[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal HRV. Check us out at optimalhrv.com Please enjoy the show.
Welcome friends to the Heart Rate Variability Podcast. I'm Matt Bennett. I'm here with a little bit of a different twist on episodes. One of the things entering 2025 is I have become connected to the great thinkers of the world in heart rate variability. And one question that I failed to ask when I had these great thinkers like the guest today, Dr. Richard Gewirtz, is how do you integrate all this knowledge, this expertise into your own self care, your own wellness practices? And I just like, well, yes, I missed this opportunity to ask this question, but what a great way to have some episodes throughout because I think there's one thing to hear about the amazing research. The irritable bowel syndrome episode we did, Dr. Gewurtz still is one of my favorites and I know one of our most highly listened to episodes. And so I really appreciate your time coming here and talking a little bit about how you integrate this into how you look at your own health and wellness. So before we get going, just in case, maybe some people aren't familiar with your work or have listened to our past episodes, but they absolutely should go back and listen to. I'd love for you just to give a brief introduction of yourself and your work.
[00:01:58] Speaker B: Okay. Well, I'm a distinguished professor at Lyon International University, California School of Professional Psychology. I've been there for 45, 45 years, coming in June.
[00:02:12] Speaker A: Congratulations.
[00:02:14] Speaker B: Yeah, it's a great, it's been a great fit for me because it's a program that combines promotion of your own clinical work with teaching and research.
And that's something I hadn't gotten before.
I had the health emphasis track, which means I get students interested in health psychology coming in and they're fantastic. They're these great kids that are really interested in this fascinating area of psychology because you get to deal with physical and psychological issues that are, that are very complex and quite interesting. I find them much more interesting than either purely physical or purely psychological problems.
So. And as part of this, I've had a small private practice, one day a week practice for all these years. Although in recent years I've cut back a bit I run a clinic with three second year interns grad students and we see patients from 8 to 80 with HRV combined with actual so a lot of my time now is just spent supervising and working with those students with clients instead of with my own clients but both and it's a very successful clinic we get we have a pretty long wait list. It's a low fee clinic so we're serving the San Diego community.
The main source of referrals is on our previous podcast our kids from our children's hospital or more adolescents than kids but combination who are coming with all kinds of problems and probably something would be worth another podcast for you is just looking at this social media generation that are really fallen through the cracks and we are releasing a big difference in our population over the last 10 years.
So I teach statistics and I've done that for years and years. I love that as well as the health psychology courses and have been part of AAPB the from the very beginnings of it was a second chairman of BCAA that was and did two terms two very painful terms as bca.
So advice to your readers. Don't ever take on a certification.
It is really not fun.
[00:04:48] Speaker A: That's what I kind of hear about it. I kind of hear that same thing from others as well.
[00:04:53] Speaker B: So in fact there's a very funny story as your listeners might enjoy. So in the second very last part of my second term our national meeting was in Boston and there was an applicant for certification who was a Harvard grad who failed the BCAA exam and she refused to accept that she had failed the exam. And so she bugged everybody and the BCAA office until they and they we rechecked the exam. I personally rechecked the exam myself. She definitely had failed it and so she came to the meeting just to harangue me about this exam and followed me around.
[00:05:38] Speaker A: Wow.
[00:05:39] Speaker B: This meeting took a workshop she wasn't interested in just so she could.
And so then we had our final dinner and was supposed to be honoring my finishing my term in a nice restaurant in Boston actually probably restaurant, you know, right on the river seafood restaurant. And I walk in and there's a whole board wearing t shirts saying BCIA complaints. Call 1-800-converts.
[00:06:06] Speaker A: I love it. I love it.
[00:06:08] Speaker B: Love that T shirt actually.
[00:06:10] Speaker A: Oh that is great. Hey, I would love I was going to ask you to do this at the end but since you brought it up about the time this podcast is going to be released it'll be time for people to get their act together to Sign up for the APB conference, I would just say, and you know, it's coming to a really good location this year, in my opinion, at least. I would love for you, just as a pioneer in the field of hrv, HRV biofeedback, tell our listeners why, if they, if they can make it happen, why they should consider coming to the AAPB conference.
[00:06:46] Speaker B: Yeah, absolutely. It's really my favorite conference. I go to all kinds of conferences, but it's always my favorite for a number of reasons. One, it's a mixture of academics and clinicians.
