Olivier Brabant, Riikka Karvonen & Nina Loimusalo-Lipiäinen
Have we human beings forgotten how to breathe properly? No matter how wise we are, how much we exercise, what we eat, how young and slim we are, not breathing properly has a long-term negative impact we are often not aware of (Nestor, 2020). Furthermore, since our busy Western lifestyle keeps many of us in constant stress, it is all the more important to find opportunities to wind down and recover.
As we all know, when sustained over a longer time period, stress typically leads to burnout and other associated symptoms such as depression, anxiety, pain, and sleeping problems. Unfortunately, these health issues are on the rise: according to the Finnish Social Insurance Institution KELA, Finland saw a 5-fold increase in anxiety disorders between 2005 and 2021 (Blomgren & Perhoniemi, 2022).
Breathing and stress regulation
Stop for a second to observe how you and people around you are breathing. You will probably notice that many of us have developed the habit of breathing from the upper chest, using a fast and shallow breath. This type of breathing is part of the fight-or-flight response and should not be prolonged more than necessary or become our usual way of breathing. Otherwise, our stress levels will remain artificially high, making it impossible to switch to the rest-and-digest mode. However, since the breath is one of the few physiological processes we can consciously influence, by changing how we breathe, we can help our mind and body to relax and rest.
This is the common idea between all the breathing techniques that have become increasingly popular and are now being used for the treatment of various emotional and stress-related disorders (Brown et al., 2013). One of these techniques is resonance frequency breathing (RFB), also known as coherent breathing and heart rate variability biofeedback.
Health benefits of resonance frequency breathing
RFB has been actively studied for more than 20 years, and it is known to be effective for the treatment of various physical and emotional disorders, for example asthma, hypertension, chronic muscle pain, anxiety, and depression (Lehrer et al., 2020). RFB is based on the idea that everybody possesses an optimal breathing speed, where heart rate and respiration rate are in resonance, meaning where they are highly synchronised and potentiating each other.
When people breathe at their resonance frequency, the autonomic nervous system instantly shifts to parasympathetic dominance, leading to a state of calm alertness. In adults, this optimal speed is located somewhere between 4,5 and 7 breaths/min, with the average being 6 breaths/min.
Health benefits of music
Besides controlling the breath, another powerful and easily accessible tool is music. Engagement with music and music listening is known to positively affect well-being of various patient groups (Fancourt & Finn, 2019). Overall, music can be used to support well-being in both clinical and non-clinical settings.
For example, in hospital settings, music can help to reduce anxiety prior to procedures, and to improve the mood and tolerance of patients. In recent years, affordable and easy-to-use music technology solutions have been developed to facilitate the application of music in various therapeutic and healthcare contexts (Krout, 2014).
Combining breathing and music in the current project
The Mus&Te project (Musiikista etähoivaa ja terveyttä – Promoting health digitally with music) is conducted by JAMK University of Applied Sciences and the University of Jyväskylä (JYU). The project aims at making music a part of daily life in the healthcare sector with the help of digitalisation. As part of the project, we wanted to bring RFB to a larger audience and make it easily usable and accessible.
Two things are crucial for successfully using RFB. First, one needs to find out one’s optimal breathing speed. This can be done through an objective physiological assessment involving a heart rate sensor, or subjectively through trial and error. While the first approach is more exact, the latter is more convenient and readily implementable by anyone, without the need for any special equipment or know-how. Once the optimal speed has been determined, it is important to follow that speed as precisely as possible when doing the breathing exercise.
In the Mus&Te project, we decided to create pleasant and high-quality music for performing RFB. With the help of the music, it becomes easy for listeners to follow the correct breathing rhythm. We worked with two local composers whose task was to compose songs that would include clearly audible cues for inhalation and exhalation.
Six different versions were produced for each song, corresponding to different breathing speeds. To ensure that people can recognise and follow the breathing cues, we tested these songs with various end-user groups (care home staff, workers at the hospital Nova, and local therapists), collected feedback, and improved the songs accordingly.
Suggestions and experiences from healthcare workers
The music composed for RFB was subsequently piloted in the healthcare sector of the Jyväskylä area. Healthcare professionals with different patient groups volunteered from hospital Nova of Central Finland and the Jokihovi care home, as well as music therapy students from the Eino Roiha institute. It was deemed important that the healthcare workers first tried the method themselves. After having their own experience with RFB, they would understand the benefits of the method, and would know better how and when to incorporate RFB in their daily professional work and with their own patients.
