ArticlePDF Available

Heart Rate Variability Biofeedback as a Strategy for Dealing with Competitive Anxiety: A Case Study

Authors:

Abstract and Figures

Heart rate variability (HRV) biofeedback (BFB) is a relatively new approach for helping athletes to regulate competitive stress. To investigate this phenomenon further, a qualitative case study examined the impact of HRV BFB on the mood, physiology, and sport performance of a 14-year-old golfer. The golfer met once per week at a university lab for 10 consecutive sessions of HRV BFB training that included breathing at a frequency of 0.1 Hz. The format and duration of sessions followed the HRV BFB protocol outlined previously by Lehrer, Vaschillo, and Vaschillo. Acute increases in total HRV, low-frequency HRV, and amplitude of oscillation at 0.1 Hz were observed during biofeedback practice. This effect became stronger across sessions, suggesting increases in baroreflex gain. Following HRV BFB, the golfer achieved his personal record score for 18 holes of golf, and his mean golf score (total number of shots per 18 holes of golf) was 15 shots lower than in his previous golf season. The golfer received no golf instructions during HRV BFB training. The results of this case study suggest that HRV BFB training may help the athlete cope with the stress of competition and/or improve neuromuscular function.
Content may be subject to copyright.
Biofeedback
Volume 36, Issue 3, pp. 109–115
©Association for Applied Psychophysiology & Biofeedback
www.aapb.org
Biofeedback Fall 2008
109
FEATURE
Heart Rate Variability Biofeedback as a Strategy for
Dealing with Competitive Anxiety: A Case Study
Leah Lagos,1 Evgeny Vaschillo,1 Bronya Vaschillo,1 Paul Lehrer,2 Marsha Bates,1 and Robert Pandina1
1
Center of Alcohol Studies, Rutgers, The State University of New Jersey, New Brunswick, NJ; 2University of Medicine and Dentistry of New Jersey,
Department of Psychiatry, Piscataway, NJ
Keywords: biofeedback, heart rate variability, golf, competitive stress, optimal performance
Heart rate variability (HRV) biofeedback (BFB) is a relatively
new approach for helping athletes to regulate competitive
stress. To investigate this phenomenon further, a qualitative
case study examined the impact of HRV BFB on the mood,
physiology, and sport performance of a 14-year-old golfer.
The golfer met once per week at a university lab for 10
consecutive sessions of HRV BFB training that included
breathing at a frequency of 0.1 Hz. The format and duration of
sessions followed the HRV BFB protocol outlined previously
by Lehrer, Vaschillo, and Vaschillo. Acute increases in total
HRV, low-frequency HRV, and amplitude of oscillation at
0.1 Hz were observed during biofeedback practice. This
effect became stronger across sessions, suggesting increases
in baroreflex gain. Following HRV BFB, the golfer achieved
his personal record score for 18 holes of golf, and his mean
golf score (total number of shots per 18 holes of golf) was
15 shots lower than in his previous golf season. The golfer
received no golf instructions during HRV BFB training. The
results of this case study suggest that HRV BFB training
may help the athlete cope with the stress of competition
and/or improve neuromuscular function.
Introduction
The term “heart rate variability” (HRV) refers to a measure
of the beat-to-beat changes in duration of the RR intervals
(RRIs) in the electrocardiogram (ECG). The RRI, or
interbeat interval, is the distance between one R-spike and
the next in the ECG. Psychophysiological models consider
HRV as a measure of the continuous interplay between
sympathetic and parasympathetic influences on heart rate
that yield information about autonomic flexibility and
thereby represent the capacity for regulated emotional
responding (Applehans & Luecken, 2006). The activation of
the sympathetic branch of the autonomic nervous system
(ANS) increases heart rate, while the activation of the
parasympathetic branch, primarily mediated by the vagus
nerve, slows it. Variation in heart rate can be caused by a
variety of factors, including breathing, emotions, and various
physical and behavioral changes. The heart rate changes as
well in response to internal body rhythms, many of which
reflect various homeostatic control systems. In general, high
HRV represents a flexible ANS that is responsive to both
internal and external stimuli and is associated with fast
reactions and adaptability. Diminished HRV, on the other
hand, represents a less transient, less flexible ANS that is
less able to respond to stimuli change (Giardino, Lehrer,
& Feldman, 2000). It follows that HRV may provide a
promising index of an athlete’s ability to respond to both
physical and emotional stress and thus of the capacity to
perform physically at maximal levels.
Strategies for Managing Competitive Stress
A number of stress reduction exercises have been described
in the sport psychology literature to treat child athletes’
symptoms of competitive stress. Studies have dealt with
the influence of relaxation techniques on anxiety in sport,
as well as the integration of cognitive behavioral therapies
to diffuse stress in a number of anxiety-provoking sport
situations, ranging from athletic practice to competition.
The development of mental rehearsal skills has been a staple
of traditional sport psychology interventions (Cummings &
Hall, 2002). The purpose of imagery interventions has been
to reduce state anxiety by familiarizing the athlete with a
specific sport task. Through mental simulation of a stress-
evoking situation in sport, the athlete is believed to get
the “feel” of successful sport-specific motor performances
and reduce precompetitive anxiety. Many protocols call
for athletes to vividly re-create a particular stress-eliciting
situation in their minds and draw attention to the sensation
of stress in the body. Yet the vast majority of such relaxation
techniques aim to relieve the psychophysiological symptoms
of stress rather than address the source of autonomic
imbalance in the body.
Resonance Frequency Breathing
According to Vaschillo, Lehrer, Rishe, and Konstantinov
(2002), the cardiovascular system is characterized by
specific resonance frequencies of HRV that exist at a specific
110
Heart Rate Variability Biofeedback
Fall 2008 Biofeedback
frequency for each individual, within the low-frequency
range (0.05–0.15 Hz) of HRV. The spectral distribution
of HRV is organized into conventional frequency ranges
specified by the Task Force of the European Society of
Cardiology and the North American Society of Pacing and
Electrophysiology (1996) and in other consensus papers, for
instance, Berntson et al. (1997). The resonance frequency
for each individual can be detected as the frequency at
which maximum HRV is produced, when the system is
rhythmically stimulated at that frequency. The resonance
frequency in HR for most individuals is close to 0.1 Hz, or
about six cycles per minute.
