[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 here with my great friend Dr. Debra Bourne. Dr. Deb, welcome back to the show.
I'm so excited to talk to you about HRV and addiction. I know this is a long held expertise of yours and I'm excited to have this conversation.
So just because it's been a little while, I would almost say too long since we've had you as a guest on the show. Why don't we just start out by giving a quick introduction of your vast array of experience.
[00:01:06] Speaker B: Vast.
Well, hi Matt. And I make a commitment to not have it be so long between times that I come on here. Okay, thanks.
So I am a social worker, doctor and addiction specialist.
I work, I'm not working today, but I work for the San Francisco Department of Public Health and I take care of people that live on the street. But another huge part of my work is I do integrative health.
I do acupuncture and energy medicine and mindfulness based practice. I teach mindfulness for the health department and I also teach and train the addiction fellows and addiction medicine.
And my love as you know and passion is how do we actually incorporate a science to discuss what we're doing. And I take care of people that live on the street, deal a lot with the overdose crisis, with homelessness, with poverty.
And when we're addressing these social determinants of health and societal issues, you know, we still need to bring in the fact that we are a biological being and we have neurons that run the show. And so how do we actually use what we know to connect to behavior change and making this world a better place for each of us as individuals and collectively. So that's my passion.
[00:02:32] Speaker A: I Love our almost 20 year friendship now because initially we bonded in such a nerdy geeky way around, you know, neurobiology and I think quality improvement was yes. Oh, we're fellow travelers and how our.
[00:02:49] Speaker B: Relationship is just motivational interviewing. Yeah, yeah.
[00:02:52] Speaker A: Mmi as well.
So about the, you know, not now, you know, we were able to co present last year at an energy conference together. So it's Just been one of those great professional interests that sparked a great friendship over, over the last many years. So I'm excited to explore too, you know, with that, that expertise in addiction. I know we talked a lot of this leading up to our presentation that we did, just, you know, bringing in, especially for those residents that, that you're training, you know, all those vast areas of expertise that you mentioned and how you're kind of looking at HRV as part of what you're teaching to new practitioners.
[00:03:42] Speaker B: So, you know, one of the, I want, you know, the teaching and serving and clinical work is always our greatest teachers. And I think about one of my favorite addiction fellows. So these are people that have gone through residency and are going to go specialize and be addiction attendings. And this amazing woman came and said, I have three day motivational interviewing training. And it was the best thing. And I learned so much. It has changed my life. I think I might have told you the story before. She said, but Deb, I don't understand.
What do we do if they don't want to stop using?
[00:04:17] Speaker A: Yeah.
[00:04:18] Speaker B: And. And she was really perplexed.
And it made me realize how much we are putting on the actual, like, you must change and the action phase in the stages of change and not understanding that all of the stages of change must have an intervention. And we as human beings, to get to action, need to have space and a way of working with someone that both we as clinicians understand and we're just not pussy footing around.
Like, you know, it was just Mother's Day yesterday. I was with my kids and I was like, okay, I wish I had instilled a little more Jewish guilt because then you would maybe do something for me and you would make that action phase like, but I didn't do that for you. So. But how have you changed and developed as a human being? They needed to change themselves at the level of their identity.
Like my, my eldest kid's going in to get a PhD in math right now. Total geek. And their younger sister doesn't think she's smart and she's brilliant and she's now doing like neurocognitive computation or something. But she, she still thinks she's done. But she needs to change herself at the level of identity to understand that, yes, you can understand this stuff. But her friends are like, you're smart. But she doesn't see herself as smart. So as she's going through her classes, she just, every time she fails something or doesn't get the perfect grade, it's just reinforcing that one part of her narrative. And all of that takes place in our brain.
That whole story of I'm not good enough or maybe I can't do it sits in the part of our brain and they're also the part. What's in our brain is the part of maybe I wish and hope that I could have something different.
Also sitting in our brain as maybe I feel guilty.
And also sitting in our brain is I feel so much shame that I'm doing this thing.
So she feels bad that she didn't get a good grade and she thinks that she's going to be letting her family down if she doesn't do well in school, which is shame. So how does all of that play out?
I just was doing a training on HIV with the addiction fellows last week and when I showed them the stages of change, I said, where do you do all your work?
And unanimously, they're like in the action phase. And what would it feel like for you and how would you be as a clinician and what impact would it have for you with your clients if you actually had an intervention that you knew work scientifically at every stage and you weren't just poo pooing and letting it let what you do as work be argued at on a national political level. Right. But there's actual.
And so that's why I feel like, you know, for me, HRV is for my clients, social justice makes good common sense and we're proving what our grandmothers could have told us, you know. Yeah. So.
