[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us
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Welcome, friends, to the Heart Rate variability podcast. I'm Matt Bennett. I'm here today with doctor Judith Anderson, who I become familiar with her work, her articles through APB. I missed the workshop at the conference because I was stuck in conversations in the hallway, which happens way too often at AAPB. But I was really excited that she was open to coming on the show. So Judith, I want to welcome you to the podcast. I am so excited to explore your work. I think you're doing both incredibly powerful work and incredibly important work. And so when I can throw nerding out about HRV into those two equations, I can't think of a better way to spend an hour. So welcome to the show. And just for our audience, can you do just an introduction of yourself?
[00:01:27] Speaker B: Thanks so much Matt. And thank you for inviting me on the show. It's really exciting. I am a professor at the University of Toronto, Mississauga in Canada, and I am a health psychologist. Psychophysiology. I study field research outcomes of stress, the impact of stress on performance, mainly among law enforcement, but any high stress profession, really, we've worked with medical workers as well as emergency workers and other kind of high performance individuals, military and so forth. So yeah, I've been doing that for the last. Since 2011 now. It's been a while.
[00:02:11] Speaker A: Awesome. So I'm curious, when, how did you come across heart rate variability?
[00:02:20] Speaker B: Yeah, so I in, you know, I've always been a proponent of looking at biological variables in addition to psychological variables, and particularly in my work with military veterans. At first I did a postdoc.
I was in the US for grad school and my postdoc at the US Department of Veterans affairs. And so I wanted to look at psychological outcomes associated with PTSD, but also the physical health outcomes. And what we see is that obviously PTSD accelerates physical illness onset and severity. So then when I got my professorship job back in Canada, came back here, I wanted to look at resilience factors. If there was something that we could do before people a got PTSD and before they had the physical illnesses associated with it, that would be even better. So I began working with police officers and tactical team members across Europe and in North America, and was looking for a psychobiological intervention that. So what we realized early on is all of these PowerPoint wellness interventions are not going to cut it completely because they only last so long and don't translate to the high stress world of policing or public safety.
So I worked with some tactical officers in Finland. Actually, we did some of our first research over there, Doctor Harry Gustafsburg, and he was a commander of the finnish federal tactical team called Karhu. And he was very, very interested from the law enforcement side, what could we do to improve performance? So this is a long winded story. Initially, I came into working with police thinking I was going to do health. Health and wellness. And so HRV biofeedback would be great for that because of all the clinical efficacy trials. And then when I worked with the police, they said, how can we improve our performance? How can we actually get into our day to day? The acute stress, obviously, the accumulated stress and the long term traumatic exposures. HRV biofeedback is great for that, and let's do that, too. But a challenge was starting to work with the acute situations.
[00:04:55] Speaker A: Excellent. So then, as I got the paper open right here, the I prep protocol, if I could call it that. But I'd love for you to kind of. So you get engaged in law enforcement, and I would imagine with your interest background in PTSD, it sort of gives a very intense learning environment. Having worked with some police forces around the country, I've really just come to appreciate the stress and trauma that the typical officer experiences. I think that sometimes if there's not a shooting or something like that, there's less attention paid to. But just the stories that I heard were incredible. And then sort of, you know, and I think my police officer friends would be okay if I say this sort of a culture of, you shake it off, you tell the therapist what the therapist needs to hear. So you get back on the streets and get on your job. And so that mentality can really put people in danger. And, you know, the little research I've kind of done in the heart rate variability world of, as we know, if you're in these high risk situations, a bad decision can have huge consequences.
I would love to hear about how you've integrated HRV biofeedback into your thinking around resiliency and performance.
[00:06:23] Speaker B: Yeah, that's a big question, one that I spend my days doing. So evolving. It's constantly evolving. Right. But so in backing up a little bit in our first initial research, when I worked with doctor Harry Gustafsburg, he went on and got his PhD, got so interested in academia, we were using traditional available HRV biofeedback field monitors at the time, and I won't go into, because I'm not promoting any one company at all, but the equipment that we had, again, had to be ready to be worn in the field and during scenario based practice, and it had a lot of limitations in that. So I found that we needed to come up with something that could be used in real time, and so we separated the two. So there's HRV biofeedback, you know, your traditional sessions for recovery and I health and mental resilience building. This is the following. You know, the protocol that follows pretty close to the Hair 2013 protocol and many other protocols, obviously, look at HRV biofeedback, paced breathing, resident frequency, all of that. But then to look at something for the acute stress, I happen to get paired up with doctor Joseph Arpaia, who is a clinical psychiatrist in Oregon, actually, but has worked with many police officers, first responders, healthcare professionals over the years. He heard another news report that I did and gave me a phone call, actually. And he had designed this app for his patients that just met all the needs that we had for law enforcement that could look at real time and it could give instant kind of biofeedback. So that's. We paired up, we became this team of three, the cop, the psychologist, and this doctor. So you can think, or the medical doctor. Right? It's like the start of a joke or something.
