[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'm Matt Bennett, and I am thrilled to have a friend of the show, HRV Pioneer, and one of my favorite people to nerd out with, doctor Richard Gewirtz. Back to the show. Doctor Gewirtz, I think it's number four episodes with you. It's just, I gotta say, when I started this thing, to know I could have somebody like, with your prestige on this show four times, I would have had to pinch myself back in the day. So I am really excited to have you back on the show to talk about just this concept of introspection.
Been just fascinated with this concept. And when we talked to Nate a few episodes back, he mentioned that he first learned it from you. So it's like, I don't need any more of an excuse to reach out and see if I could have another conversation with you. So just in case, and I really suggest folks go back and listen to our previous episodes together, but maybe just a quick introduction of who you are, and then we'll dive right into it.
[00:01:47] Speaker B: Okay. Well, I'm a distinguished professor at California School of Professional Psychology and Eliade International University.
And I've been working for many, many years in a clinical PhD program that has a health emphasis in it.
So most of the people that you know and that are connected to stuff we talk about came out of that health emphasis.
And they're great. They're great kids. They come in with a lot of interest and enthusiasm. There's a lot of stuff to learn, and they master it. If they master it, then you put them on your board.
[00:02:24] Speaker A: I love it, I love it. I love it.
[00:02:27] Speaker B: And so I've been involved in psychophysiology since I was an undergraduate, but since then apply psychophysiology over the last 30, 40 years. And that started off with very simple kind of equipment and simple ideas. But about 20 some years ago, I'm being a little bored with the traditional modalities.
Paul Lehrer and I started exploring heart rate, and heart rate itself was somewhat interesting, but not great. But then the technology sort of allowed us to start looking at heart rate variability.
And our initial thoughts were really all centered around the bare reflex and the efferent pathways from the brain to the heart and how that could help us understand the autonomic nervous system.
Little by little, though, as we begin with biofeedback of that, we started noticing really powerful effects on the brain around brain based systems, we think, like depression and anxiety, rumination.
And so that sort of forced us to really start thinking about pathways from the heart to the brain, from the bodies of the brain, which are afferent pathways.
And that also coincided with one of my colleagues who was studying a phenomenon called alexithymia, which is a particularly difficult trait that some clients have in therapy.
Literally means without words for feelings, with no words for feelings.
And these are very difficult clients because you can ask them about anything going on in their body or in their mind, and they really don't know how to tell you that they don't have any words for it. Yeah, it's not that they don't feel it, but they don't really have a good way of exploring it. And that's been seen for many years as a risk factor for talk therapies.
But it also kind of highlights what we've been interested in as we started to see the HIV biofeedback having effect on a number of systems in the brain, that possibly we should start looking at these afferent systems.
So we set on a series of studies that we first did, and then we also got Evgeny Viscelo interested in, and now most recently Maura Mathers group at USC.
And our first study was a fairly simple one. We just looked at something called heartbeat evoked potentials.
So these are little snippets of EEG and central placements.
There's a lot of placements with central placements that respond to stimuli. In this case, the stimulus is the QRs complex of the ECG, the R wave.
And the EEG folks for centuries have basically filtered that out because it's a way bigger signal than EEG waves, which are little wavelets. And this wave coming up from the r wave of the heart is a big tsunami compared to the wavelengths in the EEG. So for them, it has to be filtered out, otherwise they can't see anything in the brain of starting in Germany in the sixties, a researcher said, well, let's just see what happens. And we don't filter it out. We see what factors affect this wave. And it's an interesting wave.
If you look at the evoked potential, you see a giant wave, right? Almost just a few milliseconds after the R wave, which is just an interference of the R wave going to being picked up everywhere in the body. But then there's another wave that's about 250 milliseconds later, a negativity wave that's been shown to be a wave that is reflecting the way the brain is processing signals coming in from the body, especially from the heart, but probably from all different afferent sources in the body.
That gave us an idea that maybe we could study heart rate variability that way.
And this was star McKinnon, dissertations student, and we published that. And she did is she used four different conditions.
One was just baseline normal, the other one was a positive heart mass, positive buy in, where you think about something that you're really appreciative and lovely kind of thing, puppy dogs baby, something really positive.
And then when there was a negative buy in, where you think about a really terrible thing. And then we did 6 /minute breathing. We didn't do resonance frequency. Just taught people right on the spot, actually, with no training, just to breathe 6 /minute as best they could.
[00:07:32] Speaker A: Yeah.