[00:07:11] Speaker A: So I'm curious for, for those that might not be as familiar with the stages of change, I would love to talk about a little bit, you know, because I know you and I have nerded out about this over many years. But like some of the insights that you have had as we work through pre contemplation to, to the action stage, which can still be the goal, but if we're the ones pushing for action.
I know, yeah. Not good things happen as far as out.
[00:07:42] Speaker B: So there's a lot of different ways that you can talk about the stages of change. And you and I go back and forth like we don't even just talk about it when you're doing a training, but in motivational interviewing, which has been proven to be very helpful. They've broken in like my work started 35 years, 30, oh my God, 30 something years ago, doing work on, on someone's ability to make change. Like how do I achieve this particular goal? And an addiction, like what's right now there's a war on. People that live on the street, are using drugs, they're getting arrested, this and that.
Treatment, you got to go into treatment. But it's basically, you know, we're asking people who don't have the skills to speak Greek to speak Greek.
So the stages of change really gets, you know, you've never even heard of the language Greek.
Yeah. Let me tell you, there's actually a language called Greek. That's. That's pre contemplated. Right.
Or there's a country called Greece. I didn't even know there's a country. Oh my God. Like that's pre contemplated. I had no idea that this was even something I wanted to do.
So. And then there's contemplative. Like, you know, I think maybe I want to learn Greek.
That seems like a really. Oh my God. Because I would. My friend wants me to go to this cruise onto Greece. This is my fantasy, I guess. But anyhow, I will not be a cruise, but come live on an island somewhere. Yes.
And, and, but I need to be able to speak the language because no one speaks English there. And there's a lot of good reasons for me to learn Greek. And that's contemplative. Like I think I want to do that. So we've all had this experience with lots of things. Right. We didn't know it existed.
I didn't know it was an issue. Like I could do Greek and then I can get Greek and that's contemplative. And then like I'm going to study Greek.
Like how do I go and study Greek?
Like who can teach me Greek? Well, you know what, I have a Greek school. I have these tapes. You can do it and whatever. And that's your action. You're going to be learning Greek and then what's the next one?
Just kidding. And then once I get there and I learn Greek, I need to practice.
[00:09:45] Speaker A: Right?
[00:09:45] Speaker B: Like I need to maintain. I need to figure out how to talk Greek. And you know what? I ended up not going to, to Greece right away. I didn't talk it for a year or two years. I forgot it completely. And that's going back to what they call relapse. So. And it's natural.
I have this all the time because I speak Spanish. Like oh my God, I forgot. I haven't spoke Spanish in like two months. I can't remember. But like I need to go talk Greek with someone because I just completely forgot. So those are the stages of change. It could be applied to anything. I'm of course applying it right now. To addiction.
But, but it could be like as simple as talking about Greek. That was a good one.
[00:10:19] Speaker A: And this goes really well with our last week's episode. As I was talking about one of the changes a lot of our, our listeners, whether it's their personal life or whether it's professional helping somebody is we know all these benefits of HRV biofeedback, but getting people to adapt it as a habit is a frustrating thing. I know in the field. And I think one of the things that we miss is if you're introducing something brand new to them, you know, understanding that they're at best in contemplation stage and it's kind of working with them to get to planning under, giving them health literacy information, all that stuff. So for, for those that listened to last week's episode, this is a really good complimentary piece to, to that integration as well.
[00:11:09] Speaker B: Yeah. Because habits. So it's. I, before I came on, I was like, I didn't check my hrv, I didn't study Greek, whatever. And I could be like, well, I'm a loser because I didn't do it. And here I am being hypocritical because I didn't check my HIV this morning.
Or I could be like, huh, that's curious.
And I didn't do it, that's okay. And like I don't really care about Greek, so I'm not like judging myself about it. And if I go, I don't go. And so I can have a little space around myself and compassion and curiosity and those are superpowers in our brains that actually curiosity, compassion actually increases our hrv. So I can do that with Greek, but it's really hard with things that are really closer and near and dear to my heart. So I have a little more judgment about not checking my hrv. And I have even more judgment if I didn't call my mother for Mother's Day. Right. So the things that are closer and closer to our soul where we feel maybe not as good about ourselves, like I still think I'm a good person if I don't study Greek, but I definitely don't think I'm a good Jewish daughter if I didn't call my mother for Mother's Day. Right. So that is a more of a shame based thing. And what does that do? And it all has to do with the salience network in our brain, which I want to geek out about. But it's the thing in our brain, like incompetent, incompetency, whatever. You know, those different, like you can say you're incompetent. Incompetent. But that's like you're saying this network doesn't know it exists. It's a part of our brain and it starts like in the reptile part and it goes to the midbrain, which is our emotions. And then it goes to the front part of our brain, which is where we're. Hypothetically, we're all thinking, right, hypothetically, but it actually incorporates all of that. And it's this network that's powered by dopamine, which is a neurotransmitter that's hugely impacted by. It's about how all habits happen.
