Episode Transcript
[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal HRV. Check us out at optimalhrv.com Please enjoy the show.
Welcome friends to the Heart Rate Variability Podcast. I'm really excited for our guest today, Dr. Heidi Hillman. I've got actually her article right here in the APB Biofeedback Journal. I got through it and I reached out immediately.
I'm fascinated with the population, the article and Dr. Hillman, I'm just excited to get to know you and your work a little better and introduce you to our audience as well. So let's start out just with just a brief introduction of yourself.
[00:01:06] Speaker B: Okay.
Well, I guess if there's one thing that I've learned in life, it's that figuring out what you want to be when you grow up is highly overrated. And so, you know, especially when you can just keep going to a school. So after I gotta say, the letters.
[00:01:28] Speaker A: Behind your name are incredibly impressive. I think you've got more letters behind your name than I have in my name. Which is exactly it.
[00:01:37] Speaker B: That's exactly it. And so after pleading both a master's and a doctoral degree in Behavioral Psych at the University of Kansas, I ventured into the wide world of ABA to work as a bcba, which is a board Certified Behavior analyst.
Then I took a DO tour and I became a school counselor, followed by my current stint as a university professor. And then finally I decided to add on a private practice as a psych where I work mainly with teens on the autism spectrum and those dealing with anxiety and depression. So I guess it is safe to say that sometimes I think that I have more letters after my name than in my name.
And so I don't think I still have quite figured out what I want to do with my life.
But at least I've made a career out of, you know, making all these interesting things.
[00:02:52] Speaker A: I love it.
[00:02:53] Speaker B: And so it's I probably know one of the first questions that you're going to ask is why?
Why odd? Why odd? Why autism?
As a bcba, the primary diagnosis in encountered is often autism because of the established effectiveness of ABA in addressing the unique needs associated with autism.
Me personally, I think it's more where the money is because insurance covers ABA therapy.
However, not all people who are autistic are advocates of AABA as a beneficial therapy.
And so it wasn't until I had kids and I discovered that I was autistic that I experienced kind of more of like, I don't know if I feel comfortable with working with changing behaviors because that's one of the things that Agaba does is it kind of focuses on normalizing, aiming to make the autistic behave in more neurotypical ways.
And so the things that ABA will focus on are things like stimming or flexibility, getting away from rigid schedules.
And it wasn't until a couple years ago. And if you read a lot of my articles, you will, you will start to get the flavor that I'm a very strong advocate.
And so instead of focusing solely on modifying behaviors, I started getting into what is the authentic person and how can we work with the autistic and you know, embracing their unique, you know, perspectives, ways of interacting with the world.
And that's what kind of brought me to biofeedback. Well, actually not bad. It was a student of mine actually introduced me to biofeedback and we wrote an article and it was biofeedback and the effects on anger. And surprisingly there were no studies the effects of biofeedback and anger. And that was my first kiss working with HRV biofeedback. And after that, and that was like in 2018, I think it was. And after that I started kind of sittering. Could this be used with autistics because you're focusing more on the physiological? Yeah, rather than mo. Rather than modifying their behaviors and making them kind of look more like a neurotypical, anxiety is a large component of a lot of the stimming or meltdowns that we observe in the autistic community.
So I primarily teach conditioning and learning classes at the university and focusing on reducing anxiety inducing stimuli rather than solely attempting to modify behaviors, I feel is a more compassionate and effective approach that actually addresses the root causes of anxiety rather than just saying don't stim or don't have a meltdown.
And so that's where I got into incorporating HRV biofeedback into therapy for the autistic teens.
By teaching them how to control their breathing, increase their hrv, we can now enhance their awareness of their physiological responses and help them develop self regulation strategies.
And so I feel as an advocate and one that empowers an autistic, that biofeedback empowers an autistic to manage sensory overload, to manage anxiety, to focus on emotional Regulation more effectively leading to a better overall well being. But with that said, I am very much an infant in this area of research.
So I am honored that you asked me to come, you know, on your little podcast.
But seriously, you know, I'm literally just an infant still learning very much about this area, that I am warm that, you know, I do.
[00:09:08] Speaker A: And it seems like you're an infant. After reading your article, you didn't seem to find a lot out there. So, you know, it's one thing to be an infant in a well developed field. It's another thing to, I think, be a newbie, so to speak, to a field that needs you. Like there doesn't seem to be necessarily a whole lot of people who have been doing this research with autism and biofeedback, you know, to give you a whole lot of meat for this literature review. And I wondered if that as somebody who's, who's in the field, I wonder if that surprised you, if you went in kind of expecting that, you know, where sort of, why has the field, I guess in your opinion, maybe missed this population that's so important.
