[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us
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Welcome, friends, to the Heart Rate variability podcast. I have Doctor Dave siding back on the podcast. It's been a while, my friend. How are you doing?
[00:00:43] Speaker B: I am doing wonderful and it is great to be back on the podcast.
[00:00:48] Speaker A: Well, and you didn't come alone either, so you brought a student. And a student who, as I learn more and more about her work, I am just thrilled to talk to today. But I'll give you a chance, Dave, just to sort of kick us off here. And I'm excited to explore her expertise.
[00:01:11] Speaker B: Yes, absolutely. Well, Carmia is our guest for today, and she is one of my students, and I'm very fortunate to have her as a student.
And she is very unsuspecting. She's a petite girl and very quiet, so I didn't know much about her in the beginning of our last trimester here at school.
All of a sudden, after one of our first quizzes, she asked if she could meet with me.
And I sat down in my office, and most students who asked to meet with me are people who are in danger of failing or having these. And she comes into the office, and I pulled up her, her report, and I'm like, you got an a. Why do you want to meet with me?
And I think she wanted to know about the one question she got wrong.
It says a lot about a student, and she was one of my most outstanding students last trimester. So I was very happy to get to know her.
And during that time, she actually told me about some of her past, which crossed over with yours, Matt, a whole bunch.
So I said, you know what? We need to get you on a podcast here, and we need to learn more about your past, what you've done, and where you are going.
So, Karamia, if I could get you to introduce yourself and tell us a little bit about who you are, where you're from, and what your background entails here.
[00:02:41] Speaker C: Sure. So, my name is Karmia Alberga. I've lived in the Chicagoland area my whole life, and I was very fortunate to be in doctor Dave's class. Last try. I'm a naturopathic medical student. And before that, I was also an EMDR trained social worker, which is something I'm still continuing. I am also an author of a fictional novel exploring the topics of grief and resilience. It's a book called all that's left behind. And finally, I'm the primary researcher of a study on the topic of mindset, self regulation and health behaviors, which is what I was primarily hoping to discuss today.
[00:03:24] Speaker A: Yeah, I say let's dive in.
I'll let you introduce sort of, I've seen the abstract. I'm so excited. You ticked off a few of my favorite things just with that introduction. I'm a huge fan of Carol Dweck's work with the growth mindset. Obviously, our listeners know that I came to heart rate variability through trauma, you know, polyvagal theory, all these good things. So I'll let you kind of kick us off with just the introduction of your work.
[00:03:56] Speaker C: Sure. So going into this research, my primary goal was to investigate why do people make the health related decisions that they do, and how does this affect health outcomes? And I completed this research, and it's still ongoing, but it began when I was in my master's degree for social work. And so I began tackling this problem from primarily the psychological factors behind it and the resilience, investigating the factors that lead to health outcomes ultimately. And so I began this research with a moderated mediation model. It was proposed by researchers Burnett and colleagues in 2013. And ultimately, what that means is I was looking at three primary variables, which is self regulation, is, can people control the goals that they set for themselves? Mindset, if it's fixed or if it's a growth mindset, can they develop their skills? Can they believe that they can do that? Or do they believe that they are set with the factors that they have? Like, is their health fixed for them?
[00:05:02] Speaker A: And so before you move on, I would love, I'm assuming most of my audience have heard of fixed and growth mindset, but we might have some folks out there that are a little new to it. So I would love to get sort of your definitions of, I know two key concepts of research that not only made me look at my work differently, but also, you know, myself with that, which is always great research when you have to have your own reflection on it as well.
[00:05:31] Speaker C: Yeah, I love that you mentioned Carol Dweck, because her work is what I've based a lot of the mindset factors on. So ultimately, the way that she's described the growth mindset is, and we can take this from the perspective of health, because that's what I was focusing on in this study, is, can I change my health if I exercise every day, if I try to improve, if I change my diet, will my health get better? And people with a growth mindset think, yes, like, I can improve, I can heal myself, I can get better at sports. People with a fixed mindset think I am born with a certain set of fixed characteristics. These are just my genetics and whatever diseases pathologies that occur, I don't have much control over changing. And it's interesting, I want to get into this later, but a lot of these beliefs, Carol Dweck has shown, come from the family of origin. It comes from what your parents have told you, what you've learned from your environment. A lot of that comes developmentally from childhood.
