[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.
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Welcome friends to the Heart Rate Variability Podcast. I am back with a past great guest of mine, Dr. Heidi Hillman.
She has just published Effectiveness of HRV Biofeedback in Decreasing Anger Among Adolescents with Autism Spectrum Disorder and I am so excited to talk to her about her research.
Heidi, welcome back. It is so great to have you back on the podcast. Obviously you've been up to something really cool, so why don't you just, if somebody hadn't heard your previous episode, maybe just a quick introduction before we nerd out about the research you've done.
[00:01:16] Speaker B: Okay, so I guess a little bit about me.
I'm a dedicated researcher and advocate in the field of autism, so if you read a lot of my stuff you'll get that flavor.
I have published extensively in peer reviewed journals on topics such as anxiety reducing techniques, biofeedback, collaborative strategies for working with parents of autistic children.
My work bridges research and practice focusing on empowering families, enhancing self regulation skills, promoting just neurodiversity.
And since there are very few researchers in the autism field who are actually autistic, I am an autistic and so I am committed to supporting the autism community through education and evidence based practices. So you know, I, you know I've, I've kind of gotten into it to this area because I feel it lends more credibility when it's a person who knows like their participants a little bit better.
So that's just a little bit about me.
[00:02:57] Speaker A: Awesome. So I'm curious, there's, there's usually around a good research paper there, there's usually at least a story behind it and obviously sharing that you've got lived experience in this area which it informs your work. But I'm curious, you know, you're putting HRV biofeedback along with, you know, autism, but also specifically around anger as well. And I'm curious just sort of what, what got you interested to do this specific study?
[00:03:31] Speaker B: Okay, so it basically was a dream that became a reality.
So it's this, this has started ways back.
So I worked with a student of mine who said, did you know that there's really not much research in the field of anger and biofeedback. And I was like, really?
And he was a very angry person and was trying to try all these different techniques about to work.
And he was introduced to biofeedback.
So he found it like, wow, this was really changing.
So we did a literature review on biofeedback and anger, specifically on anger management.
So that stuck with me when in the autism world I thought, huh.
Autistic teens often experience more anger due to a combination of neurological, sensory and social factors. So since their brains process stimuli differently, making them more vulnerable to like sensory overload, such as loud, loud noises, bright lights, chaotic environments, this can trigger this intense stress response which, which usually comes out as anger.
So then add on to that where then they have challenges with the emotional red. It's array. It's a regulation.
And then come it's, it's communicating those, hey, I'm, I am experiencing this overload. So usually it then comes out as this anger explosion.
[00:05:38] Speaker A: Yeah.
[00:05:39] Speaker B: So working with autistic teens in my private clinical psych practice, I was seeing this anger, like, let's work through it through a therapy model. And I had this thought of like, okay, what if we actually worked on like this biofeedback?
Because autistics love very concrete things.
And so here you have this concrete thing to help you breathe, to help you focus on, for a better lack of words, your internal functioning. Yeah. You know, just, you know, reducing that anxiety.
So could we use that with these, you know, patients of a mind? And then once we do with that, could we actually add on, you know, a de escalation technique?
Because just the biofeedback by itself self, you know, may be e effective, may not be e effective. But then what if we also taught them this pre getting mad type of technique? And so it was this marriage between my clinical background and biofeedback. And the results showed that all of the participants experienced a decrease in not only the number of anger episodes, but also the severity of the episode. So the intensity.
And then when the de escalation component was added, the number of anger episodes and the intensity of the anger both decreased further. And so, you know, this evidence shows that here we can combine. And then the really cool thing that I'm like, you know, is this is the first article that has tried it.
Mean, granted, there's three part participants, it's a very small sample, but wow. I mean, it's the first article that is out there that has studied anger among autistic teens as well as the first article to combine this psychological therapy with a physiological thing, biofeedback.
[00:08:37] Speaker A: I love that too because I mean just you know, with my experience with autistic youth, like you know, in working on one end of the spectrum where they, there, there was violence, the anger was too violent for them to be in a typical public school setting. So it was not, you know, it was that, that piece of the population. I know we're talking about a very diverse population on every level.
