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| CASE REPORT |
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| Year : 2021 | Volume
: 5
| Issue : 3 | Page : 90-94 |
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Case study: Monitoring the effectiveness of aromatherapeutic breathing with heart rate variability biofeedback
Adrian Low1, Stella Chan2
1 Hong Kong Association of Psychology, Hong Kong, China
2 Chinese University of Hong Kong, Hong Kong, China
| Date of Submission | 16-Mar-2021 |
| Date of Acceptance | 07-Jul-2021 |
| Date of Web Publication | 29-Sep-2021 |
Correspondence Address:
Dr. Adrian Low
Room 906, 9/F, Office Tower 2, Grand Plaza, 625 Nathan Road, Mongkok, Kowloon
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/hm.hm_22_21
Heart rate variability (HRV) can be used as an objective measure of mental health and workplace stress. Workplace stress is associated with poor performance and organizations desire optimal performance from employees. In this case study, the researcher utilizes a heart rate variability biofeedback (HRVB) tool to biologically monitor the effectiveness of aromatherapeutic breathing intervention for his client, a manager who works in an educational center in Hong Kong. The researcher presents a review of each of the four sessions he has conducted with his client. Both aromatherapeutic breathing with “earth” (ABwE) and HRVB were used during the sessions, and the client was able to shift her physiology profoundly. Results were promising, and the researcher recommends using ABwE as an important intervention and agent for change for stressful clients.
Keywords: Biofeedback, heart rate variability, heart rate variability biofeedback, workplace stress
How to cite this article:
Low A, Chan S. Case study: Monitoring the effectiveness of aromatherapeutic breathing with heart rate variability biofeedback. Heart Mind 2021;5:90-4 |
| Introduction | |  |
Heart rate variability (HRV) can be used as an objective measure of mental health and workplace stress.[1] Workplace stress is an emerging global problem. Moreover, workplace stress triggers employee reactions as in physical ailments, psychological effects, and unhealthy coping habits. Conjointly, organizational productivity drops as absenteeism, presenteeism, turnover, and sick leave increase.[2]
Heart rate variability
HRV refers to the beat-to-beat alterations in heart rate calculated by quantifying the amount of R-R intervals (duration between two consecutive R-waves of the electrocardiogram [ECG]) changes as generated from ECG data.[3] The R-R interval can be influenced by physical and psychological variables such as hypertension medications, antihypertension medications, and antidepressants.
The importance of heart rate variability in assessing workplace stress
The demand–control model of workplace stress suggests that, when demands are high and the control is low, low social support will cause workplace employees to be stressed. It causes an imbalance between the job demand and the person's ability to meet those demands.[4] An increased HRV decreases performance anxiety[5] and increases resilience,[6] whereas a decreased HRV is associated with the inability to respond by physiological variability and complexity. A meta-analysis[7] found that a low HRV is associated with a 32%–45% increased risk of first cardiovascular disease.
The emWave Pro Plus
The emWave Pro Plus is designed by the Institute of HeartMath.[8] It collects pulse data by placing a pulse sensor on the participant's earlobe or fingertip, and data can be plugged into a computer [see [Figure 1]. It translates data of heart rhythms and allows real-time assessment of how thoughts and emotions affect the participant's heart rhythms. It uses photoplethysmography technology which is a reliable and valid method of capturing and quantifying real-time HRV data[9] and is used in the following case. | Figure 1: Emwave Pro Plus computer hardware and heart rate variability monitor reading
Click here to view |
For this case study, HRV was measured by various parameters: SDNN, RMSSD, mean heart rate range (MHRR), and normalized coherence. SDNN is the standard deviation of all mean normal-to-normal intervals measured in milliseconds. The measure reflects the ebb and the flow of all the factors that contribute to HRV and the heart's ability to respond to hormonal changes.[10] The RMSSD is the root mean square of successive differences between the normal heartbeats reflecting the short-term variance in heart rate; this value provides an estimate of the parasympathetic regulation of the heart.[10] MHRR is the difference between the maximum and the minimum heart rate during each breathing cycle. The result is then expressed in beats per min, as the mean of these heart rate differences for each measured cycle.[10] Finally, normalized coherence is a frequency domain measure of coherence where power in the coherence peak of the power spectral density is divided by total power. This measure represents the ratio of coherence relative to total power and ranges from 0 to 100.[11] Moreover, a coherent heart rhythm is visualized as a harmonic sine wave-like signal with a narrow, high-amplitude peak in the LF (0.04–0.26 Hz) region of the HRV spectrum. Coherence is evaluated by detecting the maximum (coherence) peak in the 0.04–0.26 Hz range, calculating the integral in a window 0.030 Hz wide, centered on the highest peak in that region, and then calculating the total power of the entire spectrum.[3]
Aromatherapeutic breathing with “earth”
Research has shown that aromatherapy has proven to have significant positive results with HRV[12] such as the effect of lavender aromatherapy on HRV[13] and Juniper essential oil on HRV.[14] In this case study, the researcher introduces aromatherapeutic breathing with “earth” (ABwE), inhaling with an electrical aromatherapeutic device. The product “earth–sweet dream and passion” contains the following ingredients: rose geranium, bergamot, neroli, petitgrain, and vetiver is known to calm the central nervous system [see [Figure 2].
| Case Report | | |
This case is presented with S. E. (fictitious initials), a 34-year-old Chinese professional woman working as a manager in Hong Kong.