[00:06:36] Speaker B: Great.
[00:06:37] Speaker A: Thank you for that.
[00:06:38] Speaker C: Sure.
And so the final variable we were testing just to recap, we're looking into self regulation mindset and finally health behaviors. And ultimately this is what we're looking at, as I was pursuing a physician route, is, I think it's important as physicians to know how do we affect people's lives on a practical level. Like how do we understand why people make the health decisions that they do? And so ultimately, we're testing these different variables, and I develop some interventions to see if we can affect self regulation, if we can affect mindset, will it change people's health behaviors and ultimately their health outcomes? And so the hypothesis that I was investigating is the way I thought this was going to go, that participants who received both the growth mindset interventions and the self regulation intervention theoretically should show a significant increase in their time spent walking, which was the health behavior that we measured. And, you know, just for reference, health behaviors could be measured in so many different ways. It could be people's diet, how much they eat in a day, it could be their sleep wake times. It could be all these different daily factors of living that affect people's health. We went with time spent walking just as a way to measure it, and that was a prediction.
[00:08:10] Speaker B: Can I chime in just to make sure that I'm following and that everybody else has this as well? So what was the interventions? Or are you getting to that?
[00:08:20] Speaker C: So the interventions were growth mindset interventions and self regulation. So we had four different groups. One group would receive a mindset intervention. So it's education about a growth mindset, how to develop it. And it's based on some work by Carol Dweck as well, of how to change your mindset from fixed to growth.
The self regulation intervention is another group that they could be placed in, and that was about setting goals, how to accomplish their goals, and ultimately how to self regulate those goals. They could also be placed in a third condition where you get a both of those interventions. Now, my theory is that people who received both interventions would experience the most growth. We were also looking to see if those variables could affect individually and as a control. We had a group that received none of those conditions.
[00:09:19] Speaker A: Excellent.
[00:09:20] Speaker B: Okay, excellent. And then why walking?
And how was that given to the patients? Was that a. Was that they know that you're measuring how much they're walking, or is it just how walking become the measurement?
[00:09:40] Speaker C: So walking, I felt, was a good way to measure a health behavior. Like I said, there could be many different ones. We could have had them measuring their diet or their sleep, wake times, other things that influence health. But for me, this made the most sense in terms of being able to measure something standardized. So we just had them set, give us their baseline of how much time they spent walking and set a goal. And because this is ultimately measuring whether or not they can achieve a goal related to their health, we had them set something that was reasonable to them, ten minutes plus their baseline for week one. And in week two, it was 20 minutes plus their baseline. And we wanted to see whether or not they could achieve those goals based on the interventions.
[00:10:28] Speaker B: Okay, I am understanding.
[00:10:31] Speaker C: And to make things more complicated, of course, we did have some other measures included that we can kind of get to a little bit later, but that is the basis of the research.
[00:10:44] Speaker A: Awesome.
[00:10:45] Speaker B: Okay.
[00:10:48] Speaker A: So keep going.
[00:10:50] Speaker C: Okay, so ultimately, you know, we had this idea of how it would work, and I really liked this model that I went with because it was proven very strongly in correlations and in theory. And the problem with that is it was only proven correlationally. It had never been tested causally. So since it had never been in a practical experiment, we couldn't actually say that one thing caused another thing. And so therefore, there wasn't very strong research for possible interventions that we could implement in like, a healthcare setting. And so that's ultimately why I wanted to test these things. And the results were really quite surprising to me, ultimately, and we're still possibly collecting data, but as of right now, we did not find any significant findings for the interventions of mindset and self regulation on walking time. And this is shocking because there is the correlation there, but because there was a correlation between mindset, self regulation and a couple of other variables that we measured, including perceived health competence, which is how competent they feel about their health, and health outcomes.
It was really surprising to me to find that there was no experimental data to support this once we actually put it into practice. And so this leads me to believe that our health may be ruled more by our unconscious processes than the conscious ones involved in goal achievement and planning and execution that plan. And I'll get into more of why I think that is the case and how, like, polyvagal theory and heart rate variability may play a role later.
There are a couple other findings I think would be important to go over first, but that's ultimately the direction I think this is going in.
