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In recent years there has been substantial support for heart rate variability biofeedback (HRVB) as a treatment for a variety of disorders and for performance enhancement (Gevirtz, 2013). In recent years there has been substantial support for heart rate variability biofeedback (HRVB) for a variety of disorders and for performance enhancement (Gevirtz, 2013). During normal breathing, one of the many oscillations in heart rate usually occurs at the same frequency as breathing.
It should also be noted that respiratory-induced changes in HRV may function as a positive feedback loop, spiraling further increases in HRV, by feedback from the heart to the central nervous system, through the vagal afferent system, as described below.
These results also suggest that, where HRV biofeedback produces a 0° phase relationship between heart rate and breathing, conditions requiring better gas exchange efficiency could show improvement. Vaschillo’s early studies also showed systematic changes in phase relationships between heart rate and blood pressure, when the system was stimulated at various frequencies.
The baroreflex is a reflex mediated by blood pressure sensors in the aorta and carotid artery that help modulate blood pressure fluctuations (Eckberg and Sleight, 1992). 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.
It is a physical principle that all oscillating feedback systems with a constant delay have the characteristic of resonance. If resonance occurs in the cardiovascular system at approximately 0.1 Hz, it should not occur exclusively in response to breathing. As can be seen, the slow breathing condition was significantly more negative than the other conditions. Because HRV biofeedback is apparently helpful to conditions involving various physiological systems (pain, anxiety, depression, COPD, blood pressure control, athletic performance, etc.), it is probable that a number of mechanisms are involved in various effects, in addition to baroreflex stimulation and effects of vagal afferents.
Because of the 0° phase relationship between breathing and heart rate during resonance frequency breathing, improved gas exchange may help people with respiratory diseases, and may even decrease respiratory drive in people with stress-induced hyperventilatory reactions. Heart rate variability biofeedback involves paying close attention to nuances in breathing.
Effects on asthma may occur indirectly through effects of stretching epithelial tissue in the lung by deep breathing. In this paper we have tried to summarize possible mechanisms for the effectiveness of HRVB.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Synchronisation between other equipment and the PC or Mac you are running your psychology experiment on is a typical source of timing error. The Black Box ToolKit v2 can also help you identify EEG acquisition artefacts and apply the appropriate post hoc corrections.
This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Since conditions as widely varied as asthma and depression seem to respond to this form of cardiorespiratory feedback training, the issue of possible mechanisms becomes more salient.
Since conditions as widely varied as asthma and irritable bowel syndrome seem to respond to this form of cardiorespiratory feedback training, the issue of possible mechanisms becomes more salient. A typical HRVB screen showing the transition from normal breathing to 7 breaths per minute breathing.
He looked at the following application categories: asthma, COPD, IBS, cyclic vomiting, recurrent abdominal pain, fibromyalgia, cardiac rehabilitation, hypertension, chronic muscle pain, pregnancy induced hypertension, depression, anxiety, PTSD, insomnia, and performance1. Some processes involved in this pattern are caused by known reflexes, some with modulatory functions, often controlled by different autonomic pathways.
People often breathe at differing frequencies at different times, and various individuals tend to breathe at different rates. It controls the rate of gas exchange at the alveoli, such that 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.
It is controlled entirely by the vagus nerve, such that vagus nerve outputs to the sinoatrial node primarily occur only during exhalation.
However, most studies find that maximum effects usually are achieved when breathing at a rate of approximately 0.1 Hz (six breaths per minute). For each person, he found, there was a specific frequency where heart rate changes per unit change in blood pressure were greatest.

Baroreceptors in the walls of these arteries detect stretching of the arteries as blood pressure increases. Greater complexity, as measured by various calculations of fractal entropy, suggest the operation of multiple regulatory feedback loops. A resonant system is one that, 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 (Başar, 1998).
The constant delay appears to be caused by amount of blood in the system, although, theoretically, flexibility, and diameter of the blood vessels also should play a role. Rather, any source of rhythmic stimulation that affects the cardiovascular system should produce the same effect. These results led to speculation that some other mechanism might be at work beyond the baroreflex gains.
As expected the HRVB group improved their HRV substantailly whereas the EMG comparison group did not (see Figure 3).
However, HEP method might give us a tool to disentangle possible mechanisms of the intervention. Most of them have received little empirical attention, but they all deserve investigation at this point.
One study did find a decrease in C-reactive proteins among hypertensive patients treated with HRV biofeedback (Nolan et al., 2012). We have been working under the assumption that increases baroreflex represented a viable marker of improved autonomic homeostasis or increased complexity. TFT, soundcard, response device, it can be difficult to align an event marker to an EEG machine or sync signal from an MRI machine accurately. The procedure consists of feeding back beat by beat heart rate data during slow breathing maneuvers such that the participant tries to maximize RSA, create a sine-wave-like curve of peaks and valleys, and match RSA to heart rate patterns. While few areas have extensive support by way of controlled studies, the overall picture seems to be very promising for this intervention. It is notable, however, that the partial out-of-phase relationship between heart rate and breathing is not the most efficient pattern for gas exchange. One can think of this as the system having multiple backup systems to regulate the body, and finely tune it to environmental and internal need. An example of this from everyday life is the so-called Larsen effect, where a high pitched squeal at a single frequency results from placing a microphone in front of a speaker, and stimulating the system with sound (Weaver and Lobkis, 2006). We have found that taller people and men, who have a greater blood supply than, respectively, shorter people and women, have lower resonance frequencies (Vaschillo et al., 2006). While the source of this resonance is not completely known, it is known that the highest amplitudes of blood pressure oscillations are achieved when the system is stimulated at approximately this frequency (Vaschillo et al., 2002). Under normal physiological conditions, abrupt parasympathetic stimulation will inhibit tonic sympathetic activation and its effects at rest and during exercise. In another study, we experimentally exposed healthy subjects to an inflammatory cytokine, lipopolysaccharide (Lehrer et al., 2010). We have reviewed the evidence that led us to this conclusion, which now are somewhat established by our labs and others.
For example, if you instruct the experiment to send an event marker to coincide with the onset of an image it is fairly certain the marker will actually be sent before the images appears due to input lag on your TFT monitor. Recently, the effect on the vagal afferent pathway to the frontal cortical areas has been proposed. RSA is the heart pattern that occurs when heart rate increases during inhalation and decreases during exhalation. During HRV biofeedback, the amplitude of heart rate oscillations grows to many times the amplitude at rest, while the pattern becomes simple and sinusoidal. The corresponding oscillations in heart rate are called RSA, which can be interpreted as influences of respiration on the sinoatrial node of the heart. That is, independently, stimulation at lower frequencies causes heart rate oscillations with the highest amplitude in taller people and men. Oscillations in this range are thought to be controlled primarily by the alpha sympathetic system, and related to oscillations in vascular tone, which also is affected by the baroreflex (Vaschillo et al., 2012). An implanted electrical stimulation device is used to stimulate the vagal afferent pathways resulting in reduction of depressive symptoms. We now speculate that in conjunction with this class of mechanisms, stimulation of the vagal afferent system may also play a role, especially in disorders of negative affectivity.
How much sooner the event marker is sent can only be determined empirically with a Black Box ToolKit v2. In this article, we review these and other possible mechanisms that might explain the positive effects of HRVB.

