[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 am here today with a really exciting guest. I got to meet her recently.
Just both a ball of brilliance and joy is the best way I can describe my interactions with her. So, Doctor Sarah Gray, welcome to the podcast. I'm so excited to have you here today.
[00:00:56] Speaker B: Thank you so much, Matt. Really so excited to be here. Thank you for having me.
[00:01:00] Speaker A: Absolutely. And I got to know your work a little bit, but I'd love just to give a quick introduction of yourself for our audience.
[00:01:08] Speaker B: Sure. Yeah. So I am a health psychologist in the general Boston area.
I currently work at Massachusetts General Hospital in the behavioral medicine department, where I get to work with trainees, train the next generation with biofeedback related pieces, and also help patients with these tools. And then I also am an instructor with Harvard Medical School where I get to do some additional training and education.
And then I have a private practice in Arlington, Massachusetts, in the greater Boston area, where I do a lot of work with general psychology, health psychology, and certainly a lot of biofeedback and neurofeedback pieces.
[00:01:59] Speaker A: Awesome. You know, looking at your website as we were looking at here, and I know you work with other professionals as well, but the offering of therapeutic services that you do offer is just really impressive. I'm like, boy, I don't have any family in Massachusetts, but they needed therapy. I would definitely, because whatever they would need, the high level of both your team and your services is just incredibly impressive.
[00:02:29] Speaker B: Thank you so much. It's a real part of my philosophy. Clinically, I believe firmly in having a well stocked toolbox, and so my approach is really not one size fits all. So I want to have plenty of tools. You know, I can't. I can't have all of them in there, but the ones I can have and have trained in, including biofeedback, being a big one of those, so that I can pull out whatever's right for, for each person and really tailor that to their needs. And, you know, it's something that I love doing.
[00:03:02] Speaker A: I love it. And so with all that training you have and you didn't even mention Oxford. I was looking at you. I was joking with you before our conversation started. You have basically the best brag bio I have ever seen, and you're very humble about it. But, like, you know, if you want to list maybe the top 20 organizations in the world, you probably got five or six of them in here. Being in Boston doesn't hurt, but still very impressive. So I would love to hear kind of with within all your expertise, all your training, when did heart rate variability start to make your radar?
[00:03:42] Speaker B: Yeah. So going farther back, I had had a different career path earlier on. I came to being clinical psychologist a little bit later in life compared to the average track. And I had been really interested in health and wellness and ways to optimize those things. I was kind of looking at different pathways, and I was thinking maybe med school more, you know, kind of integrative approaches to medicine. And in that process of interviewing people to find out what pathways might be there. I met a health psychologist in Portland, Maine, and Maine is where I grew up, so I have some connections there. And she had just casually mentioned, as part of her role of things that a health psychologist might do, that this biofeedback thing might be part of it. And this heart rate variability, biofeedback was something that she had had experience with. So I went home immediately. I was kind of nodding along and, oh, interesting. And what is this and that conversation?
And really knowing that there were some neat tools that fused my interest in physiology, anatomy, medicine, in a way, into this use of psychology and health tools really cemented that. And then later on, when I began grad school, I chose my grad school, which at the time was called Massachusetts School of Professional Psychology. Here in Boston, it's now called William James College.
And I chose it specifically because it was one of the only ones in this New England area that had a health psychology track in particular. And we had someone come and give a presentation that showed some different forms of biofeedback. And I was enamored. So I just could not get enough of it. Sought out internship training locally that had it, and here I am.
[00:05:44] Speaker A: That is awesome. And I wonder, with all this, those expertise that you've developed, I'd just be curious for you. Is HRV biofeedback, I'm sure, integrative psychology. I bet I know the answer to this. So maybe the question is how? I'm assuming that HRV biofeedback is not necessarily an isolated service you offer, but kind of integrated into others. So correct me if I'm wrong with that assumption, but I'd love to. If I'm right. How does that. How do you do that in your work?
[00:06:18] Speaker B: Yeah, absolutely, Matt. Yeah.
Yes and no. Sometimes people come specifically for HRV in particular.
