[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal hrv. Check us out at optimalhrv. Com. Please enjoy the show.
Welcome friends to Heart Rate Variability Podcast. I'm Matt Bennett and I'm here today with a very special guest.
I read the paper about a few days ago, reached out and so I'm so glad to talk about two a paper that combines two subjects that I love talking about. One is workplace stress. The other is the combination of biofeedback and mindfulness. And this article brings those two things together. So I want to welcome Dr. Adrienne Lowe to the show. Dr. Lowe, before I start to nerd out with you about the amazing paper you published, why don't you just introduce yourself and a little bit about how you learned and got interested in heart rate variability.
[00:01:19] Speaker B: Great. I appreciate you for having me here, Matt. My name is Dr. Adrian Lo. I'm a psychologist based in Hong Kong. And 10 years ago I was actually working with organizations that were struggling with employee stress. But you know, they were measuring it with questionnaires from the 80s and the 90s, you know, so tools that didn't really capture what was actually happening, happening in the employees bodies. So then I thought, what if we use heart rate variability as an objective measurement? So I ran a study with 85 employees, you know, and what I found was fascinating and puzzling because some of the data doesn't make sense at all, you know, which led me to dig deeper, you know, to the cultural factors, you know, and emotional regulation.
So that earlier research set me on a path that eventually led to combining HRV biofeedback with mindfulness, which is the work we're discussing today.
[00:02:12] Speaker A: Awesome. So let's talk a little bit about workplace stress in Hong Kong where, where your study was completed when what are some things that you know are showing up in the workforce, you know, through the study or just through what's happening in the culture? I know in the US burnout is still relatively at an all time high. We may have gone a little bit down, you know, since the post Covid highs, but you know, we've gone down a little bit not to a pre Covid level. So I would just love to see, just to hear what you're seeing in Hong Kong.
And some of the things that may have you found out during this study as well?
[00:02:55] Speaker B: Yeah, that's a really great question because, you know, I would say I'm from my opinion, you know, Hong Kong professionals, they are some of the most stressed people in the world. I'm talking about people, you know, working in finance and law, healthcare, tech, you know, these high pressure jobs where you're expected to work long hours, you know, and never complain and just keep going, you know. And culturally, you know, the Asian culture, there's this expectation that you gotta hide your stress. You don't talk about it, you just push through. Right? So here's the thing, you know, as a psychologist who study stress, the stress doesn't disappear, you know, it builds up in your body. And we just wanted to find a way to actually help these people in a way that felt culturally acceptable. So that's where our study came in.
[00:03:42] Speaker A: And I'm curious, you know, one of the things I have a real passion for workplace health, wellness and performance. Performance. And your study was like written to me personally.
I loved it. How you combined this. I'm curious the reception you got from your subjects.
Obviously high stress situations. But I'm just, hey, we want to study hrv. I'm just curious, kind of what the response was from your subject.
[00:04:14] Speaker B: Yeah, that's a really great question. Because, you know, the thing about the Asian culture, particularly Hong Kong, you know, that's a really, really important because that's a strong norm, you know, that we should hide our emotions. So in a way, we are being historic. I think that's the word. You have to be tough, you know, so emotional restraint is seen as a high sign of maturity in the Asian culture. So therefore, when we do the study, you know, we have to frame it, you know, instead of saying, let's work on your emotions, you know, so we frame it as like a professional skill, you know, so we say things like, how about, let's develop emotion awareness, you know, for better decision making and. Or how we can help you to perform better under pressure. So these are some examples that how we, you know, we frame the language, you know, to make sense to the Hong Kong professionals. And I believe that not just Hong Kong, but all over the world as well.
[00:05:13] Speaker A: Right.
[00:05:14] Speaker B: So instead of talking about healing or therapy, we talk about optimization and performance.
