[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 Heart Rate Variability Podcast. I am back here with friend of the show, friend of mine, Dr. Janelle Messner. Janelle, welcome back to the show. I'm so excited to talk about the research you has published lately. I've been trying to get you on the show now, I think for probably about a year to talk about some of this stuff. And I know you got to publish your research, but I'm so glad to have you. I've been dying to have this conversation with you. So just in case people haven't listened to previous episodes that we've had you on, just give us a quick introduction of you before we jump into the great research that you've done.
[00:01:11] Speaker B: Sure. Thanks for having me. I'm excited to be back. And yes, I'm here primarily today to talk about the new paper published in Journal of Personality Assessment, but just for a brief background. I'm a professor in the Department of Clinical and School Psychology at Nova Southeastern University in Fort Lauderdale, Florida.
I teach measurement theory and statistics as well as an elective course in eating disorder interventions.
My areas of expertise are quite diverse, being quantitative methods on the one hand, and an interest in eating disorders and clinical interventions to help prevent them and treat them on the other. So I'm happy to be here today to talk more about how we can intersect hrv, interoceptive awareness, and interoceptive sensibility with the eating disorders and measurement fields that are my areas of expertise.
[00:02:15] Speaker A: I love it. So it's been a little while. This is when I was trying to get you on the podcast to talk about some of this introception. Since it's been a while since we've had this topic up, let's define our variables here as good researchers do before we move forward. So interoceptive sensibility, what are we talking about with some of the words that you threw out at us in your introduction?
[00:02:41] Speaker B: Yes, this is super important because I think this is one of the biggest problems in this field is that interoception itself is very hard to define and it has multiple facets to it. Some are more subjective in nature and others can be Measured more quote, unquote, objectively, if you will, or through behavioral tasks. So the 3 facet model, which was put forth by Sarah Garfinkel and colleagues in a paper I think in 2015, gives interoception, like I said, multiple components, one of which is referred to as interoceptive sensibility, the term that I use in the paper I wanted to discuss with you today. And interoceptive sensibility is really, in a nutshell, just our ability to read the signals from our body and adaptively integrate those signals to maintain homeostatic equilibrium. So it's a really important survival mechanism. Without these interoceptive skills, our signals coming from the brain to our body to tell us how to take care of ourselves and keep our body safe, get all confused and messed up. And as you can imagine, not being able to respond accordingly can be quite dangerous and lead to all kinds of negative outcomes.
[00:04:09] Speaker A: I love that. So I'm curious as you say that, you know, you know, I love to dive deeper into things. You're talking about the, the brain signals to the body.
I know we're going to bring heart rate variability in here pretty quickly. Hrv, biofeedback. Are we talking about, like, when I think about interoception, I'm thinking about a conscious awareness, or are we talking about something that is more of the autonomic nervous system, or are we talking about both? Is this happening underneath consciousness if I'm not conscious of it? Where, where do we, where do we, where do we pull this apart from conscious to autonomic? You know, below consciousness.
[00:04:54] Speaker B: Really important distinction. And I think it's, it's nuanced, it's complicated, and interception does include all of those elements of consciousness and unconscious where, you know, the autonomic system gets involved. I think interoceptive sensibility by definition is conscious because it is self report. We, we are asking people to rate on a scale like a measure, a tool that has questions on it, how they, how they respond to things, how they feel about things. And, and that by very definition, right, it has to be a conscious awareness. So interoceptive sensibility. Yes, Consciousness interoception more broadly. I think there's a lot more going on there. And that, you know, gets into a whole other area where maybe HRV is more related to, you know, as, as opposed to just more the self report component of interoceptive sensibility.
[00:06:00] Speaker A: And I know you and I kind of in our conversations around nerding out about this topic is some of the limitations.
You know, I know you use a brief assessment in the study, but limitations and you seeming to find maybe things to, you know, bring new ways of thinking about some of the assessments we're using. So I'd love to dive into that.
[00:06:24] Speaker B: Yes.
[00:06:25] Speaker A: With you and sort of your thinking around how do we assess this topic that honestly, I still think almost nobody has really heard of. Like, it's still new to so many people, in fact, people that I think you and I would hold up there as the gods and goddesses of the nervous system. Like, you know, I think this is a kind of thing we've heard of maybe at best, but a lot of people don't know about. So I'm curious, how do we assess this? What are maybe some of the limitations of those assessments?