They walk into a room and. Yeah, it was a really great pairing because doctor Joe Arpaia taught us how we can feedback the individual's psychophysiological reactivity in the scenarios, right after the scenarios give their feedback, and the person then can do some recovery breathing, or do a physiological reset using that biofeedback to perform better. And that all culminated in us coming up with this iPREp program that has multiple components in it. I.
[00:09:13] Speaker A: Awesome. So were you actually real time HRV tracking in the field itself or just through, like, training activities?
What was that kind of looking like, that real time kind of feedback?
[00:09:27] Speaker B: Yes. So we have two things, obviously, when we go in to find out if there's a problem and where the stress triggers are, and where are people getting hung up, and where does intervention need to happen? We first hook people up with heart monitors, activity sensors. We use chest bands, and we've used different kinds over time. Again, they have different benefits and challenges, each one. And then we've had different apps associated with it just to find the best one that can give us continuous monitoring. So we record all of the data of what the officer is doing from the beginning of the day when they're sitting doing their, you know, five minutes resting HRV, you know, breathing, just normal breathing. So we have a baseline. Then they go into any classroom instruction. Then they go into the high intensity scenario training, multiple scenarios where they reenact real or events that have happened in the past or that would be regionally appropriate to what they would face in the job. Like, you know, actors recreating something, like a break, an entry or domestic dispute, all the way up to very high intensity scenarios, like the reenactment of the Columbine shooting scenario or some active shooter. So there are various levels of training, and obviously, with the tactical teams, it becomes more and more advanced.
So we have found certain equipment and apps that we can record real time, and then we can use that to help the officer identify issues in their own performance, where they could then implement biofeedback techniques to improve in addition to the recovery aspect of your traditional HRV, biofeedback breathing intervention. Yeah.
[00:11:29] Speaker A: So before we kind of dive into maybe the structure of the iPref, I'd love to just like, in kind of a general sense, as you started to do this work, I wonder, sort of just kind of what, what surprised you? What, what? Like, what are some big takeaways as you started to look at this and examine people's biology and the autonomic nervous system as they're going through these, these intense scenarios, what were some of the things that just kind of stood out to you as you started to look at some of this data?
[00:12:10] Speaker B: So originally, when I came into it, I thought, okay, we're going to measure HRV as a metric and use that to make our recommendations for change. What I see during the high intensity activity, often some of the scenarios would last 10 seconds.
[00:12:29] Speaker A: Yeah.
[00:12:30] Speaker B: Or 30 seconds would be a long one.
And so it's extremely short.
And the changes in the physiological, the autonomic nervous system are so instantaneous and so short lived that you need something beyond a simple, you know, five minute metric or even a 32nd metric.
And so to actually look at these real time changes, beat to beat changes in scenario are what is, what are critical. And it's interesting because we've gotten a lot of pushback when we say that in the literature. No, no, you need to use your traditional RMSSD and so forth, you know, but there just has not been, there's just not long enough segments to use it for that. So you have to look more in depth at the changing of the heart and then this kind of instantaneous biofeedback of the one breath reset that we talk about changing nervous system and that insight and then coming up with ways to look at your HRV metrics in more of a literature friendly or what people accept or view they want.
So that's been one challenge on the academic side, but also it really is striking when you're working with officers in the field. If they were to, let's say, wear a watch that spit out HRV numbers or something like that, a. It's meaningless. What does this middle number mean? You know, and how is that associated with what I need to do in my body to think more clearly and resolve this issue? Right. So it doesn't translate from just looking at straight up RMSD numbers or SDNN, you know, that doesn't translate. So they need something that's more.
That's. That's easy to understand. They can look at just their heart rate intervals over time, in real time for those very quick segments, and then they can manipulate that through breathing. Right.
[00:14:46] Speaker A: Yeah. So I think the question some of my fellow HRV nerds would be wondering is, as you go through, as you track them through a training scenario, I could see, and maybe this is what you're talking to that, hey, I've got to react. Or things like, I just think about an officer even standing up to get out of their car is going to change their homeostasis, not in a dramatic way. But can you. And have you found ways to isolate the stress response versus everything going on physically that could be impacting both heart rate and HRV?
[00:15:32] Speaker B: Yeah. So we found that there's three really important components when you're doing this research on really acute stress and you're wanting to intervene with it in high movement settings.
[00:15:43] Speaker A: Yes.
[00:15:43] Speaker B: One, you have to be observing your participants, so there has to be eyes on and there has to be some coding of what they're doing. They're standing still. So we have research assistants all over. I mean, it's great if they allow us to video, but most services wouldn't allow us to videotape, obviously, for practical reasons. We have multiple observers. And then, of course, there's always the use of force instructor or the police instructor there to confirm. Yeah, that was a use of force.
They used the motion correctly or so forth. We have that. So you have to look with your eyes and see what the officer is doing and mark it down. Then you have to account for movement. So they either wear a movement sensor or it's in the app or the chest band. Okay. So you have to account for that. And then you.
You have to get the person's baseline so that you understand where they're working from and what would be a stress response from them. And using those three, believe me, Matt, you can clearly see when somebody is. When their stress response is activated from the psychological aspects versus movement. Because let's say you have somebody getting out of a car.
