DEPT. OF PHYSIOLOGY, AIIMS PATNA
• Studies that explored relationships between breathing and heart rate done using transfer functional analysis found out that maximum heart rate oscillations occur at the breathing frequency of 0 .1 Hz • At this frequency the heart rate oscillation is perfectly in phase with breathing • Thus highest amplitude of RSA is produced and falls in the range of LF band of HRV. 35 DEPT. OF PHYSIOLOGY, AIIMS PATNA
2. Phase relationships between heart rate and blood pressure • Studies on the heart rate changes per unit change in blood pressure – showed that highest change occurred at 0.1 Hz • At this frequency, heart rate and blood pressure oscillated in a 180◦ phase relationship • Suggests that the mechanism for heart rate oscillations with blood pressure is Baroreflex mechanism • The blood pressure oscillations with respiration are called as Traube Hering oscillations 36 DEPT. OF PHYSIOLOGY, AIIMS PATNA
3. Activity of the Baroreflex • Aortic and carotid pressure sensors – modulate pressure changes • When BP increases – baroreflex causes immediate decrease in heart rate and vice versa 37 DEPT. OF PHYSIOLOGY, AIIMS PATNA
38 DEPT. OF PHYSIOLOGY, AIIMS PATNA
3. Activity of the Baroreflex • Aortic and carotid pressure sensors – modulate pressure changes • When BP increases – baroreflex causes immediate decrease in heart rate and vice versa • When the system is stimulated at the specific frequency causing maximum heart rate oscillations and a 180◦ phase relationship between heart rate and blood pressure, effects of the stimulator are compounded by effects of the baroreflex 39 DEPT. OF PHYSIOLOGY, AIIMS PATNA
• Because of the 0◦ phase relationship between heart rate and breathing at approximately the same frequency that external stimulation causes maximal stimulation to the baroreflex, breathing becomes a natural way to provide external stimulation to increase HRV. • Conversely, each breath then stimulates the baroreflex. 40 DEPT. OF PHYSIOLOGY, AIIMS PATNA
41 DEPT. OF PHYSIOLOGY, AIIMS PATNA Spontaneous Breathing Slow Paced Breathing Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12. PMID: 35167847.
4. Concept of Baroreflex resonance All oscillating feedback systems with a constant delay have the characteristic of resonance. 42 DEPT. OF PHYSIOLOGY, AIIMS PATNA
• A resonant system when stimulated, produces high-amplitude oscillations at a single frequency, recruiting or overshadowing other frequencies, to produce a sine wave oscillation with very high-amplitude • In the cardiovascular system – the constant delay appears to be caused by amount of blood (inertia) and flexibility and diameter of the blood vessels 43 DEPT. OF PHYSIOLOGY, AIIMS PATNA
• Due to inertia – any change in heart rate is followed by change in blood pressure after 5 s • Differs slightly across individuals and ranges between 4 and 6.5 s - dependent on height (lower in taller men) due to an effect on vascular inertia, but not age or weight • Therefore it is important to estimate the individual “baroreflex resonance” frequency using HRV-biofeedback (called HRV-BF) before training 44 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Spontaneous Breathing v/s Slow Paced Breathing 45 DEPT. OF PHYSIOLOGY, AIIMS PATNA
46 Respiratory flow oscillates at approximately 0.2 Hz (12 cpm) During Spontaneous breathing Induce immediate blood pressure oscillations at 180◦ phase difference - Traube-Hering waves Baroreflex - heart rate oscillates immediately with blood pressure changes at a 180◦ phase Heart rate oscillates in phase with respiration, but with a delay because of the direct influence of respiratory neurons on the Vagus nerve. Combined cardiac oscillations are in phase but delayed Low and irregular - reflect a low vagally-mediated HRV - the decrease in heart rate during the increase in blood pressure lasts less than 1 s per cycle
47 DEPT. OF PHYSIOLOGY, AIIMS PATNA Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12
48 Respiratory flow oscillates at approximately 0.1 Hz (resonant frequency) During Slow Paced Breathing (SPB) Induces mirrored blood pressure oscillations and cardiac oscillations No delay between respiratory and cardiac oscillations (coherent phases) so Combined cardiac oscillations induced by both blood pressure and respiratory changes are in phase and synchronous High and regular- a high vagally-mediated HRV because the decrease in heart rate during each increase in blood pressure lasts five seconds per cycle (ideal time for ACh release and hydrolysis) DEPT. OF PHYSIOLOGY, AIIMS PATNA
49 DEPT. OF PHYSIOLOGY, AIIMS PATNA Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12
There is a large amount of evidence that people are more resilient – physically and emotionally – when HRV oscillation amplitudes are higher and more complex. 50 DEPT. OF PHYSIOLOGY, AIIMS PATNA