[00:10:08] Speaker B: Yeah, it did surprise me that I only found a handful. And then it's my article, I specifically focused on college students. Right. Because there's that transition there and it's, it's a large one. And so one of, you know, transitions is one of those stimuli or environmental contingencies that really, you know, illicit anxiety.
I was surup surprised.
However, part of me was not because personally speaking, the money is where the insurance pays for it and so in assurance pays for ABA therapy.
And I think that's why a lot of these other, you know, potentially effective modalities may not have been researched as much. Or it could have been that people just haven't thought about autism as an area to study the effectiveness.
My whole view was if it works on the physiological level of a non autistic, why couldn't it work on the physiological level?
Providing a very simple technique, simple method, literally focusing on breathing very in, you know, a, you know, very non invasive method. You can do it on your own. You don't have to go to counseling.
And that's another area where I have found, you know, that there's areas for research is more in like the counseling area.
But it did sort of, sort of surprise me that there wasn't more out there, especially with college students, you know, when anxiety is a, you know, very large, you know, factor that affects a lot of them.
[00:12:46] Speaker A: Absolutely, absolutely. So I'm curious, you know, I, I find this conversation where. Where I'm at in my HRV journey. Fascinating, because I was introduced to heart rate variability. I had a podcast called the Trauma Informed Lens Podcast, because a lot of my work has been with trauma. And I ran a school where, you know, not. Not a whole lot. We were working with a population that probably was not bound for college. We had a lot of nonverbal folks, but this population is so near and dear to my heart. And so I had worked with a range of behavioralists, and I kind of came to some of the same. It's like, what are we?
These. The young people are so unique and beautiful. Like, we don't need to, like, put them in a box. Like, they are their own amazing box. And, yeah, some of the behaviors could be dangerous to themselves or others. So. So we had work. That's why our school existed. And it was interesting. His conversations and mine, you know, coming from that behavioralist perspective is my. My experience of a lot of behavioralists, and this is a while ago, so there's no offense to anyone that are currently in the field, is it was more working with the external behaviors, getting the rewards and, you know, negative consequences or what? I think the. The youth would always laugh at me. It's like, you're punishing me. Like, no, it's a negative consequence, you know, getting all those factors. Right. And there's a place for that, for sure. But, you know, what I appreciate about Kurt is he was always looking for what was going on, in his words, what's going on underneath the skin that was attributing to these behaviors. And I. I just kind of wonder, as we're working with the autonomic nervous system, the ventral vagal nerve, and getting in under the skin. When you take your behavioral lens and kind of mesh the two together, what kind of. What kind of insights have you gained with. With bringing those two aspects the. The behaviors, but also what's going on underneath the skin together and how you view these folks you're working with.
[00:15:01] Speaker B: You would bring up a great point. And as a bcba, who, you know, was, Was. Was trained by, you know, some of the most respected leaders in the field. Yes, it is focusing on the behavior. When I work with my autistic teens, I explain it very simply where I say, now imagine your brain is divided in half, and there's the lower half, and there's the upper half, and your lower half is your amygdala.
The amygdala in an autistic brain is very well developed. It's continually searching out Areas of danger and socialization can be dangerous. And so because of it, the amygdala keeps firing up. It's what I call highly sensitive.
And because of that, instead of looking at reducing stimming, which is the behavior, what is underneath the stimming, what's causing the estimate. And I have found out from personal experience, from my son as well as me, as well as my teens, that I work with, if I remove the environmental stimuli, I can reduce approximately 80% of all unwanted it's behaviors. So for example, bright lights.
People don't think of things as being loud, like a light being loud.
But we were at a restaurant and my son just kind of started acting up a little bit and I could just tell that he was just getting a little, you know, his amygdala was starting to just kind of fire up, like, okay, there's something scary here, there is something dangerous here. And it was the overhead light.
And so instead of saying no, you, you need to sit still, you know, no, stop a fidgeting, it's ask one of the people, hey, can we move to the other part of the restaurant where it's not this really bright blue cold light, but it's kind of more of a, you know, yellow light.