They're going to get out. They're going to have, like, a pretty little blip in heart rate, little blip in movement. They come around the corner and they see somebody with a gun or a hostage situation, and they're standing still, basically, they're standing looking, and they're right. And so you can put those variables together and you can then intervene. Right. What could they possibly do to change their physiological reactivity? The idea is obviously that we're not trying to get people to relax. We want them to be physiologically adaptive. You should have a heart rate boost. You should have an activation from that. But can you recover very quickly? Can you come back to your ready state or the state where you're activated but not over activated? And so your brain is online. Right. Your thinking. And so that's what we work with. So it's almost like creating a profile for each person.
[00:18:14] Speaker A: So, so very like, if a police chief would pick this up and say, hey, let's do this. It's more than just saying, hey, let's buy the monitor and the app. It's. It is. You really need that eyes on piece to help understand what's going on through. Through that process, which makes total. Since on so many levels.
[00:18:38] Speaker B: Yeah. Now, what we've tried to do with our protocol paper, and obviously, it's always better to be in person. Obviously, I'm a teacher, and would I like to be teaching with my students? Yes, but we have to do papers sometimes to try to communicate because there's more people than we can actually get out and help. But the idea would be that an instructor using the heart rate monitor and app and knowing what to look for, again, those three things.
If you're using that monitor, an app, you can run officers through some basic scenarios, really easy, low movement, low stakes, and record them. And then actually, now we have the app that plots their real time physio right over a video of them.
[00:19:26] Speaker A: Wonderful.
[00:19:27] Speaker B: So you can then match it observes for you. Right. So you can then match. Wow. You were standing still. And you were at 160 while you were yelling, yelling at this person. And it wasn't effective. You were caught in that spiral loop of just, you know, lay down, lay down, lay down or something like that. Then when you did the reset breath and you got back to your ready state, you were able to talk to them and verbally deescalate them and look at your physio. Wow, it's totally changed, you know? So an instructor without training in psychophysiology can use these devices to, to help guide their police students.
[00:20:08] Speaker A: Very cool. So let's jump into sort of the structure of the program. You've already kind of mentioned some of the aspects of it. Let me start by, you know, maybe this is a good entry into that. You mentioned doing biofeedback with folks. It sounds like a little bit ahead of time to give, build up these skills. And I love how, it's exactly how I think about these is like, I do the practice, I develop a skill, then in a scenario, I can utilize that skill for performance, for success in that, that situation, or for survival, whatever the terms might be. So to start out exploring, and you can take this in whatever direction makes sense. But did you do like, you know, what a traditional, like, you know, biofeedback therapist practitioner would do? Are you more doing trainings based on app? What kind of training? What kind of, we say, you know, the biofeedback training, what's that kind of look like for.
[00:21:13] Speaker B: Yeah, it's, it's obviously a little different from a therapeutic session because we're literally in the field. So it's been adapted to meet the needs of law enforcement or high stress professionals. And this is how we do it. So the first morning of the training is just basically teaching them the general concepts, really big picture concepts of the stress response system and what's going on in their autonomic nervous system and how that communicates with the brain and their memory for all their great skills and abilities and how those can be shut off if their activation is too high. They all get it. They have examples from when that's happened to them and so forth. They get that. Then they put on the heart rate monitor and the app and we have them.
So there's a baseline recording, just their baseline, sitting, resting heart rate. We have them stand up, and then they have different exercises that they do. We take them through paced breathing. So we take them through seven or eight different paces to find the pace that is as close to their resonant frequency as you can find in the field without really high tech info. So we're looking at the curve of the wave, we're looking at the comfort level, we're looking at the consistency kind of, of the envelope and obviously what feels the best for them. Right. And so we can see that on the screen by looking at the actual heart rate data in the pattern. Right. And how in sync it is with the breathing. How is the heart rate sync with the breathing? So then once they have their resonant frequency pace, we call it, because it's as close to that as we can get.
We have that. They know that that is what they can always go to to reset themselves. Okay, they can reset themselves, but then we teach them. Okay, but how do you, when you only have 10 seconds or you only have a few seconds, then what do you do? Okay, so that's when we. They're wearing the monitor and they have this, this the app that shows real time b two B. Their heart rate comes across the screen and there's movement activity on the bottom. And it's just a simple grid. There's no extra info and there's no numbers, like there's not an RMSSD number or anything like that to confuse them because they wouldn't know how to use that. But what we can see, and we do different exercises. When you breathe in, your heart rate is going to go up. When you breathe out, it's going to go down. We teach them big one breath reset, we call it. So it's just a quick, you know. Well, not a quick, but it's a deep inhale, hold at the top for 1 second, and a long, prolonged exhalation with pursed lips. And they can see how quickly they can bring down their physiological reactivity back to this ideal state for them, activated, but not overactivated.
