Episode Transcript
Speaker 0 00:00:00 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 L L C and optimal HR-V. Check us out at optimal hr-v dot com. Please enjoy the show.
Speaker 1 00:00:32 Welcome friends to the Heart Rate Variability podcast. I am here with a very special guest today, uh, Dr. Eric Pepper. Dr. Pepper is one in our kind of pioneer series, uh, of world experts. On the topic of, uh, heart rate variability, biofeedback, uh, I met, uh, Dr. Pepper at a conference. Uh, uh, g just seemed to wanna get in his or orbit as there was some brilliance going around at the A A P P conference. So, um, I feel incredibly humbled and honored, uh, Dr. Pepper to have you on as a guest and talk about your journey. Um, I'm looking at the, the Pepper perspective, uh, your blog. And, uh, I, I'm looking at the first one of being November, 2011 as the first post, and it may even go earlier than that. So I know there's, there's a million things we could talk about, but I'm really excited to talk about your journey and sort of what got you interested in this field and just sort of where, where it's taken you. So before I, I jump in there, I'd love just to, to give yourself a quick introduction to our audience.
Speaker 2 00:01:42 Well, first of all, it's very hard at this point to speak, because this reminds me going to a funeral where, you know, everybody gives these nice presentations about the person who has just passed away, and yet nobody one's saying anything except compliments. And yet we all know about the reality <laugh>. Anyway, <laugh>, uh, uh, I am Eric Pepper, as you know, as you introduced me. Well, I teach at San Francisco State in a great program on holistic health institute, holistic health studies, which we have done for many years, which really, I think, symbolizes in many ways what I really enjoy and explore. And that is really strategies by which people can mobilize their own health. So, in a way, how can you, the word take control is almost the wrong thing to say, but what, what are the things that you can do to optimize staying healthy, joyful, and highly productive?
Speaker 2 00:02:38 I think that is sort of hidden quest. And over the many years, I think I have been continually surprised that the limits of our experience are often the limits of our beliefs. Hmm. And our family and cultural hypnotic inductions almost, which we are unaware of. And so I've been very fortunate for many years to have been exposed to a very experienced, uh, unusual people who have had really remarkable voluntary control. That goes all the way back initially to when I, in New York, when I was there in 1970, about 1971 at N Y U for a moment. And we, we got, we are exposed to a person who starts skewers through his body, uh, and claimed not to do it with pain. So we asked him to come to the lab. He monitored him. He, he took these bicycle spokes, which I had sharpened at that time, sterilized.
Speaker 2 00:03:34 Then he took his shoes. He had walked from Washington Square in New York to nyu. He put the, those sterilized skewers on the ground. He rubbed his dirty shoes on, and then he, you know, put the skewers for his side of his body and through his cheeks and all this stuff. And he had to record his e brainwave activity. And he, he said he had no pain. He pulled it out, it didn't bleed. Well, you don't expect much bleeding with puncture wounds anyway. Yeah. But still, uh, but his, his physiological, his subjective experience matched his physiology that namely we, he was, he were recording his e e G at that time and was producing a lot of activity. And he saw really no alpha blockage, which you would've expected if he had oriented and looked or react. He had really no physiological response to pain. And Dennis again, and he healed really quickly, and they were not sterilized.
Speaker 2 00:04:25 He had no infection. I am not recommending doing anything like that <laugh>, but still, it's again, of saying maybe, maybe there are more boundaries. So I've continually have been exposed to people like that include a yogi we worked with, you know, uh, K Kami from Japan who stuck skewers for his body. And that was the observation with breathing. He taught me more than anything about breathing in that sense, because what he did is when he put the skewer through first, he had no fear. So it's not just physiological, it's mental anticipation. What most of us forget is that when we think something, we imagine something, it really does change the body. Every thought, every feeling has a cor well, by definition, the feeling has a corresponding body activity. We forget equally that body changes change our thoughts and feelings. And that is really what Elmer Green pointed out many, many years ago in the Psychophysiological principle that has been probably a basis of my world.
Speaker 2 00:05:30 And so it's always this mind body are not separate. They have always been interconnected. They're really the same thing, like the elephants. I can feel the nose, the trunk, or the foot. It depends where you look. And I see in this perspective that, that has been the richness of biofeedback or now neurofeedback has brought to this world that, you know, and to psychology and to medicine. But completing this story of the yogi of Kaba sun or sensei, you know, he really mentally did not expect any pain. He just thought it would be just interesting sensations. And most of us, if we go to the dentist and we get an injection, we already yell Ouch before it almost mentally, we already react before the needle even goes in. That's a distinction. If you do not have the anticipation and can look at us novelty, then the information that comes to you, you're open for learning and growth and change.
Speaker 2 00:06:25 And he showed that with his, at, with his attention. And we were looking at his physiology. So we did do a QE G on him. We did do, we did look at his briefing patterns. And what you then saw was something we had done many times before, and I probably gave it credit to, to Brian Teep for in the 1970s when he worked with emphysema patients. But what we observed was when he put this cure through, he always did it during the exhalation phase. So he would inhale and he would almost inhale part in his chest as well, you know, but realistically inhaled. And then he start to exhale. So Daniel could say he, during the inhalation, you know, his parasympathetic system pulled out a bit, the vagus. Then when he start to exhale, it came back and he kept gently exhaling by, he put his skewer through.
