This Week In HRV Edition

[00:00:00] Welcome friends to the Heart Rate Variability Podcast. This week in Heart Rate Variability Edition, each week we explore the latest research and news from the world of hrv. Please consider the information in this podcast for informational purposes only and not as medical advice. Always consult your healthcare provider before applying any strategies we discuss. [00:00:20] This week we have an incredibly comprehensive episode that spans the full breadth of HRV applications. We're going to start with a powerful trio of studies on interventions, a landmark trial for PTSD and chronic pain, a guide for integrating biofeedback into pediatric psychotherapy, and a look at a novel technique for when slow paced breathing isn't an option. We'll then dive deep into HRV as a biomarker for vulnerability and prognosis, looking at its role in heart failure, adolescent self injury and and even the psychobiology of intimate partner violence offenders. We'll cover a mini theme on syncope, exploring how new metrics can predict fainting and how sleep apnea creates a unique and dangerous autonomic profile. We'll also look at how our environment, from high altitude living to high stress jobs, impacts our nervous system. We'll conclude with a fascinating single case study that utilizes HRV to to map the physiological changes during shamanic journeying. Let's get started. We begin with a study that offers profound hope from the Journal of Affective Disorders. This is a landmark paper Heart Rate variability Biofeedback improves co occurring post traumatic stress disorder and chronic pain symptoms A randomized wait list controlled trial the study was led by Chadwick, Tatchel, Fujiyama, Drummond and Matharesal. This is the first randomized controlled trial of its kind for this highly co occurring population. [00:01:54] Researchers studied 73 Australian participants who met the criteria for both PTSD and chronic pain. The intervention group received just six weeks of HRV biofeedback training. The results were significant. The HRV biofeedback group saw a 24.3% decrease in total PTSD symptoms and improvement across all symptoms clusters. They also showed a 24.9% reduction in pain interference, meaning the pain had a less significant impact on their daily lives. This is a powerful demonstration that a non invasive intervention focused on re regulating the autonomic nervous system can simultaneously treat both psychological trauma and its physical expression as chronic pain. But how do we integrate these powerful tools into clinical practice? [00:02:42] An article from the Cleveland Clinic's Consult QD authored by Bonor is titled Biofeedback Interventions with Psychotherapy in Pediatric the Present and the Future. [00:02:55] Benor argues that blending biofeedback with psychotherapy remains an area of untapped potential. He provides case based scenarios such as using temperature biofeedback to enhance cognitive restructuring or or using HRV biofeedback to complement exposure therapy for a patient with a needle phobia. It's a call for clinicians to get comfortable integrating these creative evidence backed approaches to make abstract concepts like self regulation concrete and measurable for children. But what happens when a patient can't use the standard HRV biofeedback technique of slow paced breathing? A practical guide From Shaffer on biosourcesoftware.com or offers a solution in his article Add slow paced contraction to your practice. [00:03:42] This technique, based on the work of Vashtihlo, involves gentle rhythmic muscle contractions of the wrists, core and ankles timed at the person's resonance frequency. Breathing rate this is a vital alternative for clinicians as slow paced breathing is often contraindicated for patients with conditions like severe copd, kidney disease or metabolic acidosis where the body's respiratory patterns are a necessary compensation. [00:04:10] Slow paced contraction provides a non respiratory way to engage the baroreflex and train vagal tone. A study in the journal Medicine provides firm support titled Effects of a Tai Chi Dance intervention on the Autonomic Nervous System in University Students. This work was led by Zhao and Ann, Li, Ding and Wang. The researchers recruited 42 university freshmen and subjected them to a 16 week Tai Chi dance intervention. They found that this 16 week intervention was an effective means to improve HRV at rest. This is a key finding suggesting that practices like Tai Chi can build autonomic resilience and serve as a reliable strategy to protect