[00:12:49] Speaker A: Awesome. We'll keep going because.
Yeah, I know Dave and I are excited you put a teaser out there for us. Yes, yes, I'm excited to get us there. But I'm curious because, again, I kind of know what's coming next. Cause you share the abstract. But I'm curious because the unconscious is something that especially nerds like me about the autonomic nervous system. So much of that is below consciousness. And I think what youre going to talk about next starts to open up what might be going on there, too.
[00:13:22] Speaker C: Right? And so it was surprising to find that there were some significant findings that I think are important to lay out as to why I think its going in the route of the unconscious processing. And thats theres the health mindset, which is in the context of Carol Dwecks growth versus fixed mindset, applied specifically to health and the measure of self regulation. These were correlated with increased perceived health competence. And so perceived health competence is something that's well studied in the realm of psychology in reference to how people feel about their health. It's another measure that has been shown to be predictive of good health outcomes. And so that's one reason why I wanted to include that variable in the study, is to see how all these variables are related. And so ultimately, we did find that those are correlated, which means that a higher health growth mindset and higher self regulation meant that there was an increased relationship with a higher perceived health competence. And so that was promising to find.
However, I think the most important finding was that the presence of adverse childhood experiences was associated with lower self regulation and lower perceived health competence. And so because these are correlated with health outcomes, it shows the importance of these factors and how everything is really intertwined.
And so with that finding, I wanted to look more into the adverse childhood experiences aspect. And this was really shocking to me because I was talking with my research team about including adverse childhood experiences in this study, and I actually, I got some questions as to why that was necessary, because it seemed loosely related to the other variables that I was investigating. But because of my background in psychology and like EMDR and understanding how childhood experiences affects psychology and health together, I thought it was important just to throw it in, you know, just on a hunch to see if there would be anything related. And the fact that this was the primary finding of the study was really surprising to me, and it made me curious, because ultimately, how adverse childhood experiences affect health outcomes is still relatively unknown. We don't know the mechanism behind it. Why do people with many aces end up more susceptible to different pathologies as they get older? I mean, it goes as far as cardiovascular disease, diabetes, fibromyalgia, whole host of diseases that are really prevalent in today's society that I think physicians should be aware of. And there are some theories as to why that's the case. Part of it could be a proclivity for risky health behaviors.
But another theory that I believe is becoming more popular is related to the dysregulation of the autonomic nervous system and how physiological mechanisms can affect overall health.
And so that, to me, is a promising direction. And we know from trauma informed social work and actually naturopathic medicine, we learn a lot about this, too, is how the disruption of the nervous system can be due to the chronic stimulation of repeated traumas, and how these traumas can cause a downregulation in the. I would say it's the neural regulation of threat reactions. So you aren't able to regulate your response to different threats, whether they're real or similar to PTSD. They're sort of a reminder of things past. And so this can cause a whole host of issues. And this, of course, goes into Stephen Porch's polyvagal theory, which I'm a big fan of.
[00:17:30] Speaker A: So I'd love to ask just maybe a speculative question. So, nothing necessarily that you need to say from a researcher perspective, but one of the things I've been fascinated with, aces and childhood trauma is the connection to fixed mindsets.
So I wonder, again, it may be more speculative, but we used to use the term back when we didn't think about our language quite like we do today, of the victim mindset, which is terrible language, but we were using that to describe senses of hopelessness, like where we don't have any power over our situation, which I loved. Carol's work gave me the gift of fixed mindsets. I saw it just being a much better, less just, you know, like I said, victim mindset is not a term I use anymore. But the fixed mindset did. So, again, maybe just speculation, but as you people, maybe with adverse childhood experiences, watch the growth mindset fixed mindset video, do you have any? Maybe just again, speculation is fine. Maybe assumptions that those people might struggle more to get in the growth mindset to bring those two variables potentially together. I don't know if you had any data to look at the aces with the growth mindset specifically.
[00:18:55] Speaker C: Absolutely. It's actually interesting.
I don't believe that we had data looking specifically on those with aces. Whether or not they were more successful in changing their mindset, that is actually a possibility for the future research. However, I can definitely speculate. There's another term within psychology that's related to what you're discussing called learned helplessness. And that's something that a lot of individuals who were in the family systems that could be, you know, dysfunctional, harmful, they experience trauma. If they have high aces, they could develop something called learned helplessness, which is very similar to a fixed mindset in that they can't supersede their circumstances. They are lower on resilience.