Speaker 2 00:07:15 You could say it's when the pain stimuli would occur. And then he would pause where however he was, and then he would inhale again while pausing. And then after he exhaled would start to exhale again, he would push again. And he had reported no pain. That process we have now applied for many people. And let me give an example. With my daughter, it's the same thing. I, when my daughter was very little, she wa you know, she had to, she had to go for a vaccination or something, I don't even remember why, but she was gonna get some form of injection. And I knew about this part now, that if you do it during the exhalation, your pain is at least reduced by 50 or 60%. Wow. And that may just be because of partly distraction technique. I happen to think it's the interaction of both.
Speaker 2 00:08:02 Mm-hmm. <affirmative> of also the, the, that the physiology is not giving the alarm reaction, which then gives that startle almost. And so here, I'm very smart. I thought I was quite smart. I went to the pediatrician. There was this very nurse practitioner who was gonna give the, her the injection. I said to my daughter, no, please, you know, breathe. And my bau, my daughter wouldn't listen to me. I can tell you. Uh, and so then luckily this older wise nurse said to me, uh, Eric, get in front of your daughter. At that time, my hair was quite wild. All these curls. I, you know, so I, now I'm a I, my hair is at my daughter's l mouth level, face level. And she said to my daughter, you see these curls, do you think you could blow air at them and make a move? Well, my daughter thought this was great. She went, and as she was doing that, the nurse gave her an injection. My daughter, till this day, never knew she ever had an injection. I mean, she probably does, but, but had no reactivity. And so when you teach breathing, that taught me a couple of things. By metaphor, one, direct instructions sometimes work, but often it takes too much effort. And what the, that nurse did was an indirect coaching, which was so much more powerful.
Speaker 1 00:09:19 I love
Speaker 2 00:09:19 That. And I think for breathing, the more we can do that, the more we can make it spontaneous, the better it works. And that's a lot of data for this. Yeah. You know, in our, in the, you know, if you go to the work by, I forgot the Italian researcher, Ben, Ben, I forget his name, Ben, or whatever the old name come to me. Uh, you know, he showed that when people were doing Avi Maria singing Avi Maria, they, you see this nice heart paid variability because it's about a phrase about 10 sec, and the people just don't know they're doing it.
Speaker 1 00:09:56 Yeah.
Speaker 2 00:09:57 And, and it's a much better, I mean, not better, it's the wrong word to use, but it's a lovely way to teach people how to do this. Yeah. And in the similar in studies we have done with toning, with MedU, with MedU, who's the one who taught us that toning, you know, you hear this lower sound like o or Oh. And if you do that and you do this in a group, now you see massive heart rate variability. Yeah. Because you do this, you're not thinking about breathing, you just think about making this sound. You feel this vibration in your lower abdomen or chest where you're feeling it, and then you really evoke it more. And to me, doses, do you
Speaker 1 00:10:36 Think the actual thought of like maybe a typical breathing practice may actually take away some of those benefits that if we could do that more
Speaker 2 00:10:49 Covertly over
Speaker 1 00:10:51 Interesting.
Speaker 2 00:10:52 Yeah, I think that data, I think, I mean, you know, we have published a data with ma asani. It's very nice. You see this massive difference. Yeah. You compare it to mindfulness and you see that during the mind we're doing meditations, whatever they are, there's much less heart rate variability. And here you do it with toning. There's massive heart rate variability within subject comparisons. Uh, there are many of those.
Speaker 1 00:11:14 Yeah. So, so I, I, I gotta ask cuz because I, I, I find, you know, as I entered my career as a, a, you know, a counseling psychology, you know, psychology student, a uh, mental health counselor, I was fascinated with technology that was sort of hitting in the late nineties, which wasn't really great at the time, unless you had a lot of money. Uh, but, but I was always fascinated. I I, I have to ask as you, as you sort of, it sound like a very fascinating introduction, uh, to this with, with people scaring themselves. But like, uh, what brought you to, to looking at the technology side of this, knowing that in the seventies where I was,
Speaker 2 00:11:57 I started all this in the 1990s.
Speaker 1 00:11:58 Yeah.
Speaker 2 00:11:59 I started this in the 19, in 1967.
Speaker 1 00:12:02 Yes. So I'm trying to think of what technology you would've even had back then.
Speaker 2 00:12:06 It's totally different, you know, yet the concepts are, are not different. Right. And so this was really when, as a first year graduate student, I get intrigued. I saw some, I saw a research on television for five minutes, Thomas Maholon, who was doing brain research kind of feedback at that point. But it was a diff it was more cybernetic model of runaway systems. So I was intrigued. I bi I took my scooter to the lab. He was at the va and he was very, he was a remarkable researcher and person. And he gave me a pile of reprints, which I didn't understand about ocular motor, visual attention and all that kind of stuff. And e, e g. And I read him and I still didn't understand. I went back and eventually after a while he said I could play, you know, like literally I would almost say the word play in the lab.
