Using HeartMath Technology with your Clients

Today’s health professional needs a variety of methods to help clients reduce stress, manage emotions, and create better health. Many are using the emWave® system to help their clients take an active role in preventing stress, managing the emotions associated with stress, and creating better health.

The emWave system is an innovative approach to stress relief that shows your clients what stress looks like in the body, to help them learn internal awareness, self-regulation and to create physiological coherence. This technology can be used to develop emotional management skills. Clients can learn to prevent stress by becoming aware of when the stress response starts and stopping it in the moment.

“I’ve used the [emWave] with several hundred clients in my rehab psychology practice, and found it extremely useful for quieting autonomic system response problems such as anxiety and chronic pain.”
— A.M. Ricci PhD, ABPP, Rehabilitation Psychologist

The emWave system allows clients to see how their thoughts and emotions affect their heart and nervous system. When stressed, the heart rhythm has a jagged, incoherent pattern. By practicing emWave techniques that combine rhythmic breathing with a positive emotional state, a client can see the heart rhythm pattern change to a smoother, wave-like, coherent pattern. By observing the change on the screen and associating it with a calm, balanced internal state, the client learns how to manage stress and create and maintain a state of physiological coherence and balance. As a health professional you can help your clients take a more proactive role in their healing process and assist them in making life-style changes and healthy choices. The emWave system is simple, easy to use and has a high rate of client compliance. It combines well with various therapies and self-care procedures, and practice often results in positive and enduring changes.

How to Use the emWave^® System in Your Practice

The emWave system can be presented as a way of achieving an optimal mind/body harmony and stabilization of the Autonomic Nervous System (ANS).

As a general rule, most clients can be introduced to the emWave system easily and then taught or coached in using it during four to six 30 – 45 minute sessions that are spaced one to two weeks apart. Clients are instructed to practice at home, work or school for a minimum of 10 minutes twice a day, although more practice is encouraged.

A simple direct explanation is all most people need. Explain that the individual will be learning skills for stress management, controlling excess physiological arousal, mediating unhelpful thought patterns, and utilizing positive emotional states to achieve a balanced state of mind, body and emotions.

It is helpful to have a basic discussion of the client’s own experience. Discuss times when they are feeling tense or stressed versus feeling calm, at ease or content. Ask them to identify the mental, emotional and physical differences they notice as correlated to their own experiences.

Then discuss what is “different” as they shift into and out of these activities and experience state changes.

It is helpful to give clients a basic understanding of Heart Rate Variability (HRV). We suggest your clients view the seven minute Science video. Click here for HRV Science video. This, along with a brief discussion to answer their questions, is all they need.

The Quick Coherence^® Technique

The emWave system is a coherence building system. Clients learn how to build coherence with the Quick Coherence technique. This self-regulation technique is easy to learn and can be used any time, at any place to reduce the negative effects of stress.

For an overview of coherence and to review the Quick Coherence Technique, click here.

Coherence Building on the emWave System

In the first or second session, introduce the emWave system as a tool that can facilitate emotional self-regulation. It can also clarify when you are in the desired state of coherence. Let the client know that the emWave program offers a way to check out whether the skills learned so far are resulting in helpful changes. Also, encourage regular use of the emWave system and Quick Coherence tool, as that will result in improvement in creating higher levels of coherence.

Provide the client with a basic idea about what the visual information on the screen represents. State that the goal is to create a smooth and ordered heart rhythm pattern and to see an increase in coherence level.

Next, have the client try the emWave system. Here’s a sample format:

1. Position the client in a chair next to the unit, comfortably and with the forearm resting on a flat surface or on the thigh. Once hooked up, it’s important for the client to remain still since movement can cause artifacts.
2. Explain how the ear sensor or finger sensor works and show how to position the sensor onto the ear or finger. The positioning of the sensor is important in order to pick up a proper signal.
   • If you are using the ear sensor, clip the sensor on the fleshy part of the earlobe and clip the lapel clip on a shirt collar or other part of clothing.
     
   • If you are using the finger sensor, make sure the “fingerprint” or “fatty” part of the index finger is over the red light of the sensor. If the joint is over the sensor, the sensor cannot pick up an accurate signal. Make sure the strap is not too tight or too loose. The sensor is sensitive to the pressure changes in the finger tip.
     
   • Emphasize that this software has been designed to illustrate how quickly the heart rhythm pattern responds to thoughts and emotions.
   • Click on the Start button.
3. Make sure the sensor is picking up a signal. If it isn’t, red lines, indicating artifacts, will appear in the HRV trace indicating that the sensor is not picking up a pulse properly.
   • Describe what is currently on the screen.
   • The connection is good when you see consistent pulse waves in the pulse window.
   • The connection is poor if the Pulse Wave pattern looks like stair steps or a flat line. Reasons for this include:
   • finger not over the red light of the sensor
   • strap too tight or too loose
   • cold finger/ear or poor circulation
   • movement
4. Once you’ve determined the connection is good, collect 1 to 2 minutes of baseline data.
5. After 1-2 minutes, click the stop button.
   • Explain that the screen is showing what’s happening in the autonomic system and that it can be changed.
6. Start a new session (click the Start icon) and lead the client through the Quick Coherence technique: Heart Focus, Heart Breathing, Heart Feeling, as described above.
7. Watch the screen to note when the heart rhythm changes. After several minutes stop the session, review the pattern changes and ask the client for personal observations of any internal shifts.
   • If no coherence shows up in the trace, look for and point out any place the wave looked like it was starting to get coherent.
   • Explain that achieving Medium Coherence (blue) on the first try is very good. Achieving High Coherence (green) is the goal but usually takes practice.
   • Point out where changes have occurred and emphasize that this gets easier with practice.
8. Repeat the entire process if appropriate.