It's the reason why, like I, I, like I'm going to use my phone. So the first time I ever looked at my tablet, my phone, or looked at a stop sign, or looked in an HRV meter, I'm like, what is this?
Yeah, I don't know how to use this. I've never seen this before. But your brain starts to say, you know what? Stop sign is a really good idea. I want to make a pattern.
And then you start to notice stop signs. Like if I got it when I was getting a new car, I didn't even like, I never thought about Subarus. Whatever. My friend had a Subaru. I'm like, I'm gonna look at Subarus. And then the other day I was in REI buying something and every car in the parking lot was a Subaru. It wasn't true, but to me it looked like every car was a Subaru. Because now that I have a Subaru, all I see is Subarus. Right. And there are a lot of Subarus out there.
[00:13:49] Speaker A: Yeah, REI is. If you're gonna find some Subarus, that's. That's a good spot to find them.
[00:13:54] Speaker B: Yeah, yeah. Anyhow, so, so this Salience network goes around, it's using dopamine and actually is a thing that helps us get patterns. And at first you're like unconsciously incompetent.
Like, how the heck do I use my HRV reader? Let's take it back to your question. I don't even know how to do that. I don't even know how to live my life. Not using whatever you're consciously conscious salient network is like, okay, now I know where my reader is. You know what? I want to put my reader next to my bed. I want to actually change my wake up time instead of being 7am to be 6:50 because I know that I need that extra time. And you can consciously start to help Work and support a pattern.
Like I stop at the stop line, I go left, right, left. I actually still have to say that sometimes if I'm not very mindful. Left. You remember your instructor you were driving? It's like left, right, left.
So we have things where we're trying to work on our patterns and then we're. We're consciously incompetent, right? You're actually working and using that front part of your brain to tell the hind brain to create a pattern. All that requires dopamine. And then you're consciously confident, right? You're where you're like doing it really well and you're thinking about it and you're still like, okay, I'm at 6, 650. And.
And then, then you have unconsciously competent and like you're like not even thinking about it.
[00:15:25] Speaker A: Yeah.
[00:15:25] Speaker B: And you stop at a stop sign and you're like, thank God, because I almost just hit that biker. Right. And you're not even trying to work.
[00:15:30] Speaker A: Without really consciously engaging in a very dangerous and complex activity, which is fascinating in our brains.
[00:15:43] Speaker B: Yes, it is. My child, who only contacts me when she's sick, just said she has a sore throat, like looking at my phone. So I think, yeah, I mean, how many times I was saying this to the fellows, how many times have you held your phone and be like, where is my phone?
[00:15:58] Speaker A: Yeah.
[00:15:58] Speaker B: Have you ever done that?
[00:15:59] Speaker A: Yeah.
[00:16:02] Speaker B: And then like suddenly. And so I want to break this pattern of grabbing my phone all the time. I want to break the pattern, but I have to be now that it's unconsciously competent, right. I grab my phone, I have like, it's just unfortunately part of who I am.
I have to use my front part of my brain to unbreak that habit.
And it really requires my brain to make some plans for the future.
So first I have to think, okay, I'm on my phone too much. I've read the day. That's not good. And then I have to think about, okay, I'm going to put my phone on the other side of the thing that, you know, of the screen and all that stuff. You know what I mean? So, so it really, it really requires thinking, right. To unbreak a pattern just like it did. Does that make sense? As much as it took thinking to create that pattern, it takes thought and noticing.
And that again requires dopamine and again has to like repattern in and into your salience network. But I want to say it requires resourcing.
So if I'm exhausted and I'm not thinking, I Will find myself on my phone.
[00:17:24] Speaker A: Yeah.
[00:17:25] Speaker B: And so the reason why HRV is so important, it's one of the, the measure, the best measure of our ability to make change.
It's the best measure for our ability to get new habits. It's a better measure for death and bad things happening from heart disease than any other measure. So on every level, it is such a good measure from our biology to our ability to make change. And so as an addiction person and speaking to these addiction fellows, what would it feel like to you if you could actually scientifically do something to help someone at any stage of change? So if someone is pre contemplative and we. I talk about the vagus nerve and how to activate the vagus nerve all the time.
And compassion is one of the studied emotions that increases our high frequency hrv, which increases that front part of our brain's connection with our my are your fight or flight or freeze and fawn part your amygdala. And if it, if like I, let's go back to picking like the phone example, if that's okay. I don't want to pick up my phone. I'm like, where's my phone? I need my phone. I was triggered and I'm looking for my phone, right?
