Heart-Rate Variability (HRV) biofeedback

Increasing the brain’s ability to adapt its response to stress

Heart-rate variability (HRV) biofeedback is effective at promoting calm, decreasing anxiety, improving mood, and enabling better coping with stress. Research has also suggested that it can reduce PTSD symptoms.

How it works

The brain is in constant two-way communication with the body’s other organs.

One important set of pathways for this communication is the group of nerves collectively called the Autonomic Nervous System (ANS). The ANS is involved in mobilizing the body to respond to a stressful or dangerous situation, then in restoring it to its resting state once the need to respond has passed.

The ANS consists of two continually active branches with opposing functions that exist in a state of dynamic, varying balance:

One of the body’s most important destinations for both SNS and PNS pathways is the heart.

In fact, the heart has so many of its own neurons, and so many nerves travelling to and from the brain, that it can almost be thought of as a small “brain” in its own right, with which the body computes, sends, and receives important information about its current state.

Testimony to the heart’s importance as more than just a blood-pumping machine comes from its status as a unique window onto the functioning of the ANS. As it turns out, the best available indicator of ANS status isn’t just how fast the heart is beating, but how variable the intervals between beats are. In general (and perhaps contrary to intuition):

• If a heart beats very regularly (think of a metronome), this low level of variability is a negative health indicator. People with low heart-rate variability (HRV) tend to be tense, rigid, anxious, and at higher risk for cardiovascular diseases.
• In contrast, people whose heartbeat pattern is more irregular from beat to beat (less metronome-like; higher HRV) tend to be more relaxed, flexible, optimistic, and able to manage changing external situations and their own internal emotions more effectively. It’s believed that the reason for this is that their two ANS branches make adjustments more dynamically and flexibly, allowing both the heart and the brain to respond rapidly and in synchrony with each other from moment to moment.

HRV biofeedback helps to shift the balance in the ANS in the direction of more parasympathetic activity and greater HRV.

It does this by taking advantage of a resonant property of the heart-brain communication pathways, placing the system into a state in which heart rate, breathing, and the brain’s autonomic control network move together in synchrony. Research has shown that repeated practice in entering this resonant state leads to longer-term changes in the way both brain and heart regulate themselves.

What does the process look like?

Because biofeedback is overseen by a psychologist rather than a medical doctor, no formal referral from a family doctor or nurse practitioner is required. You are free to self-refer by calling us to arrange an appointment.

1. The first step is an appointment in which you meet with Dr. Philip Toman.

The purpose of this appointment is to give him some history and talk about the cognitive, motor or emotional functions you would like to improve or enhance. Also at this appointment, we collect some baseline heart rate data from you using an electrocardiogram (ECG). The ECG measurement is taken using sensors that clip to your wrists, so there is no need to place sensors under your clothing.

2. After that you’ll meet with Dr. Toman again, to go over the results of the ECG.

In the interim, he will have analyzed your ECG data and compared it to a normative database, producing outputs that show how various parameters of your heart activity, and thus your autonomic functioning, compare to those of a carefully selected sample of healthy individuals your age. Dr. Toman will show you your norm-referenced results using graphs and visuals, and teach you how to do an HRV biofeedback session. He may also give you a handheld device or app to take home, so you can do HRV biofeedback practice at home. You may also be asked to complete some baseline symptom questionnaires.

3. You’ll return for a number of biofeedback sessions, typically with our technician.

Sessions are usually arranged once every week or two, and last for about half an hour. In each, you will have the ECG sensors re-applied to your wrists, and will match your breathing pattern to a pacing stimulus while you watch an animated representation and/or a live readout of your heart rate and HRV. If you’ve been using a device to practice HRV biofeedback at home, the technician may take this opportunity to upload the session data from your device.

4. The number of HRV biofeedback sessions varies from just a few to about 20.

This will depend on your progress. Dr. Toman will remain available for consultation anytime you’d like to speak with him. You may be asked to complete questionnaires or cognitive testing periodically to assess your progress.