You know, it's like I think we tried and we're you know, working with occupational therapists and sometimes just trying to figure out what they were telling us might be a good coping skill for them to kind of keep regulation throughout the school day. Whether it was brushing, we had a bouncy chair, you know, some just stimming. You know, we weren't thinking biofeedback 20 years ago with that, but it was more from an occupational therapy side. I just love the de escalation of your calm in the nervous system down through HRV biofeedback and then getting in front of it, which I don't think we were even.
We were just trying to control the moment, control the anger. And I would love to hear like what de escalation techniques worked for these youth because those results are just so incredibly promising that they could really be, you know, go from three people to a much wider population.
[00:10:20] Speaker B: So it is the d escalation come addition was.
I taught the participants what I call a four step de escalation strategy.
And so this is what they use when they start to feel those emotions, they start to feel those as symptoms.
So instead of you using like the biofeedback as here we're going to work on our breathing here is, is, is, is something that is very concrete because an, an autistic is a very rule governed person where if you give them a rule then that's what they follow.
[00:11:12] Speaker A: Yeah.
[00:11:12] Speaker B: So I taught them that when you start feeling these, these behaviors and, and we talked about what anger feels like or, or that anxiety, you breathe in slowly for a four and then you exhale for a four. Something similar that we use with the biofeedback device.
[00:11:32] Speaker A: Right.
[00:11:33] Speaker B: Then you're going to say to yourself like you know, you can say out loud or just in your head, you know, I am angry, I am feeling mad. And that is okay.
So instead of trying to shove it down where most treat it's it's treatments focus. It's a focus on, don't exhibit it. The second thing is I'm feeling This way and that's perfectly fine.
And then the third thing is where is your happy place?
So we all talked about, you know, what's your happy places.
And for one was petting their dog. For another one was going skateboarding. For another one was, you know, just painting and just, you know, just slapping paint, you know, just on a canvas.
[00:12:28] Speaker A: Yeah.
[00:12:28] Speaker B: So, so it's, the third step is now imagine being at your, your happy place. So if you can't get there, then let's, let's think about that and now let's remove us from whatever environment you are in right now and let's go to another place.
[00:12:52] Speaker A: Yeah.
[00:12:53] Speaker B: Is that going for, for a walk?
Is it going to your room?
Is it saying I need a break? You know, but in, in, instead of staying in that environment, we're now moving out. And so it's this four step, very simple strategy that then once they start feeling angry, they start walking through this.
But before this we did the biofeedback. So they got in tune with what it felt like to do those deep breaths in and deep breaths out and to feel what it was like. And so here's just like this added more of a cognitive piece of we're talking to ourselves and now we're removing us, you know, from the environment.
So that was biofeed by. Its biofeedback was put in first and we saw a d, a d increase.
And then after that we put into, or I did the escalation technique and then we saw a further decrease in both the anger episodes and the in intensity.
[00:14:21] Speaker A: So one of the things that is really a hot topic in the HRV biofeedback world right now is interoception of being able to be aware of and be conscious of your internal states. And it's just really powerful that what I think we're seeing is being able to catch it before the dysregulation turns into at least angry behavior. It may be anger already, but angry behavior. I'm curious if, if you ever thought about, if do you think the biofeedback practice allowed them to kind of have that sense of self that, that identification of anger. Whereas if you just went to the de escalation without the biofeedback, it may have been more difficult for them to connect with.
You know, it's boiling up right now like it's coming, right. Do you think that that's where sort of the biofeedback might have been beneficial to these young folks?
[00:15:34] Speaker B: That's a great question.
I actually haven't thought of that question. But I think so, because with the biofeedback, the thing that the participants really liked was that you had this light and you had to behave in a certain way to get the light to a change.
And so they had to learn what that behavior was and how to do it.
And that's a lot easier than me trying to explain. Oh, okay, now try this.
[00:16:17] Speaker A: Right.