And in more recent years especially, we've given a lot of student scholarships. So we have a lot of students. And it's just great because the clinicians, like yourself, are just great with these students. They really accept them and bring them in. And the students just have a great experience with. I won't mention which other ones, but some other conferences I go to, they really treat students like peons. They just, they're not important at all. And so, and that's true for the, everybody in the, in the society these days. There's nobody that's beyond really being interested in students. We love our students and you get to hobnob with whoever, whoever the leaders are. And these days it's pretty much HRV or neurofeedback, the two most prominent things going on. Plus we bring in great enrichment speakers.
And that's been a great thing for me because some of my favorite speakers that I want to hear, I've, I've put those recommendations into Ena Kazan or other people, and they've come. And yeah, last year we had two fantastic talks of people that I know that Steve Cole, if you don't know his work, it's unbelievable. And Mara Mather, it's probably done the very best HRV biofeedback study that has ever been done.
So it's a great conference. And this year it's in San Diego at a great time of year to be in San Diego, which is pretty much always, but especially then, hopefully there will be no more fires.
[00:08:32] Speaker A: Yes, no more. Thank you. Speak for everybody, whether we're living through it vicariously or that in person, it's. I think Southern California has had its fill. And.
[00:08:45] Speaker B: Well, we just got some rain this weekend, so I think we're done with fires for a while now. We have floods. Right. So.
[00:08:52] Speaker A: Yeah, I know, I know. It's. It's part of living out west. It's, it's the extremes. And you all seem to, you all seem to shift between those More than anybody else does in one of my favorite states to visit and work in. I always love my trips to California, so.
[00:09:06] Speaker B: Okay, great.
[00:09:07] Speaker A: Well, I would love to, as somebody who's been working with heart rate variability, you know, nearly since the beginning and has this, you know, just amazing history, sometimes it's hard to find your articles because you've written so many of them. I was joking with Paul Lier is I was like, hey, I'd love to do your recent article. And I had to even go into more detail about what recent article I want to talk to him about. And you're definitely one of those with just so much history here in building the science and the knowledge base around heart rate variability. And I would love, you know, to hear about how over the years you've applied this to yourself because sometimes I find the great thinkers don't do a whole lot themselves other times, and I'm assuming this is true of you, that there is this, this sort of filter that you see, you do all this great research, you see the impact of hrv, HRV biofeedback on your research studies or the clients that you're serving.
So I would love just to hear how you look at your own health and wellness and where does HRV and HRV biofeedback fit into your wellness and how you keep healthy, motivated, engaged in the great work you do.
[00:10:31] Speaker B: Yeah, well, so pretty much I practice what I preach, so spend at least 10 minutes a day doing slow diaphragmatic breathing.
I'm an avid bicycle rider, so I actually use the diaphragmatic breathing techniques and bike riding especially for recovery.
I and then I'm also a very active ACT acceptance and commitment therapy practitioner.
So ACT is, is a really thing. I One thing I really like about ACT is it puts the, the clinician in a kind of a parallel role with the client. You're not us in a superior role.
So I, I end up kind of re revealing within reason things about myself in the sessions with clients. I also breathe with them whenever we're doing the breathing.
And, and I try to apply those ACT principles really on a regular daily basis. Yeah. So trying to understand the kind of automatic thoughts and feelings that I got from being screwed up personal like everybody else in the world and how to kind of accept those and accept that within myself. And I have a whole bunch of those little anecdotes that I use with clients and it helps me to, to tell them those anecdotes too. Reminds me how to kind of take care of myself.
So then the Second one I do is because now I. My birthday was yesterday and I was 89.
[00:12:08] Speaker A: Happy birthday.
[00:12:10] Speaker B: Thank you. So I've had a number of medical issues somebody my age has.
And in every case I've used the breathing really especially to cope with the procedures, with anxiety about the procedures, with recovery. And it definitely really helps the third when one of those specifics is I've had like many people have had trigger points for some myofascial pain. And so I have a tennis ball in my car, in my office and my bed table. And I do breathing based releases of those trigger points whenever they act up, which is every couple months something acts up in my back or my neck or someplace. And so I. I'm an avid advocate of using combination of HRV biofeedback breathing with trigger point release. We have a study we're writing up right now for publication that showed that if you combine the slow resonance frequency breathing with actual tennis ball trigger point release compared to guided imagery, you get much faster and longer lasting result relief.
[00:13:30] Speaker A: Could you share what that just sort of looks like implementing that. And like with the tennis ball, are you like is it a massage?
[00:13:39] Speaker B: No, you put, you put pressure, the, the myofascial releases. You put pressure on the trigger point. In this case we did tension headache. So the. This was a Rachel Wine Bean's dissertation. Her father is a very experienced physical therapist, as is her mother actually. So he was nice enough to make a video for us on showing how to use two tennis balls tied in a sock and put them in the back of your. Oh wow, here and then go back and put pressure on them.