And that is something that would take a lot of retraining to, to overcome. And that's actually interesting, where EMDR can come into play, and my training in that is focusing on how those neural networks is how we refer to them in EMDR pathways of thinking can come into play in adulthood.
[00:20:11] Speaker A: Awesome. Well, you were just about ready to dive in, I believe, to polyvagal theory. And Dave and I's favorite topic, obviously, of heart rate variability. So I'd love for you to bring that into your thinking as we dive a little bit into, you know, the. The unconscious piece of this. And I look at his wounds left over, you know, from those adverse childhood experiences, especially if people haven't had treatment.
[00:20:38] Speaker C: Right.
[00:20:39] Speaker B: And, yeah, I'd like to say, I mean, geez, I'm learning so much already.
This is so cool. Yeah, this is, this is great to hear, Karen. Thank you so much. But, yes, let's. Let's dive on in.
[00:20:52] Speaker C: Okay, so I do want to see.
[00:20:54] Speaker A: The question she missed on that test. Dave, I don't know if that's a teacher error or student error, because I'm fairly impressed here so far. So go ahead.
I just want to make sure that it was a student and not a teacher error on that one question, but I'll let you continue. We'll hit that off air.
[00:21:14] Speaker B: It wasn't a psychology course.
[00:21:16] Speaker C: Okay, that's true.
So it is interesting with polyvagal theory, because I believe it to be a possible unifying theory to explain the complex interactions between an individual's choice and their health outcomes. And our research showed, just to recap, that the interventions targeting mindset and self regulation alone were not effective and did not directly impact the ability of participants to achieve their health goals. However, the adverse childhood experiences, which was a primary factor involved in the disruption of the vagus system, of the nervous system, correlated to the predictors of health outcomes, which included self regulation and perceived health competence. So that's ultimately where we're at with the results. And so, while perceived health competence and self regulation were correlated with the adverse childhood experiences, neither of these variables correlated with the achievement of health behaviors. Which means there may be an underlying physiological mechanism that explains the well established correlation between adverse childhood experiences and adverse health outcomes, which doesn't involve the achievement of individual health goals, successful or unsuccessful. And that was kind of a mouthful. But ultimately, what that means for patients, for individuals listening, who just want to change their health, is, I think sometimes it can be defeating for people who do whatever they can, who try to change their goals, who even accomplished their goals, but may not see significant changes in their health. And that can be perplexing on a number of reasons, for both the physician and the patient. And it could go in the reverse, where they try and try again to change behaviors in their daily life. And no matter how many goals they set for themselves, they just feel like they can't do it for some reason, they can't achieve these goals, and it can become defeating and frustrating. And so I feel this is important to look into for many of those reasons. And I was looking into an explanation for this phenomena.
And one thing that I discovered in some relatively recent research, actually is the dominance of unconscious and habitual decision making related to one's mindset.
What that means is that many of these behaviors that you see in daily life, whether that's your sleep wake patterns, how much you eat, if you go for a walk, if you remember to take your medications, these aren't necessarily decisions that people make consciously every day. These are habits that people have. These are routine. And research is showing that these more automatic processes that people have in every day are more strongly dominated by unconscious decision making. This unconscious decision making is strongly correlated with the implicit beliefs. So what that means is that the factors of self regulation and mindset are strongly related with the behaviors that aren't controlled by conscious thought. And so this indicated to me that our interventions were targeting the conscious processes, they were targeting the goal achievement, the goal planning. They were helping people think through things on a conscious level. But these variables may be more strongly related to the processes that happen when we're not thinking consciously. And so it ties back to the adverse childhood experiences. These beliefs that you begin to have about yourself in childhood that you bring to adulthood, these may not be conscious for many people.
