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Beginner's Heart Rate Variability Biofeedback Session

Publication date: 11 November 2013

Recently I had a client for whom we recorded their first ever Heart Rate Variability (HRV) biofeedback session in my office. The graphs that resulted told the story really nicely so I thought I'd turn them into a blog post.

The case was a forty-something year old lady (I'll refer to her using the initial M) who came to me for help with stress - in fact a fairly straight-forward case. The recorded session lasted a little over 15 minutes - here's what happened.

Initially I asked M to just observe the feedback without any effort to change. This lasted about 3 minutes. You can see from the graph below that during this time her breathing rate is initially fairly steady around 10 breaths per minute, but then becomes more irregular.

breathing biofeedback session chart

Next I started speaking, and reminded M of the methods she'd already learned using other forms of biofeedback (namely muscle tension and capnometry). During this time, about 3-6 minutes, her average breathing rate goes up as she concentrates on what I'm saying (it's mostly above 15 bpm during this time).

Next I asked M to just practise the techniques she'd been taught (more about what these were, below). At the point where she begins practising her breathing rate drops, then drops steadily for the rest of the session, reaching around 6 bpm by the end.

Heart Rate Coherence

Let's take a look at what happened to heart rate variability during the session. In the software, which I developed myself, I use a novel method of quantifying heart rate coherence, which I call simply coherence score. It's shown in the graph below.

heart coherence biofeedback session chart

If you're not sure what heart rate coherence is, just follow the link in the previous phrase.

My calculation of coherence score is based on relating the "heart wave" to breathing. To achieve a good score, the heart rate needs to rise and fall in sync with the breath, with large but regular swings. (It's an innovative method that in my experience captures the coherence phenomenon much better than the methods used in other software.) The score is calculated over an interval of 5 breaths - so changes are not necessarily immediate.

In the session, you can see that initially M's coherence score is fairly low, then drops back to zero during the time when I was speaking. When M begins practising the coherence score begins to rise again steadily for the remainder of the recording. (It drops again at the very end as I begin speaking again, and break M's flow).

Let's draw out a few points:

  • As M's breathing rate falls, the coherence score rises, reflecting the nature of heart rate coherence as a kind of resonance phenomenon, maximised at around 6 bpm.
  • The state change is gradual (from around 7 to 12 minutes). This is a typical pattern, especially for a beginner. (More experienced practitioners can often very quickly drop into good coherence.)
  • Looking more closely, we see that the coherence is related to the regularity of the breath. For example at around 11 minutes the breath becomes a little more irregular, and at the same time the coherence score drops back slightly.


My software has one more measure of heart rate coherence, called synchrony. This is simply the time lag between the peak heart rate and the peak of the breath (i.e. the end of the inhalation / beginning of exhalation). Synchrony is shown in seconds, in the graph below.

biofeedback session chart

You can see that in the later part of the session the synchrony scores are much closer to zero. This is common in my experience. As the trainee's focus becomes clear and yet at the same time more "in flow", the breath and the heart wave become more tightly coupled, reflecting in lower synchrony.

Mindfulness Practice

So what did I ask M to do? It amounts to a kind of mindfulness of breathing practice - an intense but relaxed awareness of breathing, with an open, accepting mind-set. Mindfulness with biofeedback sets up one or two emphases not normally found in mindfulness:

  • knowing the state of slow regular breathing creates optimal balance in the nervous system;
  • trusting the body to find this state rather than willfully grasping after it;
  • looking to access this state, with an open, imaginative and even playful attitude, but without getting attached in any way to the success or failure.

M was able to build a good level of heart rate coherence in her first session because I'd already taught her mindfulness techniques in combination with other forms of biofeedback.

As I've said, I developed the software myself, guided by my own mindfulness practice, and hope to make it available for sale and general rental before Christmas 2013. For further details please contact me.

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