They've heard about it, or certainly there are patients who present. And in the context of an ongoing intake, it becomes clear to me that just focusing primarily on HRV training would be beneficial for that particular person. So that's not uncommon. But probably more. Yeah, definitely more frequently is. I'm using it as a tool, um, to, um, either, uh, begin, you know, in a lot of ways, to begin with some concepts of even just illustrating that mind body connection that so many people just detached from and don't. Don't have a sense of how much they can control it. They can learn to learn to be optimizing, um. And. Or, um. You know, actually it's interesting, there's someone I was just working with earlier today where we've been working together for a number of years using some other tools related to trauma treatment. And, you know, we're at a point where we, we really came to see that she needed a little more help with nervous system regulation. And her older tools that she had been using before just weren't kind of doing what she needed to really be able to have that more control over what's coming up emotionally related to trauma. So we are shifting into doing a good piece of work with HRV training in particular, and then we'll return to some other therapies when that feels more balanced for her.
[00:08:06] Speaker A: Awesome.
I wonder how with folks like the example that you just gave us, how do you. Because throwing just heart rate variability out there probably gets you some quizzical. I think everybody in the world obsesses about it as much as I do, but I realized most of the people still have not heard about this concept. So I wonder, like, you know, as you work to integrate this into some of the other treatments, just kind of the psycho educational pieces, how do you, you know, because even parasympathetic sympathetic nervous system might not be familiar with folks, you know, especially if you're kind of like cut off by the brain stem and that, that separation between mind and body and this, the western, you know, misconceptions we have. How do you sort of like, hey, I want to hook you up to this, this machine over here.
Sometimes after it sounds like months, if not years, of maybe more traditional kind of types of therapy.
[00:09:07] Speaker B: Yeah, it's a great question. And yeah, usually we've at some point along the way, talked to, talked at least a little bit about different physiologic aspects of whatever psychological problems we're typically working on. Although as a health psychologist, I will say sometimes people are coming to see me for more kind of separate physical issues as well, like chronic pain, insomnia related pieces, perhaps some brain injury and spinal cord injury related issues.
So, as always, depends on the patient and also depends on where the patient's at. Some people really do want all the information. They want all the science. They want all the details. And so if that's the case, I'll spend more time going in depth or linking them in with some research.
But generally, we're talking about, hey, as most people have a sense of, you know, when we have any given emotion, whether it's, we're working on some anxiety with someone or trauma or depression, it's going to have a corresponding response in the body, and that can come out in different ways, and there's ways that we can actually learn and train ourselves to have more control and balance over that, other than it just automatically washing over you.
[00:10:36] Speaker A: Yes.
[00:10:38] Speaker B: And so one of those ways that we can do that is this amazing tool called biofeedback. And then I go in. So I should pause and say, I'm trained in most types of biofeedback, but by far, HRV biofeedback is my go to. It's the one I use most of all for a lot of reasons. We could talk more about that, but it's just so applicable to so many cases.
But so I will talk about how biofeedback is an umbrella term. It includes different types of biofeedback that measure different types of physiologic output or expressions, and that this is a way that we can start to visualize what's happening, because sometimes we get so used to our habits and patterns that we can't even connect with what's going on in our mind or body or how they're both talking to each other. And so this is a great way to visualize that. And then I show them. I feel like that's, I just hook them up, get them on the HRV, which is so responsive. That's another reason why I love it.
[00:11:47] Speaker A: Yeah.
[00:11:48] Speaker B: And they can see for themselves and that talk about the most powerful way to teach anything to experience it.
[00:11:54] Speaker A: I love it. So what are some of just curious clinically like, some of the insights that you have had bringing heart rate. It sounds like it's maybe been there from a little bit of the beginning. As far as your clinical work with psychology, just sort of what insights, what have you learned over the years? Working with a variety of populations, presenting problems, what are just some things maybe that surprised you, that have interest you along the way?
[00:12:28] Speaker B: So many things. Wow.