[00:16:18] Speaker B: I want you to take a deep breath in and I can't see, you know, how deep that breath is or you know, and so the biofeedback sense, it has that concrete thing that they move.
I firmly believe that that, you know, helped and then the de escalation. What I think really then, then had the impact is anyone who gets mad, you know, we all, all know you have that bad day and it's that one thing that just sets the day off and then everything else after it is just crap, you know, and it's just this crappy day. And so what happens is, is when you get mad, your cortisol levels in it's, it's increase and it takes like 45 minutes for it to decrease out of your body. Hence anything after that initial crappy day experience, it just leads to more cortisol and it leads to more, more stress. And so one of my hypotheses is, you know, blends off that question. The biofeedback helped teach them this breathing behavior, then the de escalation, you know, techniques since we're getting at more of a physiological, the amygdala, the cortisol.
And so since cortisol levels peak shortly after that anger, you know, onset or a behavior.
As participants experienced fewer anger episodes, it could be be likely that their cortisol levels were actually lower, reducing their sensitivity to these triggers which then previously had caused more intense anger episodes. So as we're seeing both the intensity go down, we are also seeing the number of episodes go down and the intensity I hypothesis, well, mine is, is that it's somewhat caused by this de escalation that like you said, we're catching it into the beginning.
[00:19:02] Speaker A: Yeah, yeah. And I wonder like, because again with my experience, sometimes you can change your environment.
Sometimes it gets a little harder to, you know, walk out if you're got a job, you know, a little bit depending on how cool your boss is. Sometimes, you know, I, I think our youth needed to get away from the environment, but sometimes they just ran a little too far away to, to do that. So I, I, I, I would be interested. Like you know, do, do, do you think that they maybe could eventually, you know, keep in that environment and manage their stress. I, I just, I just kind of think about like sometimes that's a possibility. Sometimes I, I think we do them disservices.
Sometimes I'm not letting them go, you know, but, but the reality is in some situations you can't. So I, I wonder if like you, you think there's almost a potential another step of maybe excusing for a moment but then coming back like, like, you know, using, using the breath to manage within a situation like that. Because I love changing the situation when it's sort of possible to do so.
[00:20:24] Speaker B: I totally think so.
It would.
The way that I would run with that is if I want the individual to remain in the environment.
So one thing that I write about is that instead of making the autistic change for their environment, maybe we should change the environment for the autistic. And, and so like, you know, I wrote an article on modifying the, the work environment to fit a more sensory diverse population.
And so then it actually helps everyone.
[00:21:11] Speaker A: Yeah, that's what I was gonna say.
[00:21:13] Speaker B: You know, it doesn't just help this or this or one. So. But let's say we get to a point where we're teaching jobs, job, job skills.
[00:21:23] Speaker A: Yeah.
[00:21:23] Speaker B: And we are t T. It's a teaching that sometimes like you're in a meeting and you would get pissy and you can't just leave. So how are we going to work on that? I would start with actually having them leave.
[00:21:39] Speaker A: Yeah.
[00:21:39] Speaker B: Calm down. And then we have practice them, them staying just a little bit longer in the environment but doing these cognitive things like going to Amaya happy place, realizing that I, I can leave but it's going to take, you know, a little bit of time here.
But in the beginning I would actually allow them to leave and then we slowly work back to, you know, then you would stay in here for a little bit of, of a time since there are, you know, times or this normal people do it all of the time. They are in a setting and they can't leave.
[00:22:29] Speaker A: Right.
[00:22:30] Speaker B: So they put their mind to something else. The phone comes out, a tablet comes out, they start twiddling their fingers and staring at their hands. They are basically stimming, you know.
And so then that's what I would also teach them is to give them some, some coping mechanism that then helps them remain in the environment.
That it's not just you have to stay here, stay here, you know, but also give them some coping things where you don't have to engage. You can disengage but you're still present. Yeah, if that makes sense.