Then we have them do a really, really easy scenarios. And then obviously they're not looking at the monitor all the time. While they're in the scenario, they're attending to the call, but then we review it afterwards with them. Okay. And then, so that's kind of their baseline. Then we ramp up the scenarios in complexity. And sure enough, people run into issues like everyone does with physiological over activity. We help them and teach them and remind them to do this prolonged exhalation, reset breath and practice it in so many different scenarios and body positions that they can do it without, you know, somebody else knowing, oh, you're doing a big, prolonged explanation. You know, it would be weird to have an officer. So what's your driver's license? You know?
[00:25:07] Speaker A: Yep, yep.
[00:25:09] Speaker B: So they do it in a way that becomes natural. And then they're, you know, it feels good to do this reset breath. Your body feels good and your performance begins to improve when you incorporate that into your scenarios. So then as they do it, first we have to remind them to do this reset breath. Then they begin doing it on their own. And then we always review their video and their physio data plotted over afterwards with them. And they can see when they improve and they can see when they need to take this stop and breath. And it's, at first people think, oh my gosh, you can't, you can't give an officer another thing to do. They have so much going on already. And that's exactly why we found that certain kinds of breathing didn't work. Like, I think you've probably heard of box breathing or tactical breathing, which is actually really popular in policing.
[00:26:10] Speaker A: Yeah.
[00:26:11] Speaker B: And it came out of the Grossman books. But what it requires is counting and holding breath for four. Count, you know, count in for four, hold for four, out for four. You know, this box breathing. So I always ask, okay, so what are some of the ways that, that might interfere with your job?
Oh, well, I'd be counting and I wouldn't be, you know, thinking of the call. And then we've, we've seen if, you know, we've tried the different breathing things techniques, and if they hold their breath for long periods of time, even 4 seconds, they're going to be more likely to hyperventilate.
[00:26:48] Speaker A: Right. Right.
[00:26:49] Speaker B: They're already potentially over activated, so we don't want to go into that. So it's interesting how you get kind of pushback, and I'm sure you, you've heard about this from many different fields. Well, I already breathe. You know, I'm already breathing.
It's like, yeah, well, there's not just one way to do a squat. You know, there's many ways to do a squat, and you have to do it in a body position that, you know, doesn't injure you.
So interestingly, it's the same way with breathing.
[00:27:22] Speaker A: Yeah.
[00:27:23] Speaker B: And for policing in the acute kind of stress activity, you can learn and your body, you can program your body to do this automatic one breath, prolonged exhalation without having to think about it. And so that's really cool when they start to see that on the monitor recording.
[00:27:40] Speaker A: So, so that's, I'm assuming, fairly well established in your, the data that you've collected is that that one breath is enough to, to get someone, I don't know, maybe window of tolerance is too kind of big of a word to introduce, but gets them at least some bagel break. Parasympathetic, you know, activation. You're getting something there, I'm assuming, from, from the data you've been collecting in these scenarios as well.
[00:28:10] Speaker B: Yeah. So the thing is, we haven't been able to isolate completely the effects of just the one breath in isolation. But that in combination with also doing HRV biofeedback overall is what we see in the reduction of lethal force errors, the improvement of psychophysiological outcomes. But I will tell you, Matt, the one thing that cops do like and will continue to do and tell me they do it with their families and their teenagers and their kids and is the one breath reset because they see the, they see it immediately working. Like they're able to keep their brain online and do their job and do their skills and they're not making use of force errors. And so they love the one breath reset. So we're just now beginning to be able to isolate those few seconds because it is challenging with the movement, so forth incorporated. But like I said, the whole program I prep as a program with the one breath and the HRV biofeedback component. That's what the studies efficacy are reporting that we review in that article, the.
[00:29:23] Speaker A: Protocol article, and for our listeners, the HRV biofeedback piece of this. Are you asking them to practice over time? Like, is that what I'm hearing you say when you say that? So they're still doing 1020 minutes a day. What's that sort of look like for them?
[00:29:47] Speaker B: Yeah. So again, with police officers, they're less likely to do 40 minutes and so forth. And everyone's busy. So Doctor Joe Arpaia with his patients over, I don't know, 25 years, 30 years of clinical practice, he's found that if people learn the, they get their pace, you know, they get their pace and they practice several minutes throughout the day. So maybe you're practicing in total 510 minutes at a time throughout the day.
You're going to see the beneficial effects. And we see the same with cops. So we tell them we have them when they're in the training, obviously, we set aside five minute increments. You go sit in the room, you do this here, you program. But we also try to help them to program their bodies that whenever, like, they sit down in the car or whenever they sit down at their desk and they have five minutes, they start going into the breathing and they're wearing their monitor so they can start to see how quickly they can change their state. That's, we want them to practice more often for smaller increments of time, because, one, it's more realistic, they're going to do it, and two, they can see the results. We call it. They're tacticians of their physiology. They can get into that recovery state very quickly. That's what we have emphasized. Now, obviously, we're doing a whole new protocol, trying to aim this iPrep into more of a mental health focus by doing it online. So we're sending the officers the heart monitor and the app, and then we have a whole learning management system, and we're calling that training autonomic modulation training. And then we're testing that to see if that has the same biofeedback techniques that we're using in I pRep. But it also has more mental health coping resources and things like that. And so that's currently being tested to see if that's going to be efficacious online. And we're also going to be able to isolate the one breath and the HRVB training. But for that, because it's online and we're not with them seeing their bodies being programmed, we do tell them to practice ten minutes, twice a day.
