[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 Matt Bennett. I am back with a very special guest today, Dr. Donna Schumann. I came across Donna's work in the AAPB Journal, and as our listeners know, I have a real passion for heart rate variability, especially when it applies to the work in mental health and especially with the work around trauma. And I saw Donna's article about using HRV biofeedback with veterans with PTSD. And I reached out and wanted to get her on the show to talk about both the article and her research here, but just in general, her work with heart rate variability. So, Donna, welcome to the show. I would love to just get just a brief introduction of who you are and maybe a little bit about what brought you to Heart Rate Variability.
[00:01:36] Speaker B: All right, well, thank you for having me on your podcast, Matt. I really appreciate that and I love talking about my work. So what brought me to Heart Rate Variability biofeedback was I worked as a psych tech back in the 1980s in an inpatient facility for adolescents. And I saw what we were doing with biofeed back then and it was very popular with the patients.
They got a lot of relief from it, from their symptoms. There was good tolerance for it. And so I was always interested in it. I was a technician. I just simply observed, but I always had that in the back of my head. One of these days I would love to do that job. And so flash forward a lot of years and I'm working as a social worker with aviators at Fort Rucker, Alabama, and they were flying. And this was back in 2009 to 2012, a time when there was quite a lot of stress, combat stress, and we were kind of casting around for solutions to improve treatment. And so I started doing some heart rate variability biofeedback using some older programs and software, just some really simple stuff. And the army supported my interest and sent me to training and supported my getting certified in heart rate in general biofeedback. And I did the certificate at the time. They had like a specialty certificate for heart rate variability. I know they have a certification now and then later neurofeedback. I added that also. But I was working with helicopter pilots who were coming back with PTSD and significant symptoms. And of course they wanted to keep flying.
They wanted relief from symptoms. They couldn't take certain medications or they would have to get a downslip. So biofeedback seemed like a very good solution. And so I had a waitlist very quickly. And I always started with heart rate variability, biofeedback, because it really helped calm a lot of the symptoms. I saw a lot of really good results in the clinic and I had the luxury of doing as many sessions as needed to get results.
And while I was there, I decided that I wanted to go further and I wanted to get a PhD. And I wanted to do research.
I had this idea that we needed to maximize clinic resources because we had developed a long waitlist.
Even though I was trying to do as much as I could, there was only so much that I could do. After a while, when word got out, it was popular, the soldiers we were treating really liked it a lot, and they were getting relief, they were sleeping better. We're finding they're, you know, getting relief from trauma symptoms. They were able to keep flying. The army liked that. The soldiers really liked that a lot.
So it was a win win for everyone. And so I thought, well, maybe we could figure out how many sessions would it take, maybe we didn't need to do all those sessions. Maybe we do this in fewer.
So I started working on that during my doctoral training. I was working on a PhD in social work at University of Texas at Arlington, and it was very interdisciplinary for me. I was able to pursue my biofeedback research. I was delighted about that. And so I was looking know, would this work with a single session if we could augment it with maybe using like inner balance or some kind of a home training tool? And so in my dissertation research, I had a very small sample.
I think we had maybe twelve, and it was very small and mostly it was just a feasibility study to see if this would work, would we get results, and we did get good results from that, I did see that. But the sample had fairly mild symptoms, so they responded well, but they responded well with very mild.
So after I graduated, I went to work for the University of Kentucky as an assistant professor and started doing research with the Lexington VA there with veterans who had much more severe PTSD symptoms. And so based on what I learned during my dissertation, that one session was probably, it was not going to be enough.
So I worked with Dr. Jack Ginsburg on developing a protocol. He was adamant that one session would not be enough and had some doubts about three, but I wanted to try to get it to three to see can we do this with three? And I spoke and consulted with Dr. Tony Hughes. He had a five session protocol he was using.
I looked at Dr. Lair's protocol and was trying to figure out, know, were the elements here that we would keep in this and try to get it down to three sessions. So we had two groups, a control group and then the intervention group and the intervention group, they did the three clinical sessions of heart rate variability biofeedback training. And I used a live Pioneer software and I used the breathing pacer optimizer that was built into that program. I love that software. It's just amazing, really, for clinical work. And I used electrocardiogram measures using the Biotrace and Nexus Ten, and then I measured them before and after the three clinical sessions. And then we had them, my research assistants, and I worked with them around using the Heart Math inner balance device for home training. Thinking if we do three clinical sessions and we have this home training going, and then they continue doing the home training after the three clinical sessions for four weeks, that we would see good results. That was the hope. And so we looked at depression and PTSD symptoms. And so what we found was we had marginally significant results for PTSD symptoms, intrusion symptoms. Very specifically.