51 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
Protocol for HRV B (Lehrer et. al. 2013) Instruct the patient regarding the sensors to be attached and the parameters that will be recorded. Attach sensors that will be used. Check impedances and signal test. Begin display of physiological data. Explain what each graph or number represents on the screen. Resonance frequency determination is sometimes done in the first visit, sometimes in a subsequent visit. For recording data, a form is used. The individual does paced breathing at each of the following frequencies: 6.5, 5.5, 5, and 4.5 times per minute with rest between each respiratory frequency DEPT. OF PHYSIOLOGY, AIIMS PATNA 52
After the client is breathing regularly at a particular frequency, and the spectral LF peak and LF HRV values become stable, record the values on the Resonance Frequency Worksheet Ask about hyperventilation symptoms (primarily lightheadedness, dizziness, heart pounding) and instruct the client to breathe less deeply if needed. The following parameters are recorded: 1. Phase convergence with breathing 2. Peak-trough amplitude 3. LF, as an absolute value in ms2 /Hz and as percent total 4. Maximum LF amplitude peak on the spectral graph in ms2 /Hz. 5. Smoothness of the ‘‘envelope’’ of the HR curve 6. Singularity and cleanliness of the LF peak in the spectral graph DEPT. OF PHYSIOLOGY, AIIMS PATNA 53
54 DEPT. OF PHYSIOLOGY, AIIMS PATNA
55 DEPT. OF PHYSIOLOGY, AIIMS PATNA
56 DEPT. OF PHYSIOLOGY, AIIMS PATNA
Estimate the resonance frequency from the best convergence of the following characteristics Retest any frequency where the client did not breathe at a constant rate. Inform the client of his/her resonance frequency The client should use resonance frequency breathing technique with a home breathing trainer (where available), 20 minutes two times a day. In the subsequent visit: Practice resonance frequency breathing. Fine tune resonance frequency. DEPT. OF PHYSIOLOGY, AIIMS PATNA 57
58 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
Benefits of HRV biofeedback 1. Effects through vagal efferents 2. Increased gas exchange efficiency 3. Cardiovascular benefits 4. Exercise performance 5. Muscle strength, oxidative stress, and inflammation 6. Central benefits DEPT. OF PHYSIOLOGY, AIIMS PATNA 59
1. Effect through Vagal efferents • Stimulation of parasympathetic reflexes by HRV biofeedback may produce body autonomic activity characteristic of relaxation, and thus directly counter stress effects • Under normal physiological conditions, abrupt parasympathetic stimulation will inhibit tonic sympathetic activation and its effects at rest and during exercise. This response is known as ‘accentuated antagonism’ DEPT. OF PHYSIOLOGY, AIIMS PATNA 60
• Raises eosophgeal pain threshold in response to acid – immediately • Myofascial trigger points –reduces sympathetic flow 61 DEPT. OF PHYSIOLOGY, AIIMS PATNA
2. Increased Gas Exchange efficiency • 0◦ phase relationship between breathing and heart rate during resonance frequency breathing • Improved gas exchange – good in respiratory diseases • Decrease respiratory drive in people with stress-induced hyperventilatory reactions • Mechanical stretching of airways – reduced reactivity to methacholine in asthmatic DEPT. OF PHYSIOLOGY, AIIMS PATNA 62
3. Cardiovascular benefits • Improves heart rhythm, blood pressure, and oxygen saturation • Under temporal coherence between all waves, during each individual deep expiration, the heart immediately responds (no delay) to blood pressure increases by stark decreases in heart rate and increase in vagal baroreflex sensitivity • A study done in Indian women with premature ventricular contractions – showed benefit with SPB DEPT. OF PHYSIOLOGY, AIIMS PATNA 63
• Can help lower blood pressures in hypertensive patients • Large increases in baroreflex gain -number of beats change in heart rate per 1 mm Hg change in blood pressure - occurs during HRV biofeedback • When practiced twice daily for about a 3 month period - increase in resting baroreflex gain • Indicates Neuroplasticity in the baroreflex. 64 Anti hypertensive effect DEPT. OF PHYSIOLOGY, AIIMS PATNA
4. Exercise performance • Increased Exercise capacity and increased VO2 max • SPB may impact VO2max • due to the activation of pre-ganglionic parasympathetic vagal neurons in the medulla, • provoking an augmented contractile response to sympathetic stimulation during exercise through the downregulation of G Protein-Coupled Receptor Kinase 2 (GRK2 gene) DEPT. OF PHYSIOLOGY, AIIMS PATNA 65