[00:06:58] Speaker B: So limitations is keyword here. Right. We have lots and lots of limitations in our ability to assess interoceptive sensibility. Right. So my work, and this is essentially the grant that I've been awarded from the NIH to study is really looking at ways to optimize the validity of assessing this particular construction. And so I've done a very deep dive into the literature here and there are, I don't know if I go as far as say dozens, but there are numerous, multiple methods or self report measures that look at this construct and some people call it something other than interoceptive sensibility. In fact, to be frank, I don't think there's a single paper or measure rather that calls the construct what it's been named by Garfinkel and colleagues in their three facet model of interoception. So the tool, which I think is kind of fascinating, nobody says a measure of interoceptive sensibility, the tool that that has been deemed probably the most widely adopted and has a lot of strengths that people have gotten behind, is the mailing tool. Wolfgang Mailing did a collaborative study with a bunch of mind body research experts to develop a tool to measure what they called interoceptive awareness. So again, it sort of introduces some confusion to the topic just because the terms are changing. But this was done in 2012. Well, that was when they published the first version of the tool and that measures eight dimensions. So it is not a straightforward or a construct in and of itself, just that one facet of interoception has eight dimensions and those dimensions involve noticing one's body signals. So the ability to just notice how your body feels. The second dimension is, and I'm pulling this from memory, not distracting oneself from pain or discomfort. So this ability to feel uncomfortable or in pain and not try to power through it or push it away. Kind of this mindfulness notion that discomfort's part of living, right? We all have to kind of just accept it that we're going to get a headache or we're going to bump our arm and feel it, or we're going to twist our ankle and it hurts. And being able to kind of accept those feelings of discomfort without trying to distract ourselves. So that's a dimension. And then the third dimension is not worrying about pain or discomfort. So this is a real interesting one because it really taps into that anxious temperament. If we start to feel some kind of discomfort, chest pain, leg pain, back pain, head pain, do we suddenly start to catastrophize or think that, you know, there's something really wrong with me? So not worrying about pain or discomfort, which seems a little hard for people to sometimes wrap their head around. Well, you know, if I'm in pain, why would I not worry? Right? But not worrying is adaptive. So that's dimension three. Dimension four is attention regulation.
Attention regulation is, in my view and in terms of the factor analyses that I've done on this scale, really the crux of, of the scale. It's the, the multidimensional assessment of interoceptive awareness. So just to be clear, we're talking about the mia. The attention regulation dimension is the crux, I say, because it's the strongest factor. It's the factor that explains the most variance. And it's our ability to attend, to draw or to attend to our body sensations. Some sort of butchering the description there. But it's essentially when we can, we can attend to how our body is feeling and we can sustain our attention on those feelings.
So that's dimension for dimension five is emotional awareness. This is the one that I actually am not fond of in terms of the name because it's not so much are you aware of your emotions per se, but, but it's the ability to connect your emotions to your body's sensations or signals. So I think that's a little different than aware of your emotions. It's the connection, the awareness or the ability to connect emotions to bodily feelings and signals or bodily sensations. So then the sixth one is what he calls self regulation, and that's the ability to regulate distress, emotional distress, through attending to the body's sensations. So it's sort of that, that connection to, okay, I'm not feeling good about something, I'm going to breathe, right, or I'm going to just sort of center myself in my body. That's adaptive.
The sixth dimension is Referred to as body listening. And that's what it says. It's when we listen to our body for insights like what's. What is my body telling me? It's kind of that notion of, you know, what does it feel like? What are you feeling in your gut? Right. Like sometimes I'll ask my students, like, what is your gut telling you? There's, there's some adaptiveness to what our body's insights are telling us.
So that's number six. Number. Or maybe I. Am I off? No, that might be number seven.
The last dimension, number eight, is trusting. And this is really critical in my field because it's considered the bridge factor or dimension of interoceptive sensibility for disordered eating or eating pathology. It's the ability to experience one's body as safe and trustworthy. So as you can imagine, in the field of body image and eating disorders, this is really critical. If you don't feel safe in your body and you don't experience your body as trustworthy, there's certainly going to be problems with trusting those signals. Right?
[00:13:52] Speaker A: Yeah.