You might have somebody that comes into your office and says, I'm feeling really encouraged about this treatment plan. I believe I can change my health. And when they go to implement it, it just can't follow through. And even on a social work level, working with individuals in this way, you're wondering, they're telling me one thing and experiencing another thing, how do we work through this? And the problem may be that there is a lack of awareness about the true beliefs they have about themselves. And this can be a real awakening for a lot of people, is understanding that, well, maybe my health isn't being impacted specifically by the conscious things that I'm thinking, but maybe more of the unconscious processes that I'm experiencing that I may not be aware of. And that requires a different level of work than a two week mindset intervention or, you know, a two week self regulation intervention that may require something deeper, that goes more towards the autonomic nervous system, that's more involved in polyvagal theory. And the future direction with that is just under understanding how to measure that outcome, how to help individuals overcome things that they may not consciously understand about themselves.
And of course, there's more to that, more to that explanation and more to that understanding. But that is the first piece of my conclusion on that.
[00:26:51] Speaker A: I would love to hear, maybe give a quick elevator speech on EMDR. And I would love, once you do that, to.
How does that inform your thinking about this as well? Because my understanding of EMDR is we're kind of reprocessing things in the brain by using a lot of really cool methods.
So I'd love to bring your expertise in on that and how that informs your thinking as we move into the polyvagal theory.
[00:27:30] Speaker C: Yeah, that's a great question. And I actually think using EMDR will clarify some of that conclusion, because I really am viewing a lot of this in the context of neural networks and how you trace things back. So EMDR's eye movement desensitization and reprocessing, ultimately, what that's looking at is how to identify and process certain triggers. And one method is using eye movements that essentially replicate REM sleep and the processing that you get from that.
Ultimately, when there is a trauma, there is a phenomenon that in EMDR we call the isolation of neural networks, where you have a trauma. And this memory, it becomes isolated. And whenever you get a re triggering of that memory, it triggers something deep within, and you get autonomic reactions, you get a fear response. It's not connected to higher level processing within the frontal cortex and other areas that help to integrate this memory into a broader system and come to an understanding. And what some people explain is an acceptance of what's happened. It remains isolated and unexpected. And for some people, it feels almost uncontrolled. And so what we do with EMDR is recall this memory in a controlled and safe environment and begin to trace it back. We say, for example, what does this remind you of? And when is the first time you've experienced this? We trace it back until we find a core memory, a core belief about themselves that you begin to see how it tracks through their life and affects different areas, different decisions, different experiences, and begin unifying these things in order to help them heal.
[00:29:29] Speaker A: Amazing. So then bring, I'd love to just take that EMDR lens and put it on your thinking of, because, again, the re traumatization or PTSD response seems to be automatic. There's no, like, oh, I'm just going to go relive my trauma right now. Something in the environment triggers it. And then we get to, like, the decision, the health decision making and this whole piece of things. And, you know, again, and giving you full permission to speculate because I know just your abstract is like, oh, there's about dozen more research studies to be done here with what you're talking about. So love for you to just kind of, okay, you know, you know about, you're an expert in trauma healing and healing. Healing aces. And just kind of how that informs as we talk about these health decisions folks might be making. Or, you know, how does, how does that lens help you look at this?
[00:30:32] Speaker C: Right. And, you know, I was hesitant to make the direct link because this, of course, is speculation at the moment. But you're absolutely right. I think the way that we view neural networks and the automatic processes that occurred from re traumatization directly apply to some of the findings that we're seeing here, in that when you have the habitual and routine decisions that are ruling your health, it could actually be due to certain beliefs that you have from childhood. And that's where the adverse childhood experiences come in. And, and it really reminds me of this study.
It was done in 2022 by Daniel and colleagues, and it stated that behaviors become habitual, and these behaviors that are habitual in daily life are more likely to be controlled by the non conscious processes, and they're tied with stronger associations to mindset. And this is in contrast to the controlled, accessible beliefs that are more likely to be associated with behaviors that require deliberate decision making, such as the goal achievement that we measured. And so this really indicates a disconnect between the model that we applied, the moderated mediation model in the beginning when put into practice and applied to health outcomes. Because ultimately, what I believe we need to be targeting is the unconscious patterns, is the neural networks from childhood, the things that you developed from traumas you may have had, or health behaviors that you saw in your family growing up, and how this affected you and your beliefs that you bring into adulthood. And as it's proven, these unconscious beliefs are more strongly tied to the actual health behaviors that you practice every day, the health behaviors that ultimately rule your health and your health decision making and your health outcomes.
[00:32:37] Speaker A: This is so. Give me a chance to jump in here.