[00:07:33] Speaker B: And what we found is that the positive viand made no difference. It was no different than the control. The negative did reduce how much the brain was paying attention to the heart rate, but the breathing really enhanced it.
So suddenly the brain was saying, this is a very interesting signal coming from the body, and I want to pay really close attention to it. So it really did a lot of processing of that wave during the 6 /minute breathing.
And so we interpreted that as meaning that somehow what's going on during our resonance frequency breathing, our low, slow breathing, is something that's a pretty powerful signal to the brain through the afferent, presumably through the vagal pathways.
We really can't prove it's vagal because it could be other senses or other pathways, but most likely it's coming up through the vagal afferent pathway, which is about 80% of vagal fibers.
[00:08:36] Speaker A: Yeah.
So keep going. I'm fascinated. You just blew my mind there. So forgive for lack of better questions. So what, like, I'm just curious, what does this start to mean?
[00:08:52] Speaker B: Well, for us, it was a hint of what we are getting is results that I was skeptical of at first, that the HIV biofeedback was having really powerful effects on anxiety and depression.
[00:09:04] Speaker A: Yeah, right.
[00:09:05] Speaker B: And since then, we have three meta analyses and lots of studies, some of showing. One meta analysis showed a 0.98 effect size. That's a big effect size on depression. A more conservative one was a moderate effect size. So why would that be? Why would breathing at a resonance frequency for ten minutes a day induce your depression? That was what the question always was for me. We knew it would improve the barrel. Well, we knew at that time it would improve the barrel reflex, the ability of the body to regulate blood pressure. And that had been shown in a number of our studies and visilo studies. But now we're getting these results time after time, where depression was even more greatly affected. So it made me think that that must be the pathway.
Christina Wang did the second study where she actually trained two groups of people. One, she trained in facial muscle relaxation and relaxation training.
So she used real EMG biofeedback and had them practice progressive muscle relaxation ten minutes a day. The other group got heart rate variability, biofeedback with resonance frequency determined. And over five weeks we monitored those folks. And what we saw was that, number one, as we've seen many times, that baseline heart rate variability numbers go up 25% to 30%.
So your resting level hr variability, HRV, which presumably reflects homeostasis of the autonomic nervous system, can be trained up 2025, 30% over the course of a few, three, four or five weeks. And now we've got many studies that have shown that.
But in addition to that, the evoke potential, the heartbeat evoked potential, also went up substantially, only in the HRV B group.
[00:11:06] Speaker A: Interesting.
[00:11:07] Speaker B: Actually didn't change at all for relaxation, nor did HRV change for relaxation either, for that matter. Wow. So it's not that relaxation is a bad thing, right? It's a good thing, but it really does not affect the autonomic nervous system in any permanent way.
So that gave us even more idea then two more studies out of our labs. One, Geneva, she loads started looking at spectral analysis of the bold response of the MRI. Bold response were with the frequencies. And he found that when people breathe at 6 /minute basically everywhere in the brain, some parts more than others are greatly affected by that and to the frequency of the breathing, whereas ordinarily those frequencies are way down low, they are nowhere near 0.1 hz. Okay, that's true. Pretty much everywhere I look. Some places, like the cerebellum, was even bigger than the motor strip and all kinds of places. So it looks like when you're breathing at that pace, the brain is getting a very powerful signal everywhere in terms of the, if the blood response of the MRI presumably reflects a neuronal response as well, probably does.
Then finally, Mara Mather, her colleague at USC, decided to pursue this after being a very renowned neuroscientist and did an amazing study, a series of studies that did heart rate variability, biofeedback with one group of healthy young people and then fairly healthy older people. And the control group got a very clever placebo, which was they were told to smooth out their heart and make it get lower.
They thought that was made sense to them.
The control group actually believed that they were in the actual experimental procedure. So it's a real great control.
[00:13:13] Speaker A: Yeah.
[00:13:13] Speaker B: And what she saw was that in, especially the left amygdala to right prefrontal cortex affect regulation system was greatly enhanced over four or five weeks of training. Only in the biofeedback group, the True biofeedback group, the sham group, actually even got a little worse, but not significantly. And since then, she's done three or four more studies, including one that showed reduction in tau amyloid plaques. Yeah, only in the biofeedback group and not in the other group, and a whole series of other positive effects on the brain. And I think her ultimate goal is to look at dementia and because that's her research area, so we'll see what happens in the future. She gets a lot of NIH funding.
[00:14:01] Speaker A: So that's kind of a topic, obviously, nowadays.