[00:23:14] Speaker A: Absolutely. And that's like. I'm thinking about, like, how we set up classrooms in the school of having a place to. To. To go, you know, and again, some went too far. You know, you can't go to the next town or you can't go on the interstate, or, you know, there's. There's safety things concerned with that. But just trying to find a alternative, you know, while making the environment, like you said, more sensory friendly to the students, you know, that, that was. I mean, we have harsh, harsh environments in our society that aren't good for any of us, like you mentioned. And that's where, like, you know, trying to work with them because our goal was to get them back more into a public school setting with all that stimulation and everything going on. I was in a middle school hallway way, you know, a few months ago, and I was overstimulated. Like, I, like, I couldn't imagine the students we had while walking through that. It's just so much going on, you know, and trying to find those solutions with that, I think such a powerful way. And then to work again to get.
What are those coping skills and does that breath come, you know, like I said, maybe that eventually becomes it, but looking for a way to, you know, self stim, for lack of a better word, or maybe for the right word, to stay in that. That environment, maybe even a little longer, if it's safe for them to do so.
[00:24:54] Speaker B: Yeah, it's like one of my participants, you might find this as a funny story, but it's when I was going through the d.
Escalation and he was one of my older ones, and I said, okay, now the third step is, you know, you go to your happy place. And he goes, wait, wait, wait, wait.
Is that Happy Gilmore? I go, yes, exactly where I. I got it from. And I'm laughing, going, yes, him in golf. He was told, now go to your happy place.
[00:25:30] Speaker A: That's hilarious.
[00:25:31] Speaker B: And I'm like, yes, yes.
And so then that really helped him because he had just seen this really, really old movie, a Adam Sandler, you know, Happy Gilmore movie.
And he got it. Then he's like, oh, you know, and it was like, yeah. And so I'm into a. That where it's now, like, if we compare things, like, they understand, they know. And so where is your happy place? You might not be able to go skateboard, but what do you feel like when you can or just like, try, try to imagine yourself back in that spot and hopefully we get to kind of reduce the anger, relax you so that now you're presently in that spot.
And so, but another one of my participants, you know, when, when I said, you know, now the fourth step is you want to remove yourself from the environment.
And he is like, well, yeah, that seems like the most logical thing, you know, because the environment's making me mad. And I'm like, yeah, yeah. You know, and so it's, you know, this could be, you know, applied to a schools but I, I would caution of not just to make them stay in that environment, you know, like a middle school like you imagine it would be a slow infusion.
[00:27:12] Speaker A: Yes.
[00:27:12] Speaker B: Into this world. Where, where do they get used to the various stimuli? And when they get over stimulated, that's when we pull them out.
[00:27:23] Speaker A: Right.
[00:27:23] Speaker B: And then say oh, okay, you know, and so you might have one kiddo that can only handle it for a minute and we have another one who's good for four or five.
[00:27:35] Speaker A: Yeah.
[00:27:35] Speaker B: You know, and, and so then it's really dependent on. Yeah, but you would bring up a really great, great point of, you know, what if you can't leave? Well then we would just stop at the step three where it's, you know, you are doing this imagination but you're doing the breathing first.
You're, you know, focusing on that. And then you would bring up a great, great point that since biofeedback came first, we can't tease out what, what, what caused, you know, a decrease.
We saw that biofeedback did decrease anger. We saw that the de escalation decreased it further. We can't separate the two out.
But I feel that you bring up a great, great point that then, you know, that biofeedback training, since it's very, you know, objective, they get the feeling for what it feels like when they breathe in and breathe out and you know, they are now more regulated that then that made the de escalation more potent.
[00:28:49] Speaker A: Yeah.
I'm also curious too because you know, and this is where the OTs taught me so much about humanity with their approach. Because you know, usually, you know, I think about when I get anger and because I practice a lot of biofeedback, I feel like I'm, I'm way better than I used to be on, on this topic. But you know, I kind of joke that sometimes my toaster oven will get me in. Yeah. Like it's, it's usually appliances nowadays that, that can still like push me a little bit further than I'm proud to have gone, you know, but. But I think it's. It's interesting for.