5. Muscle strength, oxidative stress, and inflammation • Skeletal muscle fatigue or dysfunction correlated with inflammation and oxidative stress in the diaphragm muscle in chronic obstructive pneumopathy disease (COPD) • 4 weeks of SPB in COPD – improved peak inspiratory pressure and 6 MWD along with reduction in TAC and IL-6 DEPT. OF PHYSIOLOGY, AIIMS PATNA 66
• Decrease in mean blood pressure and pro inflammatory cytokines in those with hypertension at 6 cpm • Mechanism – splenic stimulation by vagus – releasee of Ach – activation of splenic macrophages – suppress pro inflammatory cytokines – Cholinergic Anti inflammatory pathway 67 DEPT. OF PHYSIOLOGY, AIIMS PATNA
6. Central benefits • SPB – Associated with increase in vagal inputs to brain due large amplitude changes in blood pressure every 5 s • Leads to baroreceptor activation and large amounts of vagal inputs to the brain –leading to activation • Activate diverse regions of the prefrontal cortex in the left hemisphere, including the insula and cingulate cortex, as well as limbic regions - increases connectivity DEPT. OF PHYSIOLOGY, AIIMS PATNA 68
69 DEPT. OF PHYSIOLOGY, AIIMS PATNA
a. Cognition • Higher levels of self-control in decision making were correlated positively with vmHRV – ACC, involved in decision-making • Acute SPB increases the learning and retention of motor skills, improves executive function. • Breathing through one’s nose synchronizes oscillations in the olfactory piriform cortex and secondary in the hippocampus through direct connections 70 DEPT. OF PHYSIOLOGY, AIIMS PATNA
b. Meditation effect Heart rate variability biofeedback involves paying close attention to nuances in breathing. This is very similar to what is done in mindfulness meditation exercises. DEPT. OF PHYSIOLOGY, AIIMS PATNA 71
c. Addiction, stress and anxiety • The increase in interoceptive regions during SPB -positive effects on uncontrolled impulsivity and substance abuse • Anxiety is a result of an increased anticipatory response to a potential aversive event, which manifests itself in enhanced right anterior insular cortex processing - SPB may increase activation in the left interoceptive areas to counterbalance • HRV BF – 4 weeks training – reduced anxiety, depression DEPT. OF PHYSIOLOGY, AIIMS PATNA 72
d. Fibromyalgia • SPB and HRV-BF were effective in reducing perceived pain in veterans those with fibromyalgia • Mechanism – vagal activation, activation of the peri aqueductal gray, increased activation in the left mid-insula and the left anterior cingulate - to counterbalance the acute activation in the right anterior insula involved in pain processing DEPT. OF PHYSIOLOGY, AIIMS PATNA 73
74 Overview • Biofeedback Definition • Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
Summary • Biofeedback is a type of therapy that teaches a person to change and control physiological processes through practice. • Heart Rate Variability is a specific type of biofeedback that noninvasively measures harmony of autonomic nervous system. • Stress, anxiety, and maladaptive thought patterns result in incoherence. DEPT. OF PHYSIOLOGY, AIIMS PATNA 75
• With practice and guided exercises, individuals can utilize techniques to improve self-regulation and psychosocial functioning. • Empowers patient to be their own agent for change. 76 DEPT. OF PHYSIOLOGY, AIIMS PATNA
References 1. Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014 Jul 21;5:756. doi: 10.3389/fpsyg.2014.00756. PMID: 25101026; PMCID: PMC4104929. 2. Lalanza, J.F., Lorente, S., Bullich, R. et al. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback 48, 275–297 (2023). https://doi.org/10.1007/s10484-023- 09582-6 3. Lehrer, Paul & Vaschillo, Bronya & Zucker, Terri & Graves, Jessica & Katsamanis, Maria & Aviles, Milisyaris & Wamboldt, Frederick. (2013). Protocol for Heart Rate Variability Biofeedback Training. Biofeedback. 41. 98-109. 10.5298/1081-5937-41.3.08. 4. Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12. PMID: 35167847. 5. Gilbert, Christopher. (2014). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.. Biofeedback. 42. 130-132. 10.5298/1081-5937-42.3.05. 77 DEPT. OF PHYSIOLOGY, AIIMS PATNA
THANK YOU ! saran.adhoc@gmail.com DEPT. OF PHYSIOLOGY, AIIMS PATNA 78

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Principles and Methods of Heart Rate Variability Biofeedback

  • 1.
    Principles and Methodsof Heart Rate Variability Biofeedback (HRVB) Presenter : Dr. Saran A K Preceptors : Fourth Unit Faculty DM Seminar | 04 April 2024 1 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 2.
    DEPT. OF PHYSIOLOGY,AIIMS PATNA 2
  • 3.
    3 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 4.
    Biofeedback is definedas a process that enables an individual to learn how to change physiologic activity for the purposes of improving health and performance. DEPT. OF PHYSIOLOGY, AIIMS PATNA 4
  • 5.