[00:14:05] Speaker B: Yeah, very hot topic. So we're very excited about it because that study is.
She had a 52 people per group. They all got pre and post mris. I mean, this was an amazing study compared to anything we've been able to do.
But it really reinforced this idea that these pathways, I mean, sort of clinically, we've thought about these for years, as people who are interoceptively aware seem to have a lot of psychological skills that people who aren't do not.
And so this kind of reinforced that the biofeedback was enhancing that and also kind of reinforces the whole idea that we might be able to measure interoception by looking at how the body is communicating with the brain.
[00:14:54] Speaker A: I'd love for you to dive into that a little bit more, because I think sometimes, and like said, I'm going to rewind and process what you've just given us already in this episode about ten times to make sure it all sinks in. But I think things like interoception and putting feelings into words. Well, I mean, I appreciate the neurological pieces of that. I think sometimes, you know, I may be guilty of this, too, with heart rate variability. Biofeedback, we're thinking sometimes about, you know, how well the parasympathetic or ventral vagal is regulating the sympathetic response. And we're diving into really complex neurological functioning here, which is then manifesting back into more awareness of the state that I'm in. And I just love, like, when you think about this, you know, what do you think is going on here that is getting such, these powerful results of just breathing at a certain obviously, really powerful pace?
[00:16:05] Speaker B: Yeah, well, that was what we didn't know. But it just looks like what's happening is that pathway from the viscera to the brain is getting enhanced with this training. And then there's many other areas we don't know. Like the microbiome also communicates with the brain largely through the vagal afferents.
And so there's a whole lot of interest in the microbiome these days. And yes, maybe how that is affecting. We don't really, it's too complicated right now for anybody to understand it very well, but we do know that that's a possibility.
And the, but the initial measurement part just was kind of reinforcing therapists impression.
[00:16:49] Speaker A: Yeah.
[00:16:49] Speaker B: That people who are sort of unaware of their feelings and body sensations have more problems in life.
[00:16:59] Speaker A: Yeah.
[00:17:00] Speaker B: And in fact, Chandra, the first person who did the evoke potential studies showed, and some later studies showed that, in fact, people who had that high evoked potential from their heart rate were much better able to predict what their actual heart rate was without feeling anything or just sitting there quietly. And then there's two or three other studies that showed kind of measures of consciousness seemed to be correlated with that evoke potential as well.
And there's one on empathy as well.
[00:17:32] Speaker A: Fascinating.
[00:17:33] Speaker B: So this whole idea that I think has been around for a long time, probably early psychodynamic theories about kind of mind body integration, that the mind and body are kind of an integrated whole. And then if we're nothing in tune with what's going on in our body, that is, that is a problem in terms of psychological adjustment.
That would be before we do any bio, nobody ever thought you could change that, right? So that was going to be just an immutable trait. If you're alexithymic, you're alexithymy. Well, now we think maybe HRV biofeedback is actually affecting those interoceptive paths and probably could be a benefit in talk therapies. And just for a whole variety of reasons that we're seeing positive effects. And that may be one of them. People do seem, I mean, clinically, you probably observed that people do seem to get more aware of their body sensations when they do the biofeedback absolutely. Because in a way, it's kind of a mindfulness exercise to step outside yourself and see what your body's doing.
In fact, Aaron Rolnick, the israeli psychologist, you might think about having him on. He's a fascinating guy.
You have to time it with Israel. But he has a whole series of papers on biofeedback as a kind of a mindful exercise, a way for us to step outside ourselves and be the observer of ourselves and why that might work in various ways. And it's an interesting idea that he has.
[00:19:20] Speaker A: One of the questions that I've been fascinated with ever since getting into HRV, biofeedback. And some of it's just my own practice, myself and Ina and I go back and forth because I'm not always the best student, though I try to be.
Is like, are we just. And it kind of goes back to what you just said, like, okay, so if I'm sitting there watching tv but breathing at my residence frequency rate, I do see, like, low frequency go up a little bit.
And I think I'm hitting the inhale, exhale. Pretty strategic. Like, I'm getting close. Like, I think even when I'm doing it focused, my mind wanders, and I miss that, too. So maybe there is a little bit more accuracy when I turn the tv off and off. Just focus on it. But I don't think it's an incredible difference between throwing it up there while I'm watching the soccer last night versus turning the soccer off and paying attention to the breathing itself.