You know, I think, first of all, how, how responsive it usually is. So, you know, I love being able to have someone give it a try, and we'll just play around with it at first just to kind of illustrate. And so for how powerful it is for someone to see, okay, you know, just sitting here, you know, we're not doing anything. We were not thinking about any deep, deep topics. But let's just have a little bit of a thought of that stress at work that you were telling me about the other day. And then what happens on the screen with their patterns. And, you know, I then some of those breathing techniques we've been talking about, let's just try that. Let's just play around that and just how they can so quickly change it. And then I step back, I say, you don't even need to know a thing about HRV to know what you're looking at on the screen right now. One is different than the other, and just see where that changed in real time. And this is what we can work on. It turns out you can really control that more. So the power of that, just that seeing and experiencing it and what that does to then motivation. So one of the examples I often talk about is earlier on in my career, I worked with Spaulding rehabilitation hospital in a few capacities. And one of those was working with a chronic pain program as a pain psychologist there. And it was a shorter term program, generally eight weeks on average. And it was an interdisciplinary program.
And the patients would rotate through a number of therapies and groups and classes and a one on one meeting with me. They might only get to see me sometimes two, three, maybe four times throughout the whole program. But often, sometimes it might just be one time or a couple times.
And to demonstrate, to use HRV in particular, to demonstrate those changes that they could see in real time and then learn to shift often was the turning point for them. I often would have patients say, oh, yeah, people have talked to me about all that mind body stuff, that breathing stuff, all of that stress management. Until I actually saw it in my own body, I didn't really kind of want to sit down and do all those breathing exercises you talk about. Now I will. Now I will. And they do. And they come back a couple of weeks later and their patterns show it.
[00:15:18] Speaker A: I love it. Yeah, I love it. And like, when you know, people have sort of this insight, that motivation piece that sounds like really picks up there as well. But I'm kind of in that rehab sort of setting with, and you may mention the pain stuff as well, just sort of. What did you sort of see as you progress with folks? And I know you didn't get a whole lot of time with them, but, like, what did you kind of see maybe shifts in their. Their mindset coming out of their work with you?
[00:15:53] Speaker B: Oh, it's such a great question because I think that that almost is the biggest shift, in a way, the shift in mindset and particularly the sense of empowerment and efficacy. And when people have been living with chronic medical conditions and especially chronic pain, you know, by the time they would get to our program, they had tried everything else. They had gone through all the conventional routes, and so they were really often feeling very hopeless, very down. Definitely felt like that there was nothing that they could do or even the brightest doctors in the Harvard medical system could do at that point.
So to be able to show them in conjunction with my colleagues, too, we have brilliant Ot's and pts and physiatrists all working their magic, helping reiterate this message. But I think that's part of the power that I could show them even in that one session of HRV training, that they did have more control and efficacy, and they could start to change things, change patterns that have been there for a while, and you could just see the difference that that made in so many people, to just have a tool that really could do something and they could see the evidence of it. That's the beauty of biofeedback in general. Right? Yeah, we got the proof. They don't have to talk about that mind body stuff. No, they're seeing the proof of what they're doing. Absolutely.
[00:17:15] Speaker A: It brings that kind of western mindset into the power of the breath. Right. You know, it's amazing. And I'm right in this mindset as well. It's like, to see the data just really helps. Helps me breathe again right. The next day and keep that motivation up. And it just like, it still breaks my heart, like with. Especially with pain, because I've done a lot of, you know, work where chronic pain has been part of additional issues that folks are working with. And it's like almost. It sounds like, which doesn't surprise me. With our modern medical system, it's like, oh, you know, you've exhausted everything else. So let's try the breath, because there's other things we've tried with pain and I'm not saying this was with your folks, but, you know, has up and created, obviously, a huge epidemic in our country around opioids and just an issue that, oh, we, you know, you can't give them any medication or treatment. It's like, you know, we got this really great best practice here that is, you know, very affordable. And once we teach them how to do it, and yet it kind of, you've exhausted everything else. So. So now let's, let's use the tool that you do a thousand times a day, and we're just gonna, we're just gonna tweak how you breathe in and out and picking all this research that we know can really address some of the pain issues.