And that's all that it took to then, you know, calm, then his, you know, hold physiological thing. And I feel that that's what HRV biofeedback does as well as you take one piece, which is breathing. And if you can monitor that, the amygdala starts thinking, okay, there's not a scary thing here. So then, you know, the anxiety starts to reduce, the unwanted behaviors start going a away. But that's how I explain it to my team is I try to explain it very simply. Yes. But once they've heard that and they understand, okay, rather than going the whole physiological route, which I am just, I mean, I want to do a shout out to those that have, you know, turned biofeedback in, into the fields that it is.
I mean, just, I'm very thankful for those that have done lots and lots of research and have, you know, shown the effectiveness of this with all the variety of, you know, behaviors, you know, oh my gosh, I am so grateful because that's allowed me to do what I've done. So right now biofeedback is not shown to be effective to a work with an autistic because there's not much research out there.
But when you look at the area in general, the non autistic groups, you can see that it is Very effective at, you know, reducing depression anxiety among those who don't have autism.
[00:19:30] Speaker A: Yeah. So I would love to ask a question and maybe a little bit of a roundabout one, but maybe you can even give me better language to ask. It is, you know, with my mental health background, going to work with the autistic students that I did.
I started to joke that I'm really an occupational therapist tech. That was. And it was kind of a joke. But we, we had to figure out the sensory integration piece. And for those. I, I will, I will allow you to expand my definition. But things like brushing. We had this magical bouncy chair and it was unique for each individual. And some of that stimming behavior, you know, for, for our students, sometimes it was just heartbreaking because it was like head banging behavior against not just a soft place, but a really hard wall. Like that's. And it was regulating for them in some sort of way. And obviously we, we really tried to, you know, you, you want to prevent harm. So we did try to prevent that and find something else that worked. And then there was this like again, magic is not a scientific term. But when you found the right mix of ways to help them regulate their nervous system, you know, it could have been like headphones that blocked out. It could. We put drapes over all the. We have this beautiful new building with really bad lighting. So we did drapes over the lights. We, we took the posters off the walls. We, we. We worked out to figure out what was working because most of our students had basically gone through all the resources a public school would have to offer. That's. That was our baseline students. And so I think what I'm hearing is those things like brushing and those sensory integration pieces that while we might not call HRV biofeedback sensory integration, we're kind of getting to the same aspect of this as you're using HRV biofeedback, maybe with higher.
Again, these youth are going to college that this could be a way for them to self regulate in high anxiety situations.
[00:21:46] Speaker B: And so it is. What you're talking about is how I define it is.
It's, it's overly sensory.
That it is.
Lots of autistics are very sensitive to stimuli that can be sound, that can be touch, it can be light.
It's a light that is too bright.
It's. It's. If you just focus on the physiological. It's the body just kind of going into this stress reaction.
[00:22:32] Speaker A: Yeah.
[00:22:33] Speaker B: But it can be anything from.
So here is the difference. If you went into ABA and So you have like. Let's just come up with an example of a. A child likes one pair of pants because they are the silky kind of athletic running pants and they just feel better.
As a trained bcba, I would be trained to try and get him out of those into other types of pants. So maybe cotton pants or heavier pants or whatnot. Me, I'm like, no, just buy 15 colors of the pants that he likes, you know, just. Just to stick with that.
[00:23:20] Speaker A: Absolutely.
[00:23:21] Speaker B: And so when you remove that sensory.
Another family that I worked with, it was the shower, and it's sometimes just the water coming down. It's. It's painful. And so it is hard to explain that, you know, over sensitivity. Now on the other side, there are autistics who need more sensory. Then that leads to the head banging because now they need more feeling and more loudness. And they need. They are the ones that do really well with the weighted blankets. Yeah. Because now it's a squishing feeling. But it's all stimuli. It's all that sensory where I have found if you focus on the sensory and you add or subtract and you find what you said, the magic mix, at least 80% of my unwanted behaviors just melt away.
And with that kind of thought in my. My head, that's what attracts me to the biofeedback. Because in 2018, when I worked with my student and he says, hey, there's this thing and I've used it and it's decreased my anger. What really tell me about this? And he showed me this. This device very simplistic and breathing very simplistic. And I'm like, this is almost like voodoo. I mean, it's. It's like, wow, this works.