Speaker 2 00:12:53 So I then worked, I volunteered in the lab, and very quickly, you know, he, they taught me e e g, you know, they taught me how to do the biofeedback. That was mainly recording the e e g from the back of the head. And then the signal was analyzed, and then the subject would sit in the soundproof light proofs room. Totally. And then the, the, you know, depending what the e e G did, they would get either visual displays or whatever. So we're studying ways by which you could understand the attention, visual attention system. And it was clear that if you record it from the back of the head, to be very simplistically, when you converge your, your eyes and accommodate alpha that point blocks I inhibits. If you diverge your eyes, it's almost like this block in this far distance look, then alpha would reappear.
Speaker 2 00:13:42 So when you're giving efferent motor commands, all the teams seems to block. If you stop giving efferent motor commands from the cortex, it would increase. So we did this, we did many different studies. It's a different kind of approach. Yeah. Uh, I got intrigued in this. Uh, and then we had many different subjects and we did. And then whenever I had a subject and I did not, under they, I looked at their E EEG and they respond in different ways. I would always do one thing which maybe psychophysiology weren't always doing. After every subject, I would, uh, always try to ask what did they experience? And during that time period, what was going on. Not just they did the study, but you know, if you get these physiological changes, what is that associated with insight? So that's one. Often they would not know per se.
Speaker 2 00:14:32 But I'll tell one fun story about that in a moment. Uh, but then if I saw a pattern and I didn't understand, I would go back in the room and I would try to produce the same pattern. And so I tried to figure out what were they doing emotionally, physically to produce that kind of electrical pattern in a sense. And we have published a number of studies together with Thomas Moholland and others about the E E G. But I'll give one plot example, which we have published. But it's, we are doing a study where you looked at the per, let me say, let me outline this study. The person sits in it totally light proof soundproof chamber, electrically shielded, because at that point, the problem, so electronics, it was much more difficult. You had this old model seven graph polygraph it, the pens going, which you had to fill up the inking and all that stuff.
Speaker 2 00:15:22 <laugh>, you adjust it, you know, all the appropriate. And whenever the brain produced activity, it would then either turn on a signal or off, it could be a sound or whatever. And you can also change the slope of the light going on or whatever. And in this case, we are intrigued in asking how would the person react to a different picture. So these are all VA employees, so they're men. And so we had two elegant, we had two pictures. One was a kind of erotic, elegant nude. Very, no, not, uh, you know, very, just very beautiful. And one was a flower. They were balanced for color and light intensity. So you can't argue that was it. And then we showed it. Well, was clear. Now imagine you sit in the dark, then after a while when you're in the dark, you eye, you then produce all activity that would allow the picture to occur.
Speaker 2 00:16:11 But the moment you looked, your eyes would accommodate and verge, the alta would disappear and the picture would disappear. Hmm. And then you would have to wait in the dark till you somehow would reappear again. Then the picture would show. So you could now use the time periods how long alpha took to reoccur as a curve of habituation. Wow. Okay. They, and so what we did is we had 10 subjects or so, nine of them, or you gave all the same responses. Basically. They saw the nude, they looked, it took them a long time before the alpha reappeared that, you know, that curve took a long time because they want to look, they want to see more. But then the moment they looked, it disappeared. Yeah. And then they would be almost activated. They still want to see more. On the other hand, when they saw the flower, it was, you know, very quickly they saw the flower.
Speaker 2 00:17:10 They couldn't care less, you know, and the moment they couldn't care less looking almost, they stopped paying visual attention. Alpha reappeared. Hmm. Okay. So you could look at that as a kind of capturing the internal interest. Yeah. That was very interesting. We had one subject who did the inverse. And then you could say normal data makes no difference because 90% success rate is remarkable. Right. Right. It's a probability of more than 0.01 is basically right. Of doing it. So we never had to do anything more. But I was always intrigued in what makes people different. Yeah. And that is, and so then I asked them, and it worked out, this is, you know, it's, you don't, it's hard to believe this was a man. He had just come back from his honeymoon. He had to Hawaii, he was probably satiated of nudes, I shouldn't say that.
Speaker 2 00:18:00 And his hobby at the same time was horticulture, was was horticulture. And he didn't know what planted was. Ah. So he kept looking at that flower, trying to figure out what is it, you know? And that taught me the importance of individual difference. Yeah. So when I always think of research, it isn't just that you wanna look at the average, what is to me is much more important, or who are the people who are most successful and who are the least successful. And almost all studies, there are some people who show remarkable positive changes and some where they should be showing changes. They don't. Yeah. And to me, that's what, what much of statistics eliminates, because almost all studies showed a meme, but clinically that is not as useful at times. Yeah. Anyway, that is a side note. Let me go back to breathing for a moment.
Speaker 2 00:18:55 All right. Because I think that's, I mean, there's one more part about breathing, which is critical, which I really learned by studying Sufis a few years ago. It's eight years ago. So in the Mount Jordan who start knives with their bodies, they didn't use breathing interestingly, but they had total trust and safety. So if you have 100% trust and safety feel safe and trusty in your shake in that sense, then you can do activities. And now you combine that with breathing. If you think of breathing, then you really are doing what I would, what I would call effortless breathing. And I think I'm in the philosoph perspective for John from Dick's Horn, who's one of the proud of world premier experts about breathing. He's Dutch, uh, who I really deeply respect and have learned massive amount from, uh, that breathing, when you really do breathing, it is effortless.