We did get significant results for SDNN, the Time domain measure, that's sort of the big, broad measure for autonomic balance.
And so we did see significant results with that improvement. And we also had some significant results for depression. So that was exciting, too, because depression, it's a fellow traveler. It's more of a symptom with PTSD.
Even with the brevity of the intervention, we were able to see some good results from it with our participants. So I'm happy to talk more about that if you have any questions about that, because I've been talking a lot.
[00:09:52] Speaker A: Yeah, well, one of the things that I would love to get your kind of thinking on is, at least in my conceptualization, when trauma escalates to being post traumatic stress disorder, because not every traumatic event necessarily leads to that diagnosis. And I won't even get into the controversy around diagnosis with trauma and developmental pieces and all that, you reach a certain level to get PTSD. And I usually think of that as your nervous system has in many ways, developed traits resulting from your trauma. So it's not like, hey, I experienced this really hard thing on Tuesday. Wednesday I was really messed up. Thursday I was okay. Again, there is in many ways, a long term and probably with heart rate variability, if we tracked it, we would see a decrease in a lower level of HRV probably over time after the traumatic event, if we had that metric, which we usually don't. So when you're looking at these interventions, I'm assuming if we look at the nervous system polyvagal language, we're looking at using heart rate variability, biofeedback to help, if I could use the word, and you can feel free to correct me here, heal that long term nervous system functioning. So I'm really fascinated with this short term interventions where you are getting some really measurable results. How are you conceptualizing helping a Dysregulated nervous system start to regulate, using biofeedback as the tool to help do that?
[00:11:44] Speaker B: I want to go back to what you said a little bit earlier when you were talking about the variability in PTSD symptoms. So in the study, all of the participants had clinically defined PTSD and met criteria for PTSD at the time we did the study.
And then how am I conceptualizing this idea of healing the nervous system? And I think within polyvagal theory, within other ways that researchers have looked at it, that it causes this neuroendocrine cascade, a positive neuroendocrine cascade that heals the nervous system.
I think that really the best way to describe it is the resonance that's created from doing the intervention.
It causes positive changes in the body that start to dial down the symptoms.
[00:12:58] Speaker A: Awesome.
This may be a hypothetical, so just kind of maybe speculation. I think your research can inform some of this answer, but as we look at again, if I can use my language and correct me if you look at this differently, but I think we're talking the same thing, is that trauma dysregulates the nervous system? We're using HRV biofeedback to help bring back regulation when we look at the intervention.
What I was fascinated with your article and your work is really looking for again, I'm going to use words that you're probably not using, but almost a minimal dose of HRV biofeedback to see improvements in that regulation. And from a military perspective, which might be different than the veterans that you work with, I want to acknowledge that is really to getting them back to performance, to fly in the helicopters in your initial work with this. So as you start to look at this and doing this research and really getting into the data, when you look at PTSD, do you have an idea? And I'll let you use, like clinical plus maybe at home practice, if you were to start to formulate a minimum dose, to start to see positive trends in HRV, knowing it's individualized. But what would be some of your, again, maybe assumptions, speculations? Or maybe if you want to speak with more confidence on it, what would you say? Here is what the protocol would be to help someone start to recover from that traumatic experience that they've had.
[00:14:47] Speaker B: I think what I figured out is there's no standard minimum dose. It really does have it depends on the symptoms and the constellation of symptoms. It seems like intrusion symptoms responded better than avoidance symptoms.
The mood symptoms took longer to respond, but they did significantly.
So I don't think there's a minimum dose. It's very dependent upon the person who comes in. Some people, after a few clinical sessions, are going to start to see some relief, but others are going to take many more sessions to see relief. So it just depends. I guess we were hoping that we could come up with a minimum protocol or a protocol that would point to a minimum number of sessions, but that didn't happen. What we saw was it just depended on severity. And there were some really good things about this type of intervention that were obvious. And one thing was, it's portable. If we train them to use the inner balance, they could take that. They could use it anywhere.
One of the issues we had was, of course, follow through.
It's hard sometimes for them, for participants, or for patients to see that that's what's helping them.
If there was a way that we could reinforce it better, or they could see that, yes, this practice is what is helping you sleep better. This practice is what is helping you tolerate difficult situations and better. I'll talk a little bit about that. Anecdotally a participant that I worked with that had a really interesting result.