If your readers try that, this is where tension headaches come from. Right from back here.
So you just lean back in those and then do your, in my case, six per minute breathing. But whatever your resonance frequency breathing is diaphragmatically and then put a little more pressure on when the pain relieves and a little more pressure when it relieves and then gently release.
[00:14:31] Speaker A: I love that.
[00:14:34] Speaker B: These are techniques that myofascial therapists have had for years and they really work. But what we found is there something called the parking lot phenomenon that it would work great in the office. You go to your car and the headache was back.
However, what we discovered in the work that we did with my colleague Dave Hubbard, neurologist, was that these, the pain is coming from nodules, trigger points or nodules in the muscle and they're alpha sympathetically mediated.
We had trigger point EMGs that we found and that we did this work on and we found that they were not cholinergically mediated at all like regular muscle, but only through alpha sympathetic input.
And so the idea is that, and we think that there's spindles, that part is a bit controversial, but I think we're right. So we'll see.
So the muscle spindles are the kind of sensory components of the muscle and they are activated by this alpha sympathetic loop, feedback loop, probably as sort of as a readiness for fight, flight.
And so the parasympathetics didn't, we didn't really think they played a role. However, this is some phenomena of accentuated antagonism which is that parasympathetic or vagal tone really limits the degree to which sympathetic input into organs occurs. It's kind of a governor.
So what we found is that we're really enhancing vagal tone with our biofeedback techniques as many, many of your podcasts will demonstrate. And it seems to limit the reuptake of the input to the trigger point. So once you. So the client does the breathing on a regular basis, at least 10 minutes a day, 20 is better. And then when they go in for physical to physical therapy or chiropractor massage or using the tennis balls themselves, they'd start by the breathing first, then do the release and do the breathing during the release and after the release. And what we found is that we have a substantial gain and relief when you do that combination. And I can tell you for myself, in fact, one of the things that happens is go to a party and my wife grabs me and says, you know, Marilee has a headache come over and release her headaches and I have to teach him to do it at a party. Not my favorite thing, but it's, but it's pretty much a miracle. Right? So when you, when you do those. But the trick is not to get, not to get immediate relief from the pain, but to get long lasting relief.
[00:17:22] Speaker A: Yeah.
[00:17:23] Speaker B: And that's where our, there probably are many, many processes we don't even understand yet from the slow breathing, but that's at least one of them. That's great. So as I say, I've got a tennis ball in my car and my desk at work and my bed table everywhere that I might need it for trigger points in my neck or my back.
Years ago I had a bike accident and got a trigger point in my left scapula and it doesn't really bother me very much. Every now and then though, it X up and it's real easy to release with a tennis ball. So I just wedge it in here in this chair, lean back on it, do my breathing, pretty much takes it takes it away for the day.
[00:18:08] Speaker A: So that's so fascinating. Yeah, I mean so the, the, the tennis ball and the additional pressure.
[00:18:16] Speaker B: You, you.
[00:18:17] Speaker A: I'm going to try to say this in lay person language and I, I'll let you give the, give the better explanation. Are we like triggering a little like. I'm sure when you put that pressure on the pain increases a little bit, but doing the breathing brings that vagal break on it and then we see decrease in pain over time from that practice.
[00:18:42] Speaker B: Yeah, our theory is that we have an article on this, the spindle spindle theory. Our theory is, but this part has been disputed is that the trigger points are actually muscle spindles. We know that muscle spindles have feedback loop to the brain with unmyelinated C fibers and substance P which are the neurotransmitters for pain. These are little capsules with hydronic acid inside of them. And our theory is that you, we actually are squeezing and they're pressure sensitive. The capsules are pressure sensitive. That's how you get referred pain. You only get referred pain from capsular organs in the body. Like the heart attack doesn't hurt where the heart is. It refers pain down the arms and so on. Or gallbladder pain often shows up somewhere else. It's a medical school phenomenon. If you see referred pain, you know, it's probably coming from someone. So we think that makes our case that these are capsules and that they're filled with acid. And we think through excessive, either through injury or excessive sympathetic input, they kind of expand and send feedback to the brain of pain from that. So what any of the techniques do is they kind of squeeze the acid out of it because it's open ended, we think.
And once that's. So that's where the immediate relief comes from because there's no more messages to the brain.
So you sometimes one of our anecdotes was that some of our patients were doing acupuncture with this and they would, it would kind of work. And then one week they'd come in and say, oh man, he really got some pain when he got that needle in there. It was like it really hurt and boy, the relief was way better. Yeah, we think they actually pissed.