I'm fascinated because sometimes when I read residence frequency breathing research or six breaths per minute, it's just like, you just kind of got to get your breathing pace right. However, when I look at my results, and I think most people see this is, I think if I shut the tv off and focus on it, I'm seeing better results. So I kind of wonder what your thoughts are. As if we could just have something buzz. And I'm inhale and exhale and doing God knows what.
I sometimes some research, I kind of conclude, hey, I get all the benefits. But I'm also finding that mental cognitive focus really helps my results. At the end of the training. I just love to get your.
[00:21:18] Speaker B: It's a great question. I don't think we really know the answer. We've been saying all along that do the resonance frequency breathing and try to achieve a mindful state while you're doing it.
But actually, we're saying that without any evidence at all, just clinical, clinically. I mean, what you've observed and I've observed is that if people really focus on it, it seemed to get a bigger peak and they seem to do better. But I don't know of any study that has actually compared those two conditions, wherever, where somehow I don't know how you would do it.
It's unlikely that you're breathing exactly at your residence frequency if you're completely distracted. But maybe we could teach people to do that.
And while they're watching a soccer game.
[00:22:08] Speaker A: Yeah, I mean, just like, I put it right up on the tv, and I don't do this anymore because I do want Ina to talk to me still. But, like, I put it right up there, and I'm pretty, like said, I think I'm pretty close, but, I mean, obviously, accuracy would improve if that's all I'm focusing on, you know?
[00:22:26] Speaker B: But.
[00:22:26] Speaker A: But again, I think I'm close enough. But I think it's like, I love to see the study of, because I think we get a lot more compliance with the 20 minutes a day. If somebody could watch not like Game of Thrones while they're practicing their breathing. I'm just. You know me, I'm the practical person of how do I. How do I get this individual 20 minutes and maybe, you know, watching Netflix.
[00:22:52] Speaker B: Uh, well, it would be interesting to put on. You put a pacer on it while you're watching Game of Thrones. What we do know is that other sources of resonance, like muscle contraction.
[00:23:03] Speaker A: Yeah.
[00:23:04] Speaker B: Or shifting attention, will produce a low peak.
[00:23:08] Speaker A: Yes.
[00:23:09] Speaker B: But not near as large as breathing. Yeah. So breathing is. Is by far the. The larger ones. And there are some people who think maybe we should combine them, actually do muscle tensing and breathing at the same time. That might produce even more. But breathing is far and away, in fact.
Well, as I said in the earlier study, just a positive mental attitude without the breathing, produces nothing in the way of this brain change. I mean, it's a good thing. I'm not saying don't put a little love in your heart. Put a little love in your heart. It's good, but it doesn't really affect these same pathways that we're talking about. So it's a great question.
We always instruct people to do it the way you just said, pay attention, try to be mindful. And we do have some evidence that people do get better at mindfulness when they practice HRV biofeedback.
[00:24:04] Speaker A: Yeah.
[00:24:05] Speaker B: At least in paper. There's only one way to do it as a paper and pencil measures.
At least right now, we could possibly. Somebody will be able to do brain networks that reflect mindfulness. There are some possibilities of that. Right now, I don't think anyone's done that. But we just assume based on people's self report that they get better. The anecdotes I always like are these computer engineers that I get to see sometime. They get referred to me because they won't go to a psychologist. Referral source says, well, this guy is not a regular psychologist. Go see him. And so. And I do nothing but biofeedback with him and start with, I don't say any. Anything about feelings and. But after about four or five sessions, then I introduce a mindful shift idea. And when I tried to do that in the old days, they would just look at me like I was from another planet. Like, you know, this is my mind, I can't shift it.
[00:25:07] Speaker A: Right.
[00:25:09] Speaker B: But I've had good success clinically with people saying, oh, yeah, I think I know what you mean. I'm able to kind of step out of myself a little bit, be a little bit more open minded, open hearted about my own self. And that's one of the things we think is happening with the HRVB.
[00:25:26] Speaker A: Yeah.
[00:25:26] Speaker B: And it may actually be affecting the interception in some ways too. These are all jumbled together. But that's a good question, though. I don't think I could talk a student into doing a dissertation. Maybe I could see if I can get a student to do a dissertation on trying it distracted and focused and see if we get any difference.