And I need space between my front part of my brain and the trigger to be able to actually make some other choices. And so compassion is a very powerful emotion because it builds neurons between these two, starting with compassion. And I teach compassion and I teach gratitude is an integral part of medical care and part of it is for the state of the health of the provider. Like I, you've heard me say this 7,000 times. I tell all doctors, if you cannot say thank you to the person sitting in front of you, even if they're driving you crazy and yelling thank you for letting me know how you feel. If you cannot say the word thank you, your nervous system doesn't allow you say thank you because you want to punch that person in the face or whatever's going on, then your brain is not in a position to be able to actually use your frontal lobe.
You're going to just respond in a not so smart way.
So, so that thank you gratitude is for the provider and the compassion is not just so that you're getting Mother Teresa award, right? It's actually for your brain when you hold compassion for someone that's smoking fentanyl in front of you or whatever, or just overdose. If you can find compassion and actually allows again your brain to come up with different choices and that's an intervention. So if you could get a person to feel compassion for themselves, for compassion for anyone, anything, their dog.
You know, when I see people on the street buying food for each other, I know that they're exercising and increasing their connections. Right. So how do you. And community does that too? I'm gonna. I could talk all day long. But even when someone is pre contemplative, there are concrete things that we can do. Very simple, even without an HRV reader to help that person increase what's called their locus of control mat which is their ability to know that they can make change.
And at the end of the day, none of us can make change if we don't change ourselves at the level of our identity.
[00:20:54] Speaker A: Yeah.
I'm curious if I. Because you unlike probably I would say most of our audience, I'm not going to say all of our audience, but I think the great insight that you bring to all this as well is you know, you work with, you don't have private pay cash folks. You know, you're working with individuals who a lot of times their drug use has resulted in a range of life issues from housing to disconnection, from family to, you know, sex work to a whole bunch of other, you know, things going on in their life sometimes to support that habit or just to stay alive.
That contemplation that we know with a lot of addiction can really hinder prefrontal cortex functioning on top of trauma and everything else going on survival mode and everything else. And I'm curious how you help someone who has many, many issues.
How do you engage them in that, that contemplation to, to start the conversation around change.
[00:22:13] Speaker B: So you know, it's so interesting you asked me this question because I was just thinking about this.
It was one of my heroes, Gene Houston's birthday on Saturday and I was talking with another friend of mine about Gene and some of her work. And if you haven't heard of her, you should google her. But she does a lot of work with imagination and she was like the grandmother of, of all of the self help work that we do now in this country.
And I can say without question because I do do work with people that are resourced.
I and I do more of my woo integrate more integrative health. I read tarot and do astrology and all that fun stuff for me with people that are resourced and all of that. I actually met with a client.
I meet with clients, I do energy work, I do acupuncture with people that are resourced and I do it for donations to the Homeless Youth Alliance. So if anyone's interested, I can do it online. And all that goes to donation to my favorite nonprofit.
And working with those folks, it's deeper work. They're resourced, they didn't have to worry about what they getting money for food that morning.
The questions are the same, Matt. Yeah, it's really, there's, and I remember saying this to Gene, there's no difference between my, those conversations and the conversations like one that I had on Friday night with a gentleman who has Huntington's Korea, sleeps outside with his partner who had given birth on the street. I mean, you can't get more like intensive stories and the juxtaposition between what this person and his family are dealing with.
And the issue is the same because we are human beings. We're in a, you know, spiritual creatures and in a bodysuit and, and what our experiences and what's in front of us. Some of it's harder than the other. Or we could just say, you know, you have what you have, you know, you're not your bank account.
[00:24:08] Speaker A: Right.
[00:24:09] Speaker B: I wish the whole nation knew that on both sides, you're not your bank account. You actually are this creature and of a physiological being and it just what's relevant to you. Does that make sense? So, so understanding that level of humanity and you don't necessarily even have to care about humanity. I mean, I happen to care. But you just need to understand how biology works. Right.
So if you're struggling for eating, drinking, you're tired, those are things that impact your hrv, right?
[00:24:37] Speaker A: Yep.
[00:24:38] Speaker B: So you haven't slept, your HRV is going to be lower.
You haven't, you haven't eaten, your hiv, or all you get is just crap food, your HRV is going to be lower. The police keep on coming and sweeping and taking all your things. So you're in constant state of fear and people don't talk to you because you smell bad.
So you know, it's just a higher level. It's a more intricate surgery. If we think about this as surgery, like how you approach someone with that and understanding their level is the same. But I can tell you when I first checked my hrv, it was lower than the first time I checked some of my patients, hiv.
So there you go.
