Authors (including presenting author) :
Chan L(1), Chan TY(2), Cho WV(2)
Affiliation :
(1) Palliative Care Unit, OLMH (2) Department of Clinical Psychology, CMC
Introduction :
Mood and stress management involves coping strategies aimed to reduce one’s level of stress or negative affect. Relaxation techniques including diaphragmatic breathing have been shown to have positive effects on reducing blood pressure (Wang et al., 2010), sustaining level of attention, reducing level of negative affect and stress (Ma et al., 2017), and increasing one’s heart rate variability (Lehrer & Gevirtz, 2014).
Since HRV, an objective marker, has been proved to have an association with emotions, and HRV can be influenced by breath patterns (Crockett et al., 2016), the current study aims to determine if a relaxation training session run by trained psychology assistant could effectively regulate distress and stress and indicated by HRV.
Objectives :
1. Diaphragmatic breathing enhances patients’ heart rate variability; and
2. Diaphragmatic breathing lowers patients’ level of distress
3. This low intensity intervention run by trained psychology assistant is effective in helping patients to manage their stress and distress.
Methodology :
A total of six patients with the needs of mood or stress management were recruited in this study and thirteen training sessions were provided. EmWave Pro Cohere Training Software (Culbert, 2014), a software to reflect HRV with an electronic sensor, would be adopted as an assessment tool. By assessing their HRV, the influences from stress or moods to the autonomic nervous system would be reflected. High HRV pattern shows benefits in both psychological and physiological ways. In the software, Coherence Ratio is classified as three levels: Low, Medium and High. The higher the coherence ratio refers to the better heart rhythm pattern, which also means the better emotional stability and physical performance.
In the first three minutes of the diaphragmatic breathing sessions, patients would breathe as usual and their breathing patterns and subjective units of distress (SUDS) would be recorded as pre-treatment results. They would then learn and practice diaphragmatic breathing in the next ten minutes with the assistance of trained psychology assistant. The HRV would be recorded as post-treatment results. SUDS would also be recorded by the end of the session. By comparing pre- and post-treatment results via paired sample t- tests, the efficacy of diaphragmatic breathing could be assessed.
Result & Outcome :
Paired sample t-tests were conducted to evaluate the effectiveness of the diaphragmatic breathing relaxation exercise. Results showed that the breathing exercise significantly improve patients’ heart rate variability. Low coherence ratio was significantly decreased after the breathing exercises, from 38.08 to 21.75 (t(11) = 2.603, p< .05); high coherence ratio was significantly increased after the session, from 33.67 to 53.83 (t(11) = -2.643, p< .05). Average heart rate also decreased after practicing the breathing exercise, from 66.92 to 64.83 (t(11) = 4.051, p< .01). However, though there was a decreasing trend in SUDS after treatment, the drop was not found significant was among our participants in this study noted after treatment, from 5.269 to 4.538 (t(12) = 13412, p= .183, < .05).
Our findings suggest that diaphragmatic breathing relaxation exercise with EmWave run by trained psychology assistant is effective in enhancing patients’ heart rate variability. It implies an improvement over patients’ stress and distress level. The EmWave results and graphs could also show patients their progress in a clearer and more concrete means, which could often facilitate their learning of the skills. Future research could include larger sample size and the look more specifically into changes of more subjective sense of stress and distress.