Speaker 2 00:19:52 Yeah. And obviously breathing is never one pattern. It is always depends by a mental and physically emotional state. So flexibility in breathing is the sec is the other major component. Hmm. But if I'm looking for restoration for regeneration, which is often when people think of slower, what I'll call effortless breathing, then what you see is that you need to allow the abdomen to widen almost. Yeah. And that means you have to let the abdomen relax in a certain way, the muscles. But if you think about it, when we get fearful or defensive, the automatic biological response is to tighten the abdomen slightly mm-hmm. <affirmative> to protect yourself. That shifts, you often do slightly more thoracic breathing. Yeah. And so in order to really do effortless breathing, I think you really wanna be able to allow your, you want to, you wanna have such trust that you can make yourself be open in a certain way and deeply relax and lower.
Speaker 2 00:20:57 And what you see when people do tasks or work often, then they really unknowingly tend to shift to slightly faster breathing and slightly more in their chest, which you'll see people working at the computer. Yeah. Because when I am stressed, I work at the computer, I start leaning forward. When I lean forward, I have to breathe more in my chest. I have no choice about that. Um, because I'm constricting my abdomen. Mm-hmm. <affirmative>, I start breathing a bit sha and then I also make it neck and shoulder pain. And you know, for any of, you're intrigued in that we did a book recently, which is called Tech Stress, how Technology is Hijacking Our Live Strategies for Coping and Pragmatic Ergonomics, I think, you know, that has lots of stuff about the breathing in it and other things. Yeah. But that can be applied, these concepts to, at the computer as I think about it. But breathing is, it's intriguing. Then the final, you know, I am not even persuaded that having maximum H R V is always the best. There's no data for that. But I'm, uh, talk
Speaker 1 00:22:00 About that. That's fascinating. So, so why wouldn't talk about that. I, I'm fascinated is,
Speaker 2 00:22:06 Well, the reason I say that is because when I look at subjects, sometimes the highest H r VV tend to get, if I have someone inhale in their chest mm-hmm. <affirmative> and then exhale, then you get slightly higher. If you breathe somewhat lower, then we see I, you know, slightly less, you still see very good H R V, but you see a little bit less MinMax differences.
Speaker 1 00:22:33 Interesting.
Speaker 2 00:22:34 Well, you know, we don't have systematic studies. I've observed that if students a number of times, I'm not gonna say that works for any other part. Conceptually, I think briefing should always be variable.
Speaker 1 00:22:45 Yeah. Well, it's, it's interesting. I, I asked a few people and I, I, I, I, I, so I gotta ask you this question because it's something I have no research to back up, but I just found it useful. As a student of Qigong, one of the things is Doo breathing. So there's the Buddhist breathing, which is probably right, aligned with most of the mainstream belly breathing, you know, extend the belly on the inhale, you know, probably how we would teach people to breathe healthy. But then there's like the Dao breathing, which reverses chi in, in this, uh, system of leaf. But there's the inhale of the, the, the chest. And I, I found that, uh, I just started this and then got covid for the first time. And this is what got me really interested in this. And because I not chest did any breathing in my chest for years, because you're always told not to.
Speaker 1 00:23:42 It was so weak. Uh, and so I just started this practice. Cause I, I mean, I was like, well, I gotta exercise these muscles and my ribs would kinda like pop in and out. Like it was like, so, like I hadn't used these part of my lungs in so long, and then I got covid again. And I, I felt like, and who knows, there could be a lot of variables, but I had that strength in there. So you're the first person I've ever heard that, that has like, I'm a fan of chest breathing just with like my morning kind of breath. The
Speaker 2 00:24:12 Key thing is, what you're saying is, which the error we make not from my perspective, is breathing depends upon task performance.
Speaker 1 00:24:23 Yeah.
Speaker 2 00:24:24 And breathing should be adaptable. If you don't, if, if you cannot chest breathe, you're sick. Right. If you can only belly breathe, you're sick. From my perspective, the key is if you look, if I have to think of, and breathing depends. Really. Do you wanna be activated or do you wanna be quiet? Yeah. Do you wanna use time to restore or do you wanna energize mm-hmm. <affirmative> And they really are different.
Speaker 1 00:24:51 Yeah.
Speaker 2 00:24:52 And I think people, we forget that we, the challenge, what has happened, I think we have to work, most of us do, is that we have so many people who are stressed. Yeah. That when they are stressed, then you wanna teach 'em more di you know, because they breathe out, they, they hold their up and then tight all the time. Right. And I would say that's the category of anybody who almost has gi distress. Anybody who is, I would say quickly emotionally sensitive and feels other emotions strongly, they tend to tighten this up. And they learn this as a tiny toddler, when the world was dangerous, you give this defense reaction, which is usually tighten your app and shallow gasp and then shallow breathing on top. And when you do that, and then that becomes your predominant pattern, then you tend to have, like I said, GI distress.