[00:13:53] Speaker B: So that's the MIA in a nutshell. And to get back to the question of measurement, this is really probably the most widely adopted tool I've seen in the literature there. I mean, there's arguably a couple of others that are older that may have been used more often, partly due to the age. But in the literature reviews I've seen, the MIA takes up so much of the pie in terms of which tool is being used for this construct that I would argue it's certainly the most. One of the most widely used. And it's also been translated into well over 30 languages by now. So because I think 30 languages was like in 2022 or something. So it's been adapted quite extensively. The factor structure has been studied extensively.
What my work's trying to do is really understand what this construct means in the context of understanding eating pathology and how does it connect to mind body interventions. I see interoception as a potentially important target in interventions to help people feel better about their body and reduce their eating pathology, reduce their. Their disordered eating behaviors and attitudes. So if we can target interoception in an intervention, we can hopefully reduce disordered eating. To target a construct like interoception, though, you have to be able to measure it. Right.
So that's what led me to this particular grant.
There are some problems that need to be worked out in terms of how we do measure interoceptive sensibility. And, and that's what I'm spending the next couple of years really digging into how are people interpreting these questions? What does it truly mean to them? And how are these different dimensions really related to disordered eating? And the paper that was just published in the Journal of Personality Assessment kind of turns on its head some of those assumptions that all of these dimensions are adaptive in the way that we, we assume. So that's, that's where I'll pause.
[00:16:34] Speaker A: So, you know, it's interesting, as you were going over the different aspects of interoception, I, I, you know, what kept popping up in my mind is, oh, this sounds like mindfulness. A lot of times the, the awareness, the maybe they use the word acceptance, you know, that all those like, you know, understand your worrying and then let it go. Like, am I, is, is it fair to connect those, or are we talking two separate arenas?
[00:17:06] Speaker B: Okay, no, absolutely. Mindfulness is part and parcel to interoceptive awareness. Right. And the, the work by, by mailing is. I mean, he's, he's a mind body researcher. It's very centered in mindfulness work. Some of the other authors on the scale, the mia, like Cynthia Price, they do mindfulness based work. So this is very, very much connected. In fact, you know, in the work I'm doing with some students, they're looking at ACT as an intervention for eating disorders, which of course involves mindfulness as one of the principles. And I think they are inseparable in a lot of ways. And so how does interoception differ from mindfulness? I think that's also very nuanced. Right. Like there are, I think, elements of mindfulness for sure, in interoception, but this is very, very much connected to the body. Right.
How are we reading these signals specifically in the body? It's not just sort of, you know, our surroundings, it's our body that the interoception is focused on.
[00:18:22] Speaker A: So I'd love to jump into the disordered eating expertise as well, because in the HRV field especially bulimia is a very mysterious.
Basically one of the only conditions that we see have negative health outcomes a lot of times for folks, but also higher hrv. I was at a conference, I mentioned on the podcast. I was going to a heart rate Variability Institute conference. And the speculation was maybe the vomiting is activating the vagal nerve, which gave an explanation that was more than I kind of heard before. So I'm curious, with disordered eating, where does interoception kind of help inform your thinking? There's this piece of. Can there be too much of a good Thing which I find fascinating with this, I'd love for you to dive in. Is there. Are we. Does trauma create a disconnect that can lead to, you know, disordered eating? You know, that whole consciousness, unconsciousness piece. I'd love to just get your thoughts and expertise on this.
[00:19:44] Speaker B: Yeah. So I think you, you, you hit an important point and I almost forgot the title of the paper. I'm kind of looking around me because I feel like I, I should have the paper in a pile of stuff on my desk. But it is something about too much of a good thing. Is that in the, in the very beginning of the title.
Do you have the paper in front of you? I just want to.
[00:20:09] Speaker A: I do. Here, I'll pull it up. So eating pathology and interoceptive sensibility using the assessment can there be too much of a good thing? So it's right there in the title.
[00:20:21] Speaker B: Yes. So can there be too much of a good thing? Was, was really kind of to get at this questioning of our assumptions. Right. That the interoception is a skill. Right. And that deficits in interoception are theoretically. And this goes back to Hilda Brutsch from the 1970s, theorizing. She was a well known psychiatrist, one of the, you know, the found foundational people in the field of eating disorders. She described anorexia nervosa as basically like an interoceptive failure. Right. That, that, that people with anorexia nerve nervosa were not able to read signals from their body. Right. That they were unable to eat when they were hungry or unable to even feel the hunger, you know, once the disorder was entrenched or unable to see their body for, you know, for what it was.