One ready source of rhythmical stimulation to the
cardiovascular system is respiration. In a phenomenon known
as “respiratory sinus arrhythmia,” vagus nerve activity shows
a rhythmical ebb and flow associated with rate of respiration.
Breathing at about six breaths per minute activates these
resonance properties and induces high-amplitude oscillations
in heart rate at 0.1 Hz. Individual factors such as total blood
volume can render the resonance frequency slightly higher
or lower than 0.1 Hz (six cycles/minute). Resonance in the
cardiovascular system at 0.1 Hz is caused by frequency
characteristics of the heart rate closed loop of the baroreflex
system, through which blood pressure changes are modulated
by changes in heart rate (Vaschillo et al., 2002, 2006).
Breathing at one’s resonance frequency activates and
strengthens the heart rate baroreflex system and thereby
strengthens an important source of ANS modulation
(Giardino et al., 2000; Lehrer et al., 2003). Increased gain in
the baroreflex is found both acutely and chronically after
biofeedback training (Lehrer et al., 2003). HRV biofeedback
(BFB) training appears to bestow a number of benefits to the
system. These include (a) maximizing respiratory efficiency
by making blood more available when oxygen concentration
in the alveoli is at a maximum during inhalation (Giardino
et al., 2000); (b) decreasing hypoxic ventilatory response
while improving oxygen saturation and increasing resistance
to hyperventilation (Bernardi, 2001); (c) increasing the
efficiency of the baroreflexes that indirectly modulate
general emotional reactivity (Lehrer et al., 2003); and (d)
improving the ability of the cardiovascular system to adapt
to circulatory requirements (Landeau, Turcotte, Desagne,
Jobin, & Boulet, 2000). This results in a system-wide energy
efficiency and metabolic energy savings that has been
demonstrated to enhance athletic performance.
Literature Review of HRV BFB and Sports
Applications
Vaschillo and Rishe (1999) and Vaschillo, Visochin, and
Rishe (unpublished data) applied HRV BFB with resonance
frequency breathing at the Lesgaft Sport University in St.
Petersburg, Russia, to 30 elite wrestlers with encouraging
outcomes. The training group, consisting of 15 wrestlers,
performed 20 minutes of HRV BFB twice per day for
10 consecutive days. The control group, consisting of an
additional 15 wrestlers, did not perform respiratory training.
Vaschillo and colleagues found that when athletes breathed
at individual cardiac resonance frequencies, they increased
the amplitude of their heart rate oscillations. In addition,
heart rate decreased (while HRV increased), blood pressure
normalized, and skin temperature increased. Further, the
group trained in HRV BFB demonstrated a reduction in
reaction time, as well as speed of recovery in relaxation
of quadriceps muscles, as compared to no change in the
control group. Through the implementation of HRV BFB,
Vaschillo and colleagues enabled athletes to maintain a state
of autonomic balance marked by a cessation of sympathetic
dominance during competitive challenges.
Strack (2003) also examined the effects of HRV BFB on
high school batting performances in baseball. He reported
that the HRV BFB group improved greater than 60% more
in batting performance than the control group. In addition,
he found that the HRV BFB group demonstrated an increase
in the percentage of total low frequencies in the heart rate
spectrum.
Raymond, Sajid, Parkinson, & Gruzelier (2005) compared
dance performances of 24 Latin and ballroom dancers.
Twenty-four participants from a college dance team were
randomly assigned to an alpha-theta neurofeedback,
HRV BFB, or a no-treatment control condition. Findings
indicated that HRV and neurofeedback improved the
dance performances of individuals as compared to the no-
treatment group. The subscale of timing was increased
by neurofeedback, while the subscale of technique was
increased by HRV BFB.
All three research studies reported HRV BFB as safe with
no side effects. Yet, because of the limited evidence that HRV
BFB can be used to enhance sport performance, the sport and
psychophysiological community may justifiably question
whether these preliminary results can be replicated among
varying populations of athletes. Further research is needed
to evaluate and define the utility of HRV BFB for athletes of
multiple ages, skill levels, and sporting types.
The objective of this case study, therefore, was to evaluate
the utility of HRV BFB as a strategy for reducing competitive
anxiety in a 14-year-old golfer and to encourage further
research in this area. This study was based on the hypothesis
that HRV BFB can be used as a coaching tool for young
athletes to learn how to regulate emotions and improve their
functioning in sports practice, competitions, as well as their
111
Lagos et al.
Biofeedback Fall 2008
day-to-day lives. The following information will introduce
the background of the participant, methods, and findings
associated with HRV BFB training. A larger scale study with
collegiate golfers at Rutgers University is underway at our
laboratory.
Background of Participant
The participant in this applied case study was a 14-year-old
competitive golfer beginning his first year of high school
competition. He had played golf since the age of seven,
had been an all-state competitor in elementary and middle
school, and had lived and trained at a golf academy for
the previous two and a half years. During the golf season
prior to HRV BFB training, the participant had maintained
an average score of 91 in an 18-hole golf competition and
an average score of 70 during an 18-hole golf practice. He
attributed this discrepancy to his inability to manage stress
and anxiety during competitions and cited a general fear
of negative social evaluation. He described several panic
episodes marked by shortness of breath, rapid heart rate,
sweating, and fear of losing control while playing in golf
competitions. He experienced similar symptoms during
school exams and when speaking in front of audiences.
Panic attacks did not occur, however, in golf practice. With
his parents’ consent, the golfer sought assistance to improve
his performance in competition from a sport psychology
consultant. During the 10 weeks of HRV BFB training, the
golfer did not receive any professional golf instruction or
training.
Method
Procedure
The 10-week HRV BFB protocol designed by Lehrer,
Vaschillo, and Vaschillo (2000) was implemented with the
participant. The protocol integrated 10 HRV BFB training
sessions that were conducted at a university lab. Each session
lasted 45–60 minutes, included four tasks (A: baseline, B and
C: biofeedback training, and D: baseline) for five minutes
each. Sessions 1, 4, 7, and 10 served as recording sessions.
In the first session, the golfer’s resonance frequency was
defined as 0.1 Hz (Figure 2). ECG and respiration were
recorded during all four tasks. In each recording session,
measures of mood and anxiety were obtained. Sessions 2, 3,
5, 6, 8, and 9 were performed without physiological record.