Practical Tips on Designing Effective Strategies

To maximize the effectiveness of the emWave system, it is helpful to set up an overall strategy. Following are suggestions, based on the experience of Timothy P. Culbert, M.D.

Compliance:
Look for and support even small changes. Encourage regular practice. Set up a system for regular practice using criteria that include some or all of the following:

• Allow clients to participate in setting goals for practice.
• Create readily accessible, easy to use self-report record systems.
• Ask clients to record readily observable and meaningful behaviors.
• Provide adequate instruction on why and how to self-monitor.
• Reinforce client’s accuracy and completeness.
• Convey that client’s records will be reviewed.
• Create preprinted calendars, instruction sheets.
• Determine realistic scheduling, time commitment.
• Use motivators and re-enforcers.
• Pre-book a sequence of appointments.

If a client has difficulty generating the high coherence (green) level but uses the Quick Coherence technique and reports significant positive benefits, remember that physiological change is not always the ultimate expression or necessary marker of success.

If a client is improving, don’t overly focus on the HRV feedback portion of the training for awhile. Just continue to have them use the Quick Coherence tool. Often coherence, as measured by the emWave system, will improve eventually.

Between sessions, encourage “mini-coherence breaks” during the day in which the client takes 60 seconds to practice the Quick Coherence technique. The results of this practice can be demonstrated and reinforced with the emWave system.

Breathing is one of the key rhythms that modulates and affects heart rate variability. The modulation of the heart’s rhythm is due to respiratory activity called respiratory sinus arrhythmia (RSA). The in-breath causes the heart rate to speed up, and the out-breath causes the heart rate to slow down. In cases where the client consistently attains low coherence scores, you may want to teach the client to focus on their breathing by taking five seconds on the in-breath and five seconds on the out-breath. This will help coax them into coherence and will often increase the range of their heart rate variability. It also helps to have them pretend the breath is flowing in and out through the heart area. Once they get the feel of this, be sure to add the focus on positive emotions, as this is key to significant benefits.

emWave Games
The emWave system has additional features to make the coherence building experience even more enjoyable and fun! With all the games, higher levels of coherence change what’s happening on the screen. We recommend that individuals not attempt to use these features until they know how to use the Quick Coherence technique and can achieve 50% or less low coherence (red) on the Heart Rhythm Display screen.

Sessions Map

The emWave system can be effectively used in sequential sessions and can be introduced in either the first or second session. The following is a suggested sequence of activities for an average client.

Session 1

• Evaluate appropriateness for use
• Agree on expectations and commitment to practice
• Explain coherence and Heart Rate Variability
• Introduce the basics of the Quick Coherence technique
• Establish symptom diary tracking system
• Schedule 4-6 sessions (or appropriate number)
• Review Options for telephone or email communication between sessions
• Review a suggested practice plan

Session 2

• Review application and practice — successes and impediments
• Review the Quick Coherence Technique
• Offer adjunctive techniques as needed to enhance experience
• Use the emWave system with the client
• Review practice plans
• Begin to identify when and how to use the Quick Coherence technique in daily activity
• Explore triggers of the stress response (emotional, internal and interpersonal)
• Review plan for an ongoing diary
• Review practice strategies

Session 3

• Repeat the steps of Session Two
• As the client is beginning to show coherence control and mastery, reinforce this experience, by introducing the client to the games. (Note: games will only work once client has had some success in coherence level — medium to high.)
• Review symptom diary
• Review longitudinal data from all 3 sessions as a composite to show progress or lack thereof
• Assign homework
• Review effective practice strategies

Session 4

• Repeat the steps of Sessions Two and Three
• Discuss challenges and impediments
• Move into more strategies to take the skills and transfer them to more challenging settings and situations where they are most needed

Session 5

• Repeat the steps of the previous sessions as needed and continue to focus on transferring the client’s insights and use of the emWave system and HeartMath techniques into daily life
• Begin talking about the long-term view, how to think about continuing to utilize these skills
• Develop a personal plan for future use of the emWave system and HeartMath® techniques

Session 6

• Review

Discuss maintenance sessions and the possible benefits of follow-up sessions (even email contact or phone call) once every 1-6 months — individualized to each person

Trouble Shooting

Technical glitches-red lines

• Red lines seen in the HRV trace indicate that the sensor is not picking up the client’s pulse/heart rate adequately. If red lines are appearing, readjust the sensor on the ear or finger or change fingers, ear and try again. Often it is helpful to stop the recoding and then restart after adjusting.
• Of note, if the audio is on, a sound will also correspond with the red line. This can be disruptive for some. The sound can be turned on and off.

Cold hands, circulation problems

• Occasionally the sensor will not detect a pulse, even after appropriate sensor placement and adjustments. Sometimes this is secondary to peripheral vasoconstriction, reduced peripheral blood flow and “cold hands”. Generally, as coherence progresses, many, if not most, clients will experience peripheral vasodilation as the SNS activity declines and the hands will warm as blood flow picks up. If this is an interfering factor, you can have your client use the ear sensor.

Breathing Problems

• If you observe shallow or thoracic breathing, quickly help the client find the proper breathing pattern. Use rhythmic breathing exercises, such as counting 5-6 seconds on the in-breath and 5-6 seconds on the out-breath.

Too easy or too hard to attain Medium and/or High Coherence

• People will vary in terms of their ability to achieve and sustain higher coherence levels. The emWave system has four challenge levels. The “Medium” Level works well for most people. If, however, if someone is having a hard time getting any medium and/or high coherence, lower the challenge level to “Low” which will reward them more easily. If you find that your client is getting into sustained high coherence quite easily, you can motivate them to go further by increasing the challenge level to “High” or “Highest”.