[00:18:47] Speaker B: Oh, well said. Well said. I mean, and to be able to track their progress over time because, you know, so often with anything, you know, even if, you know, I think even if you're weight training or learning something new, you get lost in the process of learning. You don't realize how far you've come. So that benefit, too.
And, you know, that they may have been told by other providers along the way, you know, do some breathing, but so few providers have the time to sit and discuss that. You know, it doesn't have to take all that much time, but certainly in a 15 minutes visit that a lot of people have, they don't have the time to really illustrate that. So to really be able to sit down, have a tool that helps guide someone in learning that. Yes, tremendous.
[00:19:36] Speaker A: Let's do this.
[00:19:39] Speaker B: Agreed. Agreed.
[00:19:40] Speaker A: So I'm kind of wondering, too, like, with the expertise that you've developed over years and your training and your, I would say unique, but something that I love your perspective and I don't think it's unique because I get to talk to other brilliant people like yourself.
That's the only reason I don't say that anymore.
I just have amazing conversations. I also realize we're the minority in our own profession when we do this, but when you look at ventral vagal activation, heart rate variability, just sort of like, where does it fit in when you're maybe working with somebody for the first time when you introduce it, how's it informed, your clinical thinking?
[00:20:29] Speaker B: Yeah, you know, it's funny because, I mean, some people will reach out for services specifically because.
[00:20:39] Speaker A: You find those people are a different personality than others. Is there? Or have they just kind of been referred, you know?
[00:20:46] Speaker B: Yeah, it really depends because I think sometimes the word is getting out. I mean, that's good news probably in large part to all that you're doing all the great work you're doing here.
So that is encouraging that, you know, even, you know, maybe five or six years ago, so few people even knew, you know, what HRV was, what is that, let alone, you know, what it could do. So I do think there's a lot more awareness, so thank you. And so. Right. You know, it can really vary. I do find there are certainly people who are data driven who want that evidence also sometimes even a little more type a, perhaps, because they want, you know, they want to compete against themselves and, you know.
[00:21:36] Speaker A: But I'm not surprised with that answer.
[00:21:38] Speaker B: So I'm all for it, but great. We've got something that can actually help. We use that as a strength and we're going to work to balance things.
[00:21:47] Speaker A: Well, it's something that we haven't really had to offer in psychology historically. I mean, we had our surveys, I mean, obviously their own self report on emotions and pain, you know, all that. But it, we've been, you know, as I like to kind of say, it's like when I did work in HIV or diet, you get lab results, you get concrete numbers. And as a therapist, that was, yeah, I could do some depression inventories or this, that and the other, but I never really trusted them and they weren't, you know, I don't know.
[00:22:21] Speaker B: It can only go so far.
[00:22:22] Speaker A: It can only go so far.
That's what I love about HRV is, oh, it's quantifiable.
[00:22:29] Speaker B: Yes, yes. And you can use it in the context of other measures. And, you know, and I think, too, it's that, that way to personalize treatment. You know, we're getting someone's individual data in real time and session, session, even in between sessions. That adds so much more breadth and depth to the treatment in a lot of ways.
[00:22:53] Speaker A: Yeah, well, that's what I was going to ask is one of the things that I have as somebody who didn't get trained, I kind of came HRV initially from the tracking perspective, until I met our friend Doctor Ina Hazan and somehow got just the opportunity to work with her, which has been a jotter.
As I started to look at, oh, knowing the biofeedback side existed, I was like, oh, now I gotta go build this expertise next. It's gonna take years. It just took one phone call to a very person to allow me to stay as a minor expert in the field when you work with some of the top experts. But I always like, like, to me, that integration piece was like, around sort of homework for folks, whether they're tracking it or just breathing at the residence frequency, because all my work, one way or the other, clinically, we're working with usually more severe, like homelessness or severe addiction, those sort of things. Severe trauma, complex trauma is like, I'm working to regulate this nervous system. And yes, I can ask you to journal because I, you know, as soon as you get a bachelor's degree, you're going to ask everybody in your life to journal with you.
But here is like an activity that goes, I think, just one step further. And, hey, let's take that, that ventral vagal parasympathetic to the gym and give it a. Give it a nice, kind workout to strengthen it in between sessions and just to see that progress just accelerate and maybe accelerate to a small, sometimes large degree. But, man, the homework that it offers, I think any health professional, is, to me, so exciting.