During sessions the participant was taught to breathe slowly
at his own resonance frequency (but not too deeply) using
abdominal and pursed lips breathing techniques. Also the
participant was asked to engage in two 20-minute breathing
practices each day at home using the “StressEraser” device
(Helicor, New York). The participant submitted a weekly log
of his score per round (e.g., 18 holes) in golf competition to
the experimenter.
Psychological Measures
The Profile of Mood States (POMS): The 65-item POMS
measures six mood states, including anger, confusion,
depression, fatigue, tension, and vigor, and yields one
overall score. The POMS possesses high levels of reliability,
with alpha coefficients from 0.80 to 0.91 (McNair, Lorr,
& Droppleman, 1971). Further, the POMS has been used
extensively in sport psychology research with over 250
sport-related published papers since its introduction (LeUnes
& Burger, 1998).
Because the POMS did not address the full range of
positive mood states that also influence sport performance,
Figure 2. Profile of Mood States (POMS) form. Results on POMS demonstrated
significant improvements in tension, anger, depression, and fatigue through
HRV BFB training.
Figure 1. Participant’s resonance frequency determination. To determine
resonance frequency, the participant was asked to breathe following the pacer
at five frequencies, including 4.5, 5.0, 5.5, 6,0, and 6.5 breaths per minute.
HR and respiration frequency spectra and transfer function (TF) between
respiration as the input and RRIs as the output were calculated separately
for each frequency. The TF was computed as a quotient through dividing HR
spectral power by respiration spectral power at each frequency. Thus, the TF
shows HR response to respiration when participant breathes at each frequency
with the same depth of breathing. Resonance frequency is where the TF is at
the maximal value.
112
Heart Rate Variability Biofeedback
Fall 2008 Biofeedback
such as confidence and calmness (Hanin, 2000), the
Competitive State Anxiety Inventory (CSAI-2) was used to
assess participants’ affect and cognitions about competition.
Developed by Martin et al. (1990), the CSAI-2 consists of
27-items, each rated on a Likert scale from 1 (“not at all”) to
4 (“very much so”). The 27 items represent three nine-item
subscales, including somatic anxiety, cognitive anxiety, and
self-confidence. Each scale yields a separate score ranging
between 9 and 37. Alpha coefficients ranging between 0.79
and 0.90 demonstrate a high degree of internal consistency
for the CSAI-2 subscales.
Physiological Measures
A J&J Engineering (Poulsbo, WA) I-330 DSP-12 physiograph
unit was used to collect ECG and respiration data. ECG
data were collected at a rate of 500 samples per second. To
measure ECG activity, a negative electrode was attached
to the upper part of the right arm, a positive electrode was
attached to the lower part of the left leg, and a ground
electrode was attached to the upper part of the left arm. To
record respiration, we used two strain gauges: one placed
around the abdomen at the level of the navel, and one at the
level of the upper chest (thoracic placement). As the gauge
stretched, the voltage across the tube changed, and relative
changes in length were measured with a range of 0–100
units of relative strength.
Performance Measures
To measure golf performance, the participant recorded
his weekly score per golf round. This score represents the
number of strokes required to complete 18 holes of golf.
He recorded his weekly golf scores for 10 weeks each sport
season.
Data Analysis
Raw ECG data were analyzed using the WinCPRS software
program (Absolute Alien Oy, Turku, Finland). Beat-to-beat
RRIs were assessed from the ECG signal. A spectral analysis
of RRIs and respiration was performed for each 5-minute
task. Total, low-frequency, and high-frequency HRV indices
were calculated. Cross-spectral analysis was used to calculate
coherence1 between heart rate and respiration curve.
Results
Compared to the first baseline session, changes were found
in affect, physiology, and sport performance following HRV
BFB training.
Affect
The severity of the golfer’s self-reported unpleasant moods
was reduced following HRV BFB. As indicated in Figure 2,
the golfer showed reductions in four out of five negative
mood states between session one and session ten on the
POMS. Notably, he reported a complete absence of tension,
depression, anger, and fatigue after 10 weeks of training.
There was a minimal decrease in vigor, from a score of 14
to a score of 12. There was no reported change in confusion,
which remained at a four. The golfer’s cognitive and somatic
anxiety was also reduced, as measured by the CSAI-2. As
demonstrated in Figure 3, cognitive and somatic anxiety
scores were 14 and 21 in the first session, respectively; the
golfer reported experiencing no cognitive or somatic anxiety
in the final session. Self-reported confidence increased from
a score of 4 to 26 through HRV BFB training. A score of
4 in the initial session indicated that the golfer had lower
confidence than the average high school male athlete (M
= 24.5, SD = 5.52; Competitive Anxiety in Sport, 1990). A
score of 26 in the tenth session demonstrated that the golfer
possessed higher confidence than approximately 50% of
high school male athletes.
Physiology
High-amplitude 0.1Hz oscillations in heart rate, blood
pressure, and vascular tone at the golfer’s resonant
frequency also were elicited during HRV BFB. The phase
shift between HR oscillation and the respiration curve at 0.1
Hz was close to 0°, that is, HR increased during inhalation
and decreased during exhalation (Figure 4). Heart rate
was synchronized with respiration with a coherence equal
1 Cross-spectral coherence assesses the interrelationship and overlap in
spectral properties of two time series. High coherence between respiration
and HRV would occur if a large component of HRV consists of respiratory
sinus arrhythmia. In normal breathing rates, spectral coherence is generally
high in the high-frequency HRV range (0.15–0.4 Hz).
Figure 3. Competitive State Anxiety Inventory (CSAI-2). A comparison between
pre and post scores on the CSAI-2 revealed that the golfer felt markedly less
anxious prior to golf competition and significantly more confident about his
ability to perform.
113
Lagos et al.
Biofeedback Fall 2008
to 0.983. Results show that total HRV2 (Figure 5a) and LF
HRV (Figure 5b) considerably increased during HRV BFB
procedure. This effect became stronger across sessions. HF
HRV (Figure 5c) decreased during the HRV BFB procedure
(tasks B and C) in comparison with baseline (tasks A and D),
whereas it considerably increased across sessions. Results
show that total, LF, and HF HRV in baseline (task A and D)
cumulatively were increasing.
Sport Performance
As illustrated in Figure 6, there was a reduction in mean golf
scores after 10 weeks of HRV BFB training. In the season
prior to training, the golfer completed an 18-hole golf
competition in 91 strokes on average; in the season following
training, his mean score decreased to 76 strokes.