S. E. expressed stressors about the overwhelming workload at the workplace, isolation, and high anticipation from her family. She suffered from neurocardiogenic syncope (also known as “simple fainting”), insomnia, easily feeling tired, frustrated, and anxious. She agreed to participate and expressed interest in participating in heart rate variability biofeedback (HRVB) and ABwE with the hope of reducing the stress she experienced with her family and workplace.
Sessions summary
S. E. attended four sessions with an analysis of the emWave Pro Plus data and the ABwE.
Session 1
In session 1, breathing and HRV data were collected as the baseline by just focusing on the breathing. S. E. was tracked with around 11 breaths per min with 3 sudden intake of breath with coherence score at 40% low coherence (LC), 24% moderate coherence (MC), and 36% high coherence (HC). In a 1 min HRV assessment, S. E.'s MHRR was 17.2 beats per min (reference range: 8.9–38.4), her SDNN was 89.5 milliseconds (reference range: 35.8–144.9), RMSSD was 63.7 msonds (reference range: 19.7–137.9), and her normalized coherence score was 77.9% (reference range: 50–100). In the same session, S. E. recalled a stressful familial event and “seeing images of her father and images of being trapped” with coherence scores (LC = 91%; MC = 0%; and HC = 9%). Uneven breathing pattern and high arousal patterns were noticed and discussed. After that, S. E. practiced ABwE with the researcher and noticed more consistent and sine-like waves (more coherent). Overall coherence levels: LC = 12%; MC = 12%; and HC = 76%. S. E. was invited to practice the ABwE as homework. The visuals related to this session are presented in [Figure 3], [Figure 4], [Figure 5]. | Figure 5: Overall coherence levels in session 1 with aromatherapeutic breathing with “earth”
Click here to view |
Session 2
After reviewing the assigned homework, the researcher and S. E. were adopting the ABwE intending to help S. E. to recharge her energy and help her feel calmer, relaxed, and activating a regenerative feeling. S. E.'s HRV and the pattern generated more consistent and sine-like waves (more coherent). The average heart rate was lowered from 75 BPM to 61 BPM. Overall coherence levels: LC = 4%; MC = 10%; and HC = 86%, with the main peak heading nearer toward 0.1 in the power spectrum, which suggested the balance between her sympathetic and parasympathetic branches of her autonomic nervous system upon the utilization of the ABwE. S. E. was invited to practice the ABwE as homework. The visuals related to this session are presented in [Figure 6]. | Figure 6: Overall coherence and the spectrum average in session 2 with aromatherapeutic breathing with “earth”
Click here to view |
Session 3
After reviewing the assigned homework with S. E. on her practice of the ABwE, S. E. explored another HeartMath tool known as “attitude breathing” with the researcher. Together with ABwE, the tool could help her to replace draining, negative attitudes with healthier positive ones by recognizing a feeling or attitude with a replacement attitude and focusing the attention in the chest area with slower and deeper breathing. On the emWave Pro, it showed S. E.'s heartbeats per min further decelerated to an average of 68, where the peaks and valleys of each beat look more consistent after 60 s. Overall coherence levels: (LC = 8%; MC = 10%; and HC = 82%). After that, S. E. practiced the ABwE with the garden game and further achieved coherence levels of 100 (HC). The visuals related to this session are presented in [Figure 7] and [Figure 8]. | Figure 7: (a) Attitude breathing with aromatherapeutic breathing with “earth” in session 3. (b) Attitude breathing with aromatherapeutic breathing with “earth” in session 3
Click here to view |
 | Figure 8: The garden game on heart rate variability biofeedback in session 3
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Session 4
As the concluding session, S. E. has overall coherence levels of 5% (HC), 13% (MC), and 82% (LC) with ABwE. After that, without ABwE, she was able to reach the highest peak closer to 0.1 and attain overall coherence levels of 10% (LC), 19% (MC), and 71% (HC). S. E. was encouraged to continue practicing ABwE in her everyday life. S. E.'s breathing appeared to be lower at around 8 breaths per min. As a concluding remark, S. E. was encouraged to continue practicing ABwE in her everyday life. The visuals related to this session are presented in [Figure 9] and [Figure 10]. | Figure 9: (a) Overall coherence levels in session 4 with aromatherapeutic breathing with “earth.” (b) Overall coherence levels in session 4 with aromatherapeutic breathing with “earth”
Click here to view |
 | Figure 10: (a) Overall coherence levels in session 4 without aromatherapeutic breathing with “earth.” (b) Overall coherence levels in session 4 without aromatherapeutic breathing with “earth”
Click here to view |
| Conclusion | | |
S. E. was able to see directly how stressful thoughts and emotions could adversely affect the body. It was uplifting to see that S. E. was motivated to change from the visuals she saw flaring up on the emWave Pro Plus. S. E. appreciated the ABwE that it was easy to practice which by doing that she was able to shift her physiology profoundly and generated more coherent HRV. The present case demonstrated that ABwE can be used as important stress reduction protocol and that HRVB can further evaluate other protocols in future. Future research studies could continually use HRV stress measurements to evaluate the effectiveness of stress management such as using ABwE with more experimental subjects. Finally, organizations can objectively identify the most effective intervention types and customize an employee assistance program to reduce workplace stress.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Ethical statement
Ethical statement is not applicable for the article.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
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