So just the portability of it, it's practical, it's portable, they can do it more often. So if they only had three clinical training sessions to really reinforce, this is why you need to do it, this is how you do it. And then they've got that homework trainer that they're using, that they can use it more often as needed, and we just need to figure out how to motivate them to do that.
[00:17:23] Speaker A: Yeah, it's funny. With optimal HRV, one of the things that we really wanted is to provide clinicians and researchers a dashboard so they could track. So we put in all this work, and one of the probably the best feedback we get is it's an accountability tool. Because if somebody knows that you're monitoring their practice and you get that data, it's not all the fancy charts and the fact you can get time domains, and none of that really matters. It's just the fact that they know somebody can log into a dashboard if they do it or not. And with our veterans and people working in the military, it's amazing that if somebody's looking, making sure you're doing and following through, all of a sudden we see adherents jump dramatically with that. None of the fancy graphs or anything that we've worked so hard on. It's just the fact that somebody's there holding you accountable to.
[00:18:25] Speaker B: And cares about your progress.
[00:18:26] Speaker A: I think that's absolutely really important too.
[00:18:30] Speaker B: And helps a great deal with motivation. I wanted to share a story about one of the participants I worked with just to illustrate the power of these simple interventions. They're humble, but they are powerful.
I was working with a veteran who he was driving a truck, and he was having a lot of panic symptoms going over bridges from IEDs. And when he was deployed and he was driving over 100 miles out of his way on his route, and it was really affecting his job. And he had signed up for my study. And during this study with the work with the HRV and the home practice, he began to have more confidence and he started driving over bridges again.
That's amazing.
It's a tool, it's not a cure, but if it can provide the people who use it with a way to get through a difficult situation.
Another veteran I worked with, he was able to attend his daughter's wedding after he started doing HRV biofeedback because he could tolerate being around people in a more socially dense situation longer. He was able to get through the ceremony and considered that a real win.
I really think that it can help with symptoms enough that whoever has trauma who needs this type of an intervention can start to carve back and reclaim pieces of their life and their ability to have good quality of life back.
So now what I'm doing, I'm not doing any research with biofeedback right now. I've been working with one tribe. Foundation. This is a foundation that serves veterans and first responders whose mission is suicide prevention.
That's their primary mission. But they do other work as well. I'm seeing veterans and spouses of veterans for biofeedback through them and doing mostly heart rate variability biofeedback with them as a service project is what I'm doing now and in the hopes that we'll be able to get a research project off the ground again soon in the future.
[00:21:17] Speaker A: Awesome. Well, I want to thank you for that. It's such important work that you're doing with that something that's dear to my heart. With that I'd love to ask you, and this again with researchers, I want to give permission to speculate because I know if you don't have hard data in front of you, I'm not holding you to this.
Let's move in. Unless you want to say I can speak to this with confidence because I have the data to back it up. But one of the earlier experiences in your career really fascinates me because I really think when you talk about it from a nervous system perspective, it's in many ways a unique experience, knowing that there was a whole lot of pain and suffering around it. And I want to acknowledge that piece of this, that it's not just, hey, I want to nerd out about this because it's interesting to me. I know that that's there of working with those helicopter pilots early on.
What we see and where this I think is fairly unique experience is you have a high performer, somebody who can fly million, 10 million, 100 million dollar helicopter in combat situations. So the cream of the crop as far as performance and response time and you've got a heightened nervous system that can respond incredibly well in high stress, life threatening situations, experience trauma to the point where that high performing nervous system gets dysregulated, to the point where it might not be safe to be in the helicopter.
And you worked with people not only to recover, but then get back to that high performance state where we trust them again to fly combat missions and 100 million dollar pieces of machinery with lives at stake. And I just would love to get your conceptualization of not only recovery, but really thriving, because I think a lot of times in the trauma work, sometimes we just are working so hard for recovery. But you're really almost talking about post traumatic growth in a very intense situation.
What were you seeing there? What do you think was happening underneath the skin with heart rate variability, the nervous system just again, give you permission to speculate, but in that work that you were doing, what do you think was going on to do that really important? Healing and then growth, recovery and then back to high performance.
[00:24:08] Speaker B: So when I was working with aviators, I was working with their goals and also safety was a tremendous factor as well. Some of them did not return to flying. That was not going to be, it wasn't in their future to return to flying. And they realized that was not a goal that they even wanted to pursue or could. Many of them did. Most of them did return to flying. Some of them had to take a break, they had to take a downslip for a while until they were able to get their symptoms back under control.