[00:24:55] Speaker B: Yes, yes. Like anything, I mean, the work in between sessions actually really has the most power in so many cases. And so to have this tool, extremely portable and reliable tool, especially with what optimal HRV has developed, too, I might add. Truly, truly, I mean, something just so portable, so easy to use. The app guides people so clearly. I really love and appreciate that about optimal in particular, so that you can feel confident as a clinician that patients are really going to get the clinical benefit from it, not just the kind of gamification of it. There's anything wrong with that part, but it goes so much deeper, so it's so easy to enhance the foundation that you're laying in the sessions, hopefully.
[00:25:53] Speaker A: I love it. So are there anything else that we haven't from that? I've got a few follow up questions, but I just kind of wonder if there's anything else clinically that you have seen integrating biofeedback into.
I don't. I mean, integration is probably the wrong word. It's been so central to you about having that as one of your foundations. Let's put it that way.
[00:26:19] Speaker B: Yeah.
[00:26:20] Speaker A: Anything else that has been powerful to you in your work over the years that we may have not touched on yet?
[00:26:28] Speaker B: Well, you know, you were reminding me of something just now, Matt, which is truly. I mean, I would say I use HRV with the majority of my patients, at least to some extent. So it might even be, you know, just a handful of sessions in the beginning to illustrate some concepts or to really help them get off on the right track of really knowing how to regulate their breath, their nervous system on their own, or sometimes much more in depth over many weeks of sessions to really fine tune and really help someone apply that then to other environments.
So it really, truly is a foundation of my practice, even though I'm someone who brings in many tools and does a lot of different kinds of therapies. And I often give talks on biofeedback in general to trainees or other clinicians.
And I will always say, if they were to ask me, in general, I mean, depends on maybe what population they work with. Sometimes there's a couple. There's other types of biofeedback I might recommend first. But in general, by far, if a clinician were to ask me, well, there's all these kinds of biofeedback out there. Which one should I train and invest in? Hands down, HRV. It is so versatile, so many conditions, physical, cognitive, emotional, so much research to show its efficacy in so many pathways.
So that's clinically been just really interesting to continue to see the research come out that supports that and to be able to offer that spread the word to get more people trained in using this wonderful tool.
[00:28:12] Speaker A: And I love you out there spreading the word for this as well, because I really think that that's where we sort of are with this movement is how do we, how do we help integrate this in? And that's where, like, the $10,000 piece of office equipment can sometimes I think, you know, that was my sort of initial, you know, perception of, oh, those are those people with a budget, you know, that have that. And even if you, I mean, obviously, there's a benefit to, you know, that, that level of sophistication. Yet now we also just either complimentary or even for folks to bring biofeedback in, it's not a $10,000 investment.
And I think how we utilize that effectively is just a key messaging as more and more people learn about the heart rate variability.
[00:29:07] Speaker B: That's such a good point. It doesn't have to be a barrier. And the technology continues to advance in incredible and affordable and portable ways that don't sacrifice the accuracy and precision. It's wonderful. Very exciting time for.
[00:29:22] Speaker A: Yes, it is.
[00:29:23] Speaker B: Clinicians. Yeah.
[00:29:24] Speaker A: Yeah. And so, you know, my couple follow ups are kind of more about you. And your thinking is, I've been smart enough to realize when I get folks like, like you on with all this training, this expertise, experiences, how has this impacted you?
You know, I rarely find a biofeedback practitioner that has, doesn't hook themselves up from time to time. So you're obviously in mental health, you're dealing, you know, emotions can be contagious and, you know, we, a lot of times people see us because they're struggling. So I just kind of wonder, when you think about your own health, your own wellness as an integrated whole person, how is HRV, HRV bio feedback informed your thinking or your practices personally?