[00:25:46] Speaker A: Yeah, yeah, exactly. So if we like, you know, and in doing the trauma work that I've done over the years, I mean, there's, there, there are. And I love the, you know, and I've done a lot of work with schools, like social emotional education. Like it's all about, in many ways, putting your, you know, having reflection on your internal state. And maybe that's, hey, I'm in the blue zone or I'm in the red zone or the yellow zone, you know, and always trying to use words. I've been, you know, kind of hyper aware of, I believe, Broca's area. Sometimes the workies and brocas gets, I think Broca is the expressive, like we see that underdeveloped with trauma and harder to put, which puts something on the clinicians is, hey, just, you know, we gotta be. We gotta, you know, kind of help people do this. And this is why, you know, up to the extent where we've got folks who have disassociated because of complex trauma being just out of. I mean, I've seen this with some of the special education students I've worked with. Like, there is like this just fascinating disconnection and tragic from mind to body. Like, it's almost just, there's something horribly disruptive there that there's very little insight to that point. And so this is what really fascinates me from that clinical application perspective is so, so such difficult work, especially with complex trauma folks who are, have disassociated with as a survival technique to reassociate is just incredibly intense. And while I'm always cautious of saying, hey, just do this breathing exercise, because it can be a trigger for a smaller population within this already small population, I'm just really curious about the clinical aspect of maybe starting with the breathing to start to reestablish or support. I don't know if reestablish is the right word, but strengthen some of these pathways or activate these pathways. Maybe you can give me better language to start to reestablish an integrated system that has been so disrupted due to trauma, traumatic brain injuries. I've seen some, some issues there with this as well.
So.
And I may be asking you to speculate from where the research currently is, but like, for those who want to apply this, it seems like there's a range of really exciting potentials here.
[00:28:32] Speaker B: Yeah, yeah. And I think you're exactly right and has to be done carefully. So I actually did write a chapter in the Handbook of Trauma psychology, my colleague, Constant Dollenberg, and she's a super trauma therapist and was president of the Trauma divisions 56 of APA. And so she's incorporated this into her therapy.
We try to do it as carefully as we can. So just that your insights are right. So what she does is she tries to start with the slow breathing and try to create a safety net for these clients so that they feel comfortable with it. And very few of them, if you do it right, very few of them get triggered by the breathing. Occasionally you do get that and you have to kind of work around it. But mostly they, they much rather do that than re exposure to the trauma.
[00:29:26] Speaker A: Right. Yes.
[00:29:27] Speaker B: That's horrible. Yeah. So before she even introduces the exposure hierarchy, she gets them safe, you know, and porges idea, this kind of neuroception idea, I think, fits here and then. But we do believe that you do need to also do the exposure.
I think the evidence is pretty strong that only exposure type techniques really work.
So we kind of incorporate those things together. And what we're just, as we're saying earlier, we're positing that not only is it give you a safe feeling, but it's actually enhancing these inhibitory affect regulation networks in the brain that enable you to actually be able to do an exposure without going into dissociation, without going into a terrible panic attack.
And we're still trying to do a really big controlled trial to show that adding HIV biofeedback to either prolonged exposure or cognitive processing makes a difference. But we have a case study we published which showed about a 25% boost in outcomes when you added HRV biofeedback to CPT or prolonged exposure using either CBT or act. So I think we will see that in the future.
Then there's also the other side of it that I think you heard from our speaker a few years ago, Ruth Lanius, where she's looking at these salient networks, sort of rumination networks in the brain in trauma patients, and using this kind of neurofeedback with that. And she's quite interested in how that fits in with what we do, too, although she doesn't do much of that. And so I think we're getting closer to understanding a little bit of the very complex things that happen to people. As you say, it's a nature's defense system trauma for something that happens that should never happen to anybody. But if we can understand exactly how the brain is modified by that, I think using body techniques, van der Kolk may not be accepted by everybody, but certainly his idea that including the body is now pretty well accepted in trauma world. I think so, yeah, absolutely. So I think we ought to be paying attention to that.
[00:31:57] Speaker A: Yeah. So I'm curious on the other end of this, maybe on the other end of the spectrum. Well, one, just a piece of comment, because this is where I'm really interested with, like, what Fred Schaefer's doing and others around the contraction, because I think for some people that could be a safer way, even maybe if not as powerful originally, if we can even tap into 50% of the power of the breath. But it's a safer thing. Maybe we work up to the breath eventually, but it's maybe a good entryway into that. And if they're focused on contraction while breathing, whether it's an additive effect or just we're getting to the breath, I think there's some great potential ways we can help avoid the re traumatization piece. So that's, that's one of my excitements around this research, is for those that breathing isn't a safe thing. And again, where I think we're talking about a small, small fraction, especially if they get social support along with it.
I think what Fred and his folks are doing is, and others is really potentially powerful just to make it accessible to more folks.