Speaker 2 00:25:40 You have much more dys and many other symptoms. And for them, and that's the largest population we see as patients in some sense, my guess is, and therefore, because those, you know, uh, and for them teaching lower diaphragmatic, or I would say called effortless breathing, more effortless breathing, which we tend to call diaphragmatic breathing. But diaphragmatic breathing is not just the belly plopping out forward, it's the pelvic floor on the inhalation going down. It's the lower ribs widening slightly. And it's like, I look at the body like a pear, just what isles want it to be <laugh> and the pear expands, you know? And so really what you want is that the diaphragm goes down. And that is the other forgotten information about diaphragmatic breathing. And I really mean that we tend to think of diaphragmatic breathing predominantly as a pump for gas exchange. Mm-hmm.
Speaker 2 00:26:39 <affirmative>, that's oxygen eventually going in and carbon dioxide going out, being somewhat simplistic. Uh, and then the second one is as a, uh, as a pump or a co-factor in increasing heart rate variability. Yeah. That's sympathetic parasympathetic bowels. There is the least a couple of major other components of breathing, which when you are doing, I'll call effortless breathing, or you may call whole body breathing depending on the size. And that is, if you think, if you now think back of a little baby, an infant sitting a happy little infant, then what you see is the stomach doesn't just go forward. Almost the kidney area vids the pelvic floor wide, the upper chest has very little movement, but the spine also moves. Yeah. So it's a whole dynamic expansion and then constriction. So that's one. So that means, but you can't do that if I sit on a chair, because when I sit in a chair, my spine is locked mm-hmm.
Speaker 2 00:27:42 <affirmative>. And so there's no more movement. So all I do is I move forward outward. Yeah. The second part is, so that's the absence of spinal movement. The second one really is that the, the diaphragm is a pump for Venus and limb free turn from the abdomen. And so when the diaphragm may I in when I, no, lemme make one more. Okay. When I'm exhaling, I'm co essentially needs to need in the vertical position, need to tighten the muscles of my abdomen slide it transfers and obliques my pelvic floor slightly tightens. All of that squeezes the optimal content upward against the diaphragm. They are the antagonist muscle for the diaphragm that pushes the diaphragm up. That increases theoric pressure, that allows the air to flow out. Yeah. Then when I inhale, I really, I don't need a diaphragm, in fact, for inhalation in the vertical position, because all I need to do is relax my, my abdominal wall muscles, relax the pelvic floor, the liquid content in my abdomen, which is all the organs.
Speaker 2 00:28:51 GE gravity pulls it down. That pulls the diaphragm down, uh, reducing theoric, you know, air pressure, allowing the air to come in. So in the vertical position, inhalation, when you're doing effortless breathing, takes no effort. Fascinating. And what that does, it acts as a pump in the abdomen. And so during the exhalation phase, the veins are slightly squeezed, the limbs are squeezed, the fluids are during the inhalation phase that relaxes allows them to fill. So it increases circulation. And you know, when people are starting to practice, you know, heart rate variability, which is usually occurring when you're breathing about six best a minute, but, and somewhat slowly mm-hmm. <affirmative> that often they experience barbarism or these noises in their abdomen mm-hmm.
Speaker 1 00:29:42 <affirmative>.
Speaker 2 00:29:43 And that is because finally, and think of it in a very simplistic way, which I, a phrase I really borrowed or adapted from simp polsky from Stanford. Yeah. Know, when you think about it, you know, when you see a dangerous animal, when you're in danger, your body gives a defense reaction, which really means it's mobilizing itself for fight and flight for survival at that moment. Why should you digest foods? Why should you boost your immune system? Why should you regenerate yourself when you become someone else's lunch? Yeah.
Speaker 1 00:30:16 Yeah.
Speaker 2 00:30:17 And so that's where the combination of this slower, effortless breathing and being safe is critical.
Speaker 1 00:30:24 Yeah. Fascinating. So, I, I, I've gotta ask cuz I'm just, I, I really wanna like build upon, so from the sixties to here and then what, what, what's sort of, you've seen, and you know, I'm sure laboratory has changed dramatically in your time and what, what the lab looks like today versus what it looked like when you first started. Probably very different, but measuring probably some of the same actual stuff. I, I just kind of wonder what are maybe some of the surprises that, that you've discovered along the way? Like, like what were some of those, uh, you've already mentioned some of, maybe some of the epiphanies, but just like in, in your, the span of your career. What, what are some of the things that just like, wow.
Speaker 2 00:31:08 Well, I think the most surprising part, not surprising to me in a sense, has been that we keep rediscovering the wheel in a different way. <laugh>,
Speaker 2 00:31:18 It's, I don't, I don't mean it in a derogatory way at all. No, no, no. But the concepts are not that different. Some, we just reframe them differently. You know, if you look at the history of biofeedback, we start with e e g, there, you go to muscle there, you go to temperature, then you go to breathing, they go to H R V, and now you go to Q E E G. And then, you know, and I, but underneath it all, there are many similar concepts that occur. Or you think of meditation. Mm-hmm. You think, you know, we started in our recent time, well, you had progressive relaxation and autogenic training. First in our more western model, then we have, uh, transcendental meditation. Those were all big waves. They all showed superb medical outcomes. Yeah. Then now we have mindfulness. But if you go forget about all the labels on 'em, then you see there are some really commonalities of those.