And, and you know, we all know that, I mean, we could do it on a non measurable thing. But I swear to you that I have patients on the street that when I've chanced to check their hrv, it was higher than mine my first time. Yeah, so, yeah, humbling. Correct. You know, it's not a measure, so it's all relevant to yourself. So I want to just answer your question by starting not from a real Kumbaya thing, Matt, but from the reality is that we are these biological creatures and it's all going to be relative.
So that's important to understand. So how would I approach anyone, regardless if they have.
By our societal standards, I understand the difference between shame and guilt is hugely important.
And when. And I first started thinking about this in a book about, I think it was called Conscious Uncoupling after my divorce and just how horrible it felt to me as a human being that I was getting divorced and not guilty. But I felt like I failed society and I failed my kids. I felt the sense of shame. And I started reading about, like, the research on shame and guilt.
And I asked one of my patients, Martina, who you know, and, and that we presented with, and I had asked her, like, what did it feel like to be on the street sleeping there?
And she said, I. I just feel horrible. Like, how did I get here? I used to work and. And she's in a different stage of change than when you and I worked with her now. And I could tell you more about it afterwards, but.
And she's a different person in this stage. And I've known her since 2001 because she's changed herself at the level of identity, even when she's in a different cycle. But anyhow, she said it felt bad about myself, so she felt guilty. Like, how did I do that? And I said, well, how did it feel when you think about society and how society feels about you? And she said it feel. Feels like a lead boot is on me and I can't even get up off the street. Yeah. So for herself, she could get up and go and eat, even though she felt like. And how did I get here? But when she thought about how society was thinking of her, she became immobile.
[00:27:33] Speaker A: Yeah.
[00:27:34] Speaker B: So she's. I can't even move. I can't get up. I can't do anything for myself because I feel so bad. And that's the shame part.
And that can be measured. Right. And we can measure into what that does in our hrv. So when I approach someone that isn't pre contemplative, I'm thinking about their connection and where they are with shame.
And because I know that we have that regardless if it's about food or if it was about divorce. Right. Because it's not like, who cares? But I feel bad.
And then the humans I work with have a lot of courage. They have to identify themselves as someone in need when they walk into a methadone program. They identify themselves when they have to sign up for housing.
Like you have to have a certain level of courage to be able to do that.
Right. So they have resource and they have incredible strengths. I couldn't last a day on the street. You and I talk about that all the time.
Like not one day.
And like think about if you don't have your right toothbrush or toothpaste, how bad you feel. Well, hello. Can you imagine being so amazing that you can figure out like how to take care of yourself and not have a toothbrush at all? So those humans are resourced in a way that other folks aren't. So I think about that with whoever I'm working with. Matt, where are they strong?
[00:28:55] Speaker A: Yeah.
[00:28:56] Speaker B: How do I elevate them? How do I bear witness? Because we have to change ourselves at the level of our identity and that comes even in the pre contemplated. Does that make sense? So I think about those regardless of people's social, economic status.
And I'm curious, does that answer your question?
[00:29:12] Speaker A: Yes, I'm curious. Like with the hrv. HRV biofeedback. I know you're introducing this to residents and I think we're on the early stages of HRV integration.
Though the Bay Area has been known historically for leading the way around some innovative practices.
If there was the ideal that you could really integrate this into helping somebody make that transition out of, you know, maybe cutting back on use or if their goal is total sobriety, that pathway to sobriety, housing. You know, what, where, where would this sort of. In your ideal world, how would hrv.
[00:29:57] Speaker B: How would an hrv.
I can answer that. First of all, the providers.
[00:30:02] Speaker A: Yes.
[00:30:03] Speaker B: So the first thing would start with the workforce.
A hundred percent.
[00:30:06] Speaker A: Yeah.
[00:30:08] Speaker B: Because if you walk and you're frustrated and you walked in and I remember one time we were doing a talk on trauma and you talked about this dental clinic.
I can't remember where it was. And just how amazing the front desk staff were.
[00:30:25] Speaker A: Yeah.
[00:30:26] Speaker B: Even with all these people whose face hurt and everyone was okay. Yes, please. So if that front desk person is feeling good that day and knows their work is valuable and has a high hrv, they're going to treat folks nicely. And people are not going to be in as much pain in the waiting room.
[00:30:45] Speaker A: Yeah.
[00:30:46] Speaker B: Because their stress level won't be as high. It'll decrease pain of the patients.
But if that person's hrv, they don't like their job. Their boss doesn't care about them. They have the is their one of sex jobs. No one cared that, you know, they got reprimanded and written up for being five minutes late, whatever's going on. And their HRV is low. They're not going to treat that person as kindly. And I've told you this story like 800 times when I worked out one encampments and I look at people's eyes and in terms of how they feel about what society has expected of them, there's this look of hopelessness because there's no resources. They've tried, they've tried, they've tried.