So this goes way back to the very beginning of, I shouldn't say the very beginning, but you know, the early days of talking about eating disorders, anorexia nervosa in particular.
So can there be too much of a good thing? So interoception again, was, was conceptualized as, as life saving. Right. As critical for maintaining homeostasis in our body. And what I showed in the Journal of Personality Assessment paper was that the higher you scored on three of these dimensions, the higher your eating pathology tended to be.
Now again, these are associations. So to be clear, these positive associations are not causal. These are not data that can make causal statements. These are regression analyses.
And the associations are not strong effects.
But I think what's important to remember is that effects like this matter, right? No, they're small. No, they're not large. And I feel like Large, small, medium, effect sizes. I've been reading up a lot on effect sizes and the problems that we have in characterizing the importance of effects and that there's all kinds of problems with words like small, medium, large. Right. Because compared to what? Right.
So it really, it comes down to does this matter? And in my opinion, it does matter. These are not large effects, but it does matter. And there's a paper I'm in the midst of really tearing apart by Funder and Ozer, 2019 in a methodological psychology methods journal. The name is, is escaping me at the moment, but it's an excellent paper on effect sizes saying that even, oh, I have it in front of me. It's the association for Psychological Sciences journal, Advances in Methods and Practices in Psychological Science. So it's basically telling us for effects like the ones that I found that are considered small in size, right?
We shouldn't be disregarding them because they're small. We have to remember the accumulation. We have to remember how effects kind of build over time and what kinds of, of power they hold in the grand scheme of things. And we have to, to really kind of consider a lot of things in context. So I just want to state, yes, these effects are small and yes, I still think they're important. Right.
So why is it that if you have something adaptive, your, you know, your likelihood of, or the association between something adaptive is positive with something maladaptive like eating pathology.
So I don't have a great answer, but I do think a lot of this has to do with the other things going on. Right. If I feel a.
Well, I'll tell you the three dimensions that came up. It's noticing your body's sensations that were, that was correlated with greater eating pathology.
Emotional awareness was correlated with greater eating pathology. And listening to your body for insight was correlated with greater eating pathology. And so those things don't really make a lot of sense.
Maybe I could argue noticing because I don't know, the paper goes into some deep dives on each of those things and what it could mean. And I compare it to some past literature. But a lot of this really, I think, has to do with what else is being controlled for in the model. And if you think about noticing your body signals or being able to connect emotions to your body or listening to your body, all of those things, yes, they are adaptive, but without something like trust in your body or the sense of experiencing your body as safe, none of that's really going to matter. If you listen to your body, but you don't experience Experience it as safe.
How do you reconcile that? Right. So if you're feeling, if you're noticing a lot of comfort or discomfort in your body, but you don't trust your body, are you going to listen to it? You may, you may say, yes, I go to my body for insight. But do you adaptively integrate the signals from your body in the absence of trust? So if you're not, if you don't have that critical thing of trust, then how can you adaptively listen? How can you adaptively connect emotions to bodily sensations? How can you adaptively notice bodily signals without that critical element? So I think the biggest thing here is the controls, which again, trusting was in the model and we were essentially controlling for it, means we're assuming everybody has the same level of trust. So if you take trust out of the equation, then these different relationships start to emerge. I mean, to be clear, though, these relationships were present even in a bivariate context. It was not only a multivariable context. So if I did just a correlation between body listening and eating pathology, I saw that positive relationship. Same with noticing, with emotional awareness. So it's complicated. It's enormously complicated. So can there be too much body listening? Can there be too much noticing your signals or any attending, connecting your emotions with your body?
Maybe? Right.
Maybe there's a tipping point here. Maybe people who are so focused on their body have, have more of a maladaptive element of, of the, of the construct we're discussing. So over noticing or hyper focusing maybe is the better term. I think that's what I use in the paper. Hyper focusing can lead to maybe some catastrophic thinking, right? Like, oh my, like my, this hurts or that hurts. Or, you know, maybe it's too much. It's, you know, too much attention to the body. So I think it really, it depends on a lot of other things going on. It depends on a construct that I haven't actually mentioned, that I plan on talking about in a workshop at the AAPB next month. But central sensitization, I think is a really critical missing component here. This is a construct that was developed probably 15 years ago. I think the first paper I saw published on central sensitization was in 2011.