And some of them were able to continue flying throughout. It just really depended on the individual.
But I will say that not all of them were able to return to flying, although most of them were. So I worked with them around learning basic breathing exercises and mindfulness and things like autogenic training and progressive muscle relaxation. We did a lot of just the real traditional stuff as well, and heart rate variability, biofeedback, and I think it is very calming to the nervous system. And when they were able to begin to have mastery over these symptoms and see that a lot of it, it could have just have been a dysfunctional breathing pattern under stress, that they were able to correct that and they were able to see some of the physiological symptoms of that start to abate.
It gave them more confidence and realizing I have control over my physiology.
As their self efficacy there increased, their symptoms decreased, they were able to return to those activities that they were performing before. I think there's a lot of it that we still don't quite understand about fully how it all works. But some of it we do, a lot of it we do.
If you can stop the stress hormones flowing into the body and you can get some healing, then the nervous system starts to calm down.
It's always been surprising to me how quickly that can happen. And I think that it happens quickly because the correction in dysfunctional breathing and then breathing not against your cardiac system and your respiratory system, your blood pressure and all of that working together and not against each other. This idea that you're pressing the gas pedal and the brake at the same time. I think I saw a lot of active duty personnel who were experiencing that.
[00:27:18] Speaker A: Did you see one of the things because my initial work in my career has been more around homelessness, like that side of trauma, working in child welfare, foster care systems, addiction, those sort of arenas where we're trying to sort of, in some ways, get back to a level of functioning that may have been lost early on in childhood due to the horrific traumatic experiences with trying to get people if their goal was to get back into flying. Did you see that?
The education because this is one of just a passion of mine, kind of the psycho educational piece of this, isn't that there's necessarily something wrong with you sort of thing. That the concreteness of the nervous system for people that were probably pretty hard and self driven. Did you see that? Just education and understanding also impact kind of their motivation to engage in these interventions.
[00:28:24] Speaker B: I think tremendously when people know what's going on in their bodies, when they know what's happening, it's not as frightening for them.
And when they can see through biofeedback, like for example, that they have control, that they can make changes in their physiology and quickly they feel very empowered and I think that gives them mastery over trauma symptoms. Absolutely.
It's great when you can watch that the light bulb moment when that happens, when they realize, wow, these symptoms are happening in my body. They're very disturbing, they're very distressing. I feel out of control. But there are things I can do to dial that down and reassert some control.
[00:29:25] Speaker A: Love it. So again, maybe entering speculation again so just want to throw that give you permission to do so. But I'm curious about your current work and this may be again speculation, not necessarily where your work is at right now, but with first responders, another population that I've been exposed to, more so with my heart rate variability work. Just curious about the preventative side of this. Knowing that police officers EMTs, I work with a lot of emergency rooms folks. We're going to experience things that could potentially be traumatic for the individual.
I know things that if I just would experience with some of the folks I work with, experience on a typical Monday today would be totally overwhelming and traumatizing to me. It's just there Monday morning and it's probably going to be even worse in the afternoon potentially. I wonder just again, it might be speculation on your point, but looking at HRV biofeedback in the research article, we're looking at it as a treatment approach. Kind of would love to get maybe again, speculation or just thinking that you have about what if we started this in basic training or I'm really working with some I want to get into nursing schools where we know burnout rates, medical schools, police academies to start to get this in there early on as a potential preventative piece of this building, resiliency of the nervous system ahead of time. And love to get just kind of your response to that, your speculation about how this could be used if preventative is the right word measure as well.
[00:31:17] Speaker B: I love that idea. I really do, actually, and think that we could start in elementary school honestly, using simple heart rate variability biofeedback now that we've got mobile apps and it's just so easy to use a smartphone for these and every kid has one, these simple interventions could be well, they could be taught preventatively. Yes. And I think it would be very helpful. It won't prevent trauma from happening, but it will definitely help with managing the fallout of it, for sure.
[00:32:06] Speaker A: I'm curious about just I'd love to get your thought on this because while I totally agree with you, it won't prevent all trauma. I wonder, especially if we let's go to the military folks here.
Again, maybe speculation on this, but let's say we in basic training, had people practicing 20 minutes of HRV biofeedback. I love residence frequency breathing. So residence frequency breathing, 20 minutes a day. I wonder, and I'd love to get your thoughts on this if we don't get a nervous system that might let me put this in understandable language that we sort of increase the resilience of your nervous system. So things that might be traumatic if I'm not practicing because they're overwhelming, they may not rise to the level of trauma. There still would be things that would rise to the level of trauma. But do you think we could maybe minimize PTSD experiences if we get this as a preventative measure? Not all PTSD experiences, to be very clear, but I wonder if we kind of raise the resiliency of the nervous system to prevent some experiences of things rising to the level of trauma, if that makes any sense to you.
