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I learned about biofeedback from brief mentions of it in books with regards to therapies for ADHD. (I read a lot of books about psychology). When it was mentioned, it was usually in the context of “ other than medication, the only treatment that has shown significant results in studies is biofeedback therapy”. So being a health fanatic (of both mental and physical health), of course I had to try it. 

The biggest problem with biofeedback therapy is the cost, and the fact that it’s not usually covered by medical insurance. I have a DIY mentality, so I wondered if I could do biofeedback on myself, and I started reading. I learned that there are, in fact, a few things I could do on my own with a little bit of equipment. There are finger sensors, chest harnesses, and even smart watches that can be hooked up to an app. I bought a chest harness heart rate monitor, and I downloaded an app to measure my heart rate variability- or HRV. Think of HRV as all of the lines between the heartbeat when you look at a heart rate monitor screen.  

When you compare your HRV with your heart rate, you can learn whether you are in a sympathetic (fight or flight) or parasympathetic (rest and rehabilitate) state. If you tend to lean toward the sympathetic, “paced breathing” should help bring your nervous system to a balanced state.  To find your ideal breathing pace, you can test yourself by starting with six breaths per minute, which is a pretty average rate, and checking your HRV on an app that connects to the heart rate monitor through bluetooth.  I found that my HRV was the highest at around 5 or 5.5 breaths per minute, depending on the time of day. 

I got in the habit of doing 10 minutes of paced breathing after lunch and 10 minutes before bed. I collected a lot of data but didn’t see any patterns or improvement, even after a few months. In the meantime, I discovered that a naturopathic school near me had a program for biofeedback therapy practitioners, and they needed patients who would be willing to do biofeedback therapy with an advanced level student under teacher supervision. The patients would need to sign up for eight 50 minute sessions over eight weeks, at a reduced price. I leapt at the opportunity!  

I didn’t take detailed notes of everything that happened during these sessions, so I might not get 100% of the details correct, but I will try my best.

For the first session, we just talked.The student practitioner asked me about my goals and issues, and also mentioned that her instructor may or may not be listening from the next room. I answered that I was looking to reduce anxiety and improve mental clarity.  The instructor came into our room later in the session. It became clear pretty quickly to me that they had experience in counseling or talk therapy. This, in fact, took up the bulk of what we did over the eight weeks, and I learned a few new therapy tools, such as labeling my emotions when they come up, rather than going down the rabbit hole of concocting scenarios that I’m scared will happen in the future.  I was given a homework assignment to sit for ten minutes each day and pay attention to my breathing, and then write down any observations. Since I had already been dedicating time to my paced breathing practice, this was easy for me. 

On week two, the student practitioner hooked me up to all of the biofeedback stuff, which included a belt that went around my abdomen to measure my breathing patterns, a heart rate monitor on my finger measuring my heart rate variability (HRV), and a monitor on my other finger to measure skin conductance, or the electrical conductivity of the skin. (kind of like measuring the sweatiness of my palms, but much more sensitive.) 

She had me do a series of three stress tests. One involved labeling things I saw on the computer screen, one was solving math equations, and one was recounting a stressful situation from my life. Between each test, I rested for a few minutes to allow my nervous system to reset. Then we looked at the data. I was surprised that the most significant physical change was not in my breathing or my heart rate, but was actually in the temperature and skin conductance from my fingers. I’ve never noticed myself getting sweaty palms in stressful situations, unless I’m playing a video game and holding onto a controller. 

The sensors were all hooked up to a computer program that showed line graphs of my heart information, breathing, skin conductance, and finger temperature. The student explained to me that they were looking for coherence between breathing and heart rate, and the flat parts of the graphs meant that my nervous system was in an ideal state. 

Over the course of the next few weeks, we did a lot more talking about the things in my life that were causing me stress, and a little bit- maybe about ten or fifteen minutes- of actual biofeedback. We did some paced breathing, and they came up with roughly the same ideal breathing pace for me through their machines that I had come up with through self experimentation: 5 to 5.75 breaths per minute. They introduced me to a free breathing pacer app that doesn’t require being hooked up to a heart rate monitor in order to use it, and I started practicing with it for my homework. During one of our sessions, I was pretty upset about something that had been stressing me out during the previous week, and we spent the entire session talking about it, not doing any biofeedback at all. The instructor told the student that sometimes that’s what happens during the sessions if that is what the patient needs. 

During one of my last sessions, they hooked me up to a different biofeedback system, which only used a finger sensor. I think it was just a heart rate monitor but I’m not sure. The computer program made two sounds, providing immediate feedback when I was in an ideal state and in a not-so-ideal state. The look that the student gave me before we started almost seemed apologetic, as if she expected the experience to be stressful. In fact, the opposite was true. I loved the reward of the positive sounding “ding” that came when my nervous system was in its ideal state, and the negative “ding” made me want to laugh, which had the effect of sending me to the ideal state and achieving more positive “dings”. 

I kind of wish we could have done more with this program, but then again, I don’t know how helpful it would actually be in helping me to reset my nervous system in the real world when I don’t have the immediate feedback. 

So what are my takeaways? I definitely thought the eight weeks was worthwhile, although I’m a bit underwhelmed with the biofeedback therapy sessions themselves. There is only so much actual biofeedback therapy that happens during a session. I’m not sure whether that is the norm in most practices, or if it was unique to how this particular school teaches its therapists. It could just be due to the limited amount of research we currently have about biofeedback therapy in general. 

What I gained from the experience was

– Stronger habits for my daily paced breathing practice (due to weekly accountability)

– An introduction to a better “paced breathing” app (“Kardia”, if anyone is in the market for one- and no, I’m not being sponsored) 

and

– Some basic psychotherapy tools, such as labeling emotions, and labeling thoughts and feelings that come up while doing paced breathing. 

I would have loved to have gotten more biofeedback while doing various types of stress tests, or seeing how certain stimuli affect my nervous system. I now know that breathing at a certain pace can help me to reach a more balanced state, but who is to say that doing more interesting activities, such as yoga, dancing, and watching comedy shows won’t help my nervous system even more? I’ll have to continue my own home experimentation with my heart rate monitor to find out. 

I think biofeedback is a useful tool, but it’s still in its early stages of being used as therapy. With new apps and smartwatches coming out, and more studies being conducted, maybe one day biofeedback hardware and software will be as common in the household as a thermometer, but instead of using it to check our physical health, we can check the “temperature” of our emotional health. 

Thanks for reading!

Rebecca H. Lee
 

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