But it's really this, it's a neurology construct where there's like an excitability of the neurons. Right. And it's very evident in people with pain disorders.
So is there something, you know, related to central sensitization in these factors of noticing, emotional awareness and body listening? There are some studies that look at Both the Central Sensitization index, which is a self report measure, and the mia, the measure of interoceptive awareness. And do find the connections I just mentioned and I do talk about that in the Journal of Personality Assessment paper. So, you know, the long story short, we could never even go into this in a podcast and in true depth is it's so complicated. There are so many, so many variables and I think it's, it's unwise to just say like, oh, we need to do this one thing right. Without kind of surveying what else is going on, because that one thing's not gonna respond the same for everybody.
[00:30:43] Speaker A: Right. Well that, that leads me to my. The what? As you were talking, you know, when we talk about heart rate variability biofeedback, we're kind of trying to help people.
One, we're trying to help people regulate their nervous system. I think that first and foremost, especially with optimal's approach, with optimal zone raising low frequency hrv, building that regulation. Now what's going on in your body or mind as we do that?
Question mark. But I would say that some of the things that may be going on in a escalated way that may not be leading to positive outcomes would be exacerbated by HRV biofeedback potentially. So I'm curious with your thinking on that. Is that a tool that we would not want to recommend because of all this complexity or is it a potential way to help people get the right type of interoception? I'm kind of at a loss here about.
[00:31:47] Speaker B: Yeah, so it is, it is super complicated. And I never actually answered your question about the bulimia and hrv, partly because I don't know the answer. I'll put that out there.
[00:31:58] Speaker A: Nobody does as far as I learned it.
[00:32:01] Speaker B: Yes, and partly because I think that's also super complicated. But I do want to add in terms of this biofeedback as an intervention or possibly giving something that's not helpful or not not useful.
My opinion on that is, is no, I, I, I in well I should be clear then. No, I don't think that biofeedback would harm somebody because of these findings.
In fact, to clarify the, the paper that I published last year, and I think I was on this, this podcast talking about it probably almost a year ago now, was looking at the optimal intervention in a, in a sample, a small sample of healthcare workers who did have evidence of eating distress, they scored in the clinically significant range on loss of control eating behavior. So we have some data to suggest that using HRV biofeedback with a tool like optimal or was optimal, in fact would actually help folks in those positions, in those not positions, but in those having feelings of loss of control in their eating.
Now this is not a clinical trial. We talked about that for as a pilot study pre post. However, the HRV biofeedback not only improved people's perceived loss of control eating and their disordered eating attitudes as measured by the EDEQ short form, but it also improved all but not distracting on the mia. So people improved attention regulation, they improved self regulation, they improved body listening, trusting, noticing and not worrying. And they also improved not distracting, just not significantly. We had a small sample.
So the short answer was no, I don't think biofeedback would harm people. Now these are not people with eating disorders. Remember, these were community worker, these were healthcare workers from the community. They were not clinical eating disorder samples.
Would it harm somebody with an eating disorder? I would still argue no. In fact, yes, there are concerns about people with eating disorders having abnormally high hrv. And I think that's, that's a real thing. I think people who restrict, who do not consume enough calories to meet their metabolic needs, their HRV goes up. And, and that for that reason I do think HRV could be in and of itself maybe a negative intervention. HRV monitoring, I should add HRV monitoring could be a negative intervention for people with eating disorders, clinical eating disorders, who are restricting. Because you have to be very careful with this population.
They can kind of think in their heads, their heads, trying to justify why they, you know, why they are okay with what they're doing, why, you know, why they should restrict their food, why they shouldn't eat X, Y or Z. And if there's a piece of data like HRV telling them that, that they have a really good or high, if good is high, right. They have a really good HRV and then they restrict more and it's going up. That could be problematic. So that I have to clarify that I think could be negative. HIV biofeedback, on the other hand, no, I think what that could do is get a client with an eating disorder in touch with their body's signals. Now, that is essentially in my view, an interoceptive exposure intervention.
[00:36:23] Speaker A: Right?
[00:36:24] Speaker B: Because doing biofeedback could be, could be exposing somebody to very frightening stimuli. Getting in touch with your body, if you have a serious eating disorder could be very hard. And that goes back to the comment you made about trauma.