But when you think of it as kind of a physiological. And the way that I explain it to my teens is it's the amygdala firing. And when the amygdala fires and it takes over, it hijacks the thinking part of the Abraham. You're. You're a rational part of the abrain. And now you're just acting. You are having your meltdowns. And then you can't talk with the Akido, you can't guide them because they're fully in this, you know, anxiety land. But yeah, you will use great. You know, like it's. It's a words, it's. It's the sensory integration. It's. I just say, you know, it's overstimulation that's. Most autistics have over stimulus. And it's lots of Areas where a neurotypical, they don't get it. And so as I've learned about biofeedback, I really focus on, like, Maya breathing. And one way that I teach Maya kiddos is you imagine you're going up a hill and down a hill, and as you go up a hill, you will breathe in. And when you get to the top of the hill, you are now going to breathe out.
And so then they get that, you know, thing, and then I switch it and then I say, oh, okay, now we are going to go down the hill. Is breathing in because you usually go faster going down the hill and going up the hill. Now we're going to breathe out because you go slower going up the hill. And so an autistic is a visualizer. And because of that, I also think that biofeedback helps in that way, that there's buttons, there's colors. You're making a color change. You can talk about, like these mountains, and you're breathing in and breathing out.
Very good for an autistic brain that, you know, when you're in the moment of your, a amygdala has hijacked, you know, the arrest of your brain. You just have to think of this simple, okay, we're going to breathe in, we're going to breathe out, we're going down the hill, we're going up the hill, you know.
Yeah, but it's that sensory, physiological, kind of bringing, you know, the breathing down, which then just by itself will then help the a amygdala quiet down.
[00:28:06] Speaker A: Yeah.
[00:28:07] Speaker B: Which then pops the brain back into more of the rational part of the brain that now we can think, okay, now what's going to be my next step? You know, instead of just reacting, we are acting now.
[00:28:23] Speaker A: I love it. So if we, if there's somebody listening to this who may have googled, you know, autism and biofeedback, and they're listening, they may not have expertise specifically in this area, but maybe are working with a client or two or maybe have some motivation to partner with their school district or. Well, are there any other lessons that you. You just gave some really great ones, but any other lessons, you know, to. That you've learned along the way to help integrate this and, you know, get. Get people set up for success with the biofeedback? Do you do. Do you have them do home practice as well as office practice? Kind of. Kind of. What does that. That work look like, you know, in your private practice kind of setting?
[00:29:13] Speaker B: So I have another article that is under review currently.
[00:29:19] Speaker A: Sounds like Another episode I gotta have you back.
[00:29:22] Speaker B: And so but it's dealing with anxiety among teens.
And it, it's an interesting one because I come a bind biofeedback along with self regulation strategies. So first of all, so the participants came into a thea clinic and they would do the biofeedback, they would learn how to run the ADEA vice.
I would help hook them up and then I would leave and then they would do you know, their session 15, 20 minutes and it was a couple times a week. And I noticed that there was a decrease in anxiety.
But I had this thought, is there a way that I can decrease it even further?
And so instead of just relying on biofeedback and the breathing, could I put a cognitive come opponent? And that is what I did is I put a cognitive thought come opponent with it.
And that was very effective. And one reason why I think it was is if they got themselves into a situation a and it was anxiety producing stimuli they now can talk themselves through. Okay, I'm feeling a little anxious. It's okay, it's fine. You know what's something that I can do? Some like to a skateboard, some like to go and read a book, you know, go find my happy place. Go and find, you know, then they can do their biofeedback, they're they're breathing and combined I actually found that it was very powerful.
So I showed that biofeedback by itself it's decreased anxiety. However, I could get anxiety to a decrease even more with a cognitive.
And so I thought that I was kind of hitting on both a physiological and more of the non scientific way of saying calming the voice in your head, you know, where you're walking through those cognitive strata strategies, you know.
And so I, I think that there's the potential for biofeedback to become a bind such as that. But again there's not many studies with teens anxiety biofeedback.
I would say the worst thing that a counselor can do is take a treatment and say that it's effective for everybody. Because it might not be. Yeah, so that would be my biggest takeaway point is that yes, it focuses on a physiological. Yes, I think it's beneficial for many.
However you might find that one that you just got to add a little bit more to it.
Don't get frustrated, you know, don't, don't get frustrated.
But you know, it takes a while to find, you know, that magic mix of the sensory, the environment, the physiological.
Because for someone who is looking for more sense, it's more A sensory biofeedback might not be as effective as one that is overly sensitive.
[00:33:47] Speaker A: Yeah.
[00:33:47] Speaker B: To a stimuli. So, you know, I guess that would be my takeaway point.
But the one thing that I do like about HRV biofeedback is it empowers the autistic.