[00:33:12] Speaker B: Yeah, well, and it just. It just shows the power of resonance, anything that triggers at that resonant frequency. Remember Paul Lair did a study with pilots in a. In a simulator.
[00:33:25] Speaker A: Yeah.
[00:33:25] Speaker B: He just. Every 10 seconds, he had them go up, go down, go left, go right, and also got a peak.
[00:33:31] Speaker A: Yeah.
[00:33:31] Speaker B: And we get peaks from Evgeny. Did one with drug people in drug rehab, where he showed them drug paraphernalia every 10 seconds, and it got a peak.
And as they rehabbed and detoxed, that peak went down.
[00:33:49] Speaker A: Oh, that's awesome.
[00:33:50] Speaker B: So it's salient. The more salient the stimulus, the more. The more it works. But, yeah, absolutely. Anything that you can do at that resonance frequency will produce some of that. And I think Fred's idea, your idea, that for some people, this might be a good introduction or safe way to do it, and there's. There's no doubt it works. It's just a way smaller effect.
[00:34:13] Speaker A: Yeah. So now I want to go those kind of engineers, those very intellectual folks that are referred to you not to do any of this soft talk therapy that folks like myself do. So, I mean, I'm assuming. And maybe stereotyping here, but, uh, probably very much in their heads. Uh, probably not. I wouldn't call it disassociation. That's probably too strong for most of them.
[00:34:43] Speaker B: Oh, no, no, no.
[00:34:44] Speaker A: But, but a disconnection from maybe any kind of introspection of their state. So I. I'm curious of, as you work with them, is there more? Well, what do you see with that group, which is kind of highly specific as well?
[00:35:04] Speaker B: Yeah, well, some of them are on the spectrum. Some, you know, some.
So if you. If you're slightly on the spectrum, and you're really great in math and science, and you get a degree in computer science and you go work writing code all day. Yeah, right there. Those folks, typically not, are not the greatest social creatures in the world. The joke is that how do you.
What's the definition of an extroverted computer scientist? Someone who stares at someone else's shoes.
So these guys, I mean, a lot of them are south asian, and it's just part of that culture for males to not do touchy feely stuff. There's a whole series of events. But, yeah, I. But they love the science of HRV.
[00:35:58] Speaker A: Yes.
[00:35:58] Speaker B: You know, and when I first see them, I give them the most technical explanation I can come up with, right. All the parameters of the spectral analysis and they think, wow. So right away they say, well, this is not a touchy feely psychology.
[00:36:12] Speaker A: No, no.
[00:36:14] Speaker B: So that gets their attention. And then when you hook them up, they're fascinated, of course.
[00:36:19] Speaker A: Yeah.
[00:36:20] Speaker B: And so after a little while, then you can kind of delve into some of these other issues. They're trying to strengthen those pathways that would help with that. So actually, I love working with those guys, actually.
And they're very happy customers and they don't come in and spill their guts and tell you everything wrong in their life. They come in with very, now I have a problem for you today.
[00:36:45] Speaker A: Yes, yes.
[00:36:46] Speaker B: My girlfriend says I never listened to her.
[00:36:51] Speaker A: Well, that's probably, I mean, that was kind of my follow up question of working with that population as well. Again, more in the special education world. So maybe somewhat more severe. But understanding the Persona and whether they may be severe, they also have tremendous strengths in other areas.
I was going to ask about the relational side of this because I'm wondering, as you see improve interoception, I'm assuming that that has, whether it's quantitative or just qualitative from what you're seeing, improvements on relationships as I get more in touch with my own self in states.
[00:37:34] Speaker B: Yeah, that's our clinical impression.
I don't know if we have any real data on that, but my impression is people, it just kind of changes their attention a little bit also, it maybe gets them to practice some behavioral skills. Then you can teach them. Right? You know, like, listen.
[00:37:57] Speaker A: Catch yourself wanting to talk.
And I do the same with professionals too. So. Yeah, it's like when you catch yourself, mister physician, wanting to solve all the problems. Just shut up for a second and listen.
It's a universal problem. We all have the answers to everybody else's problems, right, right.
[00:38:17] Speaker B: Except our own.
[00:38:19] Speaker A: So I'm curious, as you have seen, because one of the things I'm seeing now, and I saw this in Nate's workshop at AAPB, a lot of excitement around this concept of introception. I've done a deep dive into literature. We've got aspects of it, different strategies. I think what Nate does maybe better than most people that I've seen, is take these complex subjects and then really bring them into the interventions that he is doing supported by the HRV biofeedback that he does in his practice as well.