Having trouble with emotional shift

• If your client is having a hard time experiencing a positive feeling, get to know the client’s history and something about their interests. For example, if the client is a parent or grandparent, ask them to re-experience what they felt the first time they held their child or grandchild after they were born — a very powerful positive feeling in most cases. Other things to focus on would be loved ones, pets, favorite activities, or past vacations. For those clients who say that they don’t have positive emotional memories, you could ask them a hypothetical question — “How would you feel if…”

Disclaimer
Use the emWave system and the exercises contained in the software as tools for individual balance, optimal performance and growth. Although this instrument and exercises are believed to be very safe and have potentially great benefit, no medical benefits or cures are expressed or implied. These programs and exercises are not to be used as, or used in lieu of, any course of medical or psychological treatment, but for research and educational purposes only.

None of the feedback or summary data provided in the software is to be interpreted as medically or psychologically diagnostic.

Finally, heart rate variability patterns differ widely from one person to another. There are no “right” or “wrong” patterns. The coherence scores in the programs and games are especially useful for comparing one’s own progress. With practice, the ability to maintain a physiological coherent state will be increased. Scores should, however, not be compared between one individual and another. Individuals with heart rate irregularities, such as atrial fibrillation or flutter or intense clusters of premature atrial contractions and children who are unable to sit still may be unable to use the emWave PC system successfully.

Related Links:

Health Professional Resource Web site: https://www.heartmath.com/health-professionals/

A Therapist’s Guide – Using HeartMath® Tools with Clients with Post-Traumatic Stress, Addictions, Chronic Pain, Grief and Loss

Webinars by health professionals on incorporating HeartMath into their practices https://www.heartmath.com/webinars/webinar-health-professionals/

Health Professionals: Results

Applications and Case Studies

A host of health professionals are using the emWave system in a variety of situations to help clients reduce stress, increase self-control and learn to better manage their emotions. This includes most stress-related illnesses and many chronic psychophysiological illnesses.

“If shifted to a more positive, balanced emotional state, many patients find that performance and behavioral control improve. The [emWave] has been used successfully with clients having emotional/behavioral conditions.”
— Nurse, Allegheny Hospital, Pittsburgh, PA

Some applications in which the emWave system has been successfully used for reducing stress related symptoms as a primary or secondary approach include:

Acute, Chronic and Recurrent Pain

• Headaches — tension type and migraine
• Recurrent abdominal pain
• Burns
• Acute procedural pain

Psychophysiological Problems

• Insomnia
• Stress management
• Cardiovascular rehab
• Irritable bowel syndrome
• Somatization/somataform/conversion disorders
• Habit disorders
• Tics/Tourettes

Emotional/Behavioral Problems

• Anxiety disorders
• Depression
• Anger management
• Emotional dysregulation
• Asperger’s syndrome

Learning and Performance Issues

• Performance anxiety
• Peak performance training
• ADHD
• Test anxiety

Chronic Illness

• Asthma
• Chronic pain
• Fibromyalgia
• Cancer
• Atopic dermatitis
• Diabetes type I and type II
• Hypertension
• Reflex sympathetic dystrophy – complex regional pain syndrome
• Sickle cell anemia
• Immune system dysfunction
• Inflammatory bowel disease (Crohn’s and ulcerative colitis)
• Muscle spasticity

The following section contains descriptions of some of the research studies and a sampling of the many case histories from healthcare professionals who have used the emWave system to help their clients achieve greater stress reduction and improved emotional management.

Reduced Blood Pressure and Improved Psychological Well-Being in Individuals with Hypertension

Hypertensive individuals enrolled in a workplace-based risk reduction program exhibited significant reductions in blood pressure after using HeartMath tools and the emWave system for three months. Participants also experienced significant reductions in distress and depression, concurrent with improvements in work performance-related parameters following the intervention.

Summary: Hypertension, defined as a blood pressure (BP) of 140/90 mm Hg or higher, is considered one of the most prominent public health issues in the United States today, affecting approximately 60 million Americans – one in four adults. Hypertension is a major risk factor for death and disability related to coronary heart disease, heart attacks, strokes, kidney disease and vascular complications. Additionally, high systolic BP has been linked with decreased cognitive performance, memory loss and the loss of healthy brain tissue.

In the Personal and Organizational Quality Assessment the impact of a workplace-based HeartMath program and use of the emWave system was investigated in a sample of 32 hypertensive individuals, using a randomized controlled trial design. The program sought to reduce employee stress, depression and high blood pressure, three major and well-known risks in the workforce. Their primary-care physicians had diagnosed all participants with hypertension and they either were currently taking anti-hypertensive medication or had abnormal BP readings during the four-week run-in period. Eighteen of the participants were randomly placed in a treatment group, the other 14 — in a waiting control group. During the three months following the training, participants were encouraged to practice HeartMath tools daily. The emWave systems were made available to treatment group participants for use daily in the workplace and on weekends to facilitate learning and effective implementation of the interventions.

Blood-pressure measurements were obtained using a standardized protocol before and three months after completion of the training program. Psychological and performance-related parameters were assessed concurrently with blood-pressure measurements to determine the overall impact of the program on employees’ health, well-being and effectiveness.

The employees, who had participated in the HeartMath program, had a mean adjusted reduction of 10.6 mm Hg in systolic BP and of 6.3 mm Hg in diastolic BP, compared to reductions of 3.7 mm Hg systolic BP and 3.9 mm Hg diastolic BP in the control group. When compared with the control group, the HeartMath group also exhibited significant reductions in symptoms of depression and overall psychological distress, as measured by the brief symptom inventory (BSI). The Personal and Organizational Quality Assessment also revealed reductions in stress symptoms along with improvements in emotional health and psychosocial functioning.