[00:32:12] Speaker A: Yeah. So I'm curious about, you know, the, you know, especially with your, your history and your experience working with post traumatic stress disorder. One of the things with veterans that, that I see in the research is usually the, you know, and I'm going to say usually because trauma is so individualized that we can't talk in, hey, this is how it's going to impact Judith. This is how it's going to impact Matt. But, but we often see if trauma existed before the trauma of war. Um, you know, knowing just generally that a lot of officers come from histories of trauma. And just, again, working with police officers, I'm just aware of there's so much trauma inherent to their work, much of which is just a Tuesday sometimes in that mentality, I kind of wonder how you, how you think about like, that past piece of your expertise in work, kind of informing a work where we know you're working with occupation that experiences a maybe one of the highest, if not the highest rates of trauma on the job.
[00:33:29] Speaker B: Yeah. So my burning desire, and this is what I've gleaned from my colleagues, both the tactical doctor Gustafsburg and doctor Joe Arpaia, from the clinical aspects and the research aspect is that we need to teach people these skills before they even hit the road. We should be teaching these skills. Yeah. In academy, we should be teaching skills to our kids in elementary school.
[00:33:53] Speaker A: Yes. Yes.
[00:33:54] Speaker B: So that they have the ability to modulate their physiology throughout time. Now, that's obviously not to say that they won't encounter traumatic things. We know that they will.
But they have an additional psychophysiological tool to repair more quickly, recover more quickly, as much as they can, and then also not have that accumulated stress build up over time, which is what we see eats away at people over time, and then they're burned out. Right. But you know, what other thing I've noticed is that most police academies do not focus on concrete, tangible techniques to avoid, to manage stress. They have a PowerPoint, you know, they have, okay, you need to eat healthier and drink more water and exercise. And maybe they have exercise classes, which are great, but almost. No.
You know, and I've been. I visited hundreds of agencies across North America and in Europe, and now there's. There's a few more. And especially Europe is really making a move toward integrating HRV, biofeedback. It's really taking off over there. I have some colleagues who would love to be on your podcast, I'm sure, who. It's kind of taking off over there as well. Like, let's integrate this into police academy. Yeah.
[00:35:18] Speaker A: Yes. Yes. I can't amen a million times to that because why are we releasing people into these jobs, training people to be successful and safe and create safety for the rest of us without these. Without really much of any skill set? And what I love about your program as well is what I found useful is you're training them on their nervous system. So it's not a psychological weakness or impairment or something like that. I think it takes the. I don't know if machismo is the right word, but I'll use it. You know, that sort of mentality, at least it addresses that, I think, in more of a biological way, which I love. That's part of your program as well.
[00:36:15] Speaker B: Well, it's interesting because, you know, what makes cops effective in showing up to all of these traumatic things that we wouldn't go to. We run from these instances. They run towards them.
That ability to shut down and deal with things very concretely and work through the problem with objective facts, that is beneficial on the job, but it can be very difficult off the job, then if that is not processed. And so it's like when you come in with just a purely psychological intervention, you're basically saying to these officers, well, you're weak. You're not good. This isn't a good strategy to have so it's a confusing message that we might send to them.
You're supposed to be like that on the job, but not, you know.
[00:37:07] Speaker A: Right.
[00:37:08] Speaker B: Not in other times. Well, so having a psychophysiological intervention where you're just. Even the words matter. I do not say psychology. I do not say mental health. Aside from that, other mental health. Well, you know, wellness intervention that we're advertising as that. But in iPREP and all of our work with officers on the job currently, we just talk about the biological aspects, training, physical training. They're very used to physical training. And really, that's a huge part of it. You know, obviously, if somebody has a mental health condition beyond what can be addressed, just physical training or I, HRV biofeedback alone, that those resources are there for them either at the agency or, you know, kind of nationwide resources. But, yeah, we're very careful about our wording, about the way that we present this training and. Yeah. And I think that's. That's tailored to the audience.
[00:38:10] Speaker A: Yeah. I find, and I hope my police officer friends will laugh with me. And if I use tactical 20 times every two minutes, they listen in a different way. Like, I don't know what it is about that word, but just throw tactical in a bunch and I keep their attention a little bit longer. I find, like, yeah, it's funny how that word can get you a long way with these folks.
[00:38:38] Speaker B: Yeah, absolutely. And, I mean, we change our words for different professions. Why would.
[00:38:43] Speaker A: Absolutely.
[00:38:44] Speaker B: You know, as well.
[00:38:46] Speaker A: So I wonder, as you collect all this data, are you, and if so, insights that you may have gleaned from this? I'm assuming you're getting HRV data over longer periods of time. So I kind of wonder if you've looked at the data in this way, as they integrate the program and they start to practice, do you get baseline, like RMSSD readings or overnight RMSSD readings to track some overall sort of health metrics, you know, in any way since you got all this great data you're collecting already?
[00:39:30] Speaker B: Yeah, so we have.