As we get excited about this, and I'm a good example for you, it's like, oh, I need to go train the world on this concept because it's so powerful.
What do we need to, like, maybe it's like, okay, Matt, you might want to just pause here or what should we, as folks who want to go apply this, hopefully with some good HRV biofeedback support, just, just maybe, you know, things that you would put on our radar is you may pump the brakes on this, you may go full force on that. But just any maybe suggestions that you might have for those really excited to.
[00:39:46] Speaker B: Go implement this just like anything else, I think we should. We need controlled trials. Yeah. I mean, you know, so many things work that are just placebo. Yeah. And so, and you convince yourself that what you're doing is unique and great, but it could be that anything else you did similar would get the same results.
[00:40:04] Speaker A: Yeah.
[00:40:05] Speaker B: I would always want to see some kind of a controlled trial where people did some other procedure that was credible. Yeah. And, you know, and that's the problem with neurofeedback. Right. Because we have so few trials with a credible control for it.
And when the ones we do seem to, the controlled trials seem to work as well as the actual feedback trials. So then you wonder, what does that actually mean?
So I would just say we try to be as science based as we can with HRV biofeedback, even though people get really excited about it and want to extend it.
Especially Paul has been really good about saying, wait a minute, let's look at the data first.
[00:40:55] Speaker A: Right.
[00:40:56] Speaker B: And only when we have some data on this kind of stuff. And like, even on the trauma, as convinced I am by my own experience with it, I really think we need a big control trial showing what the difference is when we add HIV biofeedback to already empirically based therapies. And how big an effect is that? And is it an effect? Is it just a placebo?
I'm pretty convinced it's not, but I would caution anybody to believe me until they saw a better trial on that. Yeah. And there have been psychodynamic interoceptive techniques for sentinel for decades, but as far as I can see, there's almost no empirical support for that. So. Yeah, I mean, not that there is. There's just no one's done. No one's tried to show it one way or the other that I know of. I might be missing it, but, yeah, they might have a better feel for that literature than I do.
[00:41:52] Speaker A: Yeah. I mean, I think it's just, it's one of those things that I know in my training is so important that it's. I mean, I mean, it's just almost an assumption.
And maybe again, because when I was trained, this is important, I would assume there's good research behind it, but that obviously maybe my teachers also thought that when they were told about it too. So a little homework for me to do from this episode as well.
[00:42:25] Speaker B: Well, even around Alexithymia, there's tremendous differences of opinion about how you measure it, what the scales are. One of Doctor Dollenberg's, my colleague, student did a dissertation on alexithymia, heteroception, and it turned out to be really complex.
What exactly do we mean by that?
There's several scales that don't even really look much like each other.
So it's really, and you know, that's going to be a very tough, maybe with some MRI stuff we'll be able to get more information about it. Right now it's very subjective on self report.
[00:43:06] Speaker A: So, yeah, I mean, I'm always just humbled by the complexity of, you know, how, as I kind of joke is, I can tell you what an emotion is, but I need a semester to do so, like, you know, it's. What is happiness? How does happiness show up in the brain? I think the findings of positive trying to elicit a positive state is not showing up. I mean, it could have other positive effects, but I, you know, and I also think it's interesting, the negative does have some impact, which our negative bias might show up for some of that. But you know, the complexity that we dive into here, which I just love that we're seeing very quantifiable impacts of something like strategically paced breathing, because that is simple. And we're getting some of these results in this mess of complexity, which is the brain and the nervous system.
So my final question for you today is you've been doing this work for a long time, and if I know you like I think I know you at this point, after hours of conversation, it's not just how you help other people with this science, but I'm sure you've like, you've done it with yourself as well over the years. Probably not while you watch Copa America. I'm sure you're better than I am. So I kind of wonder, like when you think about this topic and the evolution of Doctor Gewirtz from that undergraduate student to where you are now, how have you, how have you seen it for yourself as you've gone through this professional? But I'm sure there's a personal journey that parallels this with your own health and wellness.
[00:45:08] Speaker B: Yeah, there's several. So one thing is, I was a total failure at meditation.
I have a really busy brain and especially transcendental meditation. To me, that was just. Yeah, it was actually torture. I couldn't do it.
Mindfulness was a little easier, but actually, as long as I incorporate breathing, I can kind of do that. So, yeah, I use it for everything. I use it. I had an MRI, and I'm not even claustrophobic, but they put me in that thing, and this banging right in your face, and I think, this is not pleasant. I immediately went into my resonance frequency breathing and almost fell asleep. So that really worked on that for almost any, you know, dental procedure. Anything, anything at all that's stressful. I just almost on autopilot, go into Billy 6 /minute breathing. I can do it without any pacers. Yeah.