[00:34:04] Speaker A: Yeah.
[00:34:05] Speaker B: So instead of them going to another person who's teaching them strategies and they feel like I have to continually being in therapy to get better, it empowers them to manage their stress, their anxiety.
And that's what I just love about it, you know. But that's my advocacy, you know, coming out.
[00:34:35] Speaker A: Yeah. I'd love to ask a quick follow up to that because, you know, I totally. And when I tr. When I train like on trauma informed mindfulness, I'm never like, we need to stay away actively from trying to empty your head. Like we want something. I call it. We want. We want to be counting or have a mantra or a prayer or something. We want that. We want to give the prefrontal cortex something to chew on because it could be triggering for folks. And so, you know, as you were talking about that, I know you know, our app and others, we're not unique with this, but have a lot of guided meditations. Is that something you think would. For some folks? Because I would never say it would be a. I'm looking for a universal answer and it may be a speculative, non research answer to. I always love to give my PhD guests the ability to speculate without being held to it officially. But like a guided meditation of some sort or visualization.
Do you think that that could be an effective.
A cognitive tool as they're following a pacer or doing biofeedback pieces?
[00:35:52] Speaker B: Possibly.
I haven't done research in that area, so it could be.
The only law that I could see is not to make fun of like the meditation. But if you've ever done, you know, like yoga or meditation, they always, you know, use, you know, pretend you're like the wind or let your cares, you know, just fly like a bird.
[00:36:25] Speaker A: Yeah.
[00:36:25] Speaker B: And autistic is very literal. And they're like, my thoughts are in here, dude. Yeah, you got virgin in your head. Wow, you got some serious problems there, dude. You know, that's a great.
And so it's because of that if it was a very literal. I think that's where bio.
[00:36:50] Speaker A: Like almost a muscle relaxation where you're tensing and.
[00:36:54] Speaker B: Yes. Or some.
[00:36:55] Speaker A: Because I could see that could also again, like you said, sort of overstimulate versus under, you know, for. For some it might Be more literal, like a progressive muscle relaxation.
[00:37:07] Speaker B: Yeah, yeah. And I think that would probably be more effective, but if you get into the meditation.
[00:37:18] Speaker A: Yeah, definitely. Mindfulness, I think more.
[00:37:21] Speaker B: Yeah, yeah. It's be a be. Because knowing how literal an autistic is, I mean, oh my gosh, I'm so literal that it's like, you know, people laugh at me and I'm like, I don't get it, you know, you know, I need a person as my dictionary to kind of help me. What does this mean? You know, and so that would be my only. Yeah, but I don't know, it sounds like a great study. You know, come a pairing like a biofeedback with like a mindfulness or meditation. Hey, you know, that sounds like, you know, there might be a study. Hint, hint. For anyone listening. Hint, hint. You know, I mean, you could, you know, take it and do it and see what you will find.
[00:38:10] Speaker A: Awesome. Well, I, I appreciate you and your work so much. Like I said, this is. Your work is so near and dear to my heart. And it was just really exciting to. To see this because, like, I had, I hadn't seen and come across a lot, you know, of work with this. And again, you know, you're. You're bringing in a couple passions of mine with the HRV and autistic and like, just so good for, I think, to get this out there and identify where we need to do more research. I think that trend, you know, with me, it was a lot of times helping our students transition from the classroom to the lunchroom was a challenge. So, you know, with your work, that transition to college, how overwhelming that that is for everybody, much less that change in. Dramatic change in social environment for folks that I'm really excited and I hope this sparks a lot more focus on this area. So I just want to thank you for your work and sharing it with our audience.
[00:39:21] Speaker B: Oh, yes, I appreciate, you know, coming up. I mean, I'm honored because, you know, like I said, I consider myself, oh, you know, a minor player, you know, a person who's just stepping my toes in this, you know.
[00:39:39] Speaker A: Yeah, well, that's how. That's how I think sometimes as well. And then I get to interview people like you. So I think you got a lot to teach all of us. So I appreciate your work and I really want to open the invitation up for some of those future articles. I think you've sparked a lot. I mean, obviously anxiety just in above itself is a huge issue right now, college campuses and everywhere else.
So I really please know the doors wide open for you to come back and talk about your further research. And we'll put notes about Dr. Hillman in our show, notes which you can find@optimal hrv.com and appreciate you, appreciate your work, appreciate our audience. And we will see everybody next week. Thanks so much.