[00:32:41] Speaker B: Yeah, this is just so great to hear as a practitioner. Right? Because we have these patients that come in and you say, you know, Ted, why can't you just follow this simple dietary program that I laid out for you? Why can't you do these simple exercises that I ask you to do? And I. And what we may be overlooking is that there is something deeper from a psychological level that we need to be addressing as well. And that's another possibility to consider, is maybe this person isn't just lazy. Maybe this person doesn't just want to prove me wrong or get me mad.
Maybe there is something bigger going on. So, yeah. To be able to. Just to have this as. Okay, maybe there is something here, and I need to make a referral to a psychologist.
Yeah, maybe I need to talk to somebody else who maybe can help this person work through some of these things, and then we can get back on track. So it's very powerful to know.
[00:33:40] Speaker C: It's so interesting you say that, because one of the biggest reasons I pursued this research is I had a mentor that I shadowed prior to entering the naturopathic program who said, one of the biggest frustrations you'll have as a physician is having patients that. That you do everything for and they just don't follow your advice. And for me, I felt like there was something more to that. And I really think that these results indicate the empathy that we need to have, like, as physicians and even as patients, the empathy that we need to have for ourselves, the compassion that it's not a failure on a personal level. It just indicates that there's another aspect to treatment. And that is one of my hopes. You know, I'm planning to graduate from the naturopathic program around 2027, practice in this area. And ultimately the goal of that practice I want to be, is holistic. I want to address the psychological as well as the physiological factors in a holistic way because there's more to it. There's always more to it.
[00:34:46] Speaker B: So with that, though, you know, I mean, I sit here as a practitioner and I, and I think, well, if somebody were having this type of, you know, this type of behavior, accommodations, and believe me, I can think of ten of those patients off the top of my head. Like you were saying about your mentor, how do you cross that bridge to say, especially if it's something they're unconscious of, they don't even know that they're making these decisions as a result of something. And a lot of these people may not even wherever that this is affecting them at such a deep level. So what is that? How do we cross that bridge? Do we say, I'd like you to be evaluated by a psychologist. And then they say, what do you mean? Do you think I'm crazy?
How do you go about that?
[00:35:36] Speaker C: Well, it's funny you say that, Doctor Dave, I think this is where heart rate variability comes in. I did find a study that showed that people with the adverse childhood experiences as they begin to have dysfunctions in parts of their emotional experience, you can actually use heart rate variability. Of course, this is based on a couple studies, and I'd love to hear more about your perspective on this.
Heart rate variability as an ideal measure for providing feedback on emotional regulation. It's the emotional regulation that directly links back to polyvagal theory and I believe could possibly provide indication of how people are doing with the changes that are occurring.
[00:36:25] Speaker A: Yeah, I mean. Go ahead, Dave.
[00:36:28] Speaker B: Oh, well, I was going to say so without a doubt. That's how we, you know, we apply heart rate variability is to see.
[00:36:33] Speaker A: Yes.
[00:36:34] Speaker B: How. How are these changes, you know, affecting a person.
But I, but I guess that would be, you know, if I, if we. And I would have to chew on that for a little bit.
[00:36:45] Speaker C: Right.
[00:36:45] Speaker B: If we're not. If we're not seeing the changes we want, we always ask the bigger question of why aren't we?
[00:36:52] Speaker C: Right.
[00:36:53] Speaker B: And that might lead to that conversation without a doubt.
But, yeah, Matt, what are.
[00:37:00] Speaker A: Yeah, I mean, I think what to me, if you look at somebody does a lot of work in public health, is first you got to look at health inequities. Because we always need to look at health inequities with that. But if that is not necessarily, there's not systematic or historical or other issues that might be impacting it.
And I don't feel like I'm alone in making this conclusion. Health outcomes and adverse childhood experiences. It would be my number one go to of why, again, if you rule out poverty and access to systems, those sort of things. So Dave, I mean, I guess my wonder to both of you, but I'd love to get your thoughts on this as well, is really maybe introducing the psychological aspects of your work right from the beginning.