Discussion and Future Directions
Training in HRV BFB was followed by large acute and
chronic effects on indices of autonomic function, decreases
in anxiety and various other negative mood states, and
improved athletic performance in this young elite athlete.
The mechanism for emotional and performance effects may
be biofeedback effects on autonomic regulation. HRV BFB
elicits high-amplitude oscillations in the cardiovascular
functions, which in turn train autonomic reflexes (Lehrer et
al., 2003). The increase in LF and total HRV within sessions
reflects resonance effects. The increases in LF HRV at task
A across sessions may reflect increased resting baroreflex
gain. The large increase across sessions at task A in HF HRV
suggests a longer-term increase in vagus nerve activity.
There is evidence that HRV BFB elicits high-amplitude
oscillations in cardiovascular functions, which in turn trains
autonomic reflexes (Lehrer et al., 2003). This training restores
autonomic balance and improves autonomic control that
supports emotional regulation and movement coordination.
2 High-frequency HRV (HF HRV) is defined as the frequency component
from a Fourier analysis between 0.15 and 0.4 Hz. It usually reflects
respiratory sinus arrhythmia, which is mediated by the vagus nerve. Low-
frequency HRV (LF HRV) is the component between 0.05 and 0.15 Hz; it
appears to have both sympathetic and parasympathetic mediation and is
highly correlated with baroreflex activity (Task Force, 1996; Berntson et
al., 1997).
Figure 5. HRV indices across tasks (A, B, C, D) and sessions (1, 4, 7, 10).
Increase of total HRV, LF HRV, and HF HRV indices across sessions supports the
hypothesis that 10 weeks HRV biofeedback training cumulatively activates and
improves autonomic function regulation.
Figure 4. Example of heart rate-respiration synchronization. High synchronization
is an evidence that participant was breathing at resonance frequency.
114
Heart Rate Variability Biofeedback
Fall 2008 Biofeedback
Future Directions
The golfer’s weekly homework logs indicated regular and
consistent practice for two 20-minute sessions, six days per
week throughout the study. In addition, the golfer reported
implementing breathing skills as needed on the golf course.
We note that the notion that other golfers, or athletes of
any sport type, are able to automatically transfer skills
learned in the laboratory to sport performance is not yet
supported by evidence. According to the deliberate practice
theory, expertise is generated from the development of
domain-specific knowledge structures and skills acquired
through the process of adaptation and practice (Singer and
Janelle, 1999). The development of an automatic process of
resonance breathing may be possible but would likely involve
extensive, massed practice (consistent stimulus-response
mapping) in relevant emotional states and environmental
contexts. Further questions concern how biofeedback skills
should be taught, applied, and practiced in sport.
Future research may also extend beyond the physiological
and psychological domains to include other interesting and
important aspects of young athletes’ lives. Indices such as
substance use, academic grade point average, and number
of skipped sport practices would be important measures to
gauge how the development of self-regulation skills help
define behavioral outcomes.
Caveats and Limitations
It is uncertain whether the immediate training effects of
HRV BFB amplify, decrease, or remain consistent over time.
Longitudinal research is important for several reasons,
the foremost being that researchers lack an understanding
of how long the effects of HRV BFB endure after training
sessions have terminated. Second, individuals learn skills at
different rates, and thus, some athletes may not acquire self-
regulation skills until the tenth session or later. Assessments
of the effects of HRV BFB over durations that exceed 10
weeks are needed, as is research on the utility of booster
HRV BFB sessions following massed training.
Conclusions
The general aim of this study was to demonstrate that HRV
BFB is a viable method of improving golf performance,
perhaps by reducing competitive anxiety. A detailed
understanding of the participant and the psychological,
physiological, and sport performance–related findings were
presented to highlight the utility of this approach for child
athletes. Within this general aim, several aspects of the
methodology were described, including (a) the design of the
study, (b) session format and structure, and (c) measures for
assessing emotional, physiological, and sport performance
changes. Accumulated data suggested that HRV BFB
training may have enhanced the golfer’s ability to cope with
stress and increased his ability to perform optimally during
competition. HRV BFB elicited resonant oscillations in the
cardiovascular system and apparently normalized autonomic
regulation. As such, these techniques may have been
responsible for the substantial improvements in the athlete’s
mood and confidence, reduced the stress he experienced
during competition, and enhanced his golf performance. It
is hoped that the potential benefits of HRV BFB for athletes
of varying ages, skill levels, and sport disciplines undergo
investigation in controlled experimental studies to define
the mechanism(s) of action and advance the development
of outcome measures, strategies, and methods to implement
HRV BFB in sport settings.
Acknowledgment
This study was supported, in part, by NIDA grant P20
DA0 17552.
References
Applehans, B. M., & Luecken, L. J. (2006). Attentional processes,
anxiety, and the regulation of cortisol reactivity. Anxiety, Stress
& Coping, 19, 81–92.
Bernardi, L. (2001). Interval hypoxic training. Advancements in
Experimental Medical Biology, 2, 377–380.
Berntson, G. G., Bigger, J. T., Jr., Eckberg, D. L., Grossman, P.,
Kaufmann, P. G., Malik, M., et al. (1997). Heart rate variability:
Origins, methods, and interpretive caveats. Psychophysiology,
34, 623–648.
Competitive Anxiety in Sport. (1990). Champaign, IL: Human
Kinetics.
Cummings, J., & Hall, C. (2002). Athletes’ use of imagery in the
off-season. Sport Psychologist, 16, 160–172.
Giardino, N. D., Lehrer, P. M., & Feldman, J. M. (2000). The
role of oscillations in self-regulation: Their contribution to
homeostasis. In D. T. Kenny, J. G. Carlson, F. J. McGuigan, &
Figure 6. Mean score for 18 holes of golf. Data from pre and post 10 week HRV
BFB training indicated significant performance gains. The golfer reduced his
mean golf score approximately 15 strokes in an 18-hole golf game.
115
Lagos et al.
Biofeedback Fall 2008
J. L. Sheppard (Eds.), Stress and health: Research and clinical
applications. Amsterdam, Netherlands: Harwood Academic
Publishers.
Hanin, Y. L. (2000). Emotions in sport. Champaign, IL: Human
Kinetics.