The BP improvements achieved by the treatment group are notable when viewed in comparison to blood-pressure reductions typically achieved with other types of interventions. For example, the reduction in BP, obtained with the HeartMath training in this study, is similar in magnitude to the average reduction in BP reported in a meta-analysis of controlled trials of anti-hypertensive drug therapy of several years’ duration. The BP reductions realized by the HeartMath group are equivalent to the reductions that would result from a weight loss of 40 pounds and twice as much as the average reductions achieved with a low-salt diet or exercise.

Clinical evidence indicates blood-pressure reductions of the magnitude measured in this study, if sustained over two to three years, could be expected to significantly reduce long-term health risks, including morbidity and mortality from stroke, cardiovascular and coronary diseases, as well as impairment of cognitive function. For example, a meta-analysis of randomized trials of antihypertensive treatment, with BP reductions similar to the present trial, found that cardiovascular deaths decreased 22 percent, stroke deaths 33 percent and coronary deaths 26 percent. Moreover, research indicates the systolic BP reduction achieved in this study can be expected to lower the risk of cognitive function impairment later in life by 7 percent to 9 percent.

In conclusion, results indicate the HeartMath stress management tools are effective in reducing blood pressure in a group of hypertensive individuals, with no other changes to their lifestyle or healthcare regimens.

Improvements in Patients with Congestive Heart Failure

Patients with congestive heart failure demonstrated significantly increased functional capacity as well as reduced stress and depression after learning HeartMath techniques.

Summary: An independent study conducted by the Stanford Center for Research in Disease Prevention at Stanford University examined the effectiveness of HeartMath coherence-building intervention with elderly congestive-heart-failure (CHF) patients. Despite recent advances, heart failure remains a difficult condition to manage in clinical practice and is the single-most frequent cause of hospitalization in adults over age 65. The hallmark of CHF is exercise intolerance and activity restriction most commonly because of impaired breathing and fatigue. These symptoms result in low functional capacity and progressive physical disability, often requiring intensive medical management.

In addition to physical decline, patients with CHF often report depressed mood, anxiety and increased hostility. Chronic heart failure has been associated with abnormalities in autonomic control of the cardiovascular system, including chronic sympathetic activation, decreased parasympathetic activity and impaired arterial baroreflex activity. Because of the relationship between autonomic imbalances, progression of the disease and increased mortality, recent studies have examined various types of pharmacological interventions that may reduce sympathetic activity and improve autonomic balance in patients with heart failure. Comparatively little attention has been paid to psychosocial interventions and their impact on physiological processes, functional capacity and psychosocial functioning in CHF patients. To our knowledge, this study, funded by the National Institute of Health and the Office of Alternative Medicine, is one of the few to examine the effects of stress and emotional management training on psychosocial functioning and functional capacity in patients with CHF.

Thirty-three patients, with a mean age of 66, participated in the study. All participants have had a NYHA Class IIII diagnosis of CHF for at least three months and had been on a stable medication regimen for at least one month. Participants were randomly assigned to an eight-week psychosocial intervention or a wait-listed control group. Treatment-group participants received a total of 10 hours of training offered during eight weekly 75-minute sessions spread over 10 weeks. All training was performed by a licensed psychotherapist who was also a certified HeartMath trainer. Measurements of psychosocial functioning and functional capacity were obtained one to two weeks prior to the intervention and again one to two weeks following the program.

Post-intervention, the treatment group exhibited significant reductions in perceived stress on the Perceived Stress Scale and depression on the Geriatric Depression Scale relative to the control group. Treatment-group participants also demonstrated significant improvements in mental health and vitality as measured by the SF-36 Health Status Profile.

The primary outcome measure of functional capacity found that patients in the treatment group significantly improved performance in a 6-minute walk by over 14 percent – 1088 feet pre-intervention vs. 1241 feet post-intervention – while control-group subjects showed a slight decline – 1191 feet pretest vs. 1171 feet post-test. Collectively, the data suggest that the significant reduction in stress and negative emotional arousal experienced by patients who practiced the techniques may have promoted physiological changes that permit the observed improvements in functional capacity.

The psychotherapist who administered the intervention program was particularly impressed with the patients’ overall response to HeartMath. Attendance and compliance were excellent, and in post-test debriefings the participants expressed singular appreciation for the program, reporting that the experience was both enjoyable and valuable. Patients were extremely receptive to the idea that unmanaged stress could impede recovery from their disease, and many felt considerably more hopeful after learning the techniques. Most mentioned the lack of psychosocial support they experienced for their condition and their frustration at the number of drugs required for medical management.

In conclusion, this pilot study suggests that HeartMath techniques are feasible and effective interventions for CHF patients, demonstrating that stress and depression levels can be reduced and functional capacity increased in this population through training in emotional selfmanagement. This study’s promising indications clearly warrant larger-scale controlled trials to confirm the observed psychosocial and functional improvements and further explore the implications of such outcomes for physiological rehabilitation.

Enhanced Glycemic Regulation and Improved Quality of Life in Patients with Diabetes

Diabetic patients demonstrated significant reductions in psychological distress and enhancement of quality of life after using the HeartMath interventions for six months. Increased practice of the Heart Lock-In® technique was associated with HbA1c reductions in patients with Type II diabetes, indicating improved glucose regulation.

Summary:
Diabetes is one of the most common chronic diseases, affecting more than 16 million people in the U.S. alone. Individuals with diabetes commonly must undergo extensive lifestyle changes to effectively manage their disease and often suffer substantial stress and negative effects.

A recent report of the World Health Organization and International Diabetes Federation has drawn attention to the importance of encouraging psychological well-being in diabetic patients. The establishment and maintenance of psychological well-being is recognized as an important goal of diabetes management, which is expected to reduce the occurrence of metabolic problems and complications.