Speaker 2 00:32:12 And I think that's what many of us forget. We, we jump on a bandwagon. Me too. And we say this is it. But we forget that even that much of the training and bio, especially with biofeedback or any tool, there's an interaction between this, the, this well almost say placebo or hope that we engender. And the, and the biofeedback signal shows you can have hope that gives an optimism and that does this more. And we forget that sometimes the importance of set setting or the environment. Yeah. And you know, the researcher, we all know this, but it was ed ta who first showed this eloquently many years ago in this, in the early seventies with temperature training when mm-hmm. <affirmative> lady had a technician who was super well trained by Neil Miller. And she was very good. She did the training, they did a whole protocol to teach people to warm their hands.
Speaker 2 00:33:09 They were basically unsuccessful. Now, since this is a grant, you don't wanna <laugh> not be successful. But anyway, sadly, she was a great scientific data gatherer. She was super perp. However, the people really didn't learn. Like 19 outta 20 people didn't really worm their hands, you know, and then also that was an era when people believed you could not learn. Remember that. Yeah. But I remember, I, I was, you know, then the young woman got married and left very much to t's disappointment safari. No, because she was so great technically. Uh, he got an, a college student to be the next lab technician. She did it. They then rebump the whole protocol, all the procedures, because they want, she did. And she got like 90, half, 20 people to warm their hands instead <laugh> very quickly. It made, then they slowly unpeeled the whole protocol to impact the ritual.
Speaker 2 00:34:01 They were still successful <laugh>. And part of the reason is what, what you would, what they finally, he realized was that the second technician, when she, although she's supposed to stand behind the person, give the instructions, warm your hands or whatever, you know, she would always go to the side of them. She would even have lunch and dinner with them because they're really her friends. Yeah. So the people felt safe. So we have that interaction. You have to ask yourself in physiology, what is the direction of the signal? When does it work best? Under which emotional states? And if you wanna breathe, if you want your in breathing, if you want your stomach to relax and be so you're almost more in a vulnerable position. Although it could be a position of strength, then you need to feel safe. Yeah. And if you don't feel safe, then it's gonna be hard to learn some of these skills like, like H R V and all this. You can do it mechanically, but really it's just harder to do because they demand an a, an a decrease of sympathetic arousal and an increase of parasympathetic arousal
Speaker 1 00:35:12 Will. And I, I love that. This is the, the, his second time talking about the, that safety has come up in our, our conversation. Because one of the things I think I, I'm so fascinated with how, how we can access, how we can approve. I mean, that's why my fascination with every word you say about the breath is we, we get access to that autonomic nervous system. Uh, you know, where mostly it's autonomic. So, so we don't, you know, it's operating in the background. But I love that like, you know, through your work, uh, as my work with folks who've experienced severe trauma, uh, and a lot of 'em have never or have had trust and safety taken away from them. So, you know, it's such a lack there. But that, you know, set and setting where, you know, if you're lucky enough to, as I say, privileged enough to have friends that you just laugh with, that you, you can be that vulnerable with, yeah. You may not be doing a breathing exercise, but in some ways you're getting that same autonomic balance. And I, I love, I never thought about sticking swords in people that that's a new one. But, but I love that that's come up twice in our conversation now in real measurable ways.
Speaker 2 00:36:24 Well, you know, here you come to another part, which is part of the, how we look at physiology. I'm lucky in the sense that I've often recorded multi-channel recordings. And so I can see the recording on the screen and I can see both. And I often use, I mainly use, when I look at heart rate, I use B V P or, you know, the ploys graft from the finger I use often use the thumb because if the finger is too small, the sensor falls out or whatever, and the thumb is usually warmer, so you get a little better signal. Uh, but by looking at that, you get two measures. And then I think has been the li the forgotten measure, which is much more imp at times important. You get the heart rate, which is now the hot area, right? Heart rate variability, that's the whole part of Optum.
Speaker 2 00:37:10 H r v, you, you're missing a ever a major signal, which is as if not more impor as important. And that is the pulse amplitude, the height of that signal. Mm-hmm. <affirmative>. So what you see is that that amplitude signal really changes. The heart rate could stay the same, but this, the amplitude can really go down or go up. And that really responds, especially to situations of fear. So you, I mean, I'm putting that in a very broad category. Yeah. But the motor is fearful as if the blood vessels or the cardiac output either way decreases, causing the pulse amplitude to be significantly less. And you can see the disease. And so every time there's this, you know, well, let me put it in the, if you look at the pulse's amplitude, it co it varis inversely usually to the H R V. So as the heart rate speeds up, the amplitude goes down a little bit.
Speaker 2 00:38:03 As the heart rate goes slower, the amplitude goes up because you have more cardiac output. So that is one pattern. But the second one is the vasomotor pattern, where you see that the amplitude really reduces. And so when you work with people of P T S D, you can see that if they're happy, then the amplitude can be quite high. And then you touch that, they touch that memory and they get captured. Then if the policy's empty, just drops and may stay down for 20 minutes. And that's also the work by my colleague velo dead out of Israel. And we are both persuaded that this measure is extremely important and is psychotherapy, if you want to use it that way, can, can be almost more predictive and useful than even the heart rate variability, because you can really see the signal dropping and you can ask what just happened?