Landeau, J. B., Turcotte, H., Desagne, P., Jobin, J., & Boulet, L.
P. (2000). Influence of sympatho-vagal balance on airway
responsiveness in athletes. European Journal of Applied
Physiology, 83, 370–375.
Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant
frequency biofeedback training to increase cardiac variability:
Rationale and manual for training. Applied Psychophysiology
and Biofeedback, 25, 177–191.
Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S., Eckberg, D. L.,
Edelberg, R., et al. (2003). Heart rate variability biofeedback
increases baroreflex gain and peak expiratory flow. Psychosomatic
Medicine, 65, 796–805.
LeUnes, A., & Burger, J. (1998). Bibliography on the profile of mood
states in sport and exercise psychology research, 1971–1998.
Journal of Sport Behavior, 21, 53–70.
Martens, R., Burton, D., Vealey, R. S., Bump, L. A., & Smith, J.
(1990). The Competitive State Anxiety Inventory-2 (CSAI-2).
In R. Martens, R. S. Vealey, & D. Burtons (Eds.), Competitive
anxiety in sport (pp. 117–190). Champaign, IL: Human
Kinetics.
Raymond, J., Sajid, I., Parkinson, L. A., & Gruzelier, J. H. (2005).
Biofeedback and dance performance: A preliminary investigation.
Applied Psychophysiology and Biofeedback, 30, 65–73.
Singer, R. N., and Janelle, C. M. (1999). Determining sport
expertise: From genes to supremes. International Journal of
Sport Psychology, 30, 117–150.
Strack, B. W. (2003). Effect of heart rate variability (hrv) biofeedback
on batting performance in baseball. Dissertation Abstracts
International: Section B: The Sciences and Engineering, 64,
1540.
Task Force of the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology. (1996).
Heart rate variability: Standards of measurement, physiological
interpretation, and clinical use. European Heart Journal, 17,
354–381.
Vaschillo, E. G, Lehrer, P. M., Rishe, N., & Konstantinov, M. (2002).
Heart rate variability biofeedback as a method for assessing
baroreflex function: A preliminary study of resonance in
the cardiovascular system. Applied Psychophysiology and
Biofeedback, 27, 1–27.
Vaschillo, E. G., & Rishe, N. (1999). Therapeutic method for a
human subject. U.S. patent 5,997,482. December 7.
Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics
of resonance in heart rate variability stimulated by biofeedback.
Applied Psychophysiology and Biofeedback, 31, 129–142.
Correspondence: Leah Lagos, Center of Alcohol Studies, Rutgers, The State
University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, email:
leahmlagos@gmail.com
Leah Lagos Evgeny Vaschillo Bronya Vaschillo
Paul Lehrer Marsha Bates Robert Pandina
... HRV biofeedback is the types of excellent tools develop to measure the human psycho psychology changes . The word "heart rate variability" (HRV) refer to the procedure to measure the changes of heart beat in tempo RR interval (RRIs) in electrocardiogram (ECG) (Lagos et al., 2008). Heart rate variability-biofeedback (HRV-BF), also known as respiratory sinus arrhythmia (RSA) biofeedback, It involves the decreasing level of breathing for the frequency if the amplitude HRV being maximized. ...
... Biofeedback is a technique that is controlling the situation of the psychophysiology of the clients. The biofeedback technique could be a powerful tool to control and measure the level of client circumstances whether it is positively changes in clients (Lagos et al., 2008;Peciuliene et al., 2015). Using biofeedback tool, the effectiveness of intervention techniques provided to the clients can be measured consistently and systematically. ...
Chapter
Full-text available
Abstract The transition process facing by the students from secondary school to an engineering and technical institute of higher learning contributes to the challenges in emotional, social and academic aspects. At the same time, the changes in the environment of educational setting also gives a huge impact towards physiological status of the students. Students may expose to an increase in physiological arousal state which further affect student’s psychology and performance in university. Until now, there is no special program or module in counselling session that can help in reducing the physiological arousal among engineering and technical student. Therefore, this study aims to develop and evaluate the effectiveness of progressive muscle relaxation with spirituality element using a biofeedback therapy in lowering physiological arousal of the students. This is an experimental quantitative study involving 54 technical students with disciplinary problems. DASS Questionnaire was used in determining the psychological state of the subjects. They are divided into two group which are treatment and control group in 4 session using progressive muscle relaxation with spirituality element for treatment. Another group is a control groups which received the progressive muscle relaxation without spirituality elements. Both groups are required to undergo biofeedback test before and after training. The result revealed that both progressive muscle relaxation with spirituality elements using biofeedback therapy is more effective in lowering psychological arousal as compared to the progressive muscle relaxation without spirituality elements. Indeed, the findings from this study provide a new effective technique that can be applied in counselling sessions as an empowerment to the existing counseling technique in helping the clients. Keyword: Progressive Muscle Relaxation, Biofeedback, Spirituality, Psychological Arousal
... HRV biofeedback is the types of excellent tools develop to measure the human psycho psychology changes . The word "heart rate variability" (HRV) refer to the procedure to measure the changes of heart beat in tempo RR interval (RRIs) in electrocardiogram (ECG) (Lagos et al., 2008). Heart rate variability-biofeedback (HRV-BF), also known as respiratory sinus arrhythmia (RSA) biofeedback, It involves the decreasing level of breathing for the frequency if the amplitude HRV being maximized. ...
... Biofeedback is a technique that is controlling the situation of the psychophysiology of the clients. The biofeedback technique could be a powerful tool to control and measure the level of client circumstances whether it is positively changes in clients (Lagos et al., 2008;Peciuliene et al., 2015). Using biofeedback tool, the effectiveness of intervention techniques provided to the clients can be measured consistently and systematically. ...
