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 had 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 preintervention 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 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’ 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.

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Health Professionals: Results

Applications and Case Studies