They, they actually punctured the trigger point and got rid of the pressure. Who knows? We have no idea that's really what happened. But that's the theory anyway. And so that the release. Yeah, it hurts when you push on it yeah. Then when you release it, the pressure is gone, so the pain goes away. And then the biofeedback is crucial for not reactivating the trigger point. So that's probably one of the most practical kinds of things. I would, if you asked any of my friends, yeah, we have a, we have a men's lunch group and honestly four of the six of them I've helped with this and they, they loved it. They think it's great.
[00:21:14] Speaker A: Oh, that is awesome. I love the practicality of that as well. It's so cool. So I, I'd love to hear, you know, anything else you do. And also like, as somebody who's an expert on heart rate variability, the autonomic nervous system, I, I would love to. These could just be how you live your day at this point. But like different behavioral changes that you may have made, whether that's how you, how you prepare for sleep, how you, you know, food, you know, obviously you've got the movement side down with being an avid biker there in beautiful San Diego.
Just other, just things that, you know, may have made you look at your own health in different ways over the years.
[00:21:59] Speaker B: I'd say it's more, more. I mean, so right from the beginning I just started using for obviously when any, any autonomic phenomena occur, I just use the breathing and sort of automatic now. Yeah, if I can't get back to sleep, I do it for that. I never have trouble getting to sleep, but I wake up and have trouble get back to sleep. So I use it for that. I use it for procedures of any kind, any stressful things. And then the acceptance commitment has been a bit more of a long term work to try and you know, our natural instinct is when you get this automatic thought or feeling is to relieve it, relieve it, relieve it. And that's not how I act work. So I have to really kind of work on accepting these, you know, like irrational guilt or something and try to be there with it. Be courageous enough to stay with the uncomfortable feeling is what we're trying to teach our clients.
And so that's probably been a greater influence on just being able to calm down my stress. I'm not, I'm an internalizer, you know, like my, my parent, my parents put in all this Jewish guilt. So I have all the guilt that people have from this stuff. And so, you know, these are automatic also. My dad was a professional athlete and I wasn't, I was okay, but I wasn't a great athlete. And I could tell he was very disappointed. So that Land Graham and You know, he's been gone years and years and years but that engram is still embedded in me. So whenever I have that kind of a performance bad feeling about performance I have to really immediately go into my act and my breathing to get combination. Yeah, that's probably the most influential. Otherwise I just try to live what most of us do. Exercise some moderation in diet. But yeah, it's harder as you get older.
[00:24:07] Speaker A: Yeah. I wonder. I've been thinking a lot. I just turned 50 a couple months ago and you know it's something especially as somebody who does a lot of talks on health and wellness and performance like thinking about what I would go back and tell my 21 year old self and a lot that 21 year old self, I have to give him credit, did some pretty decent things and could have done some things a little bit differently. But one of the things that just impresses me the heck out of when I go to AAPB is the cognitive brilliance of folks that whose age I'm approaching very rapidly, let's put it that way.
And as someone who seems as sharp as any 20 year old I meet, I wonder like if you were to say hey you know, somebody who turns 50 or somebody who turned 30. I want to be like as sharp as you are, you know, as I get older and still contribute the way you contribute to the field, still have your energy, what be. You know, you've mentioned hrv, biofeedback but I wonder just any other suggestions that as a role model for all of us how do we, how do we keep you know, our sharpness moving forward in our lives and our careers?
[00:25:32] Speaker B: Well first of all, choose your parents carefully.
So I, you know I got the good and the bad from both parents. My mom made it to 98 and it was very, very sharp until she was a bridge champion until well into her 90s.
[00:25:48] Speaker A: Wow.
[00:25:49] Speaker B: And my. But. And my dad died much earlier but he had other traits that so I don't know, I would, I'm not sure what I would tell my 20 year old self.
Probably believe in moderation and all things that's always been my thing. Don't. I don't think you can. For me I could never sustain very radical changes in lifestyle.
[00:26:13] Speaker A: Yeah.
[00:26:13] Speaker B: It had to be. I had to be going for moderation and exercise and food and work and work life balance.
And so I, I wish I had found act a little bit earlier. I kind of discovered it through my own clinical work of my dissatisfaction with cbt.
[00:26:35] Speaker A: Yeah.
[00:26:36] Speaker B: And actually but and came to it of on on my own before I actually knew Steve Hayes. So. But then once I saw it all incorporated, I thought, oh man, he's really got it nailed down. So, yeah. Not sure what I would say beyond that. