[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 out at optimalhrv.com Please enjoy the show.
Welcome friends to the Heart Rate Variability Podcast. I'm Matt Bennett and I'm here with a very special guest. It's kind of like booking the Rolling Stones to get our guest on today, but we got her. So I'll, I'll let her introduce herself here in a second. But, but welcome and excited for this conversation. So my friend, can you introduce yourself to, to our audience and then we'll dive into all the great work that you do?
[00:00:58] Speaker B: Yeah, sure. Thanks.
Yeah, so I'm a new coteg clinical health psychologist and I currently run the biofeedback service at Kaiser San Francisco in Pain medicine where we offer group based biofeedback services as well as individual biofeedback peripheral biofeedback services, not neurofeedback.
[00:01:20] Speaker A: Awesome. I'm curious, was biofeedback always on your radar professionally? Did you come to that kind of later on? I'm curious how that came into your professional view.
[00:01:37] Speaker B: Yeah, so I trained with, my postdoctoral training was at California School Professional Psychology in San Diego Alliance International University with Dr. Dick Kiverts. Yeah, I picked that particular health psychology program because I was interested in biofeedback. I didn't really know at that age or stage my life really what it was, but it sounded like something that, you know, I think I could help people learn more about themselves. And I thought of it as a self help tool.
And so that's kind of what intrigued me about it.
And yeah, I've learned so much. And you know, at that time I didn't realize how foundational it was to be.
My first class ever in graduate school was biofeedback with Dr. Dick Evert. So his orientation has really been foundational to me. Sometimes people will ask me, you know, kind of how do I conceptualize this whole thing in psychology? And I, you know, I definitely ascribe to like cognitive, behavioral and acceptance and commitment therapy approaches. But in my head I've always been like, I don't know, I conceptualize psychophysiologically. I'm thinking about like what's happening in the nervous system and when did it get primed and how did it get like, you know, impacted? So it's really been a foundational program.
I can walk you through my whole training because it gets kind of interesting.
[00:03:06] Speaker A: I love that.
[00:03:07] Speaker B: Yeah. So the, in that graduate program, the first two years you do, I think it's a year long biofeedback class and then you can sign up for a year long practicum and then by the end of the two years you're trained and certified in biofeedback. So it was, you know, my first two years were heavy in Gevert's approach to biofeedback.
And then it was around that. This is like 2002 to 2004. Around that time, Dr. Gewurtz became president of the AAPB, the psychology, I mean, Psychophysiology and Biofeedback Association. So I just felt like we were like, you know, following him around and he was like the king. It was really fabulous.
I met Dr. Pepper there and a gentleman, Gosh, I'm blanking on his name, but he had created a computer mouse that measures skin conductance.
[00:04:02] Speaker A: Oh, wow.
[00:04:04] Speaker B: Yeah. And so we looked at that for my dissertation. And Dr. Pepper was really active in my dissertation because we looked at upper extremity arms. I mean, upper extremity pain symptoms, which he had a book that he had just published about that topic. And so I felt like I got some really, know, important training from Dr. Pepper, although kind of distally, but, you know, he really definitely infused a, A, A recognition in me about how breath and heart rate interact with muscle systems and, you know, behaviors and habits, you know, just starting to, like, not be so focused on one physiology, like kind of more systemic. That's what I learned a lot, I think, from him, his orientation, even though he can get very specific as well. And then I did my internship at Robert Wood Johnson Medical School with Paul Lair.
[00:04:59] Speaker A: Very cool.
[00:05:02] Speaker B: Yeah. Yes. It was really great because at that time for Dr. Lair and Robert Wood Johnson, the, the whole team, the department of Psychiatry had just attained a grant from NIH to be a center of excellence for essentially somatization. But they were calling it multiple unexplained physical symptoms.
And Dr. Lair was doing a biofeedback intervention. And so I was one of the, you know, lead clinicians to deploy that intervention. So under the guidance of Dr. Lair Hu, he actually helped me in my postdoctoral years as well because I took on a faculty position and so he kind of helped me get my postdoctoral hours, which, you know, I feel, I feel fortunate to have gotten infused by, you know, kind of Dr. G's approach. And then Dr. Laird to a large degree after that.
[00:05:57] Speaker A: Very cool.
[00:05:58] Speaker B: Yeah.
[00:05:59] Speaker A: So then how did you.
[00:06:00] Speaker B: Early 2000s.
[00:06:02] Speaker A: Yeah. So how did you end up in San Francisco at Kaiser? What was that journey?
[00:06:07] Speaker B: Yeah. So then my, My. My career, after I was done kind of working with Dr. Lair, or during the time I was working with Dr. Lair, my. My career took a turn and I was in family medic.
So for family physicians, they have a residency program and they require a non physician behaviorist to kind of run the curriculum around relationships and early signs and symptoms and counseling techniques that they can incorporate. And so I did that for a decade.
All kinds of different positions.
Albert Einstein School of Medicine at Montefiore. And then I also developed some training programs in preventative and integrative medicine and worked for the Department of Defense, where I was doing this traveling gig for a year. This was all in primary care psychology. I was, like, going around and training, like, all over the United States. I could have went internationally, but I just had a baby and traveling around.
[00:07:10] Speaker A: The United States with a newborn, like, yeah, that is.
[00:07:13] Speaker B: Yeah, yeah, yeah. Lots of stories.
[00:07:15] Speaker A: Yes, I got a lot. It's a big continent from east, west, around the United States here.
[00:07:23] Speaker B: Yeah, yeah, yeah, that's right. Yeah, yeah.
And then it was during that time that my current boss kind of reached out to me. I always talk about this position as being like a divine intervention. I really should have never been even like, gotten to the point where I met with my current director, because I wasn't at that time licensed in California, and the position was only meant for people that were licensed in California. But one of my colleagues from Gevertz's cohort that I graduated with got the link for the information and said, hey, you might be interested in this. And I was like, okay, I'll put it in. And somehow I just kind of went under the radar and said. But by the time that my director had talked to me, she was like, oh, yeah, you're the great perfect person for this position.
This position that I'm in currently is Chris Gilbert's old position.
So. Chris. Yes.
Yeah, yeah, yeah. So Chris Gilbert is really the one who kind of secured biofeedback as a core service for San Francisco Kaiser members that struggle with pain.
And the director that I work with, she recognized all of the efforts that he had made to kind of develop the program with equipment, maintaining it, and, you know, kind of really developing service lines. So she made it a manager position. So I got to, like, you know, just walk in and, like, have a program that was built, and then I've been able to kind of update it and expand it in some ways. You know, we've got some exciting things happening, but it's essentially a subspecialty in pain medicine. So a lot of my patients that I see are coming in because they have complicated pain conditions or multiple conditions, complications in how it affects their life.
And then they. We have a couple of different types of multidisciplinary programs, like more intensive programs or less intensive, kind of focused on movement rehabilitation, cbt, you know, kind of life hacks working with medicine with, you know, dealing with life with pain.
And after that program, if they want to, you know, that's already a lot. After that, if they want to kind of reinforce their learnings or come back as, like, maintenance, that's when the biofeedback comes in. So, you know, it's. It's a really cool place to be. I think. I'm one of the few people that's doing group biofeedback. Most people do not do biofeedback in a group setting.
And I learn a lot from. From our patients. And so this year, one of the things that we've been able to kind of develop, because I got a postdoctoral resident from Dr. Gervurtz's lab who's already trained about FE feedback, I was able to actually extend our program services a little bit more into primary care.
We're wanting to move carefully because we. We don't have enough manpower.
[00:10:32] Speaker A: Right.
[00:10:33] Speaker B: You know, we. Right, yeah. You know this.
[00:10:35] Speaker A: Yeah. So I'm curious.
One of the. There. There's two conditions, medical conditions right now that I think are both devastating, so I'll just throw that out there. My fascination really accounts for the devastating impact that it can have on people. One is Alzheimer's disease, because it seems like it's a moving target and there's so much complexity there with it. The other is pain, because pain seems.
I think for somebody who's fortunate enough not to deal with chronic pain, pain seems like an episodic, very localized thing. Like, I kick my little toe, and that's going to be like, really horrible pain for the next 60 seconds. And then if I didn't kick it too hard, that pain goes away. But I've been just learning so much about chronic pain and sort of the.
Maybe a little bit of a mystery behind it.
Certain, like, physical conditions that might show up on a CT scan might lead to great pain for one person, but someone with a very similar scan might not have any pain at all.
So I would love to hear your just conceptualization of this thing you work with every day, which is pain.
[00:12:05] Speaker B: Yeah, it's a complicated question in some ways, or a complicated answer. I guess I would say, you know, at a very like basic scientific level, there's like a clear mechanism of nociception and the, the pain kind of signals get activated as an alarm to instigate, you know, behavior away from that.
What's, you know, I mean, it's a really good condition for kind of psychophysiological interventions because the psychological context in which that pain alarm kind of gets ignited can set off a sequence of events in the person that might be related to past trauma, might be related to their ability to pay the bills.
You know, Dr. Gewurtz had this great whiplash study where, you know, like thinking about like, you know, after a whiplash injury, you have to figure out how to get your car fixed. You have to do car insurance. What if you, you needed the car for work? Right. So all of that stuff depending on the context really changes a person's experience of that sensation.
And you know, it gets way more complicated beyond that because not every person is just a stubbed toe. Some of it is like age related arthritis. Some of it's like nerve conditions which, you know, when they get activated, they're, they're on their own kind of debilitating. Like radiculopathy is like really this like intense experience and it just doesn't get quiet for a long period of time. So during that entire time that's just a physical event. You have to figure out how to manage all of the things that you're doing in life anyway with this thing poking at you, you know, so it's, it gets complicated really, really quick. Even though in some weird sense, like we've known this science, I mean, like, you know, they were doing like hypnosis on people, you know, in the early 1900s for surgery or like you could even go thousands of years beyond before that. And there's all these evidence of people, you know, doing things like walking on nails or whatever and not feeling pain. You know, so we know that we can pull it apart, but the context really, really, really matters. And so there's not a one size fits all. And that's really what we're about when you're talking about chronic pain is that it's conditions that are persisting despite traditional interventions. And now you're kind of left with this conglomerate of events around the original pain and this kind of entrained system around it that you Know, we, we, we talk about a central sensitization, but, you know, we're still learning a lot about that.
[00:15:01] Speaker A: I love that. And I think for some, some of our listeners will be, well, of course biofeedback is a great, you know, treatment for, for pain, as some of, some of ours, others will be like, well, what does breathing and getting feedback on your nervous system, what's that have to do with pain in my leg, for example? So, so I wonder, like, how would you explain it to, how do you explain it to your clients of I, I know you're struggling with pain, we're going to hook you up to a machine to breathe. And I love, I would love to hear how you kind of introduce this concept to people that don't have, you know, the background in biofeedback and pain. Like, like you and I do.
[00:15:50] Speaker B: Yeah, yeah, absolutely. And I guess I will say like, you know, persistent pain can really come in every, in lots of different forms. So central sensitization isn't the only way. Sometimes people have, you know, like a, a neurological or a rheumatological condition that just actually progresses with time and then you add aging in. And so it's not necessarily all kind of this psychophysiological amplification, but it is very, very common.
The main role that I find with biofeedback, and this is true for the large majority of people that are dealing with pain, but not always, is that if they find, find that when they get stressed like, because of traffic, because of like having to reach for things and they notice that the, the just, just thinking about doing that activity causes or aggravates their pain. I had one patient who had like neuropathy in his feet and he would watch a show where somebody was like running in the woods, like barefooted and he would start feeling pain.
Right?
So that's somebody who I'm like, okay. I really honestly think that, you know, if they're invested and they want to learn these skills, we can train them how to down regulate really quickly. It's just a skill that you have to master and we can test and see. Did you get it? Did you not get it? And then the harder part is that we have to integrate it. But I can work with you and try to decide, okay, like when you go to that particular office or you're going to go meet with that particular person, we know it's going to be depleting, right?
[00:17:32] Speaker A: Exactly.
[00:17:32] Speaker B: We know it's going to exhaust. So let's just resource you, you do it like kind of Session to like, you know, get the blood to the tips, quiet the muscles, do your resonant breathing, you know, let go of the exhale fully, find that respiratory reflex, and then you go into the storm.
[00:17:50] Speaker A: Yeah.
[00:17:52] Speaker B: And whatever happens, happens. Maybe you've got some really good cognitive strategies to keep your cool. Maybe you do some breathing. I'm not really sure what happens, but what I tend to focus on is that when you can kind of organize the environment again, as soon as you can get yourself resourced again.
Right. So basically it starts creating this regulation habit around highly triggered environments.
But, you know, like you said it, at least in my experience, that's, that's how I am organizing the care. But as you described, like, it, it takes a person to have a little bit of psychological understanding or interest or curiosity to feel motivated. And I, and I don't necessarily spend a lot of time. I'm like, you know, if, if this is of interest to you and we can do it all kinds of. So we can, we can, you know, hook them up and then they imagine something and then they'll see. Right. Like so, so we can do like an introduction to people so they get an experience of it and then they can think about, well, how do I want to incorporate this in my pain management?
We can get them in the group biofeedback, which is more like an introduction, and they get their initial values.
Just with that, we're like, okay, if you want to take this and start working on it, you've got some stuff that you can do for training.
Go off and see how that goes.
And sometimes we identify. We're like, we think two more sessions of the end Tidal CO2 and you'll have it. So why don't you come in for some individual visits or, oh, we didn't target that other muscle. So come back in.
You know, it's, it's, it is kind of trying to match what we have as a science to offer and where people's readiness is. I mean, because it's not easy managing pain and managing life. So I'm not going to prioritize for them what is, how are they going to focus their time. But I want to, you know, give them enough knowledge that they can determine that kind of dosing.
[00:19:49] Speaker A: I love that. And some of that knowledge about kind of their autonomy. I mean, because I don't know if like before they pitch you, have they gotten this kind of newer understanding of pain that most people, I don't think have. So do you get to educate them on sort of the science behind this as well?
[00:20:12] Speaker B: Yeah, in some ways, yes. So, I mean, I'm hired as a pain psychologist and manager for the team. And so I do play roles with the patients as they're first coming in.
They've been referred to our program.
It's their first visit with our multidisciplinary team. And so during all of those times, we're really trying to give them a sense of, you know, we wish that the medical system had a clear path and, you know, intervention for you, but it seems like that's not readily available at this moment. So in the meantime, we've got this whole team that we really have some good success with. And you know, we, we do a lot of, we do a lot of group based treatment. It's a little bit a Kaiser approach to manage populations. But for pain medicine and maybe for a lot of other things that are psychophysiological, there is a lot of value for sitting across somebody else who's having pain too and watching their reaction to the conversation about what is the difference between acute pain and chronic pain.
We also have class programs where we actually sit there and talk about it. And I'm like, okay, this is what the experts have come up with, with what do you think? And then people have all their reactions and then they get to, you know, kind of process and, and think through, well, how do I feel like this matters to me or what parts of it really resonate.
So yeah, and that is, I think, where the science of pain medicine really is at, is really trying to get disseminated the, the information, but, but how to tailor it in ways that's doable. So one of my colleagues is physical therapist, researcher, and she has been really trying to work with monolingual Spanish speakers.
And so I speak Spanish as a second language. So I was on that work with her. And you know, we, we were for the people we were able to capture, we were able to do really good work with them. But there's a lot of social and psychological and cultural reasons why we couldn't get them to continue to come back to us. And so, you know, it's a little bit of, you know, why is psychology involved in my pain medicine program? And so if we had a little bit more kind of physician cloud, you know, maybe that would do something. But they have to have a relationship. There's a community, there's, there's work. I mean, there's just literal actual money that they need to go be making.
[00:22:45] Speaker A: Yes.
[00:22:45] Speaker B: And they don't got time to stop and talk to me about breathing.
[00:22:48] Speaker A: Exactly.
I love that. So I, I, before this AAPB conference where I got sit in on your. Your workshop, I, I guess this was just my fault. I didn't ask the right questions when we. We kind of met over zoom a couple of times is. I kind of assume. And at previous conferences, but I, I kind of, like, thought somehow you had worked your way in to Kaiser. Because I think one of the questions is, how the heck do I get this into my health system?
And then I go to your workshop and I realize, no, you have this whole team approach. And I'm like, wow, I just sat there.
How lucky for your patients to have access to this. Like I said, I feel like a lot of our listeners might be just like, how the heck did she get in Kaiser doing this work? And so I would love for you to talk about that team approach, because I almost was in tears in the back of the room listening to y' all, because it's like your patience gets something I feel like very few in the country have access to. And what an amazing model I was learning about.
[00:24:08] Speaker B: Yeah, thanks. I mean, you know, stand on the shoulders of giants. It was because of Chris's work.
[00:24:14] Speaker A: Yeah.
[00:24:15] Speaker B: Yeah. And then also, I mean, I guess I'll just give a shout out to my other. Another mentor in the. In the field is Peter Litchfield, who does a lot of work with entitled CO2. And so I did, I did do an extra course with him while I was there. I mean, the way I got the position is really word of mouth through aapb.
[00:24:34] Speaker A: Yeah.
Another reason we're not the AAP podcast, but another reason to think of joining.
[00:24:41] Speaker B: Yeah, I mean, it's. It's a really cast of characters that are constantly curious, and it's real easy to, like, strike up conversations. So, you know, when I was in graduate school, I knew about Chris Gilbert because he was doing presentations and I was doing posters and, you know, so we would kind of keep circling together.
And, you know, my colleague who does biofeedback was like, hey, you guys might be interested. You know, it's Chris's old position.
And then basically, we're talking all the same lingo. So for, like, my train, the training director, who actually doesn't do. But another training director, the clinical director who does not actually do biofeedback.
She, you know, talked to me for, like, five, 10 minutes and is like, oh, this is who we need. Right. So it's a little bit of experience meets opportunity. Right. So, like, I don't know, like, the opportunity just arose, which I think might be happening more often these days than people are realizing. I mean, there is a real shift in generation.
So there's opportunities there. Like, there's clinics that have been built and education systems that have been organized around a lot of important work in biofeedback. And as that generation retires or moves on to their next stage, then there's an opening and I have the right preparation to be able to manage that.
[00:26:02] Speaker A: That's awesome. So. So did that whole team exist before you as well or.
[00:26:08] Speaker B: Oh yeah. Okay, so let me speak a little bit about that. So no, when I first arrived, I created something because I went to this like regional meeting for pain providers across Northern California and I started pulling them. I was like, hey, I just got hired as biofeedback. I was like, we should do something regionally for biofeedback. So I created this whole like network of biofeedback providers. And it's been really wonderful. That particular symposium that you watched was such a. So gratifying for me because it's been like years that we've been meeting quarterly and you know, sometimes we'd have guest speakers. Judy Archuleta, who was in BCIA before, you know, gave me the, the structure so that we can count as a group member mentorship. So all the people who are board certified and biofeedback, when they come to our quarterly meetings, they can actually, as long as we're presenting the couple of cases and talking about them, they can count it towards their recertification. And so this is a group of people. There's maybe like two others. I mean, it's really small group of us across Northern California, Kaiser, who were wanting to come and speak about our services. So while it's exciting in some ways, it's a little bit, you know, it's not that big of a team when you think about the population of people that we're, you know, could be serving. But it was, yeah, I found that really inspiring too because it was that that panel that I put together is people from all different kind of walks of life doing different types of departments and really finding different ways to curate biofeedback services.
And I think that's, you know, what it's going to take. And so, yeah, I hope it does serve as some sort of, you know, stepping stone for people to think about how to integrate biofeedback into it. I mean, we've done a lot of work over, I mean, the generation before us, or maybe even this generation really has done a lot of work in terms of reimbursement. And getting recognition through apa.
So we're well on our way. But yeah, I think it's going to be exciting to see kind of how it can get infused. And you know what, I'm trying in some ways to solidify my experiences. So when the opportunity arises when somebody shines their big wallet over in this direction and wants to do kind of big wide Kaiser wide biofeedback rollout, I'll be part of that team in some way. Right. Like if not leading it, that's kind of, you know. But I don't know, you know, one step at a time, you know.
[00:28:59] Speaker A: Yeah, I, I just a real boring question, but I know probably several people have it as they listen to you so. So you get then reimbursed through the biofeedbacks Reimbursable in California.
[00:29:17] Speaker B: Yeah.
So my position and all the psychology staff that was on that panel and that's on my team, they're all hired as pain psychologists. I think one person on the panel was hired as a pediatric psychologist, but her focus is pain. And so all of us have kind of. Except for. Yeah, well. Oh no. And then there was a me and one other person on the panel. There's a physical therapist who were the only two that was hired specifically for biofeedback. But we get our salary, we get salaried from the department that's hosting us and then we submit the billing.
But there is reimbursement, you know, unlike some other services that are offered, you know, like health education doesn't get reimbursement, you know, and so like, okay, it's probably pennies compared to like how much a. The surgery gets reimbursed, but.
Yeah, yeah, exactly. It isn't it. It, you know, puts you in the black instead of in the red.
[00:30:21] Speaker A: That's awesome. So I'm curious just knowing you as a thinker around like that, I love to listen to what you enter the field of pain at a time where you could argue the, the medical.
Larger meta medical establishment really screwed it up. Like with the rates of addiction and opiate prescriptions and pill clinics and everything that has happened. I just kind of as you sort of walk in, you come into this world with a solution that you got to do some work to get the results on. I'm just curious about your experience, you know, coming in to the pain arena at such a, you know, sometimes horrifying time of seeing, you know, having worked in addiction, not knowing that that pain, legitimate pain, led to this and oftentimes the, the drug dealer was also Their physician. And I don't blame the physicians fully fuller either. Like said a meta medical issue. Just kind of like you're walking in with this, you know. Well, it's been around for a while, probably a new approach for a lot of people on pain and just kind of what that experience has been like to enter this, this very intense world.
[00:31:53] Speaker B: Yeah, yeah, no, it's, it's been interesting, I would say. I mean, you know, the pendulum swings. Yes. And, and so part of what instigated or started this particular swing was that there was a lot of restrictions on pain medications at one time. And so people were having cancer pain and getting limitations on it.
And then obviously like you said, there was a lot of influences and I actually grew up in southwest Virginia, like coal mining area. Yeah, yeah. So there's like an entire community generation that was really impacted by the targeted effort, efforts of, you know, pharmaceutical industries for which they are now somewhat being held responsible for. But it really feels a little bit like we're kind of going back to restrictiveness.
There's, I mean obviously a clear role and it, you know, and I, I, I suspect that opiates are kind of going to go out of style for any kind of long term management unless it's, you know, cancer or, or near death on a hospice care. I think, I mean that does look like the trend that that's going on and I think it, it will serve the population better because those medications, I have worked with lots of people who have either been on opioids for like you know, 20 years and then pulled off of it. I have people that I see that like have been taking like a little bit of opioids for long, long, long time and they don't ever change and it really helps them with their functioning. Like they wouldn't be able to be working if, you know, so there's a lot more variation when you're kind of working with the individuals and a lot more ability to figure out what is the best next move to mitigate whatever negative impacts that we think could happen with opioids. And then, you know, and so I think that's what we've been doing and it's, yeah, like you said, it's, it's an event and I feel fortunate for the team that we're in because they seem to, including the physician has a very balanced perspective and the pharmacist. But it, but it's a, it's a, it's a challenge for them to right now to get what they would consider clinically appropriate opioid care to people who need it. So, I mean, so I'm at a weird, weird place because I am so in the subspecialty area, like in the, you know, in the general population or even in primary care, it's just kind of like, nope, not an option.
And so. And then the role of, you know, biofeedback in all of this is as much as you think that, you know, sometimes I think about biofeedback as really kind of energy management or resource management.
[00:34:48] Speaker A: Yeah.
[00:34:49] Speaker B: So as much as your condition is wiping you out energetically, whether you take pills or not take pills, or sometimes you feel like you wish you didn't have to take a pill, I think biofeedback offers a different avenue. And a lot of people that we work with, well, I mean, even chronic migraine, they will use kind of peripheral skin temperature, raise their skin temperature. And the headache that they thought was about to come on just. Just doesn't come on. They absolutely reverse the entire process and it saves them, you know, six to eight hours of their day because now they can work the rest of the day. Maybe the headache comes on later, maybe not maybe. Or maybe it comes down lower.
So these tools are used really in a very strategic way, can absolutely help people have a better relationship with whatever medications that they're, you know, needing.
[00:35:42] Speaker A: So. So I always love to ask guests and hopefully this isn't your only time on the show though. Though I. I know I gotta start tomorrow if I'm ever gonna get you back on, but where do you think? As somebody who's been, you know, you learned at the feet of the giants, many friends of the show and names that are familiar. And then you're. You're following in the footsteps of another giant and a giant in above itself. I kind of think of you as the sun at aapb.
[00:36:12] Speaker B: Yeah.
[00:36:12] Speaker A: One, you're just always smiling and you're, I don't know, everybody that's around you is also smiling and laughing like, oh, I know that table.
And it was fun to actually hang out with you socially because we hadn't been able to do that. And you maybe more fun even there than professionally. I had a blast with you. So I'm just excited to hear your thoughts on where do you see us all going with this? The more like for the pain specific example, like, I probably picked up, I don't know, five books and, you know, these are audiobooks that I put on my library account. So they kind of roll in as they become available on really looking at nervous system dysregulation and pain or. Or a related book, that pain is a part of that topic in nervous system dysregulation. So. So this energy is getting into the mainstream.
Technology is evolving, you could argue, faster than ever in human history with AI and other things coming on board. So as.
As you look five, ten years into the future, and as maybe somebody who's creating models that can be replicated hopefully around the world, I just kind of wonder where you think that this journey is taking us. Where. What. What will. What will things look different for you, for us, you know, in the wider biofeedback heart rate variability world, you know, five or ten years from now?
[00:37:44] Speaker B: Yeah.
It's so interesting, you know, because, like, I could think of all kinds of different ideas, but, you know, when you look back at, like, our attempts to, like, predict the future, like, it's always interesting with direction. Like, we don't have the show.
[00:38:00] Speaker A: We don't hold you to it. If you're wrong, I'm not gonna call you on it. It.
[00:38:04] Speaker B: Well, no, but I just want to, like, kind of put out there that perspective of like, you know, we're like, kind of at this part of it, and what happens is that our brains kind of think linearly.
[00:38:13] Speaker A: Yeah, yeah, Right.
[00:38:15] Speaker B: So we predict this direction, but the world operates exponentially.
[00:38:19] Speaker A: Yes.
[00:38:20] Speaker B: So, like, we think this way and it's like, bloop, you know, it goes all the way out.
So with that caveat, I guess, you know, I mean, it's hard to imagine, I guess I think I mentioned to you one time before, and I'll just put it out here, is that I have some concern about, like, the pearl proliferation of HRV data to the point where people are using it as a stigma, like. Or they're experiencing it as a stigma. Right. Because, like, all the patients that I work with, and this is already happening, like, I've got one patient who. Who, like, uses, I think, that I can't. I can't remember what his watch is and what the data is that he gets, but he's always in the red zone because his. His numbers are low, you know, compared to norms, so it automatically puts him in this red zone. And. But he is. I mean, he's got POTS and he's got migraine headaches, and he's a new dad.
[00:39:15] Speaker A: Yeah.
You know, as we've said many times, population norms are almost worthless, not fully worthless, but.
[00:39:23] Speaker B: Yeah, yeah, yeah, yeah, yeah, yeah, exactly. So, you know, anyway. But he's gotten sophisticated enough to where he knows how to read it. And think about his Max and his men and his own range.
So, you know, I hope that that happens. Right. So that people are looking at their well, because it does seem like there's a proliferation and a desire for wearables for people to have the data on them.