A collaborative six-month pilot study was undertaken by HeartMath and LifeScan to determine the efficacy of the HeartMath interventions in improving hematologic measures, health and psychological well-being in a sample of individuals with Type I and Type II diabetes. Twenty-two subjects, with a mean age of 49 and age range of 31 to 67, participated in the study. Fourteen of the participants had Type II diabetes and eight had Type I.

Participants were taught the HeartMath stress-management techniques as well as various practical applications of the techniques specifically geared toward addressing stressors and challenges inherent in the lives of individuals with diabetes. Participants also used the emWave system to facilitate their practice of the techniques and increase their ratios of physiological coherence.

Participants’ stress, emotions, psychological symptoms and quality of life were assessed three weeks before and six months following the initial training. Physiological measurements also were taken, including of hemoglobin A1c (HbA1c), cholesterol and triglyceride levels and blood pressure.

Results of pre vs. six-month post-treatment assessments revealed significant decreases in psychological distress as indicated by the Global Severity Index, the Positive Symptom Total and the Positive Symptom Distress Index of the Brief Symptom Inventory (BSI). Significant reductions in somatization, depression and anxiety also were found. Consistent with these results, participants experienced significant reductions in global negative emotion, anger, distress, depression, sadness, fatigue, sleeplessness and anxiety, and significant increases in peacefulness, vitality and social support, as measured by the Personal and Organizational Quality Assessment (POQA). Overall quality of life improved as indicated by significant increases in the Quality of Life Inventory (QOLI). The Daily Stress Inventory (DSI) results showed no significant change in the number of daily stressful events participants commonly experienced, but both the impact score, or the perceived stressfulness of the events, and the impact/events ratio, or sensitivity to the events, dropped significantly following the intervention.

A linear-regression analysis revealed a significant relationship between self-reported practice of the Heart Lock-In® intervention and pre- and post-treatment hemoglobin A1c levels, a key indicator of glycemic control, in participants with Type II diabetes. Increased practice of the technique was associated with reductions in HbA1c, indicating improved glucose metabolism, while HbA1c increased in patients who did not practice or practiced only minimally throughout the study period. A similar trend was observed in the Type I diabetic patients, although the relation did not achieve statistical significance in this small sample.

The results suggest that practice of the HeartMath interventions can lead to a substantial reduction in psychological stress, enhancement of quality of life and improved glycemic control in individuals with diabetes. It is likely that these effects were mediated, at least in part, by reduced cortisol production, decreased inappropriate autonomic activation and improved autonomic balance as a result of using the techniques to transmute stress and negative emotions and enhance positive emotions and physiological coherence.

The indication that diabetic patients can lower their HbA1c levels by utilizing practical, straightforward stress-management techniques is of particular clinical relevance because patients who are able to maintain lower levels reduce their risk for major complications such as blindness, kidney disease and nerve damage, and incur significantly lower healthcare costs. In addition, improvements in patients’ emotional well-being and attitudes toward their health are likely to lead to increased compliance with self-care behaviors critical to the effective management of their disease.

Reducing Severity and Frequency of Arrhythmias

Lynne Fuller is Coordinator of the Pacemaker Clinic for Kaiser Permanente hospitals in Orange County, California and as a trained cardiology technician she takes an active role in educating the more than 600 patients who frequent to the arrhythmia clinic. Fuller has been pacemaker dependent since 1985 and suffered from persistent paroxysmal atrial fibrillation and ventricular tachycardia and hypertension for years. After years of numerous and largely unsuccessful pharmacological and electrophysiological interventions, she experienced sustained relief from atrial fibrillation for the first time after learning the HeartMath techniques. She was so impressed with the disappearance of her symptoms and consequent reductions in her extensive medication regimen she achieved using the interventions and coherence training, that she was motivated to introduce HeartMath to patients in her clinic who suffered similar problems with atrial fibrillation.

Many of these patients were also on a host of “last-resort medications” with unpleasant side effects. With firsthand experience of both, the tremendous costs and immense suffering these patients have endured and the medical interventions required to control their symptoms, Fuller had plenty of incentive for believing the HeartMath interventions could help in both regards.

Fuller therefore took a random sample of 75 patients, talked to them about HeartMath and recommended they obtain the emWave system and begin practicing the HeartMath tools. The patients were asked to follow the program and work with the techniques for three months. At the end of the three-month period, she interviewed each patient to determine what benefits they had derived from their practice. Seventy-one of the 75 patients reported substantial improvements in their physical and emotional health. Fifty-six were better able to control their paroxysmal atrial fibrillation and hypertension and decrease their antiarrhythmic and antihypertensive medications, with their physicians’ approval. Fourteen were able to discontinue their antiarrhythmics altogether and decrease their antihypertensive medications.

In examining the cost benefits, several patients were on Amiodarone, Sotolol or a mix of both to help control their atrial fibrillation. They were also taking beta-blockers, and nitrates for their hypertension. Fuller reported that the reduction in pharmacy costs to the HMO resulting from the improvements in patients’ health was in the thousands of dollars per month. Even beyond these gains, she stated, “The overall benefits to myself and the patients were significant, life-changing and priceless.”

Fuller has continued to recommend the emWave system and other HeartMath resources to patients, with results similar to those reported here. She says she is committed to doing all she can to further the integration of HeartMath programs in hospital settings. Based on her own experience and that of the many patients she has helped, Fuller is convinced educating patients about HeartMath tools and technologies early on will significantly reduce the need for invasive procedures and aggressive pharmacological interventions, which are both costly to healthcare providers and often health-threatening to patients.