We organised a series of workshops, during which we first offered background information about the RFB method, followed by an introduction to the breathing technique itself. After this, the participants got to try RFB, using one of the songs composed for this purpose. At the end, we asked them the question: “How would you use RFB in your clinical practice?” In the following, some representative quotations from the collected feedback are presented.
The music therapy students highlighted the method’s potential for “regulating emotions,” for “one’s own self-clearing, just before therapy,” or for creating a calming moment together “with the client, at the beginning of the therapy session.” Some pointed out it could be used to “support [the therapist’s] own well-being at work.”
Also, professionals working with psychiatric patients experienced the method as useful. One practitioner could consider using it with adults: “I could well use it at the beginning of a session, guiding the patient.” One professional even suggested that s/he could use it “with all psychiatric patients if they are consenting.”
One specific symptom that was brought up by several healthcare workers was pain. One professional said s/he could imagine using RFB with “young people suffering from pain”, and another suggested it could be used with “cancer patients suffering from pain or anxiety.”
Interestingly, several healthcare workers who work with patients with disabilities or special needs invented physical activities that could be used as a complement to RFB. The aim of these activities would be to provide an additional stimulus in synchrony with the music, to help the patient breathe at the correct rhythm. For example, with elderly people suffering from dementia, “a nurse could touch the patient’s arm or back while doing the breathing exercise and listening to the music; when inhalation starts, the nurse’s hand could move up and when the exhalation starts, the hand could move down”. The RFB music was also believed to be useful while doing “daily treatments that might scare people with dementia.”
One professional working with psychiatric and neuropsychiatric patients – who typically have difficulties concentrating – suggested adding functional methods such as drawing or squeezing a ball to the pace of breathing, in order to help the patient, calm down and focus on the present moment:
I would implement RFB by activating the patient’s tactile senses. For example, by letting them draw curved lines to the pace of the music and changing the direction with each inhalation and exhalation. Or by holding in each hand a ball that could be squeezed to the pace of each inhalation and exhalation […] Little by little one might try [the method] without the functional activity and continue just by breathing.
During the piloting phase, some nurses in the care home already started using RFB, for example, “while measuring blood pressure”, or “to enhance relaxation.” In their experience, RFB was beneficial as it “helped the residents to concentrate and focus on the present moment.” Further, during a group meeting, it was also experienced as “helping each person to reach their personal state of flow.”
Summary and conclusions
In the Mus&Te project, resonance frequency breathing (RFB) was tested and piloted with healthcare workers. A new, easy-to-use application of the method was created in which the breathing is guided by music specifically composed for this purpose. Healthcare workers participating in RFB workshops came up with various practical situations and different patient groups where the method and the music could be used.
By the end of the project, all the resources required to perform RFB by oneself will be freely available online (www.soitava.fi). We hope that these online resources will support the further spread and adoption of RFB among healthcare workers, their clients, and the population at large.
Olivier Brabant, PhD, project specialist, University of Jyväskylä, olivier.brabant(at)jyu.fi
Riikka Karvonen, MA, vocational teacher, project specialist, JAMK University of Applied Sciences, riikka.karvonen(at)jamk.fi
Nina Loimusalo-Lipiäinen, MA, music teacher, project specialist, JAMK University of Applied Sciences, nina.loimusalo-lipiainen(at)jamk.fi
Blomgren, J. & Perhoniemi, R. (2022, May 10). Mielenterveyden häiriöihin perustuvien sairauspäivärahapäivien määrä kasvaa taas. Tutkimusblogi. https://tutkimusblogi.kela.fi/arkisto/6636.
Brown, R. P., Gerbarg, P. L. & Muench, F. (2013). Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatric Clinics of North America, 36(1), 121–140. https://doi.org/10.1016/j.psc.2013.01.001
Fancourt, D. & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. WHO Regional Office for Europe. http://www.ncbi.nlm.nih.gov/books/NBK553773/
Krout, R. E. (2014). Music technology used in therapeutic and health settings: Definitions of devices and resources. In W. Magee (Ed.), Music technology in therapeutic and health settings (pp. 45–62). Jessica Kingsley Publishers.
Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J. & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z
Nestor, J. (2020). Breath: The new science of a lost art. Riverhead Books.