    • Precise instrumentsmeasure physiologic activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. • Rapidly and accurately feed back information to the user. • In conjunction with changes in thinking, emotions, and behavior—supports desired physiologic changes. • Over time, desired changes without continued use of an instrument. DEPT. OF PHYSIOLOGY, AIIMS PATNA 5
  • 6.
    • The mostprominent use of biofeedback is to train individuals in physiologic relaxation and stress reduction. • It long has been known that yogis and others who practice eastern mind–body techniques can induce a state of relaxation sufficient to greatly slow their heart rate and influence other autonomic processes. DEPT. OF PHYSIOLOGY, AIIMS PATNA 6
  • 7.
    A biofeedback systemis composed of • input physiological information and • output sensorial stimuli information in a real time closed-loop process that allows patients to modulate target physiological (dys)function. 7 Components of a Biofeedback System DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 8.
  • 9.
    A typical biofeedbackloop consists of four components 1. A biosensing unit 2. A data transfer unit 3. A data processing unit 4. A feedback unit 9 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 10.
    Biofeedback information canbe classified into two types: • that reflecting a physiological process designed to assist in self regulation (performance feedback) • and that indicating the results of self-regulation training (result indices). 10 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 11.
    Sakurai Y, SongK. Neural Operant Conditioning as a Core Mechanism of Brain-Machine Interface Control. Technologies. 2016; 4(3):26. https://doi.org/10.3390/technologies4030026 Operant Conditioning in Biofeedback DEPT. OF PHYSIOLOGY, AIIMS PATNA 11
  • 12.
    Goals of Biofeedback 1.Patient education regarding connections between symptoms and his/ her physiology 2. Specific skills training in changing biofeedback signals corresponding to physiologic processes 3. Development of awareness of the internal states that are linked to the arousal and relaxation 4. Application of the skills training to include carry-over without the aid of instrumentation 5. Development of an overall sense of self-efficacy and empowerment for contributing to health and well being DEPT. OF PHYSIOLOGY, AIIMS PATNA 12
  • 13.
    Types of biofeedback •EMG Biofeedback – Tension type headaches, Incontinence, fibromyalgia, anxiety disorders • Thermal Biofeedback – Stress and anxiety, Raynauds Syndrome • Galvanic Skin Response Biofeedback • EEG Biofeedback – ADHD, Anxiety disorders, PTSD • HRV Biofeedback – Depression and anxiety, Asthma, Cardiovascular diseases, Hypertension, Fibromyalgia, Musculoskeletal pain disorders DEPT. OF PHYSIOLOGY, AIIMS PATNA 13
  • 14.
    14 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 15.
    • A healthyheart is not a metronome. • Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). • Allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges. • Depends on the balance between sympathetic and parasympathetic drives to myocardium. DEPT. OF PHYSIOLOGY, AIIMS PATNA 15 Heart Rate Variability
  • 16.
    Generation of HRV •HRV has a complex structure, often referred to as “chaotic” • Involves various superimposed oscillation frequencies, non- linearly related to each other. • Some are known reflexes, modulatory functions, often controlled by different autonomic pathways. • Described as “negative feedback loops,” 16 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 17.
    DEPT. OF PHYSIOLOGY,AIIMS PATNA 17 They operate as closed loop system components that help maintain allostatic balance, while allowing adaptation to environmental demands (Lehrer and Eddie, 2013).
  • 18.
    • HRV ismainly under the control of the vagal parasympathetic nervous system, given that the sympathetic outflow on the heart is too slow to elicit beat-to-beat changes • A higher vmHRV was found to be associated with higher life expectancy, greater cognitive flexibility, resilience to stress or resistance to temptation in dietary challenges • vmHRV is a relevant marker positively related to health, wellbeing, and self-regulation. 18 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 19.
    DEPT. OF PHYSIOLOGY,AIIMS PATNA 19 Signal Processing Steps in HRV Analysis
  • 20.
    Time Domain Measures DEPT.OF PHYSIOLOGY, AIIMS PATNA 20 Kleiger RE, Stein PK, Bigger JT Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10(1):88-101.
  • 21.
    DEPT. OF PHYSIOLOGY,AIIMS PATNA 21 Frequency Domain Parameters
  • 22.
    DEPT. OF PHYSIOLOGY,AIIMS PATNA 22 Karayannis, Georgios & Giamouzis, Gregory & Cokkinos, Dennis & Skoularigis, John & Triposkiadis, Filippos. (2012). Diabetic cardiovascular autonomic neuropathy: Clinical implications. Expert review of cardiovascular therapy. 10. 747-65. 10.1586/erc.12.53.
  • 23.
    23 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 24.
    HRV Biofeedback A formof biofeedback therapy training that involves feeding back beat by beat heart rate data during slow breathing so that the breathing matches heart rate patterns. 24 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 25.
