Trauma is not a ‘mental’ disorder, the whole body suffers from chronic stress. It sits deeply within our nervous system. Our traumatized body will struggle with relaxation and sometimes we have been tense for so many years that we actually don’t know how to relax and what that even feels like. Biofeedback technology can help us learn relaxation, even if it is entirely unfamiliar to us because we have been tense since childhood.
Relaxation, heart rate and our breath
Every time we breathe in, our sympathetic nervous system gets activated a little bit and the heart rate goes up a little. Every time we breathe out our parasympathetic nervous system gets activated a little and our heart rate slows down. (That is why we elongate the exhale to calm down.) The difference between these heart rates is called heart rate variability (HRV) and scientists found out that it is a measure for how relaxed and grounded we are (more about the polyvagal theory). So, roughly speaking, the bigger the difference in our heart rates, the better.
HRV devices can gauge this difference and tell us how well we are doing. Some smartwatches can measure HRV, but there are also specialized devices available, usually with a clip for a finger, the wrist or an earlobe. We used a hand-held wireless device (Qui by BioSign) that felt less triggering for us.
I picked only 2 graphs from a greater number of results these devices can offer to make it easier to compare them.
This is the result of an average non-traumatized person without any relaxation training, measured in an everyday interaction.
In the first graph you can see how the heart rate goes up and down in sync with the breath, the difference is quite big, the amplitude is high. The scatter plot shows how the measurements look when spread out. It is a good result when single dots are all over the place and the plot is spread wide.
These are the results of a traumatized person before training. I was earnestly trying to relax as much as I could.
You can see that the average heart rate is higher, the amplitude is much smaller and the rhythm isn’t very smooth. The scatter plot shows how all the measurements gather in a tight spot without spreading out at all. This is how stressed a traumatized body is, even if we try to relax. When we feel stressed, exhausted and at our limit we are really not making it up.
The concept of biofeedback
Biofeedback devices give us feedback about how we are doing so that it becomes visible for us. An HRV biofeedback device will continually measure our HRV and show us how it develops over time. Usually it presents a warning color like red when we aren’t doing well and it turns green when our measures look good. Some devices have a built in feedback option, others get connected to a computer or use Apps that can even have minigames to guide us. The difficulty level can be adjusted to our current abilities so it won’t be too discouraging. That means we can start with a low threshold for getting positive feedback and make it more difficult over time.
When we work with a device like that it will give us feedback if what we are doing is helping or making things worse. Over time we can notice the small changes in our body that help us to get better results and do them more often. That way we can learn how to relax even if we have no clue how to achieve that. Training sessions can be kept short to avoid overwhelm. The good thing about biofeedback is that the device does it all for you, you don’t have to understand graphs or numbers, it all comes down to following the signals.
My personal experience
I really didn’t know how to relax when I started with biofeedback. After some time I noticed that if I do this weird thing with my shoulders, the results get better. It took a couple of weeks and my shoulders finally relaxed. For all my life I was convinced that my left shoulder sits higher than the right one, that my body is asymmetrical. Turns out, that isn’t the case. Because of specific trauma I had kept the muscles in my left shoulder tight, for years, non-stop, always. To the point that I didn’t even know they could be any different. A couple more weeks in something similar happened with my chest. I found out that when I do this thing around the sternum the measures get better. So I gently tried to get a feel for what I had to do. Turns out that I had kept all the little muscles in my front so tight for as long as I can think that they had become like a shield, hard and ungiving. After a couple of months of biofeedback I could feel that my ribs are actually expanding when I breathe in, that there is movement in my chest. I was able to breathe in a lot deeper than before. I have sucked at most sports for all my life because I couldn’t breathe deeply. For the first time my chest was relaxed enough to give my lungs some space. These were extremely tangible differences, with muscles relaxed that hadn’t been relaxed in 30 years. But, did my measures change?
These are my results after a couple months of training
Notice the change in the amplitude. It is almost as high as that of an untrained normal person. The plot still shows dots gathering a bit tightly but there are others that are spread out a lot wider.
The exercise has actually changed something quite significant in my nervous system. I am able to relax if I make an effort. My baseline of stress has dropped because I am better able to regulate myself.
Sometimes I still get results like this
That looks almost exactly like when I started! But these measures were taken in hyperarousal after intense stress. The relaxation training doesn’t heal my PTSD. I am still getting into dysregulation sometimes. But this is not my baseline anymore, it is the exception, after getting triggered. My ability to regulate has developed greatly since I learned how to get out of chronic dysregulation.
Some extra nerd info, because I know you want it: when people dissociate (what we tend to call ‘shutdown’ on this blog) the graph goes almost flat and the overall heart rate might slow down visibly. Going into a trance (self-hypnosis) will show a pattern of relaxation, that is how you can tell the experiences apart. Imprecise definitions of the word ‘dissociation’ make us believe it is all the same when it really is not. Zoning out into a trance is relaxing and can be done voluntarily, while we can’t cause stress-induced bradycardia in ourselves. If people can dissociate on purpose or not depends entirely on our definition of dissociation.
Practicing with DID
We tried to have the same part front for the exercise every time. You could take the measures separate from each other to make a learning curve visible for each part. There might or might not be a noticeable difference between parts, since some parts are stuck in flight/fight all the time, and mixing the data could be confusing.
We noticed that our measures got worse when other parts did other things in the background while we practiced. That is why we used a synchronization exercise while practicing to get the best results.
Breathing exercises are often recommended for self-soothing after getting triggered. As you can see in the graph of us being triggered, there is no soothing effect, even after 3 minutes of breathing. That is because the triggered part was not the part who was fronting but someone who was co-present. It shows how important it is that the parts who are dysregulated do the calming exercises and that every attempt by a host to calm themselves will fail if the triggered part doesn’t get any grounding. (More)
Biofeedback won’t replace any trauma therapy but it can be a great way to complement it. It is a form of body work that can make a crucial difference when it comes to our ability to relax and regulate ourselves. I personally honestly didn’t know how to calm down at first. Before I started this I was well able to relax certain muscle groups like it is taught in relaxation exercises but that didn’t have an effect on my stress levels.
It takes a bit of patience but biofeedback can teach things we never experienced before. It is impossible to get there through spoken instructions or advice, that is too vague and doesn’t give us a felt sense of what to do. The simple feedback how small changes influence our stress level makes all the difference. If you can find an affordable way to do this I would suggest you try it for yourself. It helps to work with a professional who actually knows how to read the data.
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