And so I, I guess, you know, if there's a little bit more sophisticated or nuanced way to deliver that information to, to the people who are using it, make it more valuable, I think that's a direction that needs to kind of come out. And then, you know, in that way I, I do like, if I'm kind of thinking more like kind of in a global way, if, if we get to a place where it's more, the knowledge is more proliferated and people are able to self regulate, I, I kind of feel like people will take a little bit of power back because I think what happens in a lot of pain conditions and a lot of dysregulation is that the person is too oriented to main, managing kind of stability outside at the expense of managing stability on the inside of themselves. And if we kind of make this really clear more often to people that like the sacrifice is you when you do that, I wonder, you know, if not them, if that knowledge is clear and aware, then they're at least their kids. Kids. Right. We'll be like, I, I don't want to go out like that. Like that doesn't feel worthwhile to me, you know, and I have a choice, right? There's a song, I think it's like Anita Franco song or something like that that's like, you know, I get a birth and a death and I'd like some say in between.
[00:41:12] Speaker A: Yeah.
[00:41:15] Speaker B: So I, I, I wonder like if there's a way that we can, you know, and I always think about people operating in ranges and it really, it fits with the functional medicine model really well. Right. That like really operate in those circles. But I think that there is ways that it could be used really well if it's you, if, if there's the knowledge and the thought behind it.
And I think what we've seen already with like BMI or whatever, there is a way that we can kind of move fast and, and actually, you know, hurt people there, there's already people that are having a lot of anxiety about their physiological numbers.
[00:41:59] Speaker A: Absolutely.
[00:42:03] Speaker B: Yeah.
And then the other place that I'm actually hoping to promote or support is more access to hrv, biofeedback and earlier stages. Almost like maybe you would go like, let's see, if you had an injury. And you want, you need to do some physical therapy. Maybe the physical therapy is not going as well. Maybe take a break, do some HRV biofeedback, then get back into physical therapy somewhere earlier on so that the people can start experiencing those sensations that actually historically did cause some major damage in their life. They can start experiencing that sensation and recognize, okay, there's a way to the. I can comment. It doesn't always have to result in this major problem.
And then that allows them to kind of engage in the movement or engage in social activities or return to work. Work. So like from the, from the inception. Right. So that sensitization is kind of better modulated.
[00:43:02] Speaker A: Right. Because I see oftentimes biofeedback is happens after not failures, but shortcomings of other. So you kind of work your way and that's for a lot of people. This is why I love that you exist and your model exists for a lot of people. You almost, you got to pay out of pocket to, to access it as well. And the fact that that's like said that it's available for your patients just like said, does my heart an extreme amount of good.
[00:43:31] Speaker B: Yeah.
Yeah. I don't know if people appreciate or recognize how rare it is. I'm definitely recognizing like as I try to imagine modules, I'm like, oh, there is a real, real problem with being able to, you know, train up providers which, you know, I think that your work has really been helpful too. And I mean, you know, Roland McCready. McCready did all that work with heart math and schools and nursing. And so, you know, I mean, it has impacts in all kinds of different ways. Like we just put our little, you know, efforts out there and then it kind of trickles.
[00:44:10] Speaker A: Yes.
[00:44:11] Speaker B: In all kinds of different directions. And so.
[00:44:13] Speaker A: Yep. Well, I, I really appreciate you for helping us trickle in a direction and being a part of, of the show. Like I said, I've always, you know, I just remember the first time I met you, I was like, who is this ball of brilliant energy? And then I met you in person. I'm like, oh, it's way better live.
And it's just been, it's been great to.
Even though physically our paths have only crossed at the conferences, I like, you know, considering you a friend and somebody that as APB conference seems more and more like a family reunion. You're. You're definitely that cool cousin that I get to hang out with a little bit and learn from as well as laugh with. So I really appreciate you, my friend. We'll put information in the show notes as we always do. And I, I hope I can talk you to coming back sometime soon because this has been a pure joy.
[00:45:09] Speaker B: Yeah, absolutely. Thanks, Matt. Appreciate it.
[00:45:12] Speaker A: Thanks everybody. As always, you can find show
[email protected] and we will see you next week.