Speaker 2 00:38:54 Oh, I just thought of something. Yeah. And, and it co varies often with skin conductants, because we would see them on the graph at the same time. Okay. You know, meaning inversely skin conductors would go up hard, Pauls amplitude goes down, goes down. However, skin conductants often comes back, but the pulses amplitude may not come back in in interest. Ptsd. D And so I think there's a signal that people have not looked at because it's a relative signal, unlike heart rate is an absolute signal. Yeah. And this is a relative mesh. So when people have cold hands, the signal is smaller. When their hands are warmer, their signal is higher, which is a great measure to know when you're teaching people effortless breathing, I would call it that way or heart rate variability. Because you really know when people are more successful for many of them than they experience their hands warming slightly interesting.
Speaker 2 00:39:51 And when their hands warm, it's like they have more trust, they're breathing slower, and or their PCO two in the bloodstream is going up. Okay. It causes vasodilation more. On the other hand, if they are doing good heart rate variability and they're over breathing all the time, then often the, the pulse's amplitude will go down a bit because the hands get colder. Hmm. So they are hyperventilating without knowing, called over breathing. Interesting. So I would look at Paul's amplitude as a counter-measure to say, you're doing it. It's not too for ffi buddy, but you can do it. Next time you put your hands, before you start, you put your hands against your throat, the OID artery, you can approximately feel the temperature of your he. This tends to stay warm anyway. Are my hands cool or warm? Then I do the training. I do my slow breathing.
Speaker 2 00:40:42 I can imagine the air going down my arms and out my hands. I do this slowly. And then I, we do it about six breaths a minute, approximately. You get a fairly good heart rate variability. And then I think, you know, and you do it without effort, and most effort is to try to breathe less, not more, exhale longer with less flow. And let the inhalation almost occur by itself. Try not to inhale in a real effortless way and do that. And then you can use some imagery techniques to keep the mind busy. <laugh>. Yeah. And then you can think of the air flowing down your legs and stuff like this. So, and if you focus your attention on your lower abdomen or legs, your breath will almost always automatically slow down. Mm-hmm. <affirmative>, if you focus your attention on your chest or head, the breathing rate will go up.
Speaker 1 00:41:36 Fascinating.
Speaker 2 00:41:36 We have published that. I mean, uh,
Speaker 1 00:41:38 Very cool.
Speaker 2 00:41:39 You can do this just by having your focus on your chest here. And you can see the runaway pattern. When you get panic, you feel panic in here. If you can distract and go to your toes and imagine the air flowing to your toes, notice it takes a long time to exhale. So without any effort, you're already tricking the person into slower breathing.
Speaker 1 00:41:58 So, toe breathing, I love it. Toe breathing. <laugh>. So, so before I let you go, I, I gotta ask is it seems like, you know, we're, the, your world is in many ways coming out of the lab in a rapid way when you look at, you know, people with apple watches and whoops. And what we're trying to do with heart rate variability, heart math out there. I know they've been around for a while. Like, you know, I, I, I got, as you kind of look wi with all the history that you've had in this field, and you look towards the future where all of a sudden I think it's
Speaker 2 00:42:38 Great
Speaker 1 00:42:39 <laugh>. Yeah. Like, now we got, we got these smartphones, which probably have more computing power than that original lab, uh, that, that you were in. Uh, like what do you see going forward that we can, we can measure this, we can quantify this, it's getting affordable for folks. I, I'd just love to see as you look forward, um, well, what do, what do you see, you know, five, 10 years out? Where, where do you see the world now that it's coming, coming into your realm? Uh, where, where do you see us going?
Speaker 2 00:43:13 The ideal way is where, where some, the challenge for all of us is that we may know, but we don't always act. Okay. I think that's one know, knowing and doing is totally different. Yeah. Changing your life. So we really are in this system. And so if we can mix patterns where our whole family can do pieces like this together, it's great. I think the most important part in the future is one will have more wearables. It's clear that some versions of wearables is, you wanna have feedback which is non-invasive. You wanna have monitoring that you're unaware of, but can give you a signal, Hey, here you can improve. There could be ways by which the feedback can be given. It helps you to breathe differently. So for example, as the work by Paris, uh, like, you know, you can use a vibrator and the skin for example.
Speaker 2 00:44:06 And so each time, it's time to inhale the vibration on the skin boot to remind you on your ABM or something like this. Those are the kind of measures where nobody would know that's occurring and it would automatically start triggering. So that would be one. Uh, but I also see that we need to embed much more in a broader perspective. It isn't just breathing. It is breathing. You know, your breathing pattern or the physiological effect of breathing will depend also in your dietary factors. Yeah. So if you are hypoglycemic and you over brief, you can trick, you can trigger an lept seizure. If your glucose is very low, if you have very high glucose at that moment, you can do any kind of breathing. You've only, that will not occur. And so we underestimate how much we are part of a larger system and breathing is one piece.
