The ADD Centre® & The Biofeedback Institute of Toronto®

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Optimize Performance

Deal Effectively & Efficiently with Daily Stress!

A Combined Neurofeedback & Biofeedback Program For Executives & Athletes:

We are all exposed to repeated stressors in our everyday work environments. In its extreme form a stress leads to a ‘crisis’ where a crisis may be defined as a personally-perceived-potential-adaptive-incompetency. The purpose of our work in stress management is very similar to the training program we use to help senior executives and top level athletes to optimize their performance. The goal is to be able to achieve a relaxed yet alert, calm, focused, problem solving mental state. 

In stress management there is a further goal which is to help individuals cope with daily stress rapidly and effectively so that it never leads to a personal crisis situation. The key to efficiently and effectively handling stress lies in the ability to self regulate one’s mental and physiological state throughout each day.

Anxiety and/or emotional intensity usually corresponds to an increase in 19-23 Hz activity relative to 15-18 Hz beta.  A relaxed frame of mind implies that the individual is not negatively ruminating and worrying. This type of unproductive mental activity may correspond to a decrease in both 11-13 Hz and 14-15 Hz activity and an increase in the amplitude of the EEG somewhere between 23 & 35 Hz (compared to beta activity immediately above and below that band-width).

In addition to the EEG changes there are also differences observed in physiological variables. It is very simple to show a how even a small stress can result in a decrease in peripheral skin temperature, an increase in skin conduction, muscle tension, heart rate, plus a respiratory pattern that is shallow, rapid and irregular. Heart rate variability is not in synchrony with respiration. They can then see that with appropriate diaphragmatic breathing and a relaxed mental state they can rapidly  shift these variables to a healthier pattern.

The goal of the EEG and stress assessment (autonomic nervous system & electromyogram assessment) is to discover how a particular client responds to mental stress.  These findings may then be used to set up a biofeedback program to help that client self regulate, that is, control their own mental and physiological responses even under stressful circumstances. In addition, practicing this control may produce an automatic, unconscious, beneficial change in that client’s response to stress in the future.

An optimal state of mental and physiological functioning will broaden associative capabilities and perspective, decrease fatigue, allow calm reflection on alternative approaches to tasks and, when combined with high levels of alertness, improve reaction time and increase response accuracy.  The individual will be flexible in terms of mental state and resilient in terms of their physiology. This constitutes effective management of the stresses of everyday life.

Note: The Thompson’s were invited to publish the first chapter on combining NFB with BFB for controlling responses to stress and anxiety. It can be found in the 3rd Edition of the standard textbook for Stress Management: Thompson, M. & Thompson, L. (2007) Neurofeedback for Stress Management. Chapter in Paul M. Lehrer, Robert L. Woolfolk and Wesley E. Sime (Eds.) Principles and Practice of Stress Management, 3rd Edition. New York: Guilford Publications.


Heart Rate Variability (HRV)Training:

HRV training involves the client learning to control the amplitude of the natural changes in their heart rate. Higher amplitude changes in heart rate correlate with health. At the ADD Centre (Biofeedback Institute) we routinely combine this type of biofeedback training with neurofeedback. An increase in HRV results in a decrease in sympathetic nervous system arousal and an increase in parasympathetic tone. By counteracting an increase in sympathetic activity which is known to be associated with stress and anxiety and by increasing parasympathetic activity, heart rate variability training promotes health and optimal functioning.

Background Information:

  • The autonomic nervous system comprises two parallel but opposite systems – sympathetic and parasympathetic. They were originally thought to be ‘automatic’ and, unlike the part of the nervous system that controls muscles, the autonomic nervous system (ANS) was thought to be outside voluntary control. The ANS controls most internal functions including your heart. The sympathetic system is activated in reactions to stress resulting in an increase in heart rate. The parasympathetic system, on the other hand, slows the heart rate, decreases blood pressure and promotes healthy functioning. Many years ago biofeedback researchers demonstrated scientifically what Asian peoples had known for thousands of years, namely, that you can control certain functions that are controlled by the sympathetic nervous system such as skin temperature and heart rate.