For. For folks that. That the stimulation might be very different, you know, than why are you angry from an outside perspective, you know, may not make sense to somebody who doesn't have, you know, trouble. I mean, I just think about. They put something uncomfortable on it could ruin the entire entire day. You know, so. So the stress was actually on their. Their body in some way. You know, sensitivity to cold, to light, to heat, you know, and there was like interpersonal anger as well. But what we saw, and this was a great insight for us, was the anger was most of the time not about us.
The anger was. I'll never forget this one.
One of my favorite people I've ever met in my life, much less worked with, is like we.
He was so sensitive to the sound and he got distracted easily. So we wouldn't have started here, but we basically put him in the back of the room facing the wall with head canceling headphones on, and his behaviors went away. You know, now. Now I wouldn't necessarily. I mean, it wasn't a punishment by any stretch of the imagination.
It was just we as somebody who act outed violently almost daily, all of a sudden the things that caused the anger went away.
And now we had one of our best students. We actually didn't know what to do with them because he's like, we have no behaviors left and you know, try to kind of turn them around slowly to get more and more used to it. But it's. I think that redefines anger in some way. It may have been striking out at us, but it had very, very little to do with us in some situations. In other situations, there was social stressors for sure. And like catching that and being aware of it, because sometimes they're not running away. Not. They're not getting away. I should say not right away. They're not getting away from people per se, even though there may be other people in the room, which is just an interesting way to, you know, interact and see somebody's emotional state.
[00:31:59] Speaker B: Like when I work with a parent, I tell them that let's work on the sensory. Yes, let's work on environment in environmental centuries. And we can reduce a. Approximately 80%.
[00:32:18] Speaker A: Yes.
[00:32:18] Speaker B: Of all the challenging behaviors that were we are seeing. Like, one of my most pop. My most popular stories is working with a family and their son didn't want to take a shower. Well, it turned out that the shower head, the water was. Was coming out too hard and the family was told just shove them in there. You know, and just make them stay there and hold them there and increase the amount of time and. And. And I'm like, no, no, no. This is painful. You don't realize what the sensory is, like, unless you have been there, or.
[00:33:01] Speaker A: You go all the way and ask me to say, like, yes, that would be what it would be doing. Or turn it freezing cold like that.
[00:33:09] Speaker B: Yes, that's what we're doing.
[00:33:12] Speaker A: It's just. Yes.
So heartbreaking.
[00:33:15] Speaker B: And so I went to Home Depot and I bought like, six different shower heads.
[00:33:22] Speaker A: Yeah.
[00:33:22] Speaker B: And we finally found one, and it's the one that we had to get na attachment. But it comes straight out of the wall, and it's like. It rains straight down on you. This big square.
[00:33:35] Speaker A: Yes.
[00:33:35] Speaker B: And it was like this. This a rain.
And he stood there, and mom's just like, oh. And I'm like, yeah. Oh, my gosh. Even Dad's like, this is the best shower head ever. And it's like, see, you know, y' all are benefiting here, you know, from this great shower head. But the way that I try to explain to those that don't understand meltdowns or they don't understand it's sensory. It's a overload. I say, we all know what happens with a can of soda when you shake it.
[00:34:14] Speaker A: Yeah.
[00:34:15] Speaker B: So imagine you're walking around with a can of soda and all of these little, little things is just a little shake.
[00:34:24] Speaker A: Yeah.
[00:34:25] Speaker B: And you're slowly shaking it, and pretty soon the cans getting really tight.
And you.
You. You kind of want to release some of that because you don't want to have this outburst. And you're taught that an outburst is not the best way to do it. And so you try very slowly to open up the soda can. And even no matter how slowly you try and pop that top of the lid off, what happens?
[00:34:56] Speaker A: Yeah.
[00:34:56] Speaker B: I mean, it. It is just this explosion. Explosion. So that's how I try to explain these sensory things is all of these little sensory things that to you. You don't notice, but it's the noise, it's the lights, it's the sounds. It's the sensory of. Of touching.
It's, you know, people in your area, they are all just little Shakespeare to this can. And pretty soon the can gets really, really tight.