Chapter
Full-text available
The transition process facing by the students from secondary school to an engineering and technical institute of higher learning contributes to the challenges in emotional, social and academic aspects. At the same time, the changes in the environment of educational setting also gives a huge impact towards physiological status of the students. Students may expose to an increase in physiological arousal state which further affect student’s psychology and performance in university. Until now, there is no special program or module in counselling session that can help in reducing the physiological arousal among engineering and technical student. Therefore, this study aims to develop and evaluate the effectiveness of progressive muscle relaxation with spirituality element using a biofeedback therapy in lowering physiological arousal of the students. This is an experimental quantitative study involving 54 technical students with disciplinary problems. DASS Questionnaire was used in determining the psychological state of the subjects. They are divided into two group which are treatment and control group in 4 session using progressive muscle relaxation with spirituality element for treatment. Another group is a control groups which received the progressive muscle relaxation without spirituality elements. Both groups are required to undergo biofeedback test before and after training. The result revealed that both progressive muscle relaxation with spirituality elements using biofeedback therapy is more effective in lowering psychological arousal as compared to the progressive muscle relaxation without spirituality elements. Indeed, the findings from this study provide a new effective technique that can be applied in counselling sessions as an empowerment to the existing counseling technique in helping the clients.
... In a single case study, Lagos et al. (16) reported an overall increase in HRV and low frequencies (LF) when anxiety and stress were measured using a questionnaire after training a female collegiate golfer with 10 sessions of HRV biofeedback training. Lagos et al. (17) also reported increases in HRV, LF, and high frequencies (HF) after 10 weeks of HRV biofeedback training in another case study for a golfer. ...
... An overall increase of HRV and LF was observed after HRV biofeedback training with female collegiate golfers (16,17). In HRV biofeedback trainings, athletes are instructed to follow a paced breathing by looking at time controlled breathing bar, which may lead psychological load of focusing on the breathing task. ...
... Evgeny and his colleague Paul Lehrer were early pioneers in the study of resonance paced breathing and the development of HRV biofeedback (Lehrer et al., 2000;Vaschillo et al., 2002. Their work has inspired the application of HRV biofeedback in a variety of clinical populations such as those affected by asthma, hyper-and hypotension, fibromyalgia and depression, and other disorders Karavidas et al., 2007;Lagos et al., 2008;Lehrer et al., 2006. As well, both HRV biofeedback and slowpaced breathing show substantial efficacy in reducing subjective stress and anxiety (Goessl et al., 2017). ...
... Metode pelatihan untuk meningkatkan HRV atau RSA melalui biofeedback terbukti efektif baik sebagai terapi depresi dan gangguan emosional (Siepmann et al., 2008;Zucker et al., 2009;Witte et al., 2016) maupun strategi coping atau pencegahan stress pada orang sehat (Lagos et al., 2006;Henriques et al., 2011;Ratanasiripong, Ratanasiripong dan Kathalae, 2012;Wells et al., 2012;Low dan McCraty, 2018). Beberapa studi meta analisis diantaranya oleh (Goessl, Curtiss dan Hofmann, 2017) serta (Yu et al., 2018) menunjukkan pengaruh positif HRV biofeedback sebagai bagian dari manajemen stress dan ansietas. ...
Conference Paper
Full-text available
The goal of this study is to evaluate the effect of heart rate variability(HRV biofeedback) as a stress management tool among industrial workers. HRV biofeedback works by teaching people to recognize their involuntary heart rate variability and to control patterns of this physiological response. Subjects consisted of 36 female manufacturing workers who were randomly assigned as the training group (n = 19), and control group (n = 17). The intervention group received five session of weekly biofeedback training. Time and frequency spectral analysis of HRV and self-perceived depression, anxiety, and stress scale (DASS) were assessed at pre and post intervention. Results showed that the training participants reported decreases on the depression, anxiety, and stress after the intervention, and were supported by significant improvement in their HRV measures. Therefore, this study indicated the potential application of HRV biofeedback training as a tool for reducing negative emotional symptoms among workers at operative level.
... During putting performance, it is also important to consider personal constraints, such as physiological characteristics like arousal level, captured by changes in heart rate (HR), which can shape a golfer's performance. For example, as the task constraint of distance to the hole changes, it is possible that the HR of an individual athlete may al-ter, due to changes in arousal levels [13]. Therefore, the individual constraints of each golfer are important considerations within ecological dynamics, because they imply unique physical, physiological, cognitive and emotional features which constrain performance behaviours [14,15]. ...
Article
Background: The behaviours of golfers could be interpreted as emergent, resulting from the cyclical relations of perception-action couplings established under the interacting constraints of competitive performance environments. Underpinned by an ecological dynamics approach, the aim of this study was to investigate how a simple adaptation of task constraints constrained the (re)organization of putting actions in skilled golfers. Methods: Ten skilled golfers, male and right-handed (42.6 ± 14.4 years old) (average handicap of 2.3 ± 1.7) were investigated when putting at different distances from the hole. Results: Our results have revealed how the coupling of perception and action captures the mutual relationship that emerges between a performance environment and each golfer’s abilities, during task performance. In this sense, the manipulation of distance constraints selectively constrained movement organization variables in specific ways. As distance to the hole increased, there was a clear increment in backswing, downswing and follow-through amplitude, speed of putter impact on the ball and maximum acceleration of the putting movement. Moreover, heart rate (HR) decreased with distance to the hole, which may have indicated that a golfer was adapting to increasing distance constraints, or that a greater distance from the hole may require a greater attentional focus. Conclusions: Underpinned by an ecological dynamics approach, these and other findings in our study suggested some regularities in the behaviour of golfers when environmental constraints (e.g., distance) are manipulated. Thus, golfers’ behaviours can be interpreted as an emergent process resulting from the perception-action coupling relations established during practice and performance.
... Based on the read literature and based on the results from the above mentioned original studies, some attributes and elements such as contact initiation, negotiation, cognition, cohesion, coherent heart, respect differences, self-knowledge, flexibility, shared interests, and purposefulness were identified to be helpful during interactions among different people, especially under the Eastern context of communication (Allport, 1954;Buhrmester et al., 1988;Chen & Starosta, 2000;Cairns & Cairns, 1994;Lagos et al., 2008;Luthar & Burack, 2000;McCraty & Shaffer, 2015;McCraty et al., 2000;Jacob, 2010;Bernston et al., 1991;Kim, 1991;Kim, 2007;Kim, 2012;Paulk, 2008;Matveev, 2002;Michaeli, 2013;Paulk et al., 2011;Wilson & Sabee, 2003). However, most of the above mentioned elements are missing in communication theories. ...