And I do a little bit of it on workouts, too, like, at the bottom of hills before I climb on my bicycle, I try to do some slower belly breathing a little bit. There's some reason to believe that might be helpful. I don't know, but, you know, after you're on the hill, you just breathe.
[00:46:23] Speaker A: Yeah, I know.
[00:46:23] Speaker B: I know.
[00:46:25] Speaker A: Yeah. I see the same things up here in the mountains of Colorado and hiking or mound biking. Like, I try to do the nasal breathing, keep. Keep everything regulated, and then, boy, that lack of oxygen is. And then I'm like, I'm almost hyperventilating because I've tried to control that. So I think that.
[00:46:47] Speaker B: Yeah, your body knows better than.
[00:46:50] Speaker A: Yeah, I know. I know. There's only so much control. It's okay. Stupid. Let me take over and keep you alive.
[00:46:59] Speaker B: The other thing I do is, in the clinical sessions when people are practicing, I do it with them.
[00:47:04] Speaker A: Awesome.
[00:47:05] Speaker B: And. And, you know, I've developed a very strong diaphragm, even though I have, my abs are pathetic.
And so I. Even with really, really conditioned athletes, I challenge them to a strength on the diaphragm. Strength. And I have always have a stronger diaphragm.
[00:47:21] Speaker A: Wow.
[00:47:22] Speaker B: So that really gets their attention in a hurry when they do that.
[00:47:26] Speaker A: Yeah.
[00:47:27] Speaker B: And I make my interns show me that they have strong diaphragms before they let them treat anybody.
[00:47:35] Speaker A: That is. I love that. That is so cool. Cool.
I mean, I'm really excited to see.
I appreciate you coming on and giving us, really, this neurobiological model to think about this, because Nate gave us kind of the. I would say the psychological. Obviously, bringing in heart rate variability gives us that great shared language of application and research, uh, with this. So. So, you know, I was like, well, you know, I know doctor Gerverse has something to add to this, but I was like, maybe there's too much overlap here and honestly just two incredibly complimentary episodes on this topic that I hope to hopefully just continue to explore because I like said, it's been such a key thing and the more introception I have, like you said, whether I'm hiking up that mountain and starting to change or whether there's you know, my, my flight which always seems to got delayed again for a half hour and I really want to scream at something or somebody just, just that recognition of anxiety and then the ability to then use the breath to get my state back into something that you know, just, I'll be a better version of myself even under stress. I think such a powerful thing with HRV having some really good impacts all directions of that.
[00:49:14] Speaker B: A positive of the interoception is that it's a bridge to a population that don't understand any psychophysiology at all. But within the therapy worlds, that is a code word that's of great interest.
[00:49:28] Speaker A: Yes.
[00:49:29] Speaker B: So if we can kind of. I think Nate does a pretty good job of bridging that those two worlds together and we can bring more therapists into our world, I think would really be good for the world as well. So yeah, I'm positive about integrating whatever we can into helping people. So.
[00:49:49] Speaker A: Yeah, well like I said, I can't think of a better homework. We love as therapists, we love our homework assignment and resonance frequency breathing. Sure. We're going to still ask people to journal because we're not ever going to stop that, which is probably very, I mean, when I say that out loud, probably very complimentary to everything we've talked about is what we were trying to do is having people reflect on the introspection, having that piece, putting into words what they're feeling, what they're going through, what they're thinking. Boy, you couple that with, if we can work people up to that 20 or even 40 minutes of residence frequency practice a day, I just think we can get people to the outcomes they want, hopefully in a much more efficient and effective way, which is the goal of psychotherapy, biofeedback, all these approaches, any kind of healing is to get people healthier. And I think that, like I said, it's just such great homework to give folks to support everything we're doing in session.
Well, Doctor Gervertz, my friend, thank you so much. This has been a, like I said, I got that whole first like 510 minutes. I'll go listen to about 20 times to try and let that knowledge seep in. But, my friend, thank you so much. I'll let you go get a bike ride in here. And we're working on that residence frequency breathing at the bottom of the hill, so, hey, I appreciate you, my friend.
[00:51:27] Speaker B: You too. You're doing great work. Hang in there.
[00:51:30] Speaker A: Thank you so much. And as always, you can find show notes and everything
[email protected]. and we'll see you next week.
