What is Heart Rate Variability Biofeedback?
Heart Rate Variability (HRV) biofeedback is a foundational therapeutic technique used to regulate Autonomic Nervous System (ANS) physiology to improve physical and mental health.
Common to depression, anxiety, ADHD, PTSD, chronic pain and across most mental health conditions is dysregulation of the autonomic nervous system. Autonomic dysregulation is often overlooked which can have a negative impact on health and wellbeing. Technological and neuroscientific developments have opened up pathways to modulate dysregulated ANS physiology, and HRV biofeedback can improve mental and physical health, therapeutic outcomes, and empower clients to regain control over autonomic functioning.
How Does HRV Biofeedback Work?
During HRV biofeedback a sensor is used to measure heart rate, which is then presented to the client in real time via a smart device. This acts like a technological mirror that lets a person interact with, and regulate, their cardio function and nervous system. By slowing down our breathing we are able to slow our heart rate. This can result in greater heart rate variability than if our heart was beating rapidly. This is important because the portion of the ANS that makes our heart beat faster is also involved in making us stressed, unable to concentrate, emotionally reactive and more likely to have social difficulties.
Conversely, slowing the breath and responding flexibly to the demands of ANS allows us to relax, manage our emotions, concentrate and be prosocial and happier.
By combining slow breathing with HRV biofeedback, we can see breath-to-breath how we are optimising our physiology. With HRV biofeedback we are able to improve the balance in the ANS to a greater extent than with slow breathing alone. It is an evidence based treatment for a number of conditions such as anxiety, depression, trauma, insomnia, pain, cardiovascular disease and HRV biofeedback can improve peak performance, overall health and wellbeing.
Case Vignette: Leyla
From a constant struggle with selfhood to a more grounded, safe and connected sense of self
Ever since we first met, Leyla described herself as a ‘bad girl’. She said: “Everybody thinks I’m bad, that I’m evil… that I’m dark. Am I bad? Am I evil?”, she looked at me pleadingly. In that moment, Leyla was 34 but seemed to be much younger.
Despite the difficulties in her life, Leyla was an insightful individual, who had awareness of her emotional and physiological states. She was aware of self-limiting beliefs and she was motivated to reduce trauma-related intrusive thoughts and nightmares. She wanted to decrease feelings of despair and anger, and improve her concentration, sense of self-worth, and ability to form and maintain healthy relationships.
Leyla is a woman from a refugee background with a history of developmental trauma, intramarital domestic violence, sexual abuse and government persecution from her country of origin.
When Leyla sought neurofeedback, her clinical presentation was complex, characterised by chronic and severe symptoms of post-traumatic stress disorder and depression. She was often on guard and fearful, and she reported poor sleep, intrusive memories and nightmares.
Leyla was depressed, she found it hard to concentrate and she had no motivation to engage in life. Since her arrival in Australia in 2013, Leyla attempted suicide on several occasions and she struggled with methamphetamine addiction. Leyla had a negative self-image, difficulties with relationships and felt unsafe in the world. She made decisions that placed her at risk of further traumatisation, and often let others decide on important matters in her life which left her frustrated and with no sense of agency”.
Leyla’s treatment lasted approximately two years and incorporated neurofeedback, heart-rate variability (HRV) biofeedback and existential psychotherapy. The creative process was used to facilitate Leyla’s self-expression and processing of her experiences. Neurofeedback and HRV biofeedback helped to stabilise and calm Leyla’s nervous system and increase her emotional regulation.
Through the use of existential psychotherapy and art, Leyla could explore her relationship with herself, with others, and the world around her. She was able to recognise the values and principles she lived by, and find more flexibility in the choices she made in her life. She started seeing herself in a positive light and Leyla reported being able to remain calm and de-escalate emotionally charged situations. Leyla was able to assert boundaries in her personal relationships and her self-identity evolved into a vibrant and grounded sense of self.
Leyla’s relationship with her physical body and environment also shifted: she exercised and ate well, she spent more time in nature and she enrolled in further studies. She started to seek out opportunities for socialisation. Leyla opened up to a healing part of herself that allowed for creativity, growth and change. She discovered a side of herself that was strong and resilient.
** Client name has been changed, and some details of the story have been modified to protect her identity.