[00:05:21] Speaker A: I love it. I love it. I'm curious with your this kind of a little bit of a sidebar question, but in a culture that the norm is emotional suppression, I wonder, your work as a psychologist, how does that sort of show up in counseling and psychology, do you see this repression, having, you know, a middle around anxiety or depression? I'm just curious how that might show up in a, a counselor's or psychologist office in that, that, that high achievement, low emotional expression situation.
[00:06:04] Speaker B: Right. It's interesting because in my earlier research, some of the fascinating results that were found was the two. Two of them. One is when heart rate therapy goes up, your emotional stress goes up as well. So that was a counterintuitive initially. I mean, probably in the US Culture, that would definitely be counterintuitive, you know, but in Hong Kong, it makes sense because people, as I mentioned, they mask their emotion. They don't actually express it, but the very people who express it will be healthier. So therefore, you know, it's a positive correlation, you know, hrv, just to make it, you know, lay manual, you can think about it as like optimal health. So a healthy person goes up. Right. Emotional expression goes up as well. Right. So with this finding, when I share with my clients, they, they get it, you know, and, and then they will, you know, start to, you know, bring down all the barriers of masculine emotion. They start to talk more about it.
[00:07:06] Speaker A: I love it. So let's talk about a little bit about the planning for the study itself because you combine two things that I love. And as our listeners know, our work with Dr. Ina Hazan, we talk a lot about mindfulness and biofeedback. But I'm curious, as you were putting this study together, some people just do biofeedback, other people just do mindfulness. I personally love that you combine these two, but I'd love to, just as you were designing this, what was some of the thought processes to bring mindfulness and biofeedback together as an intervention for work stress and burnout?
[00:07:48] Speaker B: So first of all, when we look at mindfulness, it's basically we pay full attention to the present moment without judging what we're experiencing. So in the study, what we did was we used the four main practices. So in mindfulness, there's a very classic, you know, the body scan meditation where you slowly move your attention through your whole body, just noticing the sensations.
And you do things like focus breathing, you know, you focus your attention to your breath coming in and out, you know, and also open monitoring, right, where you sit and watch your thoughts come and go, you know, and just like clouds passing by in the sky. And also the mindful movement, like gently stretching, you know, while staying aware of what your body is doing. So I think in a nutshell, you know, biofeedback will be more of, you know, how we work with our body, which is really important as well. But on the other hand, mindfulness, it actually deals with how we work with the brain. So therefore, it's kind of like a mind, body, you know, experience in altogether. So let's talk about the study. Yeah. So basically my study, we had 100 Hong Kong professionals. So we split them into two groups. So group A, group B. Yeah. So group A, they basically just, they just did HRV biofeedback with probably just a very normal kind of breathing. I mean, not normal in a sense that, you know, we, we, we teach them how to, you know, do like, you know, in a minute, you know, five to six breaths, you know, deep breathing, belly breathing. Right. And they can see for themselves, you know, how their body, you know, reacts to what they have just done. So basically, group A just did this and they used the device and they learned the breathing techniques.
The example we have just shown you, while group B, they did the HRB biofeedback plus the mindfulness. So in fact, they did everything which the group A did, but they had a structured mindfulness sessions. So both groups, you know, did the protocol for eight weeks. And we measured them again at the final.
The final week was the week number eight. And what's interesting is six months later, we measure them again.
[00:10:04] Speaker A: I love that about the study.
[00:10:05] Speaker B: So what's the result now? Group A and group B, both groups improved. So that's the good thing to know for both groups. Hrv, biofeedback works, works wonders alone. But group B, the group that got the biopaper, plus the mindfulness, improved significantly more.
So let me give you some numbers.
[00:10:27] Speaker A: Awesome.
[00:10:28] Speaker B: So basically, hrv, we look at the value. You know, you think about the value like the overall health score. So group A, they just did the biofeedback alone, has a very normal breathing. They improved by 22%.
Right. And their relaxation ability improved by 31%. Their heart rhythm coherence. Coherence. You can think about it like the symphony, the, the, the symphony, the integration between your, your left and right brain as well as your heart.