cardiovascular health in young, potentially stressed populations. We now turn to how HRV acts as a critical biomarker for vulnerability, starting with a crucial review titled association between Heart Rate Variability and Emotion Dysregulation in Adolescents with Non Suicidal self Injury. [00:05:11] Published by Saputri, Kusumadewi and Sakina, this paper connects the dots on a significant public health issue. [00:05:19] The authors review the literature showing that non suicidal self injury is a maladaptive response to intense negative emotions, a state known as emotion dysregulation. They highlight that this dysregulation isn't just in the mind, it has a clear physiological reduced hrv. This work frames low HRV as a key indicator of the autonomic imbalance and physiological distress that precedes the act of self injury, opening a window for objective assessment and intervention. [00:05:51] From adolescent vulnerability. We move to a forensic population. [00:05:55] This study is from the Journal of Criminal Justice Diminished vaguely mediated heart rate variability in a Compassion eliciting task in Intimate Partner violence offenders Led by Moreno Saiuza, Comis Fayos, Brisanuti, Blascaroz Rijo, Lila Romero Martinez and Moya Albial, researchers compared individuals with intimate partner violence offenses, general offenders and non forensic controls during a compassion eliciting task. Using virtual reality, the intimate partner violence offenders showed lower vagally mediated HRV compared to the non forensic participants. This suggests a diminished physiological capacity to connect with others suffering. It's a powerful example of utilizing biomarkers such as HRV to comprehend the intricate psychobiological factors underlying criminal behavior. [00:06:48] Moving to a hard medical diagnosis A systematic review in current cardiology reviews provides a definitive summary titled Heart Rate Variability and Heart Failure with Reduced Ejection Fraction A Systematic Review of Literature. This work by Nagai, Eubank, Nakano, Scherlag, Poe and Dasari synthesizes data from 470 patients with previous heart failure. The conclusion is clear. Autonomic impairment is a hallmark of heart issues. The review confirms that across the board time and frequency domain HRV metrics are abnormally lower in heart failure patients and these low values portend a worse prognosis. It solidifies HRV as a non invasive, powerful prognostic tool in cardiology. HRV can also serve as an early warning system even before a condition is clinical. [00:07:44] A study in the Egyptian Journal of Radiology and Nuclear Medicine is titled Heart Rate Variability and Left Atrial stiffness index by 2D Speckle tracking, echocardiography and Subclinical thyroid dysfunction. [00:07:57] This study, led by Hassan El Shehui, Esmail Hossam El Din, Fatha'llah, Abozid, Mohammed y Yassin, Ahmed Salama, Asla Kotb and El Sherbini looked at 155 participants and found that even subclinical thyroid disorders, both hypo and hyper, were associated with increased left atrial stiffness, a sign of early heart dysfunction. On the HRV side, the subclinical hyperthyroid group exhibited a significantly increased LF HF ratio, a measure of sympathetic dominance. This shows that the heart and nervous system are under stress long before the thyroid condition becomes overt. [00:08:41] Next is the study from Journal of Clinical Medicine an Open Access article titled Nocturnal heart Rate variability and Unexplained Syncope and Sleep apnea. The CINCOSIS study by Munoz, Martinez, Casal Gisande, Sopena, Torres, Duran, Garcia Campo, Corbacho Abelaira, Soto Alonso and Fernandez Villar. In this multi center cross sectional comparative study, 304 adults were divided into four 1 no syncope or obstructive sleep apnea 2 obstructive sleep apnea without syncope 3rd syncope without obstructive sleep apnea 4 syncope with obstructive sleep apnea. Researchers derive time and frequency domain HRV parameters from overnight respiratory polygraphy and compared results across groups. They found that obstructive sleep apnea was associated with an increased root mean square of successive differences RMSSD and a reduced low frequency LF power, indicating stronger vagal tone and reduced sympathetic activity. Meanwhile, syncope alone showed lower sympathetic indices LF and very low frequency VLF but higher rmssd, pointing to blunted sympathetic reserve. [00:09:58] The most remarkable findings were observed in patients with both conditions. This group displayed a mixed autonomic profile overall elevated HRV but reduced