There's often a dissociation with folks who are experiencing ptsd, a Dissociation from the body, there's a disconnect from the body. So interoception is nearly cut off because the connection to the body is not present.
So doing something like HRV biofeedback could be very frightening.
[00:37:05] Speaker A: Sure.
[00:37:06] Speaker B: And in that sense, maybe negative. Right. But if it's approached appropriately and in an environment where there's a therapeutic person helping the client to cope with what comes up by getting in touch with their body, I think it's absolutely safe and maybe even important.
So, I mean, there's a lot, there's a lot at hand, Right. I mean, maybe on their own, using an app would be, would be hard for a person who has a full fledged entrenched eating disorder. Right. But in a clinic, in the context of an environment with a trusted professional who they have a strong therapeutic alliance with, and that person understands eating disorders and understands the. I mean, in a clinic you've also remember you've got usually a respiratory respirator belt. Right. That in and of itself is an interoceptive exposure. Putting a belt around the stomach and then asking a person to breathe so that belt gets pushed out. That's frightening for a person with a restrictive eating disorder. Even bulimia. Right. Like bulimia is an element of restriction, by all means. So even a person with binge eating disorder, anybody with any eating disorder, is going to probably be uncomfortable with that. And is that bad? No, I don't think so. I think we need to expose people with eating disorders to interventions that get them in touch with things that they aren't comfortable with because that's what, that's what's required for healing. Just like food's not comfortable, you can't recover from an eating disorder unless you eat right. You can't recover, you can't weight restore unless you gain weight. That's the definition of weight restoration and uncomfortable.
So yes, biofeedback is likely going to be uncomfortable because you're getting in touch with your body, you're building interoceptive awareness, you're building interoceptive skills. And the process of doing that is probably difficult. But no treatment for eating disorders is easy. Right.
So I think that, you know, overall it's tricky and it's not going to be easy. And I wouldn't rational without, you know, a good specialization in eating disorders to, to tackle it or without at least, you know, familiarity with eating disorders to tackle it. But I think it's doable when I.
[00:39:46] Speaker A: Think that, I mean, that's why I was trying to sparse out because it seems like it could be a tool with work around a professional with expertise in disordered eating. You know, you put those things together, it could be a, a really good tool. And psycho education on HRV tracking would be interesting because we need to answer this question of what we're seeing here eventually. But at the same time, obviously the person that we care about and want to build safety with self and others is the person we're trying to help. So I think that professional add on to this is a really important message to, to just Clare, you know, shout from the rooftops around this issue.
[00:40:33] Speaker B: Exactly, exactly. I think that there's so much to be learned here. To me, it's one of the biggest untapped areas in my field of eating disorders. I feel like, you know, there's, there's been some forays into this, this work, but I just feel like there's so much more work to be done to understand a, you know, why, what's the mechanism underlying this huge spike in hrv and, and you know, in my view, and this is take with a grain of salt, like it has a lot to do with the starvation, right, with the metabolic system and, and you know, the purging with the vagal nerve that, you know, probably certainly has credence, but you know, understanding that better and really kind of getting at what's going on there and then understanding how we can utilize this exposure to help people to target those interoceptive skills that we know are failing in people and clients with eating disorders. And in fact, it kind of gives me the reminder to give the sneak preview of the work I just presented at the Biofeedback Federation for Europe conference in Italy last week. So that was super exciting. The conference was fantastic and fantastic. And I'll give a shout out to anybody listening who wants some really incredible workshops on biofeedback next year. The conference is going to be the same week. I think it's March 24th to the 29th. I'm not a paid advertiser, I'm just a fan of the organization now that I've attended their conference this year, the 24th to the 29th, I think in session Poland. So check it out. The Biofeedback Federation of Europe. But what I presented there as sort of a sneak preview because I haven't written the paper yet, is based on these data where we found that, that connection between the use of the optimal HRV app, the paper that I talked about a year ago, and improvements in disordered eating, the connection there. So whenever we think about, okay, somebody's improving a symptom from an intervention. What's the target? Right, like what's that mediator? So what is the mechanism?
So obviously with my interest in interoception, my first go to was well, did they get better? Because they improved the the dimensions of the mia. And in fact I was able to. Now this is a very small sample, so I put a caveat in there. This is preliminary and the only effects that I could detect were the large ones because of the very small sample. But what we saw was that attention regulation mediated the effect, self regulation mediated the fact, now that you remember, these are the dimensions from the media body listening mediated the effect, noticing mediated and so did emotional awareness.