And the only way that you're going to release this pressure is it has to it explode. And once it's exploded. Yes. You've lost half the can of your soda.
[00:35:44] Speaker A: Yeah.
[00:35:45] Speaker B: Which is what happens.
And an autistic comes very tired.
They have lost A lot of their energy for some it's an embarrassment thing.
Getting mad is one of those just sensory releases. And it's the can it's just been shaken and it's just has to explode.
And then when you end with that, you get a brand new can, you know, that's closed.
And so I try and use that to explain, you know, what it's like that it's. It's not.
It's not a fit to get what you want. Yeah it is because there's too much stuff coming at you.
And so that's what I was trying to do like with the D escalation was try to prevent this can from being shaken so that it doesn't explode or doesn't explode very often.
[00:36:54] Speaker A: Right. And that was like the big.
What I love about the field is like, you know, it was kind of. Because I this was in the early aughts. So it's like still behavioralism was dominant in there and it just failed miserably. And we were trying to figure out like none of this seemed like logical from a behavioral perspective. It's just.
It just did not work. And we were trying to figure out there was a group that was arguing it was more of a Tourette's sort of response. And I thought that was. It got me thinking though of an uncontrollable tick may have not have been the right diagnosis many years later, looking back for. For some of the. The can going up. But again it started getting me thinking of it wasn't a controlled that there wasn't a whole lot of ability to control the response because we weren't teaching them necessarily how to do that like you're. You would. You're doing here. We were just oh, if you craft the punishments and rewards the correct way that that worked. That did not work. I mean there were good rewards that I remember one person like love Bruce Springsteen so behaved all week. We would jam out to Born in the USA for a couple songs and the behavior went away like so there was some of that but you know, trying to understand it from an environmental stimulus response perspective. But the stimulus being sensory stimulation just was a game changer for me. Again, even if Tourette's was maybe not it never caught on but it. That they're. They're. I think philosophy in general was trying to get at something bigger which I have total respect for what they were trying to do which with that for sure.
[00:39:01] Speaker B: Yeah. It is the. The darker side because I'm a trained bcba. And so the. The one thing that as I've worked in the field more and more and more, is this, you know, like you said, the behavior went a away. Well, did it go a away or did it was or did the person just not exhibit it in the presence of you?
[00:39:31] Speaker A: Right.
[00:39:31] Speaker B: You know, so it is. I'm. I am learning and it's a term that we use in the community, masking. So I'm going to mask. I'm not going to, you know, show my displeasure. I'm not going to communicate, you know, what I need. I am not going to say stem. I'm not going to, you know, I'm going to act a appropriately to get this. Bruce Springsteen.
[00:40:02] Speaker A: Yeah.
[00:40:03] Speaker B: But does it mean that we've actually, you know, switched the behavior off?
Not.
Not technically the behaviors, you know, we have just taught them how to shove it down.
Which is why that de escalation part on the step two is I'm feeling angry and it is fine.
[00:40:28] Speaker A: Yes.
[00:40:28] Speaker B: You know, because I don't want them to put that mask on and then, then to say, oh, I'm not mad. No, no, feel the amount.
But let's, let's try and work with it to, you know, put something else that is a better behavior for both you and people around you.
[00:40:53] Speaker A: I love it. I love it. So I love to, you know, get any advice that you might have.
You know, the behavioral approach seems fairly straightforward, the de escalation side of things.
So if there's any practitioners out there that would like to work with this community, maybe schools or just individual. I'm curious if you have, you know, kind of have any suggestions for maybe somebody without as much expertise as you did about how to set up the HRV biofeedback in any way that might be different for folks, you know, with autism? Like, you know, is there any way, there any suggestions that you might have for folks interested in working with these. This population?
[00:41:56] Speaker B: That's a good one.
I guess my biggest takeaway point, because I have noticed this is with anything you read that something works for group A and then you automatically apply it to group B. You know, take anything from weight loss to exercise to stop smoking to, you know, whatnot, and you read this, oh, it works for them, hence it's going to work for me.