And when I started doing a consult service in the hospital with other providers, the social medicine consult service, when I first started, I was in the hospital all the time and I saw the same look of hopelessness in people's eyes.
I didn't check their hrv, but that was a low hrv. It was the same as the encampments. But it was my colleagues, it was the doctors because they didn't have their resources. So nothing is going to work unless the workforce is working.
And we are, you know, we need to be a caring system because if people feel welcomed and you know what that feels like, you know, when you're not getting what you need and you're in the checkout line and the person's really rude to you and you're frustrated as opposed to you're in the checkout line, the person smiles and their frustration disappears. Right. So it's super important. So number one, workforce, workforce, workforce. And a lot of the mindfulness based work and equity work that we do is around mindfulness and mindfulness and heart rate variability are interconnected. So work first, number one. Number two, I think we have a lot of interventions and we think we're making change and we're really not. And I did an experiment with the fellows. This is just an I taught them, I said then they were going off to do artwork with a therapist for their own self healing. I said, just check your HRV after all of that, I'm just curious.
And a few of them had gone up, majority of them had gone up, one of them stayed the same and one of them got lower.
And I want to talk to that guy because art therapy is not for him.
[00:33:04] Speaker A: Right.
[00:33:06] Speaker B: So we don't know it's not a one size fits all. And so I think understanding how someone responds to a therapeutic intervention, because immediately after a therapeutic intervention you should have some level of improvement of your hrv. If your stress response is decreased. Right. So yeah.
[00:33:23] Speaker A: I mean, the only counter I would put to that is sometimes therapy can be difficult.
[00:33:27] Speaker B: Yeah. Activating. Activating.
[00:33:30] Speaker A: Well, even just.
[00:33:30] Speaker B: I understand. Even so over time, let me say, let me change that. So if you do therapy and you're doing body work, you're doing somatic therapy, you're doing art therapy, you should have some kind of improvement and over time. So maybe.
[00:33:45] Speaker A: Absolutely.
[00:33:46] Speaker B: So I would talk to him. Did you enjoy that? If he's like, I felt horrible. All it did is made me think about my third grade teacher who told me I was a loser. That's all I could think about during the art therapy that might not be for him versus the one that didn't change.
Did you enjoy that? Yeah, it made me really think about a lot of stuff. And then I would say, you know, you'd make decisions with the person based on that. But if someone like went down horribly and they didn't enjoy it, they're not going to stick with that therapy.
[00:34:11] Speaker A: No. Oh, I just said. I'm just saying that sometimes what's going on in therapy and I don't know what this art therapy was for these individuals, but we do see that the post therapy reading, especially around trauma work can be lower. But you know, obviously if it's not going up within a couple weeks, then that gives you some really good information that you know.
[00:34:38] Speaker B: Yeah. I was talking about this with the Harm Reduction Therapy center when we're. I've been talking with them over the last year about starting to using HRV and what that means. And their goal are to create spaces. Their, their motto is come as you are.
And so their biggest question is, does over time having a place, just a safe place where people can go. And I'm their directors, like people can come in there and they can open a refrigerator. We don't monitor the food. They can open it themselves.
What does just being able to do that do for a human being? Yeah. In that space. So maybe the first time that was really overwhelming and triggering. But did you enjoy it? Because I want you to come back.
[00:35:17] Speaker A: Yeah.
[00:35:18] Speaker B: So we have to monitor the. Yeah, that was hard, but it was a good. Kind of hard. You and I were talking about good and bad before the training. Yes, before getting online just now and think everything that's hard is not necessarily bad. Like Matt is. People might know is. It was. It was. Is a maniacal runner. I couldn't even, like I couldn't even run away from a bear. Like I could even drive the length of your Running courses. Right. It would be too much for me. That would not be my therapy. My heart rate variability would be low afterwards and I would hate it. So you were asking, like, how do you help people create habits that are healthier, different, or start to use the meter or whatever, do the practicing. You need to have a feeling of, I'm okay with this level of bad. If not, it's just torture. Right. So, so I think that it needs to be both. And so with this young, this. I actually want to talk to them and see what they did. They enjoy it.
[00:36:15] Speaker A: Yeah.
[00:36:16] Speaker B: And she also did body massage too, by the way. So it wasn't just.
[00:36:20] Speaker A: Yeah.
So I would love to, to see anything else. Like if we got the staff on board, you know, because I think compliance with the, taking readings all the time and you know, will somebody who may be living on the street, where does taking a morning HRV or doing an HRV biofeedback, assuming their phone can be charged on a regular basis, kind of fit in. But where do you see in an environment that lends, you know, some natural barriers to adherence?