Psychophysiological Disorders Case Studies

Dr. Jeffrey Stevens is the Assistant Medical Director of the Psychiatric Unit at Kootenai Medical Center in Coeur d’Alene, Idaho, where he runs an anxiety and pain clinic. Stevens has taught his patients HeartMath’s Quick Coherence® technique and also recommends the emWave system. “I’ve had very good success, especially with people with anxiety problems… phobias and panic,” he explains. He describes one extremely nervous patient he had seen for years who had never responded to multiple psychological and pharmacological interventions: “I taught her the Quick Coherence technique and she did so well with it, she got frightened about it. She had become so calm (by doing the exercise) that she got frightened about being calm. So we had to kind of work with that and work with her, recognizing that she really doesn’t know who she is when she is calm.”

Stevens also has found HeartMath techniques helpful for people with low self-esteem and depression. He believes patients with psychosis become more grounded after applying the interventions. One patient with organic personality syndrome, secondary to encephalitis, found that his impulse control improved dramatically. Another patient with chronic fatigue syndrome was able to sleep at night and reduce medication.

Stevens believes the HeartMath interventions are “truly preventive medicine” and states, “I see HeartMath as functioning as one of those very rare tools for primary prevention,” an area of psychiatry in which he feels effective interventions are largely lacking. From his experience, he has found that the tools enable people to gain true and healthy self-control, in contrast to “selfmanipulation” – i.e. the intellect fighting the emotions. He observes that whereas a lot of human activity serves essentially as a distraction to avoid strong feelings, HeartMath techniques work immediately to help people address feelings, reduce stress and transmute pain. This process, he feels, can help lay the groundwork for genuinely supportive therapy, which enables patients to get in touch with deeper aspects of themselves. In summation, he feels that by enabling individuals to “look at issues from the vantage point of their own hearts”, the HeartMath techniques “open up a whole different domain of therapy.”

Case studies from Allegheny Hospital in Pittsburgh, Pa.

The following cases illustrate the use of the emWave system and HeartMath techniques in patients with complex mind/body issues.

Jill, a 34-year-old female with multiple sclerosis, irritable bowel syndrome and hypertension of unknown etiology came to our center for symptom management of her irritable bowel syndrome and associated stress and anxiety related to her declining health. Using the emWave system, she became much more open and communicative. It was as though she were opening her heart for the first time. Her IBS symptoms became less bothersome, blood pressure decreased from 180/90 to 126/70. Having experienced these welcomed improvements, she recognized the selfhealing ability that she possessed and recommitted to living her life to the fullest.

Karen, a 38-year-old female with a longstanding history of depression, anxiety and panic disorder was being seen for management of symptoms resulting from irritable bowel syndrome. Karen was extremely receptive to learning to use the emWave system and optimistic that it would be a useful tool. On the fourth session, she had made significant gains in her level of coherence. Karen had finally achieved a modest gain of 4 percent of high coherence. She became tearful, sobbed uncontrollably, then shared that she had been overmedicating herself and had suicidal ideations. She acknowledged for the first time that her life had meaning and achieving this level of coherence had been so cathartic for her. Following a hospitalization, Karen began to slowly engage with her family, care for her children and integrate back into society.

Brent, a 45-year-old male in for anger management and anxiety, successfully achieved a medium level, 8 percent, of coherence after 15 sessions with the emWave system. This gave Brent confidence and he began to use the Quick Coherence technique whenever feelings of anger or anxiety arose. He accepted a suggestion that he use the technique twice daily during times when there were no feelings of anger or anxiety. Upon his last visit, Brent achieved a 30 percent high level of coherence. Several months later, he wrote a note expressing how calm and peaceful his life had become. He verbalized deep appreciation for all the blessings in his life.

Emotional/Behavioral Disorders Case Studies: Clinical Psychology

The following information is provided by a licensed clinical social worker in private practice in Atlanta, Ga.

I have a private psychotherapy practice in the Martin Luther King, Jr. National Historic Site in downtown Atlanta, Georgia. I also spend a day each week in an urban low-cost clinic. I work with adults ranging in age from their early 20s into their 70s. In both practice settings most of my patients are city dwellers. They present with a spectrum of diagnoses ranging from generalized anxiety disorder to complex post-traumatic stress disorder. Some seek to resolve creative blocks limiting their art and others are seeking freedom from lives interrupted by intrusive recollections of a painful childhood. I introduce each of them to the emWave system regardless of their presenting problem.

I usually present the emWave system in this manner. I tell my patients that change, while sometimes desirable (and always inevitable), is nonetheless often contrary to the habitual nature of humans. I explain that psychotherapy will often stir up memories and emotions and that part of their therapy will involve my teaching them some basic skills. These skills, in emotional self regulating as practiced with the emWave system, will help them to understand and manage these “periods” so they might make the best therapeutic use of them.

I want to teach my patients how to “soothe” and “ground” themselves. I help them learn that they can change their minds about a problem by using the emWave system. They discover new ways to manage their emotions rather than feeling controlled by them. The emWave system quickly and easily shows them the power of their own thoughts and the immediate effect they can have on their body. One goal of therapy, stated or not, is always to heal the past in the present and thereby free the future for new possibilities. The emWave system is a valuable tool that helps my patients learn that they can change their minds.

Emotional/Behavioral Disorders Case Study: Girl with Generalized Anxiety Disorder

This case comes from a Pediatric Psychologist in Minneapolis, Minn.

Molly is a 9-year-old girl who has a significant history of anxiety and functional abdominal pain. Two years ago, at age 7, Molly and her parents began working with a pediatric psychologist. Initial interventions focused on developing Molly’s self-regulation skills for management of stress, worries, fears and functional abdominal pain. Molly’s therapy included a combination of parent coaching, play therapy, cognitive-behavioral therapy, and biofeedback training. Molly was quite successful in learning “belly breathing” and other age-appropriate relaxation techniques, including self-hypnosis, progressive muscle relaxation and positive self-talk. She improved her coping skills and was much more functional in managing stress and her feelings of anxiety.