Or it can be a symphony between your sympathetic and parasympathetic system, you know, and, and you can see they have improved their heart rhythm coherence by 14%. So that's group A. Now for group B, their overall health improved by 53%, their relaxation ability by 67%, and their heart rhythm coherence by 32%. So you can see the group B, kind of like double, you Know what group A has done in some of the areas.
But I think what's really important is these improvements didn't go away six months later.
Group B still had most of these improvements. Their heart health was still 51% better than the baseline, you know, and their relaxation ability was still 63% better.
While group A, their improvement faded a little bit, you know, but they're still better than baseline, but not as much as right after the program.
So therefore, you know, you know, as a kind of like a, a principle we can draw out, this experiment is brain training is really important, you know, to, to, to trigger long term results while, while, you know, biofeedback with the body training, you would get result right away. Right. But you need a combination of both, you know, so that you can have long longer lasting results.
[00:12:28] Speaker A: And did you see any difference? You mentioned a couple different types of mindfulness. I know my audience would be curious of the protocol that you use. Was it just the users could choose or the study participants could choose which activity they wanted to do? Did you have sort of a, hey, do this one on Monday, this one on Tuesday. I'm curious how you set up the mindfulness protocol for folks.
[00:12:54] Speaker B: Right. So basically, let me just draw out the agenda, the mindfulness agenda.
So, so you can see the group B, they received almost everything, you know, they, they did, they did what group A has done. The, on the other hand, they had a structured mindfulness practice, so for eight weeks. Right. And the session length was approximately about 45 to 60 minutes per sessions, the weekly structure sessions. But, and they do it sometimes, they do it at home as well. Daily home practice for 20, 30 minutes. So for the brain training. So what, what they learned was they, they, they learn about the body scan meditation, which I kind of like talk about just now. And so that took about eight to 10 minutes. Body scan meditation. Right. So, so basically what it did was we get them to lie down or they can sit comfortably, close their eyes, you know, and feet apart, hands resting on the lap, you know, and take three to four deep breaths. And after that, you know, we scan from their foot, you know, attention moves from the left foot, right foot, no judgment, you know, and fall by the leg. And slowly they move up to their torso, to the arm, to the head and find the whole body.
[00:14:21] Speaker A: Awesome.
[00:14:22] Speaker B: So this works really well because a lot of these stressful employees, they are very disconnected with their bodies, you know, so by doing that they can, you know, they can separate, you know, these different elements and, and slowly, you know, through the focus, attention it activates, you know, their parasympathetic system, right? And then, you know, they also have emotional awareness, like where the parts of the body having the tension, you know, or the suppress emotions, you know. So basically, you know, we train their attention and non judgment.
And after that, you know, the next practice would be what we call the focus breathing meditations. And again, you know, we allow the, the subjects to sit comfortably, close their eyes, you know, and, and, and we allow them, you know, to have awareness of their breath, you know, notice their natural breath, like, and just observe it, you know, something like that. And where do you feel your breath most clearly? Where is it? At the nostril, their chest, at the belly, you know. And then we allow them, you know, to choose one location and focus there, you know, and maybe, you know, during the process their mind would wander, you know, and we tell them that, hey, it's normal, you know, mind should wonder. And when you notice your mind wonder, just slowly bring it back to your breath, to the breath as the anchor, right? And, and, and by doing this, you know, what really happens in the brain is we actually activate that prefrontal cortex, that blinking brain being engaged. You know, their default mode quietened down, you know, the, the mind wandering would slowly, you know, turn off. And so it's kind of like a, like a muscle, you know, that's being trained, the amygdala is being calm, you know, the fear center becomes less reactive, vagal tone increases, which is the parasympathetic. Right? And because, you know, most stressful people that raising mind.
