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, 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:

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.
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.
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
Once you've determined the connection is good, collect 1 to 2 minutes of baseline data.
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.
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.
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.
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.

For additional support, please see the HeartMath Knowledge Base at:

Support: http://support.heartmath.com

Or, send your question in email to Technical Support Send Mail

Health Professionals: Overview

Using HeartMath Technology with your Clients