Psychotherapy of Heart Rate Variability ($)

Biofeedback can improve the outcome of therapy.

“If you want something you have never had, you must be willing to do something you have never done.”―Thomas Jefferson

If you think a heartbeat is a simple, regular rhythm that only varies with exertion, you misunderstand. While we feel our heartbeat’s dominant rhythm, it has many harmonics. These act as responsive metronomes that coordinate systems in the body.

The vagus nerve connects the brain to organs in the body. Most of the signals in the vagus travel from the body to the brain to inform and maintain homeostasis. While we identify our personalities as controlling our functions, the central nervous system tells another story: our body plays a major role in regulating our moods and personality.

While it keeps an even tempo, the rhythms of the heart are not simple or regular. The flow of blood through our bodies is both laminar and chaotic. These flow patterns are indicators of the health of many bodily systems, and the more aware we are of these rhythms the more we can coordinate their functions. Surprisingly, we can train better cardiac rhythms to improve both physiological and psychological health.

Rhythms

Heart rhythms range from fast atrial oscillations of a hundredth of a second to slow circadian rhythms varying over twenty four hours. These rhythms coordinate arousal, response, blood chemistry, gut activity, emotional balance, neurological coordination, hormone production, diurnal activity, the immune system, and probably everything else!

Rhythm is measured as the time between repeating structures, but also involves the shape of the pulse which reflects its harmonic components. Focusing on beats and the structures they contain measures rhythm in what’s called the time domain. This is what is easiest for us to sense and control because the time domain is sequential and specific, which is consonant with our awareness. Rhythm in the time domain is given by the pulse—which we can count—and correlates with our breath, level of arousal, and sense of time.

Harmonics measure rhythm in the frequency domain. This is measured as average patterns over time. Measuring these patterns requires the recording, comparison, and tabulation of their regularity.

We can hear auditory harmonics, and we can feel harmonics in our body as moods, comfort levels, and our ability to focus. Our temporal control affects our ability to rationalize, intellectualize, predict, and speak. We can slow ourselves down or speed ourselves up. We can be more or less reflective or reactive, and we can create more or less emotional environments.

We are more aware of ourselves and our heart rhythms in the time domain because we think in sequential terms. We are more aware of how we control ourselves in terms of cause and effect. While we are less aware of our cardiopulmonary and cognitive frequencies, we have some awareness of and control over them.

The shape of our pulse is a qualitative measure that combines rhythm and structure. A changing rhythm, which is what variability amounts to, requires changes in the dominant frequencies.

Higher frequencies contribute to the pulses’ small-scale structure. A completely smooth, oscillating pulse requires the organization of all frequencies. We can see this in smoothly oscillating waves of change in our heartbeat, blood oxygenation, blood pressure, and muscle tone.

We experience frequency control as a state of body and mind. Descriptions such as agitation, vigilance, relaxation, and flow-state describe dominant mind-body frequencies. We have varying degrees of psychological control over them. Psychologically impaired people typically have less control over these frequencies. The frequencies over which a person lacks control can be specific to their impairment (Montano et al. 2009; Forte 2019).

Something similar appears to be described by Traditional Chinese Medicine and its Theory of Pulses, which uses 28 poetic descriptions of the pulse taken manually (Al-Shura 2014). Our Western theory of the pulse is based on blood flow and the vascular system. The Eastern theory of pulses is based on life energy, or chi, and energetic centers in the body.

Heart rate variability pattern.

“Figure 1: Heart rate variability pattern for an individual participating in a deep breathing session: prior to initiating the deep breathing technique (left of the dotted line) and after starting with the technique (right of the dotted line). Note the change in emotional stress indicated by the shift from an erratic and disordered heart rhythm pattern (low coherence) to a sine wave-like (high coherence) pattern.” From Aritzeta et al. (2017)

HRV

The body-mind connection is the key to understanding the importance of the heart’s rhythms. It is clear that these rhythms guide our state and respond to changes in our environment. The degree to which these frequencies reflect and adapt is termed heart rate variability (HRV). The term is not precise because it includes all rhythms and responses, so we have to discriminate which of the body’s systems we’re talking about.

Microsecond heart rhythm changes are internal to the heart’s coordinated function. Changes over periods from 2.5 to 7 seconds correlate with respiration and are called the high-frequency band. Variability in this range is associated with emotional lability.

Changes over time spans of 7 to 25 seconds correlate with blood pressure and vascular elasticity. Decreased rhythmic variability in what’s called the low-frequency range correlates with age, morbidity, and impaired baroreflex function.

The very-low frequency band describes variations in the heart’s rhythm over periods from 25 to 300 seconds. These changes indicate a person’s ability to modulate arousal. A lack of very-low frequency variability is typical of people with chronic tension, such as post-traumatic stress (McCraty 2015).

A healthy personality responds to arousing and sedating situations, and a healthy heart  responds similarly. And because of the extensive connections between the heart and mind, mental variability is reflected in the heart’s variability. These variabilities differ according to the time and frequency ranges over which they’re measured and encouraged.

Just as a healthy mind responds smoothly and appropriately, the heart should too. We can see the mind’s health in the heart’s rhythms, and we can improve the mind’s health by improving the heart’s rhythms. This can be done with psychotherapy, physiotherapy, and biofeedback.

“Heart rate variability reflects the capability of an organism to adapt and recover. Patients with reduced heart rate variability might need additional psychotherapeutic sessions to achieve the same symptom improvements as patients with retained heart rate variability. (The degree to which) psychotherapy might increase vagal activity can be indexed non-invasively by measuring heart rate and calculating interbeat variability, i.e., heart rate variability.

“High variability means greater opportunity for the organism to adapt to internal and external challenges. Consequently, reduced HRV is a predictor of disease risk, e.g., higher inflammatory state, morbidity, myocardial infarction, and mortality. HRV was found to be reduced in depression and anxiety disorders.” (Balint et al. 2023)

Cardio-Pulmonary Rhythm

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