Molly recently returned to the clinic, at age 9, for a follow-up session because of symptoms of anxiety and some sleep onset difficulty. Her parents felt that Molly’s anxiety was interfering with her optimal functioning. She was having difficulty effectively using her self-regulation skills to modulate her feelings of stress and anxiety. Molly was introduced to the emWave system as a tool to help with self-regulation and coherence training. We reviewed the concepts behind heartrate variability training and linked these skills with her breathing and other relaxation techniques.

On her first attempt, using the heart-rhythm display screen, Molly did a beautiful job getting into the zone, with the use of diaphragmatic breathing. She obtained a high coherence level of 52 percent. We then added some new ideas about the use of positive emotion in terms of the Quick Coherence technique. Molly used these techniques with the Rainbow game screen and obtained a high coherence level at 100 percent! We reviewed these new skills with Molly’s mother and discussed a home practice program to help Molly achieve a state of high coherence to help with stress management. Molly found that with these new skills she was able to better manage stress and anxiety. Molly’s parents commented that they had observed her having greater confidence in her ability to self-regulate at times of stress and emotional arousal.

Related Links:

For more case studies using the emWave system please download the Practitioner’s Guide.

Health Professionals: Resources

HeartMath® has many other products and services available to help you get the most from your emWave2® system. Follow the links below to obtain additional resources for health professionals.

“Nearly all of my patients’ ratings of pain decrease after a session with the [emWave2]. Essentially, it helps patients step aside from their pain.”
— Michele Barr, Senior Therapeutic Recreation Specialist, NC Jaycee Burn Center, University of North Carolina Hospitals

We encourage you to register for our Health Professional program where you will receive occasional announcements relevant to health professionals, including teleseminars and additional resources.

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Free Educational Services

Health Professional Resource page.

Health Professional case studies.

Orientation Schedule of teleclasses and training.

Health Professional Speaker Webinar Series. An 1-hour teleclass to hear how other health professionals are using the emWave2 technologies with clients and the results they are seeing. Recordings of previous calls are available at the link.

HeartMath Webinars. Learning experiences available for everyone are on this site.

HeartMath Institute Free Download Library – a variety of publications, many of interest to health professionals.

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Heart Rhythm Technologies
Help your clients develop internal awareness, stress reduction, emotional management, and self-regulation skills.

emWave PRO Stress Relief System (formerly Freeze-Framer®, emWave PC, and emWave Mac). Easy-to-use interactive computer program that displays heart rhythms and shows how stress may be affecting the body. The health professional version includes a practitioner’s guide and client handouts. Includes installers for both Windows and Macintosh computers.

emWave2 Handheld. A portable, handheld device with the same heart rhythm technology used in the emWave2 Pro. It offers clients an easy and fun way to practice HeartMath’s stress reduction techniques on the go and then download those sessions to the desktop program. Take a look at the online application videos. In addition, a practice plan is available.

Inner Balance — Incorporates the emWave technology into an iOS app and ear sensor for iPhone, iPad, and iPod Touch. The app screens are dynamic and informative, giving you complete information during sessions, as well as your session history. See the walk-thru video here.

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Free Support Materials

Stress and Well-Being Survey for health professionals and clients. A comprehensive, scientific survey with multiple dimensions; online with immediate results; completely anonymous and confidential.

The State of Ease. This booklet discusses a “state of ease” that each of us can access to help release emotional turbulence and help maintain coherent alignment between our heart, mind and emotions.

De-Stress Kit for these Changing Times contains simple, practical ways for anyone dealing with the stress of the uncertain economic environment to develop coping skills and improve relationships. A Spanish version and a bookletized version that you can print with your contact information are also available at the link Tools for Well-Being – versions of the Quick Coherence technique for various age groups.

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Training Programs

HeartMath Interventions Certification Program. A in-depth clinical program delivered as six weekly 1.5 hour webinars with extensive support materials. Designed for licensed health professionals who want advanced training on adding HeartMath tools and technologies into their clinical practice. Graduates, who complete the Final Survey, receive a Certificate of Attendance granting 25 CEU’s from the California Board of Registered Nursing. (For U.S. and Canada residents only)

HeartMath Coach / Mentor Program. Health professionals become certified to teach HeartMath tools and techniques using specially designed workbooks with their individual clients. For practitioners who use a coaching model in their practice, training is conducted at the HeartMath research and conference center in Boulder Creek, CA (U.S. and Canada residents only.)

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Books
The HeartMath Solution, by Doc Childre and Howard Martin
The definitive book about HeartMath for personal development and well-being. This book contains leading-edge science, practical information and easy-to-use techniques to increase the intuitive, creative, heart-centered aspects of your personality and bring more heart intelligence into your life.

Transforming Stress: The HeartMath Solution for Relieving Worry, Fatigue, and Tension, by Doc Childre and Deborah Rozman, Ph.D.
STRESS – It’s the quintessential buzz word of modern life. It hangs on everyone’s lips from the first miles of the morning commute until the screeching alarm clock starts yet another day. Countless articles and studies tell the same story: lives controlled by unmanaged stress end early and none too well. This book describes a simple, straightforward method readers can learn and practice to literally transform stress by shifting the heart’s own rhythms.

Transforming Anger: The HeartMath Solution for Letting Go of Rage, Frustration and Irritation, by Doc Childre and Deborah Rozman, Ph.D.
If you are dealing with anger you can’t quite seem to manage, this book can give you hope, as well as practical tools to successfully handle this emotion. You’ll learn that the heart provides a unique access point from which anyone can regulate many of their reaction patterns. The heart is so powerful – generating sixty times the electrical amplitude of the brain – that it can draw your brain, nervous system, and emotions into its coherent rhythms and unlock more of your own innate intelligence.