sympathetic and parasympathetic components, suggesting a deeper state of dysautonomia despite milder apnea severity. [00:10:16] The authors conclude that obstructive sleep apnea and syncope exhibit distinct nocturnal autonomic patterns and their coexistence results in a more profound autonomic imbalance. [00:10:26] Incorporating HRV analysis into routine polygraphy may enhance clinical understanding and risk stratification in patients with unexplained syncope and coexisting sleep apnea. We now turn to HRV and new frontiers and environments. First, a foundational study from the Journal of Family Medicine and Primary Care normative data of heart rate variability in healthy populations residing at high altitudes. Influence of age and gender. [00:10:55] Led by Verma, Jani, Banderi, Patel, Parlawar, Saini and Thakur, this study established HRV norms for a healthy population living at 3,500 meters. They found that females exhibited significantly higher parasympathetic metrics like RMSSD and PRR50 than males and that parasympathetic tone decreased with age. [00:11:19] Most importantly, it confirms that normative HRV values at high altitude differ from those at sea level. This is a critical reminder that all HRV data is context dependent from the physical environment to the work environment. [00:11:33] An integrative review in BMC Nursing by Feng, Huang, Peng, Chao and Wu, titled An Integrative Review of Cognitive Workload Assessment for Safety Management is a call for objective measures. The review notes that while questionnaires are widely used, they are subjective. It identifies eeg, EOG, and ECG for HRV as the top three preferred physiological signals for classification. This push toward using biomarkers like HRV for objective real time assessment of cognitive load is crucial for improving safety and managing burnout in high risk industries and for our final study we look at a truly unique environment, the inner world of consciousness. From Frontiers in Psychology, a single case report titled Dynamic Changes in Cardiac Function during Shamanic Journeying and Qigong Meditation led by Huels, Carter, Hsu, Borjigin and Harris, researchers tracked HRV during 14 sessions of shamanic journeying. They found dynamic widespread changes. The start of shamanic drumming decreased heart rate but increased parasympathetic metrics RMSSD PNN 50 then during the shape shifting phase, heart rate and RMSSD both increased. It's a fascinating look at how these ancient practices create a unique and measurable physiological state, showing that HRV can provide a window into altered states of consciousness. We have covered a massive amount of ground. Let's distill this into our actionable insights. [00:13:08] First, for individuals, this week is a powerful reminder that you can train your nervous system. [00:13:13] The Zhao study on Tai Chi demonstrates that consistent mind body practice can foster genuine resilience. The Huels study on shamanic journeying confirms that these practices have a deep, measurable and real physiological effect. [00:13:28] Second, for clinicians, as the evidence for HRV based interventions is growing, the Chadwick study is a clear signal that HRV biofeedback is is an effective evidence based treatment for comorbid PTSD and chronic pain. The Banor and Shaffer articles provide the how to showing you how to integrate biofeedback into pediatric care and how to adapt your methods like with slow paced contraction for patients who can't use standard breathing techniques. [00:13:57] Third, for researchers, the bar is being raised. The Werma study on high altitude norms is a critical call to action. [00:14:05] We must stop using one size fits all reference values. The Chin paper on Syncope reminds us to look beyond standard HRV metrics to more specific biomarkers such as deceleration capacity. The studies by Marino and Huels demonstrate that HRV is a powerful non invasive tool for exploring complex psychobiology ranging from forensic populations to states of consciousness. [00:14:30] Finally, for businesses and occupational health, the FUNG review is your evidence. Subjective surveys on burnout are not enough, high stress jobs have a measurable physical toll and objective real time tools like HRV are the future of assessing cognitive workload, ensuring safety and building a truly resilient workforce. And that is our week. [00:14:52] From the clinic to the mountaintop, HRV continues to show us who we are, where we are vulnerable and how we can heal. [00:15:01] Thank you for joining us on the Heart Rate Variability podcast.