    25 DEPT. OF PHYSIOLOGY,AIIMS PATNA Gilbert, Christopher. (2014). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.. Biofeedback. 42. 130-132. 10.5298/1081-5937-42.3.05.
  • 26.
    • Heart ratevariability (HRV) biofeedback is the most common single-modal biofeedback technique for stress management. • Depression and anxiety, Asthma, Cardiovascular diseases, Hypertension, Fibromyalgia, Musculoskeletal pain disorders. 26 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 27.
  • 28.
    Principle of HRVBiofeedback • The procedure consists of feeding back beat by beat heart rate data during slow breathing maneuvers. • The participant tries to maximize Respiratory Sinus Arrhythmia (RSA), create a sine wave like curve of peaks and valleys, and match RSA to heart rate patterns. • Maximizing HRV via Feedback • The participant uses a feedback or a breath pacing device to produce characteristic maximized RSA. 28 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 29.
  • 30.
    Mechanisms of maximizingHRV during Biofeedback • During HRV biofeedback, the amplitude of heart rate oscillations grows to many times the amplitude at rest, while the pattern becomes simple and sinusoidal. • Temporal coherence of phases between respiratory, blood pressure, and cardiac oscillations, at the specific so-called resonant frequency. 30 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 31.
    The mechanism forthis effect lies in a confluence of processes: 1. Phase relationships between heart rate oscillations and breathing at specific frequencies 2. Phase relationships between heart rate and blood pressure oscillations at specific frequencies 3. Activity of the baroreflex 4. Resonance characteristics of the cardiovascular system 31 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 32.
    1. Phase Relationshipbetween heart rate oscillations and breathing at specific frequencies • Normal Spontaneous Breathing happens at a frequency of 0.15 and 0.4Hz or 9 to 24 breaths per minute. • Influences the SA Node resulting in Respiratory Sinus Arrythmia (RSA) • Spectral amplitude of HRV within 0.15-0.4 Hz (HF Band) - index of RSA. • At resting respiratory rates, the phase relationship between breathing and HR is asynchronous. 32 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 33.
    Respiratory Sinus Arrythmia Servesimportant regulatory functions. 1. Regulates rate of gas exchange at the alveoli • The partial out-of-phase relationship between heart rate and breathing is not the most efficient pattern for gas exchange. • Maximization of RSA improves gas exchange efficiency. 33 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 34.
    2. Reflection ofvagal activity • RSA is entirely controlled by vagus • Vagus acts only during exhalation • Greater vagal activity- greater RSA amplitude • HF HRV reflects cardiac vagal tone 34 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 35.
    • Studies thatexplored relationships between breathing and heart rate done using transfer functional analysis found out that maximum heart rate oscillations occur at the breathing frequency of 0 .1 Hz • At this frequency the heart rate oscillation is perfectly in phase with breathing • Thus highest amplitude of RSA is produced and falls in the range of LF band of HRV. 35 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 36.
    2. Phase relationshipsbetween heart rate and blood pressure • Studies on the heart rate changes per unit change in blood pressure – showed that highest change occurred at 0.1 Hz • At this frequency, heart rate and blood pressure oscillated in a 180◦ phase relationship • Suggests that the mechanism for heart rate oscillations with blood pressure is Baroreflex mechanism • The blood pressure oscillations with respiration are called as Traube Hering oscillations 36 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 37.
    3. Activity ofthe Baroreflex • Aortic and carotid pressure sensors – modulate pressure changes • When BP increases – baroreflex causes immediate decrease in heart rate and vice versa 37 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 38.
  • 39.
    3. Activity ofthe Baroreflex • Aortic and carotid pressure sensors – modulate pressure changes • When BP increases – baroreflex causes immediate decrease in heart rate and vice versa • When the system is stimulated at the specific frequency causing maximum heart rate oscillations and a 180◦ phase relationship between heart rate and blood pressure, effects of the stimulator are compounded by effects of the baroreflex 39 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 40.
    • Because ofthe 0◦ phase relationship between heart rate and breathing at approximately the same frequency that external stimulation causes maximal stimulation to the baroreflex, breathing becomes a natural way to provide external stimulation to increase HRV. • Conversely, each breath then stimulates the baroreflex. 40 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 41.
    41 DEPT. OF PHYSIOLOGY,AIIMS PATNA Spontaneous Breathing Slow Paced Breathing Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12. PMID: 35167847.
  • 42.
    4. Concept ofBaroreflex resonance All oscillating feedback systems with a constant delay have the characteristic of resonance. 42 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 43.
    • A resonantsystem when stimulated, produces high-amplitude oscillations at a single frequency, recruiting or overshadowing other frequencies, to produce a sine wave oscillation with very high-amplitude • In the cardiovascular system – the constant delay appears to be caused by amount of blood (inertia) and flexibility and diameter of the blood vessels 43 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 44.