[00:30:18] Speaker B: Oh, it's such a great question. It's such a great question because, you know, first just. Right. I strongly believe, I mean, we have to practice what we preach and kind of walk the walk. So, you know, if we're not having our own practice in some form, then, you know, the ability to really share that and communicate the values and also even troubleshooting or how to get beyond, you know, certain challenges that come up, it falls flat. We don't have our own experience and practice, and if we don't also, you know, as clinicians in particular, we gotta be filling our own cups so that we have more to give. And burnout is such a big risk factor in this profession, among others. So, you know, the ability for HRV to really just help with resilience and balance and well being in general, even if one is not targeting a specific issue, it just is so incredibly important. So, yes, I did my own practice. I actually carry the HIV device in my purse. So if, you know, something comes up where someone else needs it, or I have it with me for just a moment. It's so portable, why not?
We've always got our phones with us, or I do anyway. So we've got the app available.
You know, it helps keep me able to be navigating where I need to be and showing up as best I can as a human and a clinician.
[00:31:49] Speaker A: Ideally, I love it. So I want to go into the future time machine here.
As you've been looking at this in the field now, training others to come into the field, I just love, as you've seen it progress over the last several years. Where do you think when we connect for another podcast? Episode 2086 of the Heart Rate Variability podcast five or ten years from now, where do you see, where do you see this technology taking us? Well, what are just some of the, as you look into the future, what might be thinking about or using 510 years from now, as we kind of hit this rapid evolution of biometrics and biofeedback, you know, be, as you said, being more accessible to more people.
[00:32:45] Speaker B: Yeah, it's so exciting to think about. I can't wait to see, you know, truly just the portability, I mean, and the access to other wearables in general. Right. You know, I think there's a more openness and awareness given, you know, other wearables that have become more popular and more even accurate and precise, too, so that people are, I think, much more aware and kind of open to this idea of, hey, can we be monitoring these metrics more consistently? And since it's so easy to do and so portable, I expect to see more of that in different forms.
And we're already starting to see some of that to some degree. But to be able to as a psychologist or certainly my colleagues within the hospital, within mass general, where we're sharing a patient, working as a team, and we can get some data and get some metrics and see that in between sessions and then help the patient with some guidance about what to be working on in between.
Certainly. Gosh, I think there's just much more integration that could happen even as a first line treatment. I hope that with more and more really well done research coming out and more ability and affordability in these products and ways to measure HRV, like optimal HRV provides, certainly that, you know, hopefully it'll be more of a frontline treatment. Maybe they go to their pain clinic and go home with their own device just supplied by the office and that that is something they are started out on from the start as opposed to going through a bunch of treatments or more invasive treatments that maybe aren't, you know, don't have to be done if someone can take a different course sometimes. So we'll see. We'll see.
[00:34:46] Speaker A: Yes, I absolutely love that future. And, you know, and again, I just think it's so great, like people like yourself in, hopefully I contribute a little bit to getting that word out there, you know, even if you don't go through a week long biofeedback, you know, course, just getting, getting that education out there enough so those that want to go through that kind of certification, you know, certificate or certification, can I. But, but how does, you know, a social worker or a medical doctor learn, you know, how to, that this can be part of treatment protocol for those that at least are interested. And like you said, the price now is, you know, you know, and again, sometimes we get, you know, very expensive pills for cheap because the insurance market does that. But, you know, why is a biofeedback part of this? Just, that just takes a lot of work on our part. So in every single state in the country is the problem. But, you know, we'll start it so. Well, Sarah, this has been an amazing conversation. So I got your website, integrativepsychology.com, up here. We'll throw some links into the show notes as well for people.
So, Sarah, I just appreciate you. I appreciate your work. Like I said, as I introduced you, like, this ball of brilliance and joy is I didn't even see all, like, the Oxford and the heart, you know, I assume some of that. But it's just a joy to talk to you, my friend.
[00:36:28] Speaker B: Very kind note. So, so wonderful to speak with you again, Matt. And I'm really just delighted to have this conversation and to be part of this and just so grateful for all the work you're doing and all the great information you're sharing with people. So thank you.
[00:36:42] Speaker A: Awesome. Well, as always, you can find show notes and information about Dr. Sarah
[email protected]. sarah, thank you so much. And we'll see everybody next week.