Article
Full-text available
مقدمه و هدف: یکی از مهمترین اهداف هر ورزشکاری اجرای عملکرد بهینه در حین مسابقات است، از شیوه های نوین و رو به گسترش برای بهبود عملکرد ورزشی بازخورد زیستی (بیوفیدبک) می باشد. هدف پژوهش حاضر بررسی تاثیر تمرینات بیوفیدبک بر برخی عوامل فیزیولوژیک و عملکرد ورزشکاران ماهر تیر و کمان بود. روش شناسی: تحقیق حاضر از نوع نیمه تجربی با طرح پیش آزمون - پس آزمون با گروه کنترل بود. 24 نفر ورزشکار با میانگین سنی 5/22 سال بصورت هدفمند از بین شرکت کنندگان در مسابقات تیرانداری با کمان رنکینگ کشوری انتخاب شده و بصورت تصادفی در دو گروه 12 نفری تمرین بیوفیدبک و کنترل قرار گرفتند. بعد از پیش آزمون (آزمون عملکرد تیراندازی)، ورزشکاران گروه تجربی ابتدا 10 جلسه به تمرینات بیوفیدبک مربوط به کنترل ضربان قلب و کنترل تنفس براساس پروتکل تمرینی پرداختند و سپس، 10 جلسه همین تمرینات را همراه با هدایت رسانایی پوست انجام دادند. گروه تجربی و گروه کنترل در این بازه زمانی تمرینات مهارتی تیراندازی خودشان را زیر نظر محقق ادامه دادند. پس از 20 جلسه تمرین پروتکل بیوفیدبک دوباره آزمون عملکرد تیراندازی با همان شرایط پیش آزمون از هر دو گروه کنترل و تجربی گرفته شد. یافته ها: نتایج نشان داد که ضربان قلب شرکت کنندگان در شرایط تنش و استرس بیشتر از حالت استراحت می‌باشد(05/0 p˂). همچنین مقادیر ضربان قلب گروه تجربی در پس آزمون در شرایط استرس کمتر از گروه کنترل می باشد. نتایج تحلیل کوواریانس نشان داد که عملکرد آزمودنی های هر دو گروه نسبت به پیش آزمون پیشرفت داشت، ولی گروه تجربی عملکرد بهتری نسبت به گروه کنترل داشتند (P<0/05). نتیجه گیری: با توجه به یافته های این پژوهش، بایستی نقش تمرینات بیوفیدبک بیش از پیش مورد توجه قرار گرفته و تأکید بر استفاده از آن در کنار سایر پروتکل های تمرینی پیشنهاد می گردد.
Article
National Health and Morbidity Survey 2017 stated that 1 in 5 adolescents in Malaysia are having depression while 2 in 5 are anxious and 1 in 10 adolescents are in a stress state. This statistic is worrying as adolescents will be the future leaders of our country. Due to this increasing mental health problems, heart rate variability biofeedback technologies are used to increase resilience among university students. A person who is low in resilience is easily gets stress and a higher tendency to be depressed. Based on previous research, there were many kinds of research that have been done to quantify resilience through psychometric tools for example questionnaires and surveys. However, to the best of our knowledge, there has been little research before this in investigating how efficient heart rate variability biofeedback (HRVB) in improving resilience, especially among university students. The waveform of the HRV able to reflect either the person has low or high resilience. This study is a multidisciplinary field that includes electronics, psychology, and cognitive neuroscience. The aim is to determine the impact of HRV in resilience building among university students through biofeedback training. 120 students from Malaysia-Japan International Institute of Technology (MJIIT) are selected to participate in responding to the Brief Resilience Scale (BRS). BRS is used as psychometric tools to measure the level of resilience of the students. Based on the BRS score, the subjects were divided into 3 categories of resilience which are low resilience, normal resilience, and high resilience. The research used EmWave device and software of the HeartMath Institute to collect the variations of the heart rate data. Those who have low resilience took part in the biofeedback training for 5 sessions. The intervention used in the study is the slow breathing technique (6 breaths per min). Based on the HRV power spectrum, HRV data can be divided into 3 parts which are very low frequency (VLF), low frequency (LF) and high frequency (HF). The result obtained after completed all biofeedback training sessions shows that the use of heart rate variability biofeedback helped to increase the level of resilience of the students.
Patent
Full-text available
A therapeutic method includes determining heartbeat and respiratory rates converted in respective electric signals of a subject, displaying the heart rate, spectrally analyzing the respiratory and heartbeat signals, thereby defining a phase shift therebetween, causing the subject to modify the respiratory rate in a sense tending to minimize the phase shift and selecting a frequency of the displayed reference signal which correlates with the modified respiratory signal, and establishing an optimum reference signal displayed as a resonance frequency unique for the subject upon approaching the zero phase shift between the heart signal and the modified respiratory signal
Article
Full-text available
Attentional processing biases have been demonstrated in trait anxious individuals. The current study evaluated the interaction of trait anxiety and attentional bias in the regulation of cortisol responses to threat cues. Undergraduates (N=63) completed a dot-probe task featuring social threat words. Trait anxiety was associated with avoidance of threat cues. Attentional avoidance predicted decreased cortisol responses at higher levels of trait anxiety, and elevated cortisol responses at lower levels of trait anxiety. The results suggest that attentional processes are involved in the regulation of physiological arousal for anxious individuals.
Article
Full-text available
The purpose of this study was to examine the influence of competitive level on an athletes' use of imagery in the off-season, and to examine whether their use of imagery was related to their physical and technical preparation. Three hundred and twenty-four regional, provincial, and national level athletes were recruited to participate in this study from 10 different sports. Participants were asked to complete a modified version of the Sport Imagery Questionnaire (SIQ; Hall, Mack, Paivio, & Hausenblas, 1998) that was designed to reflect an athletes' use of imagery in the off-season. MANOVAs indicated that competitive level differences existed in athletes' use of imagery in the off-season, as well as in their use of physical and technical preparation for the up-coming season. More specifically, provincial and national level athletes engaged in significantly more imagery, regardless of the function, and physical and technical preparation then regional level athletes. In addition, bivariate correlations indicated that the more physical and technical preparation athletes engage in during the off-season, the more imagery they use.
Article
Full-text available
Components of heart rate variability have attracted considerable attention in psychology and medicine and have become important dependent measures in psychophysiology and behavioral medicine. Quantification and interpretation of heart rate variability, however, remain complex issues and are fraught with pitfalls. The present report (a) examines the physiological origins and mechanisms of heart rate variability, (b) considers quantitative approaches to measurement, and (c) highlights important caveats in the interpretation of heart rate variability. Summary guidelines for research in this area are outlined, and suggestions and prospects for future developments are considered.