Thus as can be seen in Figure 1, the participant uses feedback or a breath pacing device to produce the characteristic maximized RSA. This pattern occurs in almost everyone, and is often achievable within a fraction of a minute even in persons who have never previously been exposed to the technique. This phase relationship strongly suggested that the mechanism for the high-amplitude heart rate oscillations was the baroreflex. Thus, 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. This demonstrated neuroplasticity in the baroreflex, and suggested that regular exercise of the reflex rendered it stronger. Independently of height, age, and weight have no effect on resonance frequency, nor does experience with repeated system stimulation by HRV biofeedback. Thus, when blood pressure increases, the blood vessels dilate; when blood pressure falls, blood vessels constrict. While this technique has not been subjected to larger random controlled trials, the preliminary pilot studies do raise interesting possibilities. Although no biofeedback-induced decreases in inflammatory cytokines were found, the autonomic effects of inflammation were greatly modulated, indicating that a greater resiliency was preserved among individuals given HRV biofeedback. Clinical review: a review and analysis of heart rate variability and the diagnosis and prognosis of infection.
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, and (4) resonance characteristics of the cardiovascular system.
However, although RSA is often driven by breathing, it also may be influenced by respiratory pacemaker oscillations in the central nervous system, which occasionally differ from actual breathing. Thus breathing at this frequency produces both the highest amplitude of RSA and the most efficient gas exchange. As external stimulation causes heart rate to rise, it also causes blood pressure to fall, thus causing an additional stimulus for heart rate to rise further; and as external stimulation causes heart rate to fall, it also causes blood pressure to rise, thus causing an additional stimulus for heart rate to fall further. It also suggested that various conditions affected by blood pressure lability and baroreflex control may be affected by HRV biofeedback. This causes an oscillation in both blood pressure and vascular tone, but at a lower frequency than for the heart rate limb of the baroreflex, because dilation and constriction of blood vessels is a slower process than speeding or slowing the heart.
It is known that the vagal afferent pathways affect brain areas known to be involved in affect regulation and mood (locus coeruleus, orbitofrontal cortex, insula, hippocampus, and amygdala; Grundy, 2002). Presumably this aspect of the parasympathetic efferent system is strengthened with HRVB training. Little is known about biofeedback training to stimulate the system in this frequency range. Perhaps the function of a partially out-of-phase phase relationship is to allow the greatest degree of flexibility to the organism, such that greater efficiency can be achieved during greater metabolic need, and less during decreased need.
We have found that HRV biofeedback restores autonomic function that is suppressed when people are exposed experimentally to inflammatory cytokines (Lehrer et al., 2010).
However, it is known that experienced Zen monks tend to breathe in this very slow range (Lehrer et al., 1999). We discovered some literature that offered the possibility that these pathways could be investigated using a technique called heart period evoked potentials (HEPs). The work of the Aziz group in London (Hobson et al., 2008) has also demonstrated that slow breathing almost immediately prevents esophageal pain thresholds from dropping dramatically when acid is introduced to the stomach. At resting respiratory rates, the phase relationship between breathing and HR is far from synchronous, such that heart rate increases tend to follow inhalation at about the mid-breath point, and heart rate decreases follow exhalation also at about the mid-breath point (Vaschillo et al., 2002). Phase relationship studies at various levels of metabolic need have not yet been done, so this interpretation must remain speculative.
All frequencies are suppressed by these cytokines, much as happens when we catch the flu or are subjected to another inflammatory condition. The HEP is a unique version of the usual evoked response (ERP) in that the R-wave of the ECG is used as a signal rather than being filtered out.
Each heart beat then creates a large electrical signal to the brain which can be measured with surface electrodes.
The above mentioned studies discovered that those subjects that had better interoception (ability to perceive their heart rates) produced a larger evoked potential presumably by way of the vagal afferent system. So if HRVB is, in fact, stimulating beneficial brain structures, we might see it reflected in the HEP.

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