And so therefore it's, it's part of what teach them, you know, can do it anywhere, you know, sometimes, you know, when they are at the pantry, you know, when, when they are walking to the washroom, you know, they can do it, you know. So again, the cultural aspect, especially for the Asian culture, is we, instead of telling them, hey, let's meditate, you know, let's find your inner peace, you know. But we, we, we frame that. We tell them, let's train your attention like an athlete, how an athlete train your body, you know, or instead of saying let's connect with your spiritual self, you know, we say let's develop your mental clarity and focus for better decision making, you know, so managers, you know, the leaders, they, they love these, these jargons, you know, Right. And finally, you know, we also help them to develop a meta awareness. Like, and what we call meta awareness is the awareness of awareness. And the aim is to reduce the emotional reactivity. So basically how it works Is we. Again, we, we instruct the participant to, to sit comfortably, close their eyes, natural breathing, body relax, you know, and we tell them, hey, now we're going to practice open monitoring. Instead of focusing on one thing, we're going to notice everything that arises, you know, so imagine your mind is like the sky.
So your thoughts, your emotions, sensations, they're like clouds passing by.
And obviously we're not trying to create a cloud, but we're not trying to stop the clouds and we're just watching them pass, right? So when, when a thought arises, like I'm stressed from work, you know, or, or maybe there's a thought about work. So we, we, we, we teach them not to engage with it, don't push it away, and on the other hand, not to engage with it, just watch it like a cloud passing by through the sky. And maybe an emotion arises, I feel anxious and just notice it and say, ah, that's anxiety. So we're teaching them how to label and label that feeling. Where do you feel it in your body? Is it your chest, your stomach? You just observe it, right? So when there's a sensation that arise, like, hey, my back hurts, you know, so just notice it. Oh, that's, that's back pain, you know, to label, that's back pain, right? Don't try to fix it, just observe it. So thoughts, emotions, sensations, they would just arise and passing by like the clouds in the sky.
And so, so by teaching them, it actually develops a habit, you know, for them over the eight weeks, you know, and we teach them that thoughts are not facts. So although they're stress, it's just a thought, but it's not the reality, right? So in a way, we help them to detach, right?
And this is really revolutionary for Hong Kong professionals because most stressful employees, they are identifying with their stress like I am stressed, you know, so, so, so by doing this technique called open monitoring, we, we, we frame that to be, I have stress, but I'm not the stress, right? So this creates a psychological distance from the stress. And in, in other words, it will reduce the emotional reactivity, right?
So this is the third protocol that we teach them. And finally there's what we call the mindful movement. So we integrate the body awareness with movement to develop a somatic intelligence. So this takes about five to eight minutes. And so for the first part, we would allow them to stand, right? They stand feet and hip, hips, the feet and hip apart, knees slightly bent, arms at the side, eyes open, a soft gaze. And, and we tell them to notice what does standing feel like? You know, and after that, they can do the. The neck rows and slowly roll their head in circles, you know, very slow. And we tell them to notice what you feel in your neck. And we do the reverse direction, not forcing, just a gentle awareness. And after the shoulder roll, right. So from the head, again we go down. Very slow movement. Like, where's the tension? Where's the ease of.
So it's kind of like, you know, the muscle relaxation, progressive muscle relaxation from the head towards the toe. And they'll do the spinal twist, you know, very slow, controlled movement. How does your spine feel?
And after they do the forward fold, you know, slowly bend forwards from the hips, let their arms hanging, their knees can be bent, you know, and what do you feel in your hamstring, your back, your neck, you know, so this is body awareness, doing movement. Right. And this is really important, especially, you know, for stressful employees who have very tight, tense body. So these are mindful movements would release their tension, you know, while they build their awareness.
So in a way, it teaches the employees to be aware while they're moving.
Yeah, so I think that's. Yeah, that's basically what we did. You know, these four techniques, it's basically very foundational and enough, you know, for them to cover up during these eight weeks.