    • Due toinertia – any change in heart rate is followed by change in blood pressure after 5 s • Differs slightly across individuals and ranges between 4 and 6.5 s - dependent on height (lower in taller men) due to an effect on vascular inertia, but not age or weight • Therefore it is important to estimate the individual “baroreflex resonance” frequency using HRV-biofeedback (called HRV-BF) before training 44 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 45.
    Spontaneous Breathing v/sSlow Paced Breathing 45 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 46.
    46 Respiratory flow oscillatesat approximately 0.2 Hz (12 cpm) During Spontaneous breathing Induce immediate blood pressure oscillations at 180◦ phase difference - Traube-Hering waves Baroreflex - heart rate oscillates immediately with blood pressure changes at a 180◦ phase Heart rate oscillates in phase with respiration, but with a delay because of the direct influence of respiratory neurons on the Vagus nerve. Combined cardiac oscillations are in phase but delayed Low and irregular - reflect a low vagally-mediated HRV - the decrease in heart rate during the increase in blood pressure lasts less than 1 s per cycle
  • 47.
    47 DEPT. OF PHYSIOLOGY,AIIMS PATNA Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12
  • 48.
    48 Respiratory flow oscillatesat approximately 0.1 Hz (resonant frequency) During Slow Paced Breathing (SPB) Induces mirrored blood pressure oscillations and cardiac oscillations No delay between respiratory and cardiac oscillations (coherent phases) so Combined cardiac oscillations induced by both blood pressure and respiratory changes are in phase and synchronous High and regular- a high vagally-mediated HRV because the decrease in heart rate during each increase in blood pressure lasts five seconds per cycle (ideal time for ACh release and hydrolysis) DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 49.
    49 DEPT. OF PHYSIOLOGY,AIIMS PATNA Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12
  • 50.
    There is alarge amount of evidence that people are more resilient – physically and emotionally – when HRV oscillation amplitudes are higher and more complex. 50 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 51.
    51 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 52.
    Protocol for HRVB (Lehrer et. al. 2013) Instruct the patient regarding the sensors to be attached and the parameters that will be recorded. Attach sensors that will be used. Check impedances and signal test. Begin display of physiological data. Explain what each graph or number represents on the screen. Resonance frequency determination is sometimes done in the first visit, sometimes in a subsequent visit. For recording data, a form is used. The individual does paced breathing at each of the following frequencies: 6.5, 5.5, 5, and 4.5 times per minute with rest between each respiratory frequency DEPT. OF PHYSIOLOGY, AIIMS PATNA 52
  • 53.
    After the clientis breathing regularly at a particular frequency, and the spectral LF peak and LF HRV values become stable, record the values on the Resonance Frequency Worksheet Ask about hyperventilation symptoms (primarily lightheadedness, dizziness, heart pounding) and instruct the client to breathe less deeply if needed. The following parameters are recorded: 1. Phase convergence with breathing 2. Peak-trough amplitude 3. LF, as an absolute value in ms2 /Hz and as percent total 4. Maximum LF amplitude peak on the spectral graph in ms2 /Hz. 5. Smoothness of the ‘‘envelope’’ of the HR curve 6. Singularity and cleanliness of the LF peak in the spectral graph DEPT. OF PHYSIOLOGY, AIIMS PATNA 53
  • 54.
  • 55.
  • 56.
  • 57.
    Estimate the resonancefrequency from the best convergence of the following characteristics Retest any frequency where the client did not breathe at a constant rate. Inform the client of his/her resonance frequency The client should use resonance frequency breathing technique with a home breathing trainer (where available), 20 minutes two times a day. In the subsequent visit: Practice resonance frequency breathing. Fine tune resonance frequency. DEPT. OF PHYSIOLOGY, AIIMS PATNA 57
  • 58.
    58 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 59.
    Benefits of HRVbiofeedback 1. Effects through vagal efferents 2. Increased gas exchange efficiency 3. Cardiovascular benefits 4. Exercise performance 5. Muscle strength, oxidative stress, and inflammation 6. Central benefits DEPT. OF PHYSIOLOGY, AIIMS PATNA 59
  • 60.
    1. Effect throughVagal efferents • Stimulation of parasympathetic reflexes by HRV biofeedback may produce body autonomic activity characteristic of relaxation, and thus directly counter stress effects • Under normal physiological conditions, abrupt parasympathetic stimulation will inhibit tonic sympathetic activation and its effects at rest and during exercise. This response is known as ‘accentuated antagonism’ DEPT. OF PHYSIOLOGY, AIIMS PATNA 60
  • 61.
    • Raises eosophgealpain threshold in response to acid – immediately • Myofascial trigger points –reduces sympathetic flow 61 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 62.