I've been. We have a lot of data, and I'm just now actually getting to write up some of the stuff I've published, the most kind of the urgent ones already in progress, but literally, we've been in the field collecting data. So in the next year, some capstone papers, this is what I'm calling them, will come out with all of these kind of comparative measures, and we haven't. We've followed officers longitudinally, but during their daily program, there was two groups that we have some overnight data. So we will look at that as well, but not on every sample that we have quite the number of samples, but mostly it's during the day, but it's like an all day thing. So, yeah, we always have resting baseline in the morning and at different times throughout the day, but when they're active and then we have very concrete timings. Like this was the five minutes anticipation before the scenario. We had observers, and we have notes writing that this is the scenario on. This is the debrief immediately following the scenario.
And then those three periods can be compared to the baseline rest. Right. And we can look because.
So some of it is a challenge in looking at where should we be making the cutoffs, because obviously, anticipation, you've got a big, big increase in all your autonomic activation, and then that bleeds over into the scenario. But some people start calming down, you know? Right. As the scenario starts, it's interesting, there's all these individual differences. So creating these profiles for people and then looking at the data over time is really what we're working on right now as well. So, say, stay tuned for some of our capstone papers that are going to come out. And I'm really excited about heart rate fragmentation. Have you had anyone?
[00:41:31] Speaker A: Let's define that for our audience. That's a new term on the podcast.
[00:41:36] Speaker B: Yeah, so, so heart rate fragmentation. And really, it's my postdoc. And Jennifer Chan, she did her PhD with me. She's been specialized in this. So I think you should have her on the podcast. And then doctor Joe Arpaio was mentoring her. But basically, you're looking at how fragmented the pattern is of the art interval. And so it's not just looking at the inter beat interval, it's also looking at the pattern over time. And what is neat about it is that you can. It's like, I'll give you an example. If you're driving your car a certain distance to work, it takes you ten minutes to get there, and you drive it in two different ways. And let me ask you, which way is going to get you to the mechanic quicker? So let's say you drive it the first day, just, you know, you slowly speed up and you just drive at a current pace. And then you, you know, you get there and you brake and. And pull into your parking spot the other day. You go, break, go gas, break, go gas, break, go gas, you know?
[00:42:49] Speaker A: Yeah.
[00:42:49] Speaker B: So it takes you the same amount of time to get to work.
[00:42:53] Speaker A: Yeah.
[00:42:54] Speaker B: But you've put a lot more damage into your, your car. So the heart is the same way. Some people have much more of a smooth overall pattern.
And that's not going to be captured exactly by just looking at the interbeat interval. So we're getting into looking at how fragmented that signal is over time, like over five minute periods. Yeah. And you can see it. It's fascinating. I don't have any data here, but when you actually look at a five minute visual of the art intervals, you'll see one that looks definitely more. You can see if you look at high fragmentation versus low, you can catch it with the eye. So it's also a neat new metric to explore, because if you look, if you think about all these different labs doing HRV research and people trying to interpret visual and people data, and people have different expertise across labs and so forth, and if we have a metric that we more people can agree on and say, yeah, yeah, this is maladaptive versus adaptive and so forth, I think that'd be another tool to our toolkit, basically.
[00:44:09] Speaker A: Well, and everybody goes back, I'm sure you're aware of it, like, the 1998 European Society of whatever, whatever is still like the go to ten commandments of HRV. And one of my things, I know we've maybe taken some of those measures and invalidated them, but, like, where are the new metrics in a field that is just expanding so dramatically? It's like, did we find them all already? Like, so I'm really excited to hear. Whenever I hear new things being looked at, I get excited because we can't have, like, stopped this 25 years ago. How haven't we? You know, and I'm a big fan of RMSSD, but you know, what else? What else, like, what else is there? There's got to be some progression in innovation in these metrics, in my opinion. So I'm excited to keep an eye on that.
[00:45:10] Speaker B: And there. Did you know this just made me think of the 1998 versus the Karen Quigley et al, from northeastern. They just published the new kind of standards for psychophysics, you know, that just came out. So I love Karen. She's awesome. So I promoting that paper, but also, I didn't. I don't think they went too much into heart rate fragmentation. We've gotten it from Costa, the group at Harvard, who is using heart rate fragmentation and HRV, your traditional metric, to be able to detect cardiovascular disease, and they found that it can better, more accurately group diseased individuals versus non diseased or healthy.
And so we thought, oh, wow. So this is looking like. And in some of Jen's initial work, you can start to see indicators at much younger age. So where our HRV metrics are pretty similar in different age decades or even five year periods, but you can start to see some of this fragmentation quite younger people. We don't study anyone under 18, obviously, but.
So, yeah, I totally agree with you, Matt. We should be continuing to evolve, and I hope that journal reviewers, we've gotten some very interesting kind of pushback from journal reviewers about a new metric. Why do we need a new metric?
So that was interesting for us to encounter.