[00:22:05] Speaker A: Well, and it's really kind of a nice gift to the reader of your work, too, is, you know, if I were going to, like, pick for, you know, foundational mindfulness activities, you pick those. Like, it's. I would. I would say now, mindfulness can look a lot of different ways to a lot of different people. But, you know, the one. The clouds, the progressive, you know, relaxation, all those are, like, great, because they were Mindfulness 101 to really give that comparison.
So we're.
Let's. Talk about the biofeedback aspect of this. Was.
[00:22:44] Speaker B: Sure.
[00:22:44] Speaker A: Yeah. I'm sure you had one group just doing HRV biofeedback.
Talk to me about the mindfulness group. Were they doing biofeedback while they were doing mindfulness? Was that in addition to the mind. Mindfulness.
I'd love to hear and have you share how you structured your control group and then the experimental group as well.
[00:23:08] Speaker B: Yeah. So basically, I think the measurement, how we set the procedure is basically the same. It's the content, you know, in the middle that's different. So it's kind of like you do it, you get a baseline hrv. Right. And after you do the protocol, whether it's the brain part, you know, or the. Or the Body part, you know, and after that you do a post test. Right. So that's how you capture the pre and the post. So you do that for consecutive eight weeks. And especially the final week, you do it again. And we can compare the baseline and the final, you know, and even like six months later, you know, we can compare.
[00:23:50] Speaker A: Excellent. So the, the biofeedback folks, like, what. What would their.
Did they tell me about them? But like, well, what was their protocol in this besides the pre and post? Was there anything happening in between those? Or.
[00:24:07] Speaker B: Right. So I think for both groups, we have both groups actually exper. Experience the biofeedback.
[00:24:14] Speaker A: Okay.
[00:24:14] Speaker B: So I think what's really game changing is especially in the Hong Kong culture, you know that because, you know, Hong Kong culture is heavily influenced by Confucianism and we emphasize a lot of social harmony, face saving, you know, emotional restraint, not burning others with your proms.
So if you're stressed, don't talk about it. You don't show up. You just keep working. You stay composed.
Right. So so basically when we use the biofeedback, so we actually asked them, how do you feel about the protocol or the program? So one of them actually said, we actually noted down. And I'm paraphrasing what he said. He said the HRV biofeedback felt safe because it's technology. It's technology, it's objective. Yeah. It's not admitting I have a problem. You know, I'm just optimizing my performance. So I think that's a key insight by framing it as a performance optimization instead of stress management. You know, people felt comfortable engaging with it. So it didn't feel like therapy or asking for help. It just felt like training.
[00:25:29] Speaker A: Yeah, that's awesome.
[00:25:31] Speaker B: And, and I, for the second group, you know, mindfulness added another layer because one of them said, and this really stuck with me because he said something like the mindfulness helped me to realize that I was allowed to feel stress.
And noticing it didn't mean I was weak. So that's really profound because for their entire career, professionals were taught that noticing stress equates to weakness.
But mindfulness actually teach them something different. Like noticing your feeling is awareness and that's intelligence and that's strength.
[00:26:08] Speaker A: I love that. So I would love to hear, just kind of put this in the context, this great study into your career and working with heart rate variability. I'm curious, sort of, you know, when it got on your radar, you know, how do you get fascinated in it? I'm just kind of curious about where this article and heart rate variability fits into Dr. Lowe's career as, you know, looking at your bio, very successful and just I have to ask how all this sort of fits into your career and evolution.
[00:26:48] Speaker B: I think for this research, I think it's just a starting point and I'm happy to share what's my upcoming project as well. So for this project, I think the, I think I've said it just now, but let me just rephrase that again for the sake of clarity. Right. So this research actually help us to think of our stress response as having two parts. One is our body. Because our body has an automatic nervous system that controls our heart rate, our breathing, our digestion. So when we are stressed, the system gets stuck into go mode, you know, fight or flight, you know, and your heart rate would stay high, your breathing will get shallow, and your body just keep pumping out the stress chemicals. Right, the cortisol. Right. So the HRV biofeedback works on this system directly, you know, for the, on the body. So when you breathe slowly and watch the feedback on your device, you literally can retrain your body's autonomic nervous system. So it's like saying, hey, it's okay to calm down now. Right. So it's kind of like a bottom up regulation. You're starting from the body and working upward. And after that we work on the next part. So because a lot of, you know, people using hrv, they just work on the body part, but they, they neglect the brain part, right? So, so when we talk about the brain, you know, especially the thinking, you know, the decision making that can also control the stress.