Article
Full-text available
Heart rate and blood pressure, as well as other physiological systems, among healthy people, show a complex pattern of variability, characterized by multifrequency oscillations. There is evidence that these oscillations reflect the activity of homeostatic reflexes. Biofeedback training to increase the amplitude of respiratory sinus arrhythmia (RSA) maximally increases the amplitude of heart rate oscillations only at approximately 0.1 Hz. To perform this task people slow their breathing to this rate to a point where resonance occurs between respiratory-induced oscillations (RSA) and oscillations that naturally occur at this rate, probably triggered in part by baroreflex activity. We hypothesize that this type of biofeedback exercises the baroreflexes, and renders them more efficient. A manual is presented for carrying out this method. Supporting data are provided in Lehrer, Smetankin, and Potapova (2000) in this issue.
Article
Full-text available
This study describes the use of a biofeedback method for the noninvasive study of baroreflex mechanisms. Five previously untrained healthy male participants learned to control oscillations in heart rate using biofeedback training to modify their heart rate variability at specific frequencies. They were instructed to match computer-generated sinusoidal oscillations with oscillations in heart rate at seven frequencies within the range of 0.01-0.14 Hz. All participants successfully produced high-amplitude target-frequency oscillations in both heart rate and blood pressure. Stable and predictable transfer functions between heart rate and blood pressure were obtained in all participants. The highest oscillation amplitudes were produced in the range of 0.055-0.11 Hz for heart rate and 0.02-0.055 Hz for blood pressure. Transfer functions were calculated among sinusoidal oscillations in the target stimuli, heart rate, blood pressure, and respiration for frequencies at which subjects received training. High and low target-frequency oscillation amplitudes at specific frequencies could be explained by resonance among various oscillatory processes in the cardiovascular system. The exact resonant frequencies differed among individuals. Changes in heart rate oscillations could not be completely explained by changes in breathing. The biofeedback method also allowed us to quantity characteristics of inertia, delay, and speed sensitivity in baroreflex system. We discuss the implications of these findings for using heart rate variability biofeedback as an aid in diagnosing various autonomic and cardiovascular system disorders and as a method for treating these disorders.
Article
Fifty-seven citations from the literature on the use of the Profile of Mood States scale in sport and exercise psychology research have been added to the 258 listed in a 1998 article by LeUnes and Burger that appeared in the Journal of Sport Behavior. Of the 57 updated references. 9 are from 1997, 19 from 1998, 21 are from 1999, and an additional 8 are in press at this time. It is anticipated that the 300+ references from the combined bibliographies will serve as valuable sources of data for researchers and practitioners interested in the Profile of Mood States in sport and exercise psychology.
Examined and critically evaluated current understanding of how expertise is developed by drawing on contemporary literature dealing with hereditary and genetic accounts, the influence and potential value of practice, necessary environmental conditions, and the potential interactions of these influences on motor performance. Specifically addressed are hereditary accounts of overall health and well-being, physical attributes, personality characteristics, information processing capabilities, and intelligence. With respect to the role of practice a particular mission was to focus on recent research dealing with the quality of the practice setting, rather than debating the duration needed to achieve expertise. In this respect, the role of self regulation and competitive simulation is discussed. Finally, current ideas surrounding the potential environmental influences that allow the genetic potential and practice capabilities of aspiring athletes to come to fruition are described. Conclusions are offered suggesting that to advance the understanding of expert performance beyond its current status, proponents on polar ends of the nature-nurture continuum must adopt a less confrontational, more integrative approach in future research endeavors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The increased prevalence of airway hyperresponsiveness (AHR) observed among athletes suggests that high-level training may contribute to the development of AHR. We investigated the possible influence of the sympatho-vagal balance on this phenomenon in 40 athletes and 10 sedentary controls. Each subject filled out a respiratory questionnaire, had a methacholine challenge, and measurements were made of their baseline plasma catecholamines [epinephrine (E), norepinephrine (NE) and dopamine (DA)] as a reflection of sympathetic tone, and their heart rate variability (SDNN: standard deviation of all normal-to-normal intervals) as an indicator of parasympathetic tone. The athletes had a 45% prevalence of AHR (defined as PC20 < 16 mg/ml, where PC20 is the concentration of methacholine inducing a 20% fall in the forced expiratory volume in 1 s, FEV1) with a mean PC20 of 21.2 mg/ml compared with 10% prevalence (mean PC20: 74.4 mg/ml) in sedentary subjects (P < 0.01). Plasma catecholamine values were not significantly different between the two groups (all P > 0.05), but the estimated parasympathetic tone was higher in athletes (P = 0.01). When data from all subjects were analyzed together, plasma E and NE correlated with PC20 (r = 0.39, P = 0.005 and r = 0.29, P < 0.005) but DA and SDNN did not (both P > 0.05). However, the ratios E/SDNN, NE/SDNN and DA/SDNN showed significant correlations with PC20 (r = 0.42, P < 0.01; r = 0.33, P < 0.005 and r = 0.31, P < 0.05, respectively) This study suggests that the sympatho-vagal balance may contribute to the increased AHR in the population studied but this influence alone cannot explain the higher prevalence of AHR in athletes.
Article
Interval hypoxic training (IHT) is a technique developed in the former Soviet Union, that consists of repeated exposures to 5-7 minutes of steady or progressive hypoxia, interrupted by equal periods of recovery. It has been proposed for training in sports, to acclimatize to high altitude, and to treat a variety of clinical conditions, spanning from coronary heart disease to Cesarean delivery. Some of these results may originate by the different effects of continuous vs. intermittent hypoxia (IH), which can be obtained by manipulating the repetition rate, the duration and the intensity of the hypoxic stimulus. The present article will attempt to examine some of the effects of IH, and, whenever possible, compare them to those of typical IHT. IH can modify oxygen transport and energy utilization, alter respiratory and blood pressure control mechanisms, induce permanent modifications in the cardiovascular system. IHT increases the hypoxic ventilatory response, increase red blood cell count and increase aerobic capacity. Some of these effects might be potentially beneficial in specific physiologic or pathologic conditions. At this stage, this technique appears interesting for its possible applications, but still largely to be explored for its mechanisms, potentials and limitations.