[00:33:31] Speaker B: I'd love to theoretically sure that a more resilient nervous system is probably going to respond better, and it could maybe result in when someone has a very traumatic experience that could possibly end up resulting in PTSD. Maybe it doesn't, but maybe it's more of an acute stress reaction. Maybe it's a milder reaction that doesn't evolve into full blown PTSD. We don't know. But theoretically, I would think that we could say that it's possible that that would be the result.
[00:34:17] Speaker A: Yeah. Love to do a research project with you that we were so successful they had to cancel the project and get the control group in right away. That would be my dream research project.
Whenever I get HRV experts on the podcast, I always love this question. And I love it because there's always this event.
I know there was in my own career. I never knew it would lead me to where I'm at today doing an HRV podcast. But there was that initial when you were a psych tech.
I remember I was working in residential child welfare facility when I first saw my first piece of Biofeedback equipment. Probably wasn't even good or accurate, but I was fascinated by the technology part of it and have been a nerd about it ever since.
You've seen this field and you have grown with this field over a couple of decades now. I would love to just get if you were to look ahead.
When you're looking ahead, 510, 15 years, with your experience in the field up to this point, where do you think we're going? What do you think are some of the things we're going to be thinking about, measuring, studying, moving into the future? Where do you think we're going with all of this cool science coming out?
[00:35:48] Speaker B: I think that Biofeedback will be integrated into virtual reality, that it'll be commonplace to have access know, I think that Apple Watches are getting more accurate with certain types of feedback in health measures. I think that we'll see where everybody has access to information about how their body is functioning in different biometrics. They'll be able to see in real time their HRV. You can do that on your watch now. It'll be a lot more accurate. It'll be in every game so you can see how you're functioning as you're playing a video game or if you're in virtual reality. We'll see it there. We'll see a lot more integration. I think AI into with Biofeedback, it'll become where what once was something that was done in a clinic is probably going to be going to be more ubiquitous in our lives, in our daily lives. And we'll start to probably use that information to make decisions about what we're doing.
We already do. When your watch tells you to stand up or that you need to stand up, you can stand up. If you see that your heart rate is too high. If you're looking at heart rate variability, you understand those metrics, then it tells you when to work out or not.
We start to make decisions based on our physiology.
I think that's where it's headed. It's going to be embedded into many aspects of our lives. I've seen shirts that you can wear that will give you that information. I think it'll be integrated into more of our clothing or we'll start to see that kind of thing. So we'll see that. And I think on the other side we're going to start to understand more about relationships between, for example, trauma symptoms and maybe different psychophysiological profiles so that work will become more developed as well.
And I know a lot of that is well underway around the world well.
[00:38:36] Speaker A: And I want to celebrate you and your work because one of the things is this biometric revolution is just taking off with, as you mentioned, smartphones, the Apple Watch we're all rooting for to get.
Also, I think what your work.
[00:38:55] Speaker B: Does.
[00:38:55] Speaker A: And so many of the people that I get to interview on this podcast is also using the biometrics as a tool for healing, growth, and resiliency as well. I think that it can get missed as we're so busy tracking that sometimes we forget that, oh, there's this whole complementary science here where focus on breath, other silly things like gargling and things like this can also improve heart rate variability as well. And I just want to celebrate you and your work for taking this science and really helping individuals who are struggling with a lot of anxiety, pain, PTSD and using it as a tool for healing. And I just such an honor to meet and talk to folks such as yourself who are taking this to really help make people's lives better. So I want to celebrate you as part of this future as well.
[00:39:57] Speaker B: Thank you very much. Matt, thank you.
[00:39:59] Speaker A: So great episode. I will put some information about Donna in our show notes. You can find
[email protected]. Donna, thank you again for all the amazing work you do, sharing that work with our audience. I'm excited for that next research project, and when it happens, I would really love to have you back on the show to talk about how your work progresses in this field, because I find that the article I read, I was like, I got to get Donna on the show. So thank you for your work and all that you do.
[00:40:37] Speaker B: Absolutely. I'll keep you posted. And thank you for the work you're doing to get the word out. That is phenomenal.
[00:40:43] Speaker A: Absolutely. Well, thank you so much. And we'll see everybody next week.
