[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 am really excited for my episode. I have two great guests today.
I've known mate for a while. Leah I kind of met as we do as people meet me sometimes. I was in my typical seat in the back row so I wouldn't be too annoying of a workshop at the AAPB conference. And as I was sitting there, I was starting to just get blown away by the amazing work and thinking that you two were putting into this training that you were developing. I want to almost call it a model, but I'll kind of let you introduce it. So I don't put words, but I was like, boy. I want to share this with all of our audience. And so I'm really excited to have you both here today to discuss this and really nerd out about some of the great thinking that you have. So, Aliyah, if you want to start out, just give our audience a little bit brief introduction about your background and your work.
[00:01:32] Speaker B: Yeah. Thank you, Matt. It was great to meet you. And I'm excited to be here with my wonderful collaborator Nate, too. And we love Nerding Out, so this is a good we have a hard time keeping our meetings on time sometimes because we just have a good time talking about all kinds of things. But my name is Aliyah Snyder. I'm a clinical neuropsychologist. I am part time over at the University of Florida, where I'm a clinical assistant professor, and there I provide neuropsychology services for our multidisciplinary brain injury program. And I'm the director of an intervention or therapy program targeted for people with brain injury, concussion, and long COVID, as well as other kind of neurological concerns after injury or illness. That's called the holistic interventions for brain health and recovery. The High Bar clinic. And then I'm also a researcher at UCLA, where I help execute the autonomic assessment arm of the Care for Kids grant. And that is, I think, the largest prospective project for pediatric concussion to date. And I'm in charge of looking at autonomic functioning in kids after recovery and seeing if that can be helpful in predicting who struggles and who doesn't. Nate and I have known each other for quite a long time. We went to graduate school together at University of Florida, and we both collaborated. He started this community, Mental Health, an equal access clinic. I was a co director at one point. So we come from kind of a background of really wanting to provide community solutions for mental health, things that can be accessible to a lot of different folks. And he and I have been working for the past two years on this model that we're calling psychophysiology resilience training. We'll get into a lot more about what all those words mean, but it's a form of mindfulness based biofeedback.
But I'll turn it over to Nate so he can introduce himself as well.
[00:03:35] Speaker A: Yeah, Nate, introduce yourself to our audience.
[00:03:37] Speaker C: Sounds great. Thank you, Aliyah. It's great being here.
[00:03:42] Speaker A: I'm well, kind of again, because for the audience, I had a great record with Nate, which I lost in a computer exchange. So we're going to have Nate's solo episode, get rerecorded and get that to folks. But I've apologized now officially 150 times for that.
[00:04:01] Speaker C: I'll look forward to the next conversation as well. So I'm Nate E. Wigman. I'm a clinical health psychologist and I've been practicing biofeedback for the past few years. And I work at a hospital that's a safety net hospital in San Mateo County, in the San Francisco Bay Area, mostly with immigrants and also people on other forms of public insurance like Medicaid.
And so I treat a lot of different people using biofeedback and elements of the model and the whole model that Aliyah and I are going to talk about in the hospital from people from all around the world and lots of different types of presenting complaints from trauma to long COVID to migraine to Pots, et cetera.
So I also practice with this model and biofeedback in my private practice on Mondays personally. And then Aliyah and I also collaborate on a project in Los Angeles where we're rolling out this model as well. So looking forward to having a conversation.
[00:05:00] Speaker A: About it with I'll. Leah, maybe throw it out for you first.
What? I just love to throw my two cent in here and you probably don't need me for the rest of this talk, but I love the integrated approach because I think one of the challenges that I have had as somebody who's totally geeked out, as the audience knows, on episode like this will be episode like, almost 120. I love heart rate variability. I love talking about it, yet, like, integrating it in ways, in practical ways, that the work that Nate does with folks experiencing homelessness or extreme poverty. I love the idea of your background in traumatic brain injuries and concussions. I really think it's so under discussed when you go to conferences on homelessness, and I believe it's as much as a driver in what I kind of talk about is the psychological trauma, and those two things are so often intertwined. So not only do I love how you're thinking about this, but some of the depth that you've gone into. So, Leah, I'll let you sort of give us an intro to the model and feel free to kick it to Nate whenever it makes sense as well.