[00:46:49] Speaker A: Yeah, well, you know, yeah, I can see that. And yet, at the heart rate variability podcast, we can explore this for hours. So. But I appreciate you pushing that into that, because it does. I mean, and it is. It seems like we got something set in stone. And again, I know I'm being a little overdramatic with saying we haven't made progress in 25 years because I know we've had a lot of people doing hard work, but it seemed to solidify in a way that you don't see in other fields like neurobiology. Seems there's a new something coming out every day about the brain or epigenetics or like there's quick evolution. And I'm hoping with the focus on HRV and it becoming more mainstream, there's some interesting. And I know there's people thinking about it, but I think to get it at the terms of low frequency or RMSSD, you know, you're going again, you're trying to add an 11th commandment to.
[00:47:53] Speaker B: Religion. Oh, my God.
[00:47:54] Speaker A: The stone. The stone. So I've got a couple questions to ask to kind of wrap up, because this is such a fascinating discussion. The first one is one that I've. I've struggled with as somebody who does training, consulting, and it. Police officers, I would say airplane pilots, I would say surgeons.
There's a real interesting ethical thing that we hit.
We may hit it in different ways, but if you know that an officer wakes up and their RMSSD, their heart rate variability is crashing, I don't want, you know, I don't want my pilot to fly my plane. I do want to get from point a to point b if they're not doing well and they have data to say they're not doing well. I sure the heck don't want somebody to do surgery on me if they wake up in the red. And I really don't want police officers, for their sake and for the community sake, to go out and, you know, do the real hard, stressful sometimes, you know, life threatening work that they do if they have a dysregulated nervous system. And maybe it's not just one bad night's sleep, but let's say it's. You've got seven days worth of data that this person's not doing well.
How in your mind, and maybe concrete advice, do you give of kind of how to look at this in a way? Because is it, should we be sending officers out now that we have this data to say they need help right now? They don't need to be out because their nervous system isn't ready or capable of this. How do we get them the help they need so we can assure, you know, and not just police officers, but, like, somebody gonna cut me open. I want them to have be at least doing good today. Like, not that. So I wonder kind of how you wrestle with that, because I also know they need to show up for their shift. There's those two competing things, is we may be putting a dysregulated person in dangerous situations, and if we don't, there's consequences to not having them go out for their shift as well.
[00:50:13] Speaker B: Yeah, I mean, it's a slippery slope, right? Because if you say, I'm going to have monitor their arm SSD and then make decisions about that, what about their glucose monitoring? What about their cortisol or endocrine monitoring, metabolic. So then we would be monitoring everything. And the other thing is, I still have a healthy respect for, you know, if somebody's numbers, RMSSD or so forth, are off, there could be many other factors that are influencing that on that particular day. I think overall, the approach that I've taken to agencies will ask me this question as well. I said, either you get into fully monitoring your person, which means behaviorally, all these other biomarkers, and you're becoming the police state yourself, basically, because you wouldn't want to just have one number or two numbers that you would call somebody off, but you want to teach them these skills in training, like, you know, medical school or police academy. And then they need to self regulate. And if they are at a point where they're like, I am not in a state, whether it be from my glucose, whether it be from this, and I have tried my training, I cannot do surgery today because I cannot regulate this.
[00:51:38] Speaker A: Yeah.
[00:51:39] Speaker B: First of all, we need to train it. Number one, we need to make it required training. Two, we need to teach the officer or the surgeon to self regulate or to know when they call on and off. And three, we need the agency or the hospital to say, okay, you're telling me this, I can check the numbers if I want, and I will give you the day off until those three things.
I've done a lot of three things today, but, yeah, it's good. It's a memorable chunk. Yeah. So I think that's kind of an approach that I recommend agencies to take. Yeah.
[00:52:20] Speaker A: Yeah. I find it an incredibly. Again, there. There's, I don't think in a lot of occupations. Well, I think in a lot of occupations, you can show up and get through your day.
[00:52:32] Speaker B: Yeah.
[00:52:33] Speaker A: In the. Let's just say in the red, you know, not. Not having good heart rate variability. I just think when it's the intensity of, whether it's physical dexterity or mental dexterity or, you know, cognitive decision making under maybe even traumatic levels of stress, boy, you throw up already. And I do appreciate, like, you're only monitoring one thing, but whether your RMSSD is in the toilet because of severe burnout, family stress, maybe even that you're getting a cold, all that we know can impair cognitive functioning, even if it's just by, like five or 10%.
Could be just that difference. And again, we're working in fields that we know their load is always probably challenging their capacity already. So I think it's just an interesting, now that we have the data, how do we use the data for the safety of the officer, for the safety of the community, you know, in that piece while getting people out, you know, because a hospital canceling a day of surgery is an absolute nightmare for everyone involved, and I still don't want the surgeon operating on me if they're.
[00:53:54] Speaker B: Or the pilot flying. No, I totally agree.