Interestingly, that trusting variable, which we know is so critical to disordered eating, it's been discussed as this bridge symptom that was not a mediator for eating disorder attitudes. It only was a mediator for the perception of loss of control eating.
And it wasn't quite as powerful as say attention regulation, self regulation, and they're the two primary mediators in terms of power and size. But yeah, so what we saw in that analysis, and this is on my agenda for this year for paper writing, we really see that there's this mechanistic effect in these data in this just preliminary snapshot, small sample, but there seems to be a mechanism showing that use of HRV biofeedback and improvements in disordered eating attitudes and behaviors is connected by these interoceptive skills of attention regulation, self regulation, body listening. So that was kind of exciting. Now there are other mediators going on there too with the loss of control eating because the only interoceptive dimension that was statistically significant, that model was trusting. As I mentioned, I also wanted to do a post hoc examination and see what else. I've measured a lot of things in this trial that I did a couple years ago with the optimal app. I said what else might be mediating this loss of control eating effect? Because that was actually my largest effect. The effect size from using the app on loss of control eating behavior, if I recall, was like over 1. It was a Cohen's D of 1. The effect size for EDEQ is something like 0.8. So these are large effects. The loss of control eating wasn't all that mediated by interoception except for that trusting variable. So I'm like, what else is going on? I looked at stress, perceived stress, and that did it. It had 67% of the effect between HRV biofeedback and loss of control eating was explained by perceived stress scores. So there's clearly a lot going on with biofeedback, with stress, with interoception. It's super exciting and like I said, it's, you know, it's really ripe for investigation.
[00:46:28] Speaker A: Wow.
I remember the good old days when Nate Eekman just came on and defined interoception for our audience for the first time. I think you answered one of my questions in that last little blurb there. That was spectacular, by the way.
[00:46:49] Speaker B: I love Nate. He has an amazing clinical skill of getting this very construct, which, like you said, nobody really gets into the real world of clinical care. And I love that he's doing that. I just signed up for his webinar.
[00:47:05] Speaker A: In fact, and for our audience too. There's been several speakers on this topic to go also explore as well. This is, I think, something that I hope and I have strong confidence in. We will revisit from time to time in this episode because of the connections to heart rate variability and heart rate variability biofeedback. So, Janelle, I'm going to let you go back to reading journal articles on control effects. I'm glad there's people like you in the world who do things I would never find interesting.
[00:47:43] Speaker B: Yeah, I love to nerd out on effect sizes, that's for sure.
Factor models.
[00:47:49] Speaker A: I know. I appreciate you so much. And it's funny, we click on so many different levels and yet there's no way I would ever read that article you're reading. So I love that you're so personable and can bring this into a practical realm. And also to ask the tough questions that we don't have answers for yet. As so many times in this podcast, we, we go up to a certain point where the research will answer some of the questions for us, but there's always the next question, which is probably why we're going to go over 200 episodes here very shortly, so.
[00:48:26] Speaker B: Exactly. Exactly. Yes. And this is just a little peep at what's available or to. To ask even. Right. Like, we are just beginning. This is in its infancy. This, these connections between HRV and interception and eating and, and it's such an exciting field for me. I just can't wait for the next 10 years of work.
[00:48:51] Speaker A: Awesome. Well, I'm so excited to take that journey with you, my friend. And as always, it's a thrill to have you on. I always learn so much. And we'll put some information about Janelle in our show notes so you can find
[email protected] Janelle thank you, and thank you for the support of optimal that you've given us throughout the years. It's been a great treasure as I've made so many great friends on this journey. And as we were talking before we hit record, I was honored to be your host at Keystone Ski Resort for a week, where you and your husband destroyed me, boosted me up mentally and psychologically, but destroyed my legs physically. But it was just such a joy to spend that time with you. And I can't wait till next year.
[00:49:39] Speaker B: Can't get enough skiing in, that's for sure. That's my favorite thing to do in life. And like you, that mountain is where we can just kind of let go and be free.
[00:49:49] Speaker A: Absolutely. Well, thank you, my friend, and thank you for our audience. And we'll see you next week.
[00:49:55] Speaker B: Take care.