    2. Increased GasExchange efficiency • 0◦ phase relationship between breathing and heart rate during resonance frequency breathing • Improved gas exchange – good in respiratory diseases • Decrease respiratory drive in people with stress-induced hyperventilatory reactions • Mechanical stretching of airways – reduced reactivity to methacholine in asthmatic DEPT. OF PHYSIOLOGY, AIIMS PATNA 62
  • 63.
    3. Cardiovascular benefits •Improves heart rhythm, blood pressure, and oxygen saturation • Under temporal coherence between all waves, during each individual deep expiration, the heart immediately responds (no delay) to blood pressure increases by stark decreases in heart rate and increase in vagal baroreflex sensitivity • A study done in Indian women with premature ventricular contractions – showed benefit with SPB DEPT. OF PHYSIOLOGY, AIIMS PATNA 63
  • 64.
    • Can helplower blood pressures in hypertensive patients • Large increases in baroreflex gain -number of beats change in heart rate per 1 mm Hg change in blood pressure - occurs during HRV biofeedback • When practiced twice daily for about a 3 month period - increase in resting baroreflex gain • Indicates Neuroplasticity in the baroreflex. 64 Anti hypertensive effect DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 65.
    4. Exercise performance •Increased Exercise capacity and increased VO2 max • SPB may impact VO2max • due to the activation of pre-ganglionic parasympathetic vagal neurons in the medulla, • provoking an augmented contractile response to sympathetic stimulation during exercise through the downregulation of G Protein-Coupled Receptor Kinase 2 (GRK2 gene) DEPT. OF PHYSIOLOGY, AIIMS PATNA 65
  • 66.
    5. Muscle strength,oxidative stress, and inflammation • Skeletal muscle fatigue or dysfunction correlated with inflammation and oxidative stress in the diaphragm muscle in chronic obstructive pneumopathy disease (COPD) • 4 weeks of SPB in COPD – improved peak inspiratory pressure and 6 MWD along with reduction in TAC and IL-6 DEPT. OF PHYSIOLOGY, AIIMS PATNA 66
  • 67.
    • Decrease inmean blood pressure and pro inflammatory cytokines in those with hypertension at 6 cpm • Mechanism – splenic stimulation by vagus – releasee of Ach – activation of splenic macrophages – suppress pro inflammatory cytokines – Cholinergic Anti inflammatory pathway 67 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 68.
    6. Central benefits •SPB – Associated with increase in vagal inputs to brain due large amplitude changes in blood pressure every 5 s • Leads to baroreceptor activation and large amounts of vagal inputs to the brain –leading to activation • Activate diverse regions of the prefrontal cortex in the left hemisphere, including the insula and cingulate cortex, as well as limbic regions - increases connectivity DEPT. OF PHYSIOLOGY, AIIMS PATNA 68
  • 69.
  • 70.
    a. Cognition • Higherlevels of self-control in decision making were correlated positively with vmHRV – ACC, involved in decision-making • Acute SPB increases the learning and retention of motor skills, improves executive function. • Breathing through one’s nose synchronizes oscillations in the olfactory piriform cortex and secondary in the hippocampus through direct connections 70 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 71.
    b. Meditation effect Heartrate variability biofeedback involves paying close attention to nuances in breathing. This is very similar to what is done in mindfulness meditation exercises. DEPT. OF PHYSIOLOGY, AIIMS PATNA 71
  • 72.
    c. Addiction, stressand anxiety • The increase in interoceptive regions during SPB -positive effects on uncontrolled impulsivity and substance abuse • Anxiety is a result of an increased anticipatory response to a potential aversive event, which manifests itself in enhanced right anterior insular cortex processing - SPB may increase activation in the left interoceptive areas to counterbalance • HRV BF – 4 weeks training – reduced anxiety, depression DEPT. OF PHYSIOLOGY, AIIMS PATNA 72
  • 73.
    d. Fibromyalgia • SPBand HRV-BF were effective in reducing perceived pain in veterans those with fibromyalgia • Mechanism – vagal activation, activation of the peri aqueductal gray, increased activation in the left mid-insula and the left anterior cingulate - to counterbalance the acute activation in the right anterior insula involved in pain processing DEPT. OF PHYSIOLOGY, AIIMS PATNA 73
  • 74.
    74 Overview • Biofeedback Definition •Heart Rate Variability • HRV Biofeedback (HRVB) • HRVB Protocol • Benefits of HRV Biofeedback • Summary DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 75.
    Summary • Biofeedback isa type of therapy that teaches a person to change and control physiological processes through practice. • Heart Rate Variability is a specific type of biofeedback that noninvasively measures harmony of autonomic nervous system. • Stress, anxiety, and maladaptive thought patterns result in incoherence. DEPT. OF PHYSIOLOGY, AIIMS PATNA 75
  • 76.