  • More recently control of the parasympathetic system has been demonstrated. “Effortless” diaphragmatic breathing at a frequency that corresponds to the resonant frequency of a particular individual’s heart rate will reduce sympathetic arousal and promote parasympathetic activity. This frequency is between 5 and 7 breaths per minute for most adults. Breathing evenly at this rate will increase the variations in heart rate frequency. Variation refers to the fact that the rate at which the heart beats (pulse) is constantly changing in a healthy individual. Your pulse rate, for example, may vary from 65 to 75 beats per minute and then go back to 65 beats per minute, making this change about 6 times per minute. The diagram below, which comes from a training screen used at the ADD Centre, shows how the blue line that varies with respiration and the red line above it that follows the heart rate, vary together when this older adult begins to breathe in a regular manner at approximately 6 breaths per minute. Here he is breathing a little too quickly but, when he slowed his breathing rate, the heart rate variations (HRV purple bar) amplitude increased from 4 to 10 beats. At this point the initiation of his inspiration corresponded precisely with his heart rate beginning to increase. To help understand ‘resonance’ just think of a bell. Each bell has its own resonant frequency. If you tap it at that frequency it will get louder and louder. Similarly, if you breathe at your own heart’s resonant frequency the amplitude of the changes in heart rate, called HRV, will increase. This is an example of a general rule: when any resonant system is rhythmically stimulated at its resonant frequency, the external stimulation magnifies the persistent oscillations of that system and will increase the total variability of that system. If you push a child on a swing, pushing when they reach the peak of the arc will cause the child to swing even higher: if you breathe at the correct number of breaths per minute, the heart rate variability goes higher. In both cases, you stimulate the resonant frequency.
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  • The above screen is used in biofeedback training. It is taken from the Thompson’s Setting-up-for-Clinical-Success screen series created for the Thought Technology Infiniti instrument. It shows three variations in heart rate (red line) in approximately 30 seconds. In the bottom row on the left is a frequency spectrum. In this spectrum, the yellow area is thought to be mostly influenced by the sympathetic system while the green area is more affected by the parasympathetic system. The area coloured in purple marks an area where we want to see high amplitude and the red bar shows the frequency (0.1) of the highest amplitude of heart rate variations. If the peak is around 0.1, in the purple zone, it correlates with a balance between sympathetic and parasympathetic system activity. A frequency of 0.1 on the ‘x’ axis of this spectrum is derived by dividing the number of cardiac variation cycles in one minute by 60 (seconds) to give the rate per second.
  • In this example, 6/60 = 0.1 cycles per second. Thus breathing at this resonant frequency of the heart produces high amplitude heart rate oscillations due to the resonant characteristics of the cardiovascular system. Regular exercise of these oscillations in this manner has been shown to increase the heart rate variations, not just while doing diaphragmatic breathing, but even at rest. This is a new research finding which brings a new dimension to BFB training.

  • In the above picture, on the right hand side of the bottom row, the average HRV amplitudes in the purple bargraph usually are greater than 10 in young adults. Older subjects, however, are often closer to 6 or 7. The HRV ‘% of total power’ shows most of the power in the purple bargraph, which is what the subject is trying to achieve.

  • Activation of the parasympathetic system encourages what is called an anabolic state. This state correlates with health and is one where there is regeneration of tissue and where improvement is observed in a variety of disorders including asthma, coronary heart disease, pain, panic and hypertension. Practicing breathing in this manner can even improve athletic performance (Evgeny Vaschillo, Peper, E. 1997). In this state peripheral skin temperature increases, sweating decreases and heart rate decreases while the variations in heart rate increase. In health heart rate is constantly increasing then decreasing. The extent of these variations is an important indicator of health.

  • In conclusion, it is possible for both children and adults to learn how to control the reactivity of their autonomic nervous systems and to learn to increase heart rate variations. There are controlled studies published in peer reviewed journals demonstrating the efficacy of this approach for a number of conditions: asthma, hypertension (hypertension is associated with diminished HRV), anxiety, and elite level athletic performance. Studies are about to be published demonstrating efficacy in depression.


Systems Theory of Neural Synergy
(Thompson, L., 2008, in press)
The human nervous system is a dynamic network of interconnecting elements. It works to maintain homeostasis and equilibrium. Input to any element within the nervous system will produce change in the other elements. These elements are synergistic, they work together producing correlated action where the product is greater than the simple sum of the parts primarily involved. What does this mean for our Work? In our work we do neurofeedback (NFB) to normalize areas of the cortex often including the anterior cingulate. The reinforcement of a relaxed & calm, yet alert and concentrating, mental state is key to optimizing cognitive processing. We also use biofeedback (BFB) which provides sensory feedback to the brainstem from organs such as the heart. Heart rate is controlled by the sinoatrial node. An increase in vagal efferent tone inhibits the inherent high intrinsic rate of the sinoatrial node (pacemaker). Vagal afferents from the heart go to the nucleus solitaris which connects to other brain stem medullary nuclei, including the parabrachial nucleus and the locus coeruleus. These nuclei connect to the forebrain with links to the hypothalamus (Hypothalamic-Pituitary-Adrenal axis), corpus striatum including the amygdala, diencephalon with thalamic connections to the insula, and the orbitofrontal and prefrontal cortical areas. All of these areas give feedback to, and are, to some extent, regulated by the anterior cingulate. Thus the importance of combining NFB with BFB: they work synergistically to help the client reach their optimal level of performance, one working top down and the other bottom up but with the effects of each reinforcing the other.