But what can we realistically do in the next five years is that we can also, if we integrate this training and monitoring, there's also ethical things with sending an officer out on the road with the monitoring stuff on. So there's very few studies that I've done with that because it takes additional level kind of ethical review. It has to be medical grade devices that the public couldn't sue for because they can't have private medical information. But teaching them and their instructors, the police instructors, learn to see when the person is in the red. And that's the neat thing about if an officer is wearing a monitor and their instructors, at least in training, can start to see, then they can call them aside and say, hey, I'm noticing this. Let's do something about it. And if they can't recover right away, like at the beginning of the shift or, you know, before. Before a call out, then they don't go on that call. So to me that's, that's what I would say now, but so many people are burned out. I think you would have mass un.
[00:55:04] Speaker A: No, if you think about what you're just saying about, and I agree with you and I work also in healthcare and social services and education. So they're actually more burned out than police officers. But police officers are always in the top ten, you know, and if you just think about that reality, I mean what, how does that contribute to some of the things that make the news? And I'm not saying that that's the only variable involved. If you try to answer any complex question with one thing, it's their HRV is low. You're missing so many other things. But again, it's just such a, I think HRV can wake us up to the fact that hey, we're sending out people who are struggling right now. I mean the data already shows us that. But again, I think what your work is, boy, if we could show their nervous systems are struggling to and what the consequences of that could be, I think it furthers us. Now what do we do with that? I think is not an easy answer.
I think training, I think, I mean there's all those things that I think everybody would agree we could do more support of maybe destigmatizing mental health services for this population or at least, at.
[00:56:30] Speaker B: Least pushing these kind of HIV biofeedback as an option or different language instead of because we say that destigmatizing, but it just doesn't happen. I mean I think it's going to again come along with like you say, the requirements of the job are this. They're really good at doing this. Maybe that's not as good for mental health or processing later. So what can we do as practitioners to accommodate that and work within that with our treatments and our language? You know, maybe we need to be the ones that are changing. I don't know.
[00:57:03] Speaker A: Yeah, I have a theory that part of academy is, and as a therapist I had to do that. Well, I didn't have to, but you were highly encouraged to get engaged in therapy yourself. And I think that level of investment in the mental health of our law enforcement and heroes is well worth it. And maybe if it starts there and I think the younger generations are, there's less and less stigma, though I still see it a little too much in the areas that in things like the tactical folks still there's that stigma. But it, boy, we're almost at this, I think turning point even in those fields to realize this and yet, you know, mental health and showing up for your job, you know, it's, it's, again, it's not a simple solution to this, but it's, it's a fascinating, I think it's such a great, you know, ethical area to talk about because also, like, do you want somebody showing up for their sales call if they're in red? Well, how do we look at teams that are in red? Like, you know, those sort of things. I think, you know, these extreme scenarios of surgeons, pilots, you know, you know, police officers give us a laboratory and your work really shows, you know, helps educate the rest of us on the impact of all of this.
[00:58:36] Speaker B: Yeah, no, it's, it's definitely an exciting, if it works at the extremes, I have hope that it will work at my desk job. Yes, whatever. I'm not always at the desk, but you know what I mean, it's work for the rest of us.
[00:58:50] Speaker A: So that's, that would be my final kind of question to wrap up is what in everything that you've learned? And again, I just, I found the article just oh so exciting to read in your work, the societal impact, the impact on people that I care about that are keeping me and my community safe. You know, so important how, when you look at this, how do you apply it to yourself or people that may not be in these high, high stress, high consequence situations? What are some of the insights of your work that, hey, Judith and Matt could apply this to bring a better self, bring a more regulated self to their, to their lives and their work?
[00:59:36] Speaker B: Yeah, I think actually what I've learned is that, that a lot of what the officers are going through, it's pretty rare to have a shooting or it's very rare to have those very, very kind of intense ones. A lot of the stress we actually see is from the organizational stress. That was fascinating, too. We did studies looking at that. That's another podcast. But yeah, so the police are struggling with that too. So these techniques actually help with organizational stress, which is like colleagues boss toxic work environment. And many of them have said, yeah, it works with my own family arguing teenagers or little kids, teaching these skills to little kids.
So it's even more reinforcing for the rest of us that, yeah, we should be spreading the word about these helpful, concrete interventions that anyone can do.
You don't need a PhD to practice hRv biofeedback.
[01:00:41] Speaker A: I love it. Well, Judith, thank you so much. I hope to have you back. You already teased some research that you're doing so I want to ask you and beg you to come back as soon as you are able to talk about some of the research that you're doing. Because I just want to thank you for your work, your focus on this field, because like I said, working with police forces, you know, I just have such an appreciation. And the lack of focus on health and wellness, you know, I know, puts the officers at risk both for their own personal hells, but also for a lot of other variables as well. So I just appreciate what you're doing. Your dedication and how you're freaking doing it is pretty amazing. So I just want to. I just want to personally and professionally thank you for the amazing work you're doing.
[01:01:36] Speaker B: Thanks, Matt. Thank you for having me on here. And obviously, I have to give credit to my colleagues as well and my team and all the people that we've worked with as well. So awesome.
[01:01:47] Speaker A: And we'll put information about Judith and her work in the show notes. You can find those, as always, at optimal hrv.com dot Judith. Thank you so much. And thanks to our audience for joining us for this great conversation. We'll see you next week.
[01:02:00] Speaker B: Okay, bye.