Because I think, I think what this research, and correct me if I'm wrong, but in volumes of other research that's starting to evolve, is that if we don't address the underlying trauma which has conscious and so much unconscious impact on our decision, our health is maybe our inflammation. Piece of that is that we may be missing the root cause of, as I like to say, trauma is the why behind so many of the struggles people have. So they may be, Dave, kind of why somebody seen you might not be necessarily like because trauma happened on Tuesday, their back hurt on Wednesday, they need to see Dave on Thursday.
But it may be a part of both their decision makings and some of the biological impacts, like inflammation left over by trauma as well.
[00:38:50] Speaker C: Absolutely. I think that's definitely the way to go. Is introducing these psychological factors as a major indicator of health and helping people be aware of that. I think one way to do that is the adverse childhood experiences scale that a lot of physicians now apply just to be aware of the different things that may be impacting a person's health. Another aspect is just helping people understand polyvagal theory and how we can target the limbic activated decision making and even using biofeedback as a way to start getting at that and targeting the nervous system and helping them understand how these automatic processes are impacting their health. Even just beginning with that awareness, I think could be really powerful and helping people take back control of their health.
[00:39:42] Speaker A: Yeah, yeah. And David, love to get you because I think that it does. I mean, the tricky thing about this, because, you know, if you look at, you know, states like California did universal pediatric ace screenings and what they found was a bleep load of trauma, not, not unexpected for us, that pay attention. And they didn't have a whole lot of mental health resources to treat that in many areas. So Dave, I kind of wonder like, okay, if you were to do something like the AcE study, you know, how, because I think this is where the medical community is. What do you do with that? What if you see that somebody coming in has, you know, usually historically the ace has been out of ten. I know there's different metrics of that, but somebody has like nine out of ten, which is complex trauma history.
I think the challenge is more of a rhetorical question, unless you want to take it as an actual one, is what does a chiropractor, what does a acupuncturist, what does a physician do with that, knowing that you're not, at least I don't think you've got EMDR training yourself at this point, Dave, to deal with that.
[00:40:56] Speaker B: So. No, I do not.
But all of those, all those things that you listed. And the goal for, especially us natural healthcare practitioners is nervous system regulation. That's what we're doing with chiropractic. That's what we're doing with acupuncture.
And ultimately that's what we're doing with any kind of dietary intervention or getting into the naturopathic medicine as well. Right. With supplementation. A lot of this is all geared towards how can we help regulate that autonomic nervous system. Now, when it comes to somebody who, you know, who has a lot of those adverse childhood experiences, we could only expect that that person is going to walk in with a lower heart rate variability. And as a result of that, we know that person is going to take longer to respond to whatever kind of care we're going to give.
And that's just marrying those two things together.
So we may not know that this person has a lot of those adverse childhood experiences. Unless I were to give the question, Frank, I do not, and I'm not super familiar with that. But now it's something that I'm thinking, oh, man, am I totally missing the boat here?
And maybe when I'm seeing a patient not responding the way that I want, maybe I do have them fill out that questionnaire now, right? Because it might not be something that they're willing to just give to a patient. The magic that I love with heart rate variability is that it opens up that bigger conversation of us to be able to say, okay, Matt, you're not responding the way that I would expect. Right? We're doing everything right. You're telling me that you're doing these things right. Why are we not seeing the results that we want?
And if that's the case, then maybe it is something like this. Maybe we do have you fill out that questionnaire, and then maybe that is our great transition for me to say okay, this is beyond what I can help you with, but here's somebody who can help you over here. But bottom line with that, Matt, and to answer that question, yes, anybody coming in as a lower HRV, as you would expect with somebody who has more of these aces, is we would just expect that that's going to be a longer care plan, a longer treatment plan that we're going to be seeing this person for. They're going to be a slower responder to care.
[00:43:22] Speaker A: Absolutely. So I would love to hear your thinking about heart rate variability, ventral vagal. All friends of the show, obviously, you mentioned biofeedback as a potential way to do that. But just, you know, as I know, I can't believe time has flown, by the way it has. And I could talk to you all day long. And if you're selling stock for your future, I would like to buy some because I want, one, I want you with my position. Two, if you're selling stock, I want to own it right up front before it gets too expensive.
But I would love. I feel like I missed something big. If just how you kind of think, and feel free to kind of think ahead when you are that physician and you've got these amazing skill sets, how heart rate variability informs your thinking, where do you think maybe HRV and HRV biofeedback could, might play in your career or in future studies that you might do as well?