Transforming Anxiety: The HeartMath Solution for Overcoming Fear and Worry and Creating Serenity, by Doc Childre and Deborah Rozman, Ph.D.
Anxiety has become rampant in today’s fast-paced society. Why this is occurring and what individuals can do to overcome fear and worry and create more serenity, especially during uncertain times, is the important subject matter of this book. Most people have some anxiety about themselves, their family, and their future. Anxiety about the world’s problems — climate changes, terrorism, diseases — is also on the rise. But increasingly, people experience unremitting anxiety that can turn into an anxiety disorder. Why this is occurring and what individuals can do to overcome fear and worry and create more serenity, especially during uncertain times, is the important subject matter of this book.

Transforming Depression: The HeartMath® Solution to Feeling Overwhelmed, Sad, and Stressed, by Doc Childre and Deborah Rozman, Ph.D.
Foreword by Frank Lawlis, Ph.D., Clinical and Counseling Psychologist. Could your life be any crazier and more overwhelming? You’re bombarded all day, every day by deadlines, demands, and news, much of it bad, from across the street and around the world. After awhile, this constant sense of being overwhelmed, fatigued, and stretched to the limit can leave you feeling hopeless and uninterested in things that you used to enjoy. In other words, you have become depressed. By using the HeartMath techniques in this book, you’ll learn how to tap into new resources of energy and creativity and find new ways to connect with the people in your life. In no time, your feelings of depression will lessen and dramatic changes will take place in your mind and body that will result in better health and greater peace of mind.

Stopping Emotional Eating; The emWave® Stress and Weight Management Program, by Doc Childre and Deborah Rozman, Ph.D
This solution is not a typical weight loss program. This may be the only weight management program that doesn’t focus on what you eat, but rather on what you feel. This is about understanding and eliminating emotional eating. This program is designed to be used with the emWave Personal Stress Reliever or emWave PC. The program is designed to show you how to manage emotional reactions and clear emotional undercurrents until a new baseline behavior – a neural habit change is achieved.

emWave® Solution for Better Sleep Guide, by Doc Childre and Deborah Rozman, Ph.D
The emWave Solution for Better Sleep gives you a simple five step Easy Plan program that will help you reset your body’s natural rhythms so you can sleep deeply again and wake up more refreshed and renewed. Three advanced techniques, the Power Plan, are also provided to further improve your ability to clear stress accumulation and improve sleep patterns. In this program you will learn and use simple techniques along with the emWave Personal Stress Reliever to reset your natural rhythms. This combination of scientifically validated techniques and technology will show you how to improve sleep by making peace with stressors you can’t change and releasing stress reactions faster that have an effect on your body’s rhythms. It will help you find new balance to improve not only sleep, but other aspects of your life as well.

emWave® Meditation, Prayer & Self-Help Assistant, by Doc Childre and Deborah Rozman, Ph.D
The emWave Meditation, Prayer and Self-Help Assistant provides a comprehensive understanding of how to use the emWave to enhance your spiritual/self-help practices. Using the emWave and the Meditation, Prayer and Self-Help Assistant can be a facilitator to any system of meditation, prayer, self-help or healing techniques. In this program, all systems and techniques are honored and respected. Whatever practices you follow, using the emWave creates more ease and flow from the heart, which helps you get the most out of your meditations or affirmations and feel the benefits you are seeking more quickly. Follow this guide and you will learn how to use the emWave to experience new enrichment from your efforts. The emWave and the Meditation, Prayer and Self-Help Assistant will help you develop a deeper heart connection, refine your practices and get more value out of the time and energy you put into them.

The Inside Story: Understanding the Power of Feelings Booklet — New for Health Education, Psychology Classes and Counseling
The Inside Story is full of vital information tied to the healthy behavior and physiological and psychological well-being of high school and college students. Drawing on the latest research in neuroscience and emotional physiology, this engaging and visually pleasing text helps students understand the interplay between their bodies, emotions, attitudes, and performance.

Coherent Heart
The Coherent Heart explores communication within and among the body’s systems through the generation and transmission of rhythms and patterns of psychophysiological activity. Using the pattern of the heart’s rhythmic activity as the primary physiological marker, six different modes of psychophysiological function are identified, distinguished by their physiological, mental, and emotional correlates. Building on these empirical findings, HMI’s research on the psychophysiology of emotions is synthesized for the first time in a typology — a conceptual “map” — of psychophysiological interaction, which is presented graphically. Explored in depth are the characteristics and benefits of the psychophysiological coherence mode, associated with sustained positive emotions and a global shift to increased synchronization and harmony in psychophysiological processes. Topics covered include how coherence aids in pain reduction, the interactions between heart rhythms and respiration, and how heart coherence affects emotional experience. Of particular interest is the thorough discussion of how coherence improves cognitive performance, which highlights how the heart and brain interact to affect cognitive processes. This section provides a review of past research on heart-brain interactions, presents new research data on heart coherence, and introduces a new hypothesis regarding the influence of “macro-scale” patterns of heart activity on cognition.

From Chaos to Coherence, by Doc Childre and Bruce Cryer
The e revised edition of this seminal book is essential for developing people and powerful organizations that respond gracefully to change, crisis and challenge. Well-documented examples, biomedical research and organizational case studies show how to become more effective and reduce stress. Called the “Microsoft of emotional coherence” on Amazon.com. Quick tips, broadly applicable insights, and great stories about real successes.

Related Links:

Health Professional Resource Web site: https://www.heartmath.com/health-professionals/

A Practitioner’s Guide

A Therapist’s Guide – Using HeartMath® Tools with Clients with Post-Traumatic Stress, Addictions, Chronic Pain, Grief and Loss

Webinars by health professionals on incorporating HeartMath into their practices https://www.heartmath.com/webinars/webinar-health-professionals/

Client handout – Transform Your Stress and Create Better Health and Resilience