    • With practiceand guided exercises, individuals can utilize techniques to improve self-regulation and psychosocial functioning. • Empowers patient to be their own agent for change. 76 DEPT. OF PHYSIOLOGY, AIIMS PATNA
  • 77.
    References 1. Lehrer PM,Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014 Jul 21;5:756. doi: 10.3389/fpsyg.2014.00756. PMID: 25101026; PMCID: PMC4104929. 2. Lalanza, J.F., Lorente, S., Bullich, R. et al. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback 48, 275–297 (2023). https://doi.org/10.1007/s10484-023- 09582-6 3. Lehrer, Paul & Vaschillo, Bronya & Zucker, Terri & Graves, Jessica & Katsamanis, Maria & Aviles, Milisyaris & Wamboldt, Frederick. (2013). Protocol for Heart Rate Variability Biofeedback Training. Biofeedback. 41. 98-109. 10.5298/1081-5937-41.3.08. 4. Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.104576. Epub 2022 Feb 12. PMID: 35167847. 5. Gilbert, Christopher. (2014). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.. Biofeedback. 42. 130-132. 10.5298/1081-5937-42.3.05. 77 DEPT. OF PHYSIOLOGY, AIIMS PATNA
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    THANK YOU ! saran.adhoc@gmail.com DEPT.OF PHYSIOLOGY, AIIMS PATNA 78

Editor's Notes

  • #3 Biofeedback can be used as a “mirror” to improve self-awareness about internal states, but also as a learning tool to acquire specific self-regulation skills
  • #8 Biofeedback protocols are based on the premise that it is possible to learn how to self modulate specific aspects of the body’s physiological activity.
  • #10  The biosensors monitor specific activities, and immediately present related information back to the user with an external audiovisual display.
  • #11 The presentation of biofeedback information may affect the perception and interpretation of information and also the user experience. Based on the studies reviewed, graphic user interfaces (GUI) are most commonly used to present information in a clear and precise manner
  • #16 Healthy biological systems exhibit complex patterns of variability. Non-invasive method of detecting early autonomic impairment of heart.
  • #19 Over the past few decades, the importance of vagally-mediated HRV (vmHRV) has steadily increased
  • #22 The VLF band (0.0033–0.04 Hz) requires a recording period of at least 5 min, but may be best monitored over 24 h. Within a 5-min sample, there are about 0–12 complete periods of oscillation The ULF band (≤0.003 Hz) indexes fluctuations in IBIs with a period from 5 min to 24 h and is measured using 24 h recordings (10). The VLF band (0.0033–0.04 Hz) is comprised of rhythms with periods between 25 and 300 s. The LF band (0.04–0.15 Hz) is comprised of rhythms with periods between 7 and 25 s and is affected by breathing from ~3 to 9 bpm. Within a 5 min sample, there are 12–45 complete periods of oscillation (9). The HF or respiratory band (0.15–0.40 Hz) is influenced by breathing from 9 to 24 bpm (11). The ratio of LF to HF power (LF/HF ratio) may estimate the ratio between sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) activity under controlled conditions. Total power is the sum of the energy in the ULF, VLF, LF, and HF bands for 24 h and the VLF, LF, and HF bands for short-term recordings
  • #23 The analysis of the low frequency band was previously thought to be a pure estimation of sympathetic activity. It appears that restricting the sympathetic frequency band to 0.05 Hz and 0.1 Hz results in the best sympathetic indicator. While the frequency range of 0.10–0.15 Hz has a significant negative correlation with heart rate, suggesting a stronger parasympathetic influence in this range (Jaffe et al., 1994). A phenomenon called “baroreflex resonance” accounts for the vagal influence in this range, at approximately 0.1 Hz (Kromenacker et al., 2018; Vaschillo et al., 2002, 2006), and is described as a ‘‘negative feedback’’ system with a constant delay
  • #28 The input can be Electrocardiogram (ECG) signals or Blood Volume Pulse (BVP) signals. The content of feedback can be grouped as three types: IBI data, HRV indices, and a combination of both.
  • #34 The heart rate tends to be higher when air in the lung is richest in oxygen, and exhalation occurs when carbon dioxide in the lung is highest.
  • #43 any source of rhythmic stimulation that affects the cardiovascular system should produce the same effect. This has, in fact, been found for rhythmic muscle tension (Lehrer et al., 2009; Vaschillo et al., 2011), and rhythmical presentation of emotion-inducing pictures (Vaschillo et al., 2008).
  • #64  in the group of animals associated with persistent low vagal temporal and frequential parameters in HRV, psychosocial stress leads to a vulnerability to persistent autonomic dysfunction, cardiac hypertrophy, and ventricular ectopic beats - This supports the potential beneficial effects of SPB on cardiac events during stress episodes, with a better balance in autonomic innervation.
  • #65 It also suggested that various conditions affected by blood pressure lability and baroreflex control may be affected by HRV biofeedback.