That would be my biggest take away what I did with this and what I recommend. Find the function.
What is the reason behind the.
For this article? Anger.
[00:42:44] Speaker A: Anger, yeah.
[00:42:45] Speaker B: So if it's because I am getting angry, because I am presented with a demand, biofeedback might not help you because the function is they have learned that anger gets me out of this re quest.
My participants, they all mentioned I don't like feeling this way.
[00:43:10] Speaker A: Right.
[00:43:10] Speaker B: And so the anger was more of a sensory overload. That was the function. The function was there was just too much going on and they just exploded. But they didn't realize it till we actually started working through what the affunction is.
So that would be my biggest first step is find what the function is, then replace it with a wanted behave. You know, it's. It's a behavior.
So for this it's biofeedback would work. Well if it's the environment that is causing this anger or this, you know, dysregulation, then it, it might very well well work.
Same with de escalation.
It's. That can work with lots of things. But if like let's say the, the individual has learned that when I get mad, I don't have to do chores at home. You know, having them do de escalation isn't really going to help the ang. The. The. It's. It's the anger month. But what you can do is they have learned that it gets me out of, you know, a. A chore.
[00:44:34] Speaker A: Yeah.
[00:44:35] Speaker B: Teach them how to reacquest getting out calmly and appropriately. You know, hey, I am playing my game right. Right now. Can I do it in 10 minutes? So then we might actually do a d escalation be a for that. When you take a deep breath in. That might be where a biofeedback might work where we. We teach them, you know, what does it look like to calm yourself down.
And now we're going to teach you how to reacquest.
So that way would be my biggest take. A way is that just because this is effective with this anger among these participants, it was based on a function. It wasn't just plopped in. In there because like, let's see if it works. You know.
And so that's what I would say to a practitioner. You know, don't, don't just throw, throw it in there and then say let's see if it works. You know, it's actually find the function and then replace that function with a wanted behavior. And now you're getting the same outcome.
[00:45:52] Speaker A: Beautiful. So, so I'll start to wrap up on. On a very small question. I know throwing this out there, that might be bigger. But you know, we, we nerd out in the HRV arena. HRV biofeedback about autonomic health and you know, the broad left local, the prefrontal cord, you Know, we, we get into the weeds about what are we strengthening. What shows up bigger in a functional mri? Tracking heart rate variability and autonomic health. You know, with, you know, the students I worked with, you know, they, they, you know, it was, it was very.
That they were amazing people that we're not broken. Like, I think it's like, oh, we need to fix this. And I hear this in our country right now and it just drives me crazy. I'm like, no, these are, these are wonderful human beings who sometimes we just put in environments that set them up to fail. Like, you know, so when we think about the neurodiversity, and I know that's a big word that can range. But with autism specifically, you know, strengthening the vagal nerve, building prefrontal cortex, ability to down regulate amygdala. All the things we nerd out about. Do you think anything specific there that you know, really helps with the sensory tolerance? If I'm, you know, a word or you know, kind of being able to, you know, put the can down and tap a little bit on top. In the scenario that might be dysregulating, is there anything specific that when you think about the autonomic or the nervous system health of the folks you work with that biofeedback might be targeting something specific or is it just the general benefits that we can all get from. From a biofeedback practice?
[00:47:55] Speaker B: This great question.
I think what it's doing is. It's calming. Yeah, is. Is it's calming all of those areas.
It is, you know, like the way that I explain to a teens who don't get it is I say, you know, imagine your brain is split in half and the top part is all of your rationalization, your thinking, your what do I want for a dinner Emotional, where you're aware you can regulate a little bit, a bit more. The downstairs is your amygdala, which is your firefighter that thinks that there's this huge fire and is trying to put it out. And it doesn't care how, you know, how much of the, the house you're, you're a body it destroys. It is just trying to get, get or get, get rid of it. So most autistics, because they are living in a stressful world, they are doing a lot more living in their amygdala. And because of that it's a lot more cortisol. It's a lot more re. Re reacting. It's not pondering, thinking that upstairs part of the brain, which now they can realize I am mad now let's, let's change it. You can't do that because it's what I call amygdala hijacking the amygdala turns off that thought process. So I think that's what the biofeedback does is it calms the inner Tyrone neural system from brain to heart that when we're slowing things down the amygdala is like oh well I guess there's no fire. I'm gonna go to a bed. You know, and then it, and, and then it disappears and now we can function a little bit better. We aren't living in this constant amount of stress.
But when it comes to an autistic, I go very behavioral because then that helps them when you can see it. That's the reason, reason why you know this like, like a mindfulness things doesn't work really well because most of like the tracks like you, you will listen to, you know, imagine yourself getting blown.
[00:50:41] Speaker A: Yes.
[00:50:41] Speaker B: Anyway, and then my kids are like wow, that's a really strong wind.
[00:50:49] Speaker A: You know, very literal.
[00:50:51] Speaker B: Yeah, yeah, yeah. And, and so those are. Things don't work.
[00:50:55] Speaker A: Yeah.
[00:50:55] Speaker B: Which I think that's why biofeedback can be very, an effective treatment is because we're teaching them based on this, this thing that they can see and now they're changing something inside of them that they can't see.
And then we talk about those feelings. Yeah, but that's a great question. I mean to long winded answer.
[00:51:22] Speaker A: No, it's great.
[00:51:24] Speaker B: But it's yes. I think that it's just calming the entire system down which then leads us to the ability to now, you know, rationalize through a life instead of reacting through a life.
[00:51:44] Speaker A: Yep, absolutely. So final question. What's, what's next?
Do you ran it with three people? I mean I'm, we're gonna link to the article, you know, so, so I hope we get some professionals to, to your research because I think it's really showing something that's incredibly, you know, promising for a lot of folks, but just kind of, I mean are you, are you done with this topic? Are you gonna do a little bit more with it? Like I'm curious where, where you think your, your next step is, is going to be around your research.
[00:52:23] Speaker B: So one thing that makes this study stand out is that it also had a six month follow up.
So once the participants were done with me, I followed them for six months.
That's something that I would like to do further where if I replicated this study to include a longer follow up or possibly with the same, same participants, you know, see where they are at, you know, like, like in a year. Another step is gen is generalizability.
Taking this to various different areas and not just, you know, focusing on just, you know, the clinic or school. Yeah, but can this work in a whole host of areas? Because that's the whole thing about changing behaviors is doing this and having the behavior go back in 12 months. Well, that's, you know, we aren't sus. We aren't sustaining, you know, this wanted behavior. It's. It's kind of like woven.
We aren't doing anything.
Great then.
[00:53:50] Speaker A: Yeah.
[00:53:52] Speaker B: So that is what my, my next step would probably, would pro. Would probably be, is replicate hey this and then, you know, you know, do a longer follow up and then also, you know, sense anger, you know, it isn't picky about what setting it pops up, you know, then also hit that generalizability more.
[00:54:25] Speaker A: Awesome. Well, my friend, you, you are a gift. You've given the world a gift. So I'm excited to share this with our listeners. So please, when you do get that next step going, I would love to, I'd love to again have you back on and see what you find out in your next steps because I'm really, really excited about your research and that HRV biofeedback, you're finding it effective in this with the folks that you're working with and building onto that in really innovative ways. So I'm excited whichever direction you go.
Just, I'm excited to keep learning from you and just, yeah, love your work. So thank you for everything you're doing.
[00:55:13] Speaker B: You're very welcome. And I love your podcast. So it's, you know, it's, you know, I appreciate, you know, coming on. It's. I feel honored, especially since I don't feel like, you know, I feel like I'm still a newbie, you know, in this area. So I, I appreciate, you know, coming and, and sharing and your enthusiasm about the topic. So it's.
[00:55:43] Speaker A: Yes, thank you so much. We'll put a link to the article, some information about Dr. Hillman in the show notes, which you can
[email protected] so thank you everybody for joining us. Dr. Hillman, thank you so much for, for you and your work and sharing it with our audience and as always, we'll see everybody next week.