What, what's some of your thoughts about how we might be successful?
[00:37:05] Speaker B: Yeah.
So, you know, it's interesting, we had once talked about you were going to be using this at a respite center. Right. And so like checking people's HRV over time.
And a lot of people leave respite and people who don't know what respite is for people that are unhoused, just like the word, you know, implies. And there's respite for people that are, that are home, that are care providers. You're getting relief or a break. And so respite centers are places that people getting out of the hospital with a, an acute reversible condition can go. It's not a nursing home for the time of recovering. So you have cellulitis, skin infection, you take your medication, you're post surgical for wound care.
And a lot of people just leave respite or a lot of people just leave the hospital even though they know they need to stay.
And so I, you know, I would be again, back to my example with the, with the fellows, you know, I would be curious how we would use hrv because if someone's in a place that should be helping them feel better and their HRV should be getting up, going up over time because they're sleeping, resting and eating. And if their HRV is going down, that would be someone that I would need to work with and think, okay, this person's going to Self discharged because there's something about this experience that's actually making their brain not be as healthy as possible. So it allows you to be curious about what other layers of support this person may need to be able to stay that leaving treatment. It costs so much money to get people into treatment. And I work at this drop in center where people go. They can go for 23 hours and there's so many people that have just been discharged from treatment and they're waiting there's seven days because they hit someone or yelled at them or whatever to go back. And I was like if we could check someone's HRV every day at residential treatment. And people's HRVs are not naturally improving as they get healthier. Right. But they're having a dip. That's someone that needs extra double support or counseling. Because preventing someone getting discharged from a treatment program would be huge.
[00:39:11] Speaker A: Yeah.
[00:39:12] Speaker B: Huge cost savings, huge impact on society. Huge impact for that individual. But we have no way of knowing except for them how do you feel today? So this would be putting together not just how we ask and check in with people with groups having huge, huge impact.
[00:39:28] Speaker A: Yeah.
[00:39:29] Speaker B: So those are some really like low hanging fruit ways that we could start to incorporate it. And using HRV as a vital sign to understand how people are doing in places where quote unquote, you should be feeling better.
[00:39:45] Speaker A: Well I love that example too because like the still having worked in residential we're still. It's hard to kick the model that someone decided weighed the benefits and rewards of throwing a chair through the window. Right. That they weighed all this and then made a conscious decision to act in a way that got them suspended from the program. And I think HRV is a starting point besides what we know about neurobiology now. That's mostly a stress reaction. I would say in probably 19 out of 20 cases.
How do we maybe early intervene when we see somebody's HRV is tanking today. What is the programming for that person versus somebody who's doing well today and getting that science into what still can be a bastion of pure behavioralism which we know is just outdated for what we know about the brain with this.
[00:40:50] Speaker B: Yeah. Well we're not going to be. I mean I think about this a lot. We're not going to be able to change our models. But right now.
Right now like prison.
[00:40:59] Speaker A: Yeah.
[00:41:00] Speaker B: You know we're not. Is now a treatment center and even more so. And I have people who did so well in prison and it was one of their like Sayofa King Thomas who used to work with us. Right. Who's. Who's passed on?
She appreciated her time in prison for the ability to work on herself. She had a therapeutic support. She mean, it was just great work and it was an opportunity for her to work on her recovery.
And she really knows that her time in prison was critical for her because she used it as such. Right. And she participated. And so what would it be like for people? Like, how do we increase hrv? Her HRV was high enough in prison that she knew she could use this time.
[00:41:44] Speaker A: Yeah.
[00:41:44] Speaker B: Versus they're still in fight or flight. So I think there's some models like prison where we can't necessarily change, but it could also let us know that if every single person is feeling that way, then we can maybe change the model.
So I do think our models need to change and it would let us know over time.
But we don't measure self discharge from residential treatment as a measure of the failing of the treatment. We measure it as a failing of the individual.
[00:42:09] Speaker A: Right.
[00:42:09] Speaker B: So it really is going to take a quantum flip for how we blame people who use drugs and people in recovery and people with trauma for their own failings.
As someone who's had a lot of those things myself, that's part of shame and that they take it on. And until there's open recovery and people's voices are elevated, we're not going to be able to change that. I mean, but I, I think we can. But we're not going to be able to change rapidly if people, we don't give space. Which is why compassion is such a critical part. Because you don't have to care, but you can be curious.
[00:42:45] Speaker A: Yeah.
[00:42:45] Speaker B: You know, you don't have to really. Like your heart doesn't have to be a bleeding heart and like, you know, you get the stigmata for someone, but you can be curious. So I think if a director is noticing their own heart rate variability of the treatment program. Like you were the director.
