I wrote this for the Ohio Family Physician about four years ago. It's still a message about one of my favorite mechanical health strategies. I use it a few times each month to get more wholehearted (attempting to balance the autonomic nervous system.)
By A. Patrick Jonas, MD from my article in The Ohio Family Physician
Cardiovascular disease is still the leading cause of death
in America. Strategies to decrease the incidence of premature heart deaths are
improving. Stents, medications, exercise, diet, etc. are well known
interventions. Biofeedback strategies
for controlling blood pressure and stress were popular in the 1970-1990’s, but
lost out in the reimbursement wars and disappeared from common use. With enhanced understanding, those methods
are making a comeback, even with some support from the Professional Golfers Association
(PGA).
Golfer Nick Doherty had a habit of “choking” on the last day
of pro golf events when he was in contention.
A few years ago, he forgot how to choke and became a very effective
golfer late in competition. When other
golfers pressed him for his secret, he let them know he was using a biofeedback
technology from Heartmath.com, called emWave Personal Stress Reliever and emWave
Desktop. These tools, now used by
golfers around the globe, enabled him to be calm and focused under pressure.
Family Physicians are professionals under mounting pressures
from outside forces in the health care system as they notice extra pressures in
and from their patients. The focused
office visit to manage the high blood pressure is often stretched by the
patient into a four or five problem encounter, sometimes trivializing the
importance of the blood pressure and its complexity. The sudden addition of the need to “refill”
prescriptions for allergic rhinitis, asthma, gastroesophageal reflux disease
(GERD), and the shampoo originally prescribed by their dermatologist add to the
stress of the family physician and increase the risk of burnout. While there are many reasons for these daily
events in family medicine practices nationwide, there is no denial of the increased
stress in the lives of family physicians and their patients. With the addition of healthcare
transformation and the shift to the Patient Centered Medical Home (PCMH), the
stresses havel increased.
Could family physicians and their patients benefit from
technology that helps golfers? Could the same technology enable both patient
and physician to lower their blood pressure?
Studies support the use of the emWave biofeedback technology to lower
blood pressure, improve sleep quality and even help many with poor eating
habits when under stress. In fact,
family physicians are all trained to have insights about, and have strategies
to help patients with, stress induced symptoms and diseases. The EM Wave builds on that knowledge with
information from neurocardiology about the impact of stress on the heart and
subsequent effects on the limbic system, especially the amygdala.
One measure of heart-brain connection is heart rate
variability (HRV), commonly used to monitor the wellbeing of unborn babies
during labor, but also used as a measure of autonomic nervous system
function. Heart rate variability changes
from second to second as our thoughts change.
The amygdala is continuously scanning our emotional memory to compare
our current situation to past situations.
If a current pattern matches a past stress inducer- boom- a stress
response is turned on to protect us.
This immediately decreases the quality of our cognition (test anxiety,
anyone?) and increases heart rate, blood pressure and respiratory rate, among
other elements of the response. If our
patient is having increased stress reactions and we’re trying to help them with
the resulting blood pressure and get to the bottom of a stress reduction
strategy, we get our own stress response when they deflect our efforts with the
request for the four unrelated prescriptions.
We both need help!
The HRV synchronizes with the amygdala, sending messages
from heart to brain and brain to heart.
If the HRV is “coherent” indicating a balance between sympathetic and parasympathetic
nervous system elements of the autonomic nervous system, the amygdala is
content to allow contentment. If the HRV
is chaotic, the amygdale finds an emotional state in memory that matches that
HRV, generating a negative emotional state with a stress reaction, affecting
the entire brain and body.
The HeartMath people have a “quick coherence technique” to
teach people how to decrease the stress and re-balance the autonomic nervous
system. It has three simple steps that
also are used with their software for skill training:
“1.
Heart Focus: Shift your attention
to the area of the heart and breathe slowly and deeply
2.
Heart Breathing: Keep your focus
in the heart by gently breathing- five seconds in and five seconds out- through
your heart. Do this two or three times.
3.
Heart Feeling: Activate and
sustain a genuine feeling of appreciation or care for someone or something in
your life. Focus on the good heart
feeling as you continue to breathe through the area of your heart.” (Wilson and
Childre, 2006)
The beauty of the quick coherence technique and having the
ability to become coherent in even the most stressful situations is that the
patient or physician employing the skill need not be in a trance-like
state. This is not relaxation therapy. They can be totally present and contributing
with their best brain and heart function in full support.
The desktop version of the EM Wave Desktop includes a
breathing trainer and games such as flying a balloon or painting a meadow with
your coherence. Several screens in the
software enable the user to see a lead II of ECG, coherence scores, autonomic
nervous system moment to moment balance between sympathetic and parasympathetic
elements, and previous sessions for the same user. Multiple users can use the same software
which is totally self instructional down to the basics of HRV and stress.
Booklets about using the system to approach specific
conditions are available on the web site where the EM Wave is sold. These include, The HeartMath Approach to
Managing Hypertension, Transforming Anxiety, Transforming Stress, Transforming
Depression, Managing Emotions: Golf’s
Next frontier Booklet.
There are many ways to relate to stress reduction and blood
pressure reduction. The use of
electrophysiology and biofeedback may help many family physicians and their
patients to avoid or manage stress related diseases.