Speaker 2 00:44:56 So hopefully we'll learn to become more aware of those interactions in that. But I look at a future where we use more wearables, but it's also an educational process. But it's, let me give an example of the work we did, which we also wrote up in our book and how to be healthy at the computer. We all know we should be healthy at the computer, right? Yeah. Yes. Let's be on, now we have been talking for about 40 minutes or so, and we have just done the one thing which is really unhealthy, which has just been sitting the whole time <laugh>. And so how do I make my world such that I interact, you know, and those are the kind of messages we wanna do, and how can we make it so our culture around us and our environment support our health and that, you know, and that to me is the biggest challenge.
Speaker 2 00:45:48 So it's the interaction between using wearables or getting feedback signals of self, which increases awareness. Mm-hmm. <affirmative>, however you need to paint, you have to tell a story for people that it's meaningful. Yeah. And it's by storytelling. So what is the story that breathing is more useful? It's challenging because people don't come to breathe. They come because they have a headache. They come because they have, you know, shortness of breath. They come because they wanna perform better in sports. And those are the stories we do. Mm-hmm. <affirmative>. And then at work, you know, how can I interrupt myself? So just for a moment, just again, just just stand up for a sec, you know, and now just sort of jump up and down. And as you, you know, inhale, as you reach up, and then let it drop. And then inhale as you, you know, again, and really move, bounce up and down, good enough.
Speaker 2 00:46:42 And now sort of shake all over. And now imagine, put your hands on your stomach. And now just for a moment, exhale. First, don't inhale first. Sh unless you inhale, feel your anus relaxing, feel your pelvic bones widen. Feel this kind of whole big balloon filling. You're getting bigger. And it's almost what you can imagine. Put your hands on your hips for a moment or slightly above. And, and now exhale again with your fingers, just inside the hips, you can feel, I'm gonna way exaggerate. You can feel these muscles tightening as they're squeezing the abdomen. Then let's the airflow out. Now. Feel them relaxing. Now pull your hands away from your album as if the album gets even bigger. And now that the hands come back again as you exhale. And now once more, wiggle around, shake your shoulders. And now just sit again.
Speaker 1 00:47:41 <laugh>. I love it. And
Speaker 2 00:47:43 Now just ask yourself, did you feel a little more alert? Do you feel more quiet and yet more alert at the same time? Yeah,
Speaker 1 00:47:49 Absolutely.
Speaker 2 00:47:51 So notice health is always the alternation between excitation and regeneration. Oh. And what we haven't learned yet, at least I haven't, is to listen to myself well enough. The way I initially did this over the last few years, we used feedback devices, which we use for people at the computer as well to put on our spine. And so every time I slouched, it would vibrate on me and it would remind me to sit up. And it's that kind of how we can use feedback. If I have to use too much equipment, it takes effort to use it. That's clean for therapists, we get really excited and then goes in the closet.
Speaker 1 00:48:30 Yeah. <laugh>.
Speaker 2 00:48:33 So that is, I think the future looks, I mean, I'm very optimistic that we have a lot of potential that people can do many more things than we think, and that the limits of our experience are the limits of our beliefs. Hmm. And that we, we, we can do a lot to improve our health. However, we are not in total control of it. Yeah. It's delusional. We are embedded in a much larger system that is from genetics to epigenetics to culture, environment, and there. So best, what we can do is aim at that piece. We have control over and focus on that. That includes mind, body, and I would say even spirit
Speaker 1 00:49:11 <laugh>. Awesome. Well, you, you dropped like six bombs of knowledge there in that last, uh, minute. So I'm gonna go back and listen to that over and over again. But, uh, Dr. Pepper, I really appreciate your time. I just wanna open up an invitation. Uh, I, I know we have a lot more of your expertise. We barely scratched the surface, so, um, love to, uh, have you back at any time to dig deeper into these topics. So b before we go, let's one po The name of the book again is,
Speaker 2 00:49:43 The book is called Tech Stress, how Technology Is Hijacking Our Lives, strategies for Coping and Pragmatic Ergonomics. It really covers many, some of these, many of the topics we discussed today. It's really made for people because we all work at the digital computer. Yeah. Our cell phones and how to understand our evolutionary perspective, how that, how we have now almost misused ourselves in a way in from an evolutionary perspective. And it teaches really strategies by which you can optimize your health and be healthier.
Speaker 1 00:50:16 Awesome. Well, I, I spend my whole time on this computer, so, uh, that is on my reading list for sure. Uh, I've got the, uh, pepper perspective, uh, dot com, uh, p e p e r perspective.com. Um, I know I've visited that site several times and I'm on the email list. So, um, I would, I would highly suggest folks, uh, visit that as well. And I just wanna thank you for, for your work and your time. Uh, this has been a fascinating conversation. Uh, I, I just feel so privileged, uh, speaking to folks like you as, as somebody who just got totally obsessed with this field and trying to bring it into different places. The, the fact that folks like you exist and have this passion just gives such a strong foundation as this, the technology gets more and more exciting and accessible. Uh, we have decades of research in which to, to really hopefully help a lot of people and help ourselves, uh, uh, with all the great work you've done. So I, I just wanna thank you for, for all of that.
Speaker 2 00:51:21 Well, thank you, Matt, for both the very generosity of inviting me and hopefully that one or two of the concepts are useful for the listeners On that note. Thanks.
Speaker 1 00:51:31 Bye-bye. Thank you. Show notes, so you have all those links on optimal.com. Thank you everybody. Have a great day.