[00:43:05] Speaker A: Yeah.
[00:43:05] Speaker B: Right. And that's part of your story, is that you're. You were getting probably. If we could have tracked your HRV over time, trauma was impacting you over and over and over again.
But we need to stop blaming the person for the problem. Like my mother was telling me on Mother's Day that she got fired in the fifth late 50s as a school teacher the second she told her boss she was pregnant.
[00:43:33] Speaker A: Yeah.
[00:43:34] Speaker B: And what's changed is society has been able to change because women's voices had a little more space. Does that make sense? So I think there it needs to Go hand in hand. But if we hold biology to be true, you know, you realize that you couldn't be the director anymore because you weren't effective. But if that person would have the heart rate variability with a sense of curiosity, I think things could change. So.
But I also think that, you know, not everyone, because. But when I went to talk to the fellows, they're like, okay, so now we can use this with patients. You. There's some things you can't work with everyone. Like, if you're not resourced. You know, I. Like, I would love to do a full acupuncture session for everyone on the street, but that's just not realistic.
[00:44:16] Speaker A: Yeah.
[00:44:17] Speaker B: So what can I do? And so go back to your question you had before. What did I do for that guy that had Huntington's disease? You know, his partner had delivered on the street, and.
And it was videoed. So there's a lot of trauma. You know, all this stuff went viral. It was a horrible thing.
I do acupuncture seeds instead of acupuncture needles. And he was in pain. I was like, would you want seeds?
And I came. You know, I accepted. I. We come. Comes as he is. We're outside, so he doesn't have to go up the stairs. He can't walk up the stairs into the clinic, and he can't walk into clinics, and he's embarrassed because he's dirty or whatever's going on. And I saw him outside as we were feeding him food, and I could have the conversation because we make the spaces. We changed our model. Right. We did the thing that makes sense. So he came as he was and accepted acupuncture seeds in a VA protocol called Battlefield that I put in his ears. He said, wow, I really. I don't feel my knee pain.
So all the environment and the programs do need to change, and this was the right environment. But if I'm trying to say, well, now you need to go to treatment.
[00:45:28] Speaker A: Right.
[00:45:30] Speaker B: Yeah. So I think getting back to the original part of what we were saying, where stages of change, understanding that people being pre contemplative is part of human nature and not a judgment.
And it does require, as I said to that fellow all those years ago, every stage of change is an intervention. And if people don't stop using, that's a choice that requires her doing her own work and knowing that she's a good doctor, even though people might not go on to methadone right at that moment. Right. And that requires her attending her head doctor reinforcing what's going on and that. And one of the number one questions that people ask, the fellows ask me and the doctors ask me all the time when I was doing the consult service. I don't understand. I spent all this time with a person to make all these plans to take the medicine, take the antibiotic in the hospital and then they leave and they don't do it.
[00:46:27] Speaker A: Yeah.
[00:46:28] Speaker B: But they don't go on the methadone or they self discharged.
And I said, what does your face look like when you were talking to that person when they say, yes, I want to do your treatment? What do you look like? Show me what you look like. Matt, when someone wants to do your treatment. See that great birthday cake face?
[00:46:45] Speaker A: Yeah.
[00:46:46] Speaker B: It's your birthday face.
[00:46:47] Speaker A: Right?
[00:46:48] Speaker B: And don't you love it when it's your birthday and people smile at you?
[00:46:51] Speaker A: Yeah.
[00:46:52] Speaker B: Yeah. And. But if they don't want it, what do you look like, Matt?
Yeah. So people, we, we're just biological beings and we have these pattern recognitions that I want to stay connected because my dopamine feels better and your dopamine feels better and I have oxytocin when you smile and we laugh.
[00:47:12] Speaker A: Yeah.
[00:47:14] Speaker B: So, so understanding that this is all biology and how do we know how the biology is working as we check our hrv.
[00:47:20] Speaker A: Yeah.
[00:47:21] Speaker B: And we work on our HIV when we're not stressed.
[00:47:25] Speaker A: Yeah.
Awesome. Well, my friend, I appreciate you as always. I feel like we could just keep talking for that interesting three or four hours, but this has been, this has been great. So I would love to have you come back because I think what may have sparked some interest with people and is here is this high achieving medical doctor and you're also doing energy work, acupuncture and I would love to bring you back soon to talk about that because I know HRV informs that work as well. So I think this, let's call this a part one to that fun follow.
[00:48:04] Speaker B: Up conversation and habits I'm really interested in. The habit issue is really important. Yeah.
[00:48:10] Speaker A: Awesome. Well, we'll put some information about Deadborn in the show notes that you can always
[email protected] thank you again everybody for joining us and as always, thank you Deb. And we'll see everybody next week.