[00:06:17] Speaker B: Awesome. Well, maybe a little bit of background about why we landed on this model. What drew us to it is that so I'm a neuropsychologist and I've been working in brain injury for quite a while now in concussion. And we're always faced with this issue of why do the majority of people recover from concussion within a fairly timely manner, but then there is a substantial minority that do not recover well. And we've identified tons of different predictors of who doesn't recover well. And this is also true of many other conditions like long COVID and other kinds of injuries and illnesses. Why are there folks that don't recover well? And at least one of the things that we're starting to kind of coalesce ideas around is the role of the autonomic nervous system in preventing recovery, maintaining symptoms, or interacting in multifaceted ways.
Maybe I'll tell a personal story here because not a robot, even though some of the words we're using sound pretty robotic. So I was trying to go to the Olympics in my early 20s for a pretty dangerous sport called skeleton. And if you know what it is, you know what it is. If you haven't heard of it, there's three different sliding, ice sliding sports. There's bobsled where everybody knows about bobsled. Mostly there's Louge where you're on a sled going feet first, and then there's the third one which is skeleton and you're going head first. So no surprise there's a lot of head injuries in that.
So I was young, 20 something and had my kind of immortality whatever complex going on. But I suffered several different, several concussions and subconcussive impacts over the course of my kind of short career, such that it ended my Olympic hopes. And I spent a year having to live back at home, kind of relearning how to interact with the world well and experiencing a lot of anxiety that I hadn't had before and just very confused. This was back in kind of the early aughts and nobody had any good explanations for what was going on other than you're just anxious or psychological factors. And that was never a very good answer because it didn't fully capture everything that I was going through. And turns out that's the experience of many of our patients and many people where the answer that, oh, there's psychological factors that are at play doesn't quite capture their experience. So I've dedicated my career to trying to understand a bit more about how to help folks in that area.
And we keep coming back to kind of the role of our threat system, the stress arousal system, and how that can be remodeled or dysregulated after injury and illness and it undercuts so many different conditions. So there's something called the neurovisceral integration model that shows us how dysregulation of the autonomic nervous system or our autoregulatory control of body functions can produce a wide range of cognitive symptoms. Particular problems with attention, word finding, being easily overwhelmed which can also translate to memory problems, emotional issues, problems with irritability, feeling like you have such a low frustration tolerance and that you're so again easily overwhelmed by stimuli whether that's internal external like lights and as well as the physiological symptoms headaches orthostatic intolerance, all those things.
And so this commonality of autonomic dysregulation and things like concussion and other injuries and illnesses, how do we treat that? And right now there's not a lot of good methods, but what is coming out in the literature and what we've seen is that cognitive behavioral therapy does seem to be helpful. But why is it helpful? And that brings us to our psychophysiology resilience training program is we want to give patients and ourselves a way of intervening in a cognitive behavioral. So working on things like thoughts and behaviors and emotions, but also their real connection to the output of the system, to heart rate, to blood pressure, to temperature, to all these things that then feed back into the body and can perpetuate symptoms. So it's kind of like a common denominator that we can target through these ways.
[00:10:55] Speaker A: So I'll let either of you kind of take this because I think one of the things well, I know for me, a traumatic brain injury, a knock on the head in some way, shape or form, I know that's very unclinical way to look at it. It seems like injuries to different areas of the brain will create different symptoms. If my layman's understanding can be there, you can't read a brain book without Finnegus Gage engages, engage and all that story I'm sure you've also heard a thousand times just trying to kind of figure out like cognitive behavioral therapy helping to heal a biological wound. I think there's something incredibly powerful in that research.
Mike, if you have any understanding or thoughts on why would a talk therapy heal? Because if my legs broke, cognitive behavioral therapy probably isn't going to help my broken bone heal.
Is there any kind of thought about why we would be seeing a talk intervention help to heal a biological injury?
[00:12:06] Speaker B: I can literally talk for hours about this. So I'll have to be, hey, we.
[00:12:10] Speaker A: Can always have you back, because I could listen.
[00:12:14] Speaker B: My favorite thing to talk about yes, traumatic brain injury. What you talked about with Phineas Gage, when there's kind of a specific injury like blood in certain parts of the brain, trauma that affects certain parts of the brain, that's typically considered more of a moderate or severe injury. The more common injury, traumatic brain injury, concussion, mild traumatic brain injury is more of a neurochemical imbalance that is triggered by shearing of the brain. So it's not necessarily a focus like the certain frontal lobes are damaged or the memory centers are damaged. It's pressure on the entire system because you've had shearing that disrupts the transport of axons. So all the kind of intrabrain stuff gets stretched. It doesn't get killed. It's not dying off. But there is pressure on how those neurons and things interact with each other that comes from a neurochemical imbalance. And so what happens in concussion is you have this kind of massive neurotransmitter change, neurochemistry change, that all the energy is going towards repair. And you can't usually see that on something like a CT scan or an MRI because it's happening at the cellular level.
[00:13:31] Speaker A: Interesting.
[00:13:32] Speaker B: Now, what happens is some of those big areas that are involved in the regulatory control of the nervous system, your fight, flight, or freeze, rest and digest, that's controlled also by the brain. That's the big central nervous system hub. And so some of those long projections that are very important in those functions can get particularly stressed.
More specifically, the networks of your brain that are responsible for regulating stress, regulating emotions. Those are some of the most energy intensive things that we do that's like the top of the pyramid. And if you think of, like, maslow's pyramid regulating emotions, your brain's framework for doing that is at the very top. So if your brain's under stress, it's trying to recover neurochemically, neurometabolically, then that's the first thing that's going to go is stress.
[00:14:30] Speaker A: Interesting. Okay, just so that shearing but generalized. I don't know, I guess I feel like kind of like whiplash or something where your brain is moving in your skull a little too dramatically, it's going to offset the chemical imbalance. And because emotional regulation, I'm assuming we're thinking HPA axis, vagal nerve areas here. Vagal nerve is everybody can take a drink now. Yes, we said it. So that because it's such a higher level of functioning, it's not that those areas of the brain are damaged, but because that's so energy intensive. That's one of the symptoms that we see readily with a generalized concussion. Correct me where I might be wrong.
[00:15:24] Speaker B: I think the general idea there is correct. Maybe think about a computer that's rebooting. So the hardware is all there, but it's gotten, let's say, some kind of malware. Or you've rebooted your computer and all of a sudden it's very glitchy. That's an example of kind of what a concussion could be like. So picture of the computer, you take a picture of all the hardware. That's fine, that's okay, but it's running very inefficiently because it's trying to recover at the cellular level. Great analogy. The brain not your computer, but hopefully translates.
Yeah, the HPA axis is particularly vulnerable.
Also, long white matter projections from the locus ceruleus and the brain stem are very there's. There's two hits. There's that hit, which is the vulnerability and the repair. And then there's the second hit, which is this increase for fear learning and neuroplasticity that happens as a result of the injury. So if you have, let's say, a concussion, let's say you have a football player who has a concussion, and he's right in the middle of finals and it's his senior year and he's really stressed out and his whole identity is wrapped around football.
That kind of traumatic experience combined with the stress of when it happened may be one of the things that further dysregulates that system and can kind of create a blueprint for that stress response that's dysregulated.
Rather than not in your kind of explicit control, your brain learns that fear response through that traumatic experience under your control. And again, we have research on HRV and other things that are showing that autonomic Dysregulation certainly is one of the big things that happens on an extreme end in severe TBI where you can't even regulate blood pressure, temperature. Intracranial pressure, but on the milder end of injuries, too. You have heart rate variability. Dysregularities in the acute time period in the subacute time period. And what we're learning in people with chronic concussion also have further dysregulated HRV that doesn't seem to normalize and that maps onto symptoms pretty well too.
[00:17:44] Speaker A: Wow. So, Nate, I'm interested with knowing one of the populations you work with, which we share with struggling with extreme poverty, homelessness, health inequities all the issues that I know you also work with. I'm assuming that as we have this know, if you're working with a population who've experienced maybe complex trauma for a variety of reasons, let me say something, Nate, and then you can kind of steer me to a better maybe way to say it is. I'm assuming what I'm learning is that already Dysregulated nervous system from psychological trauma, concussion happens. On top of that, you're probably more vulnerable potentially to carrying long term consequences of both.
That vulnerability seems with what Lee is saying, just seems with your population that I know one of your specialties might really exacerbate a lot of symptoms of both sides of this equation.
[00:18:56] Speaker C: Oh, it's so true. It's so true. And I'm not an expert in TBI or concussion at all, but I think that example and I want to circle back to that population that you and I are both really passionate about. But your question to Aliyah was how can talk therapy help something that's biological? And I think when we think about something that's biological, the image that comes to mind for a lot of us are physical structures, an organ like the brain, an organ like the gut. And there's some kind of damage to that specifically. And that's very understandable because that's kind of that traditional medical model. But I think one of the most interesting trends that this discussion is getting at in healthcare and medicine and modern science is that there's so much information and knowledge and research around functioning, system functioning, not just specific tissue based issues. So chronic pain is a great example where it's really about complex systems not communicating well or malfunctioning in certain ways or for example, with irritable bowel syndrome, how does the gut and the brain communicate? You can't find anything on imaging for irritable bowel syndrome typically. But there are functional connectivity type of issues between various organs or various complex systems. And for me that brings us to the autonomic nervous system just because of how vast it is, right? The vagus nerve comes from the word in Latin for wandering because the nerve just goes everywhere.
So that's part of the idea of this model that we have been collaborating on for a couple of years now is how do we look at the underlying functioning, the underlying processes that actually underpin a lot of different issues. So instead of having one treatment for every single for generalized anxiety disorder and TBI and irritable bowel syndrome, is there a treatment that it's not certainly going to solve all problems, but is there a treatment that can get at these underlying functional issues? And in populations who have tremendous stress, whether it's stress from racism, stress from economic pressures or the many traumas that can show up in the type of population that we both work in, that system, as Aliyah was describing, is under constant pressure and our system does function ideally in a unitary way. And the more challenges that we have to that system in terms of stress or trauma, the more that our body has to compensate for those difficulties and the more compensation that we do, the more energy that we expend. And that concept is typically called allostatic load. So someone in the population that I work with are going to have tremendous amounts of allostatic load because they're constantly having to deal with psychological, physical, environmental, social stressors, right? And so you think about adding on top of all of that, some kind of injury, especially a brain injury, but also physical injury that may lead to some kind of chronic pain or other emotional, psychological issues that can kind of come up and it just puts even more pressure on that system. So the idea behind this treatment is to kind of reduce that pressure to help regulatory capacity. We want to help our patients try to better regulate themselves. And for people who have complex post traumatic stress disorder or just general complex trauma, as you were asking about, it really helps to stabilize them, to help them feel safety in their body. I think this treatment can help with that, in my experience clinically, that we can help connect someone's awareness to their body in a safe way. We can help them build regulatory capacity and skills so that whatever treatment that they need after that, they have a better chance of engaging. In. Just one more quick example.
Some of the more recent data, probably the last four or five years, suggest that people with autonomic dysregulation do worse in therapy. It's true in exposure therapy, it's true in a lot of different types of therapies. And it seems to be true even if you measure autonomic dysregulation based on breathing, breath chemistry, heart rate variability or questionnaires that get an autonomic Dysregulation. They seem to do worse in therapy to me. That's our people, right? Yeah, the people who are know I was just working with someone who absolutely fits this profile a couple of days ago, and he was just saying, nate, I've had to have this exterior my whole life. And as we're now starting to talk about trauma and I did a biofeedback assessment for him, he's starting to think about his whole body and the impact of his trauma on his body for the first time. He's 44 or something like that. So it's just really powerful to be able to introduce people to their whole systems, how it's functioning, how they can regulate.
[00:24:07] Speaker B: And I'd like to add another kind of example that helps to support that question of why what we're doing in our brain in talk therapy. Why is that effect? Why is that important?
We did a study at UCLA that is published on kids who have persistent post concussion symptoms. And so that means that they've had these symptoms that have gone on much longer than they should have.
This particular data set was kind of, I think longer than three months. And we looked at their breathing and their heart rate, and we saw that our kids with persistent post concussion symptoms, their breathing looked different than normal, non injured kids in the same way, significantly so. And their breathing showed altered neurochemistry through lower end tidal CO2. Basically what that means is they are over breathing. They're taking in ena. Kazan talks about the problems with deep breathing in a beautiful way. We see evidence of that in our kids and guess what? That breathing relates and predicts or correlates to symptom load. And then we did an experiment with them and looked at cognitive functioning and how they were breathing at baseline predicted or was related to how they did on the cognitive test in some specific ways. They tended to do more freezing, so they got stuck more often. And that's what our patients say. It's like when you're having trouble with the autonomic nervous system. Theor and Lane talk about something called the neurovisceral integration model that, again, that has feedback into our cognitive performances and our emotional abilities. So by regulating our nervous system, we can also regulate our brain functioning. And they are reciprocally intertwined. We can't take them apart, but you can also use brain strategies to help regulate the nervous system too. So our PRT psychophysiology resilience training is trying to leverage both of those systems, not just the biofeedback training through heart rate variability, breathing and other modalities, but using principles from cognitive behavioral therapy, acceptance and commitment therapy to really give you the output and the reason why traditional CBT. You don't get to see the benefits of why do I want to do thought challenging or why do I want to work on catastrophizing and rumination? Here in our program, we're able to show you this is what happens in your body when you start to catastrophize. This is what happens when you're ruminating and help you practice the other types of brain states and cognitive emotional states that puts your autonomic nervous system at a lower level of Dysregulation, if you will.
[00:27:00] Speaker A: Amazing. Well, one of the things that I love about that approach too, and this is just a little bit of my own frustration with where I kind of see a lot of us trauma nerds going is you've got the people that pay attention to the brain stem and below the polyvagal, which I don't think Stephen portraits would like that, but everything's got to be explained know vagal or sympathetic or dorsal.
[00:27:26] Speaker B: He's actually one of our advisors for our big UCLA grant. And so I can tell you.
[00:27:33] Speaker A: And then there's like, the brain nerds like I started out as, which nothing really exists underneath the brain stem. Like everything's got to be explained through here. So that integrative approach, I think, is really, I think, where the future of these interventions really lie, because why not maximize the nervous system? Which obviously, if you forget that the most complex thing we've ever found, the universe sits on top of that, you might miss a little bit of humanity in the process. So I'm wondering, with the training and the model you've developed, what does that kind of look like in practice? If somebody comes in and it sounds like it's not just for traumatic brain injury but pretty potentially generalized approach, what would that look like? Whether it's somebody maybe wanting to address past trauma, TBI, maybe generalized anxiety, what's sort of the treatment protocol for folks coming in?
[00:28:41] Speaker B: I'll let Nate take some of it. But I did want to say that what we're doing is very skills based. So kind of the overall goal is to give people skills and a framework for understanding those skills so that it can be applied again to any of these different situations and people can be more empowered to take charge of their own recovery or own management of symptoms. And we have kind of two main stages of that. But I'll let Nate take over for kind of the bigger picture of how it works.
[00:29:13] Speaker C: Yeah, that's one of the many reasons I love working with you, Alias. Because you've got the brain part, I've got the body part, and that's oversimplifying. But we do need both of those, right? And one of my favorite researchers, a little shout out, christina Taviani in Rome.
She has some wonderful papers on combining bottom up and top down types of interventions. And fruit salads are delicious, right? We should be able to do both of these things and help people in that way because trauma and other conditions present in both directions. Obviously.
One of the things I think it's important to understand about our approach is a couple of things. One is that it's transdiagnostic, so it's not for any one particular condition. And that's kind of a direction that mental health as a field is going in. So instead of simply just this diagnosis, that diagnosis and the DSM, which I think is very useful as well, there's something called a research domain criteria that the NIMH has put out and it looks at what are the underlying processes. One example being rumination. And rumination is something that someone with generalized anxiety disorder may do. Someone with mild traumatic brain injury, post traumatic stress disorder, major depressive, we could keep going, right? So how about we focus our efforts on something that can help a much, much wider range of people. So it's trans diagnostic in that way, but as a result of that, it's an adjunct treatment. We're not saying that this is a treatment that's going to replace trauma therapy or going to replace cognitive behavioral therapy. It's something that I think can prepare people fantastically for some of these types of treatments or can be something that's done in conjunction with a treatment to help them tolerate the other treatment or afterwards. Because maybe talk therapy, for example, didn't really get at the autonomic Dysregulation in some specific ways. So the big picture, and Aliyah pointed to this earlier, is recovery, stress recovery. To put know we're using lots of jargon, but the simplest way to put it is how do we get people to recover from stress and how do we keep them recovered from stress?
That's the bottom line of what we've been trying to do. And so how does that actually look?
The first part of the treatment, sessions one through five, one through six are about an assessment, a psychophysiological assessment. We do a lot of data gathering for every patient. We give them tremendous amount of very personalized feedback about their psychology and their physiology, et cetera. And then we teach them the best of biofeedback, which at this point is respiration both internal and external. So using Capnometry as well as more traditional respiration biofeedback and heart rate variability biofeedback using the resonant frequency model. So that really tries to answer that question, how can you help recover from stress physiologically? How can you reduce stress in the moment? And that's extraordinarily powerful. And I don't have to tell you or your audience that heart rate variability biofeedback has an enormous amount of applications that are evidence based because the autonomic nervous system is implicated as an underlying process in so many different issues. That's why. So that's the first part. Sessions one through six, that's what they're learning. Also, mindfulness skills, we'll teach them that early on as well. And in the second part of the treatment, we're trying to answer the question how can you stay recovered from stress to the best of your ability knowing that that's not always going to be possible? But now that you've learned this physiological regulation strategy that seems to help the brain regulate the body heart rate variability biofeedback, respiration. Biofeedback, then what do we know about how people interact with their own emotions, how they interact with their own thoughts, how aware they are of their body and how their thoughts affect their body, their body affect their thoughts? And how can we combine all of those into techniques that can really address some very difficult psychological subject material? And so we see that second part as being represented by what are the factors that keep stress going that artificially create? If I have a stressor, someone says something to me that I didn't like a friend, a colleague, whatever, that's going to produce a little bit of a stress response, at least for me. And I can recover from that. I know how to do that. But if I keep thinking about it or I try to repress my emotions, like, no, it didn't really bother me, or if I keep thinking about that interaction over and over again, I am literally recreating that stressor. The brain doesn't really know the difference, as far as I understand, between that actual stressor and how it replays in your mind. Right. So the second part of the treatment is really about dealing with skillful approaches to emotions. We like using that word, skillful approaches to thoughts and body awareness, including interceptive training and mind body awareness training.
So that's generally what the treatment looks like. And it's a structured treatment. And in any structured treatment, you always have to do your very best to tailor it to that person and whatever it is that they're coming in with while also trying to offer them something that we know works in ideally kind of a standardized fashion.
[00:34:57] Speaker A: Amazing. So I would love to see because I know we're hit towards the end of the episode here, so I would love to what has your journey been with this was I was just blown away because sometimes you show up to a workshop on a model and it's like matt created this on the way over, on the flight over. Not you. All that was obviously clear that there's so much thought bringing in research from multidisciplinary sources.
I was just sitting there like mind blown and trying to catch up to what you were saying. So I would just like a little bit of history of how you developed this now that we have a sense of it and maybe where do you see it going from here?
[00:35:51] Speaker B: I think the story of how we came to it is such a good one. So I'm glad that you asked Matt. For me, I think we kind of came through two different parallel pipelines and then converged. So for me, I was doing my neuropsychology fellowship at UCLA and the research that I was working on at that time, we were collaborating with Michelle Krask, who's a very big anxiety researcher and does some fabulous work. And we were doing a pilot using Capnometry assisted respiratory training in kids with concussion to see if that would help recovery. And so some of the research that I shared with you earlier comes from our assessment that took place as part of that. And I had never been particularly interested in physiology as an intervention. I have always been very Neurotrack. But through that trial and doing therapy using how is breath chemistry? Why is that important for panic, anxiety and physical symptoms? But really learning about that interplay between those and seeing our patients kind of respond so well, anecdotally, I will have patients come in and you can watch them breathe poorly. You can watch them gasping for air. They're trying to talk really quickly. And as soon as we would introduce some of that Capnometry assisted respiratory training and if they did it very consistently, I was really kind of encouraged that this population that has been traditionally very challenging to treat was really getting benefit.
Again, my anecdotal experience. But our trial was quite promising. So that brought me to private practice. And how can I start to leverage these things, the neuropsychology of recovery, the psychophysiology of recovery. And so I started doing Capnometry assisted respiratory training in private practice.
And then while that was going on, we were onboarding this grant, and I was learning a lot more about HRV and autonomic Dysregulation. And I was like, oh, well, Capnometry assisted, that's just one modality. Are there other things that are more accessible, maybe more effective? And how can we combine those and enter Nate? And we just had such a common interest that intersected it at a time. And so we started to develop this type of protocol that unites both of them.
So that was kind of my background and how we got there. I'll turn it over to Nate so he can tell you his pipeline, and then we can tell you about kind of where we're going and where we together.
[00:38:39] Speaker C: Yeah. And for me, I think I tried to skip the physiology class in grad school, even though I was a health psychologist, and look where I've ended up. So basically for me, working in this hospital, I was trying to find something that could help people who didn't speak English and from all around the world, and that would, quote, unquote, speak cross culturally. Right? And that's what I found in biofeedback, is that people from anywhere can look at themselves, they can see common humanity in physiology in the readout, on the screen, and they can learn what regulation is like. And we were lucky enough to get a grant from healthcare, from the homeless in our hospital to create a whole biofeedback clinic, training rotation, et cetera. And so, yeah, that's kind of where I have come from with that and just found that to be so incredibly valuable in that patient population. I think it also just gives you a broader view of suffering as a clinician and as a patient. And I think my larger mission is to try to help people regulate themselves, because I believe when people are regulated and there's good data for this, they're more compassionate, they're more generous, they're more ethical, they think about other people. We think about other people more than we think about ourselves. And we need more of that. So that's kind of my background and.
[00:39:59] Speaker A: Interest in that before we move on to where it's going. I understand the backgrounds and interest. You've done a heck of a lot of work with the structuring, the formulas. So when did you both decide of, hey, we need to really operationalize this? I don't know if you have manuals yet, but that's what I was sitting in the workshop. I'm like, oh, yeah, this is really a powerful and well thought out modality. So how did the interest turn into a real tangible model that other people might be able to implement?
[00:40:41] Speaker B: I think that desire was kind of there from the start. Nate, feel free to correct me if I'm wrong, but we went forward, I think, recognizing these things from our respective backgrounds and seeing this gap of really well structured manualized approaches to mindfulness based biofeedback, especially one that would combine maybe a little bit more neuropsycho education as well. And so I think the gap really led us to the structure. And so, again, Nate's background and kind of scalability accessibility across cultures and across contexts is something that I've also really wanted to kind of participate in.
So we wanted a structured protocol and we wanted something that we can study. So that led us to being very specific about what are we putting in where. And we spent the last two years piloting using our combined knowledge really thoughtfully, planning out and structuring this protocol and thinking about how to create tools so that it can be implemented well without so much drift, with integrity and with you know, Nate has probably taken the lead on creating this very detailed manual. We also use tools for our technicians who are involved in delivering this. A lot of videos, a lot of kind of interactive tools so that they can make sure that they're doing what they should be at that time.
Again, Nate mentioned that we want to be very data driven. So we have a lot of places where we collect data so that when we're at a place that we can study this systematically, we can make tweaks, we can understand what works and what is not working based on not just how we feel, but what patients are actually experiencing from a data level.
Yeah, so we're in our kind of towards the end of our soft launch phase where we work with a technician in Los Angeles and we're there via zoom and there's kind of a manualized approach. And we're pretty happy, I think, with where we're at and ready to start to pilot this in more patients in this hub.
But we wanted to have it structured from the start.
[00:43:16] Speaker A: Awesome.
So where are we going with this? How are we going to change the world with this amazing approach? So where do you see it going 510 years. What are your hopes and dreams for? How, like I said, a model I was just blown away about when I saw it presented. What's your hope for getting it out there into the world?
[00:43:40] Speaker C: Right? So just to kind of add to what Alia was saying, in transition to that question, I also have to brag on Alia because it's a really innovative approach. I believe, and I give Alia the most credit for that, we do have 100 page manual that goes through step by step, what to say, what to do in every single click, basically. But that's really traditional. That's how a lot of people learn, is through these huge manuals. And I think we need that. But we also need something that's a little bit more modern and accessible. So we actually have an interactive manual that someone can learn this through. As Leah was saying, videos on a particular platform can actually see an example of every kind of intervention and technique. The point of that is that we want this to be accessible to people who may not have an incredible depth of experience in Biofeedback. We don't want people this is not only for people like me and Aliyah.
As we're starting in the soft launch, we need to be as detailed and structured as possible so we can just get that model really solid and how it's trained really solid.
So eventually, though, and Aliyah, I'd love to hear your thoughts as well on it, but eventually, for me, I'd like to get it researched in kind of its entirety as a full model being delivered by technicians with supervision from people like me and Aliyah. And then if that is found to be as effective, which we, of course, hope it will be, we'd like to then either study it or engage in some kind of dismantling approach where we make it more accessible. Where we take a public health lens to it and we think about what are the most effective parts of the intervention, what are the ones that are easiest to learn. Do you even really have to go through a 42 hours biofeedback course to be able to do X, Y and Z? Or can the therapists of the future be physiological therapists as well, psychophysiological therapists, where they're engaging in these things without having to have a board certification in it or a PhD in some field related to it? And then beyond that, for me, I think Ali and I have talked a little bit about apps accessibility using some of this kind of transdiagnostic, mindfulness based biofeedback approach in ways that can be much more self guided. And so that's all going to take a long time. We're in the early phase, but I think we have energy and enthusiasm to see it through.
[00:46:18] Speaker B: Yeah, that's exactly it is that we have a lot of commitment to the fidelity and understanding why things work and how we can optimize those. But I think that 510 year goal is certainly once we have a good handle on that, how can we make this more accessible through self paced programming even like apps like Nate had mentioned. But that's I think our ultimate goal is that people can have access to these things that are really helpful and are at this point really limited to just a few providers. And these concepts are broadly helpful. Not just for people with injury and illness conditions, I will say, but I'll have my therapists who are delivering part of these being like I learned so much about myself from delivering this treatment because everything that we're doing is again, trans, experiential, trans, diagnostic. Everybody has a nervous system. Everybody can use these. Just the necessity and kind of urgency for getting a hold of that system or training that system is higher for people after injury and illnesses, but we can all benefit and maybe there is a proactive or preventative, like Nate was saying, a public health approach for some of these things. We know the morbidity associated with stress is so high. So if there's ways of teaching these skills in a meaningful way to a larger population, ultimately that's something that I hope to see in the future.