So when you notice your emotions without reacting to them, you know, when you focus your attention to the present moment, when you think about things differently, you're actually using your brain to calm down your body. So therefore mindfulness actually works on this system. And you know, mindfulness has been around for quite some time. It's just that we didn't really use it, we didn't really combine it, you know, with the biofeedback. Right. So therefore, yeah, mindfulness works on the biofeedback system. It trains our brain to regulate our emotions and control attention. And after doing the mindfulness, we do the HRV and you see the values goes up and it stays there. Right. So I think this is what's happening with this research.
Now what's really interesting is in my upcoming research which already has been completed and been accepted by some journal. I'll share that with you later once it's published. So basically With HRV data, we can also associate to the subject's pain the parts of the body that's feeling pain. Right. And so what we realize is, you know, a lot of work, workplace employees know they have pain in the body, especially the upper body area. Yeah, but, yeah, so that's, that's an insight because upper body we have like the shoulders, the neck, the spine and all that. So it's interesting. We can, we can pinpoint the exact location, you know, where the pain is being located. And so this is my upcoming project as well, which is once we got it sorted out, you know, the next step is we can see, we can come up with a predictive model. Right. So now that the research has completed for the pain and HIV research, I want to revisit these data like a year later. Right. I want to see whether the pain has intensified further, you know, because by, by, by the pain being intensified further, it will give us an insight that that is more of a predictive measurement.
[00:30:35] Speaker A: I love that, I love that.
Any, any other future ideas? Because I mean, one of the things I'm very interested in is how do we get this, whether it's Hong Kong, whether it's here in Denver, Colorado.
How do we get burned out, stressed out workforces to integrate these models so they can get the benefits that you've shown in your study. I'm just curious if you've had any thoughts on that because that's one of the hardest things to get right off the ground is, you know, that's where I loved your research.
[00:31:17] Speaker B: So I think we're in really exciting times right now with AI, you know, getting better and better, you know, so what I, what I, what I, what I really want to do is to integrate, you know, this predictive model with the AI. Right. So, so once, you know, so we can imagine like a year from now when we take the HRV reading and the AI, you know, will would analyze based on past records, you know, and you'll come up with a report. Okay. So your HRV is showing that you are suffering from, you know, quite a high stress, you know, and, and because of that, if you don't do something about it, your shoulders will start to be painful, your left or right, whatever.
And I think that would be a game changer because nobody wants to feel pain and therefore it would motivate them to start the protocol to intervene before it's too late.
[00:32:16] Speaker A: Awesome.
Awesome. Well, this has been a great conversation.
I will put the link to the paper in the show notes so people can check that out.
I encourage anybody listening to this to do that.
I can't wait for the next paper to come out. Pain and HRV is one of our reoccurring topics here because of how biofeedback has been effective for that and really exciting ways that may be alternative to medication and taking pills and other things. So I will right now invite you back when that research gets published. I'd love to do a deep dive into that as well, because it's one of the most important topics we cover.
[00:33:03] Speaker B: Wonderful.
[00:33:05] Speaker A: Awesome. We'll put information about Dr. Lowe, the research in the show notes, which, as always, you can
[email protected] and Dr. Lowe, thank you so much for your work, your time, and for our audience. We'll see everybody next week.
[00:33:21] Speaker B: Thanks so much for having me. I really enjoyed the conversation.
[00:33:24] Speaker A: Thank you.
[00:33:25] Speaker B: Okay.