[00:44:25] Speaker C: Ultimately, I think this study has shown a lot of important aspects of how to approach patient care. And I think the future direction really lies in heart rate variability in biofeedback, in paying more attention to these autonomic processes and how do we measure that. And it's really exciting, these directions on biofeedback because prior to even 30 years ago, it was very difficult to even begin measuring and understanding these autonomic processes that we now know to be major factors in people's health. And, you know, as a physician, that would be my goal is to include that aspect of health and not just push goal planning and mindset, self regulation. These are all very important things, but what we've seen is they can't be applied in isolation. It's not just about informing people about, well, it's important to have a growth mindset, and it's important to set goals. There's more to it than just that basic level of education. It's about having compassion. Understanding for different people may take longer to respond. As Doctor Dave said, different people have different life circumstances that have informed beliefs they have about themselves. And it's just about walking with them on that path and meeting them where they're at in order to help them overcome things that they may be even unconsciously aware of, and ultimately including all these different mental, physical, spiritual aspects of their health in order to holistically address a problem that may not just be back pain, this may go back all the way to their childhood.
[00:46:16] Speaker A: Dave, do you have any final questions, comments to wrap us up here?
[00:46:22] Speaker B: No questions. But, karmia, I just. Thank you so much for coming on. I mean, this.
So first of all, nobody's gonna believe that you're a student.
[00:46:35] Speaker A: I was gonna say something.
[00:46:41] Speaker B: I mean, this has been. I've already been so impressed with you as a student, but now I'm like, oh, my gosh, this girl. As a professional, you are just unbelievable. So thank you so much for giving us some of your time here.
And I'm looking so forward to see what you do in the future because I think it's going to be just phenomenal.
[00:46:59] Speaker C: Well, thank you. It's been an honor to be here. I really appreciate it.
[00:47:02] Speaker A: Yeah. And I hope part of that is coming back on the show as your research. Research and career develops, because what you're doing to me is just like, so powerful to get this information out. And I love how you, with the growth mindset, the regulation part, you almost just, I think, kind of naturally, but very intelligent strategically, was like, okay, this is the growth mindset, which has an amazing amount of research behind it. You know, the regulation piece, all, it wasn't. Something else is going on here. And define that with, with the aces.
I just think hopefully puts this on a lot of people's radar that, yeah, growth mindset might work for somebody who's gotten treatment for their trauma or doesn't have any aces, but at the same time, again, asking these questions about, again, to me, it's always the why behind the behavior.
And the answer is so often, not always, but so often childhood trauma. And, you know, to at least rule that out is really powerful research. So I just want to, as a trauma nerd for, you know, 20 plus years now, just thank you for the work that you're doing.
[00:48:22] Speaker C: There's always more to uncover. It's very exciting.
[00:48:25] Speaker A: Yes.
[00:48:27] Speaker B: And I just wanted to say I did well, when you mentioned that in the beginning, Karmia, I did look up your book. That is all that's left behind on Amazon. So that's really cool because especially after this conversation, I'm really intrigued to take a look through your book. All that's left behind. So that's really cool.
[00:48:47] Speaker C: Yeah. Thank you. It was actually born out of a lot of this interest in childhood trauma and resilience. Ultimately, that's what it's about, is a journey through resilience and processing some of these things that everybody goes through but is difficult to relate to, is difficult to process on your own.
[00:49:09] Speaker A: And I love you did so. That's, that's, that's impressive. And a published author. Dave, like, I tell you what, what an impressive, impressive student.
Like I said, if you're selling stock, my friend, I want to buy stock in your future, in your career. And I think you should move out to Colorado to my position once you graduate. So I appreciate you. We're going to put the link to the book and other information in the show notes so people can access that. And I just want to thank you for your time, Dave, thanks for sharing her with the podcast, and please, the invitation to come back as your researcher, thinking, I think there may have been like about a dozen rabbit holes we probably could have had an episode on as we went down here. So you're always welcome back, and I just thank you for your work, your passion, and sharing it with the audience.
[00:50:08] Speaker C: Thank you both. I'd love to be back someday.
[00:50:11] Speaker A: Awesome. Well, as always, you can find more information, the links to the
[email protected] dot thank you for joining us and we will see you next week.