[00:47:53] Speaker A: Wonderful.
I can imagine. Because here's what really excites me, and I know some of our listeners will share this excitement is what I have seen in my nerdy deep dive into the Biofeedback space is that I don't feel like until I saw your model, whether it's act, whether it's other approaches like Biofeedback is trying to maybe be a sidecar or how do we do this? I mean mindfulness know resonance frequency there are some things there that, you know friend of the show and often co host dr. Ina hazan has done a really good job of doing. But bringing that all into a comprehensive model is where I just got incredibly excited. It's like it is integrated in from the very start instead of trying to be a sidecar to an existing intervention which isn't a bad thing in of itself. But you've sort of taken that and built this holistic beautiful approach. And that's where I think I'm really excited to watch your progress with this because to me you were describing the next step in okay, maybe you don't ever heard of the AAPB conference? Maybe HRV is a new word for you, but you understand how important it is. Where is my entry point? And I think what you're describing, what you're building is going to be such an incredible tool for so many providers. So I'm just so excited to see where this all goes.
[00:49:33] Speaker B: Thank you. And I think we have a big challenge because it is so integrative and kind of holistic. It's hard to talk about. So I apologize to your audience that some of these things are like, what are you actually talking about? It's hard to do because it's very experiential based.
I think everybody once you do it, you kind of start to get it. But to talk about all these elements and how they come together is definitely a challenge. But I think the world is ready to build fluency in this area. People are interested in HRV. They're interested in the nervous system. You were at Amygdala. People know what that is now.
So I think we're at a good time for this type of program, and we're excited about it.
[00:50:15] Speaker C: Awesome.
[00:50:16] Speaker A: Nate, any final words?
[00:50:18] Speaker C: I would just say I think people can really understand, no matter what the science is behind it, and that's incumbent on people like us to translate the science, and anybody can understand. I know what stress is because I can feel it. I know I need to recover from it, but even that idea can be helpful. How do I recover from it and then how do I keep stress from coming back or becoming chronic? So in that way, it's actually quite accessible for folks, and there are different methods to kind of achieve that, right? But I think some of the barriers that we have and I give you credit, Matt, and your company credit for contributing to this space, but biofeedback is really hard to learn, and it's very expensive to learn, and the equipment is very expensive. So we actually have a lot of barriers towards that integrated approach that is reflecting the zeitgeist of the culture of that we're this integrated mind body system. But we're getting closer, but we're not quite there yet. And I think working on those obstacles is a great next step.
[00:51:18] Speaker A: Awesome. So is there any where we'll put a lot of information in the show notes? Is there a quick way for people to find out more information about the model and hopefully they get the actual links and resources on the show notes? But any quick place if somebody's in their car and just can't wait to pull off the side of the road and type in a domain.
[00:51:41] Speaker B: We don't have a domain yet, but the quickest way to get some more information would be to contact either Nate or I at this stage. So my Gmail
[email protected] and Nate, yours is kind of the same, isn't?
[00:51:55] Speaker C: Yeah, it's it's the classic therapist email. Dr. Natewigman first and last with
[email protected]. And thanks for putting that in the show notes, Matt. We've got some PowerPoints that we can share if people are interested, but happy to be in touch and collaborate.
[00:52:12] Speaker A: Well, I just want to open the door at any time and how our podcast can help share your work, what you're learning, any milestones, because like I said, what you're doing is incredibly innovative and I think critically important to bring this all together. So I'm excited we could put this on the radar of a lot of folks very early on and hopefully can again showcase what's your findings as you go through, but excited to watch and cheer like hell from the sidelines and share with as many people as we can. So I just want to thank you both for your effort because just watching you, hearing you, watching your presentation, I like, yeah, this wasn't developed on the plane flight over there's. Weeks and days and years of thought that's gone to this, and it really shows getting to know you, and it's been great to have this conversation.
[00:53:13] Speaker B: Thanks so much, Matt.
[00:53:14] Speaker C: Thank you so much, Matt. It's a pleasure.
[00:53:16] Speaker A: Awesome as always. You can find critical show notes this time around at optimal Hrv.com. I want to thank everybody for joining us. We'll be back next week with a new episode. Aliyah, Nate, thanks so much. And we'll see you soon.
[00:53:32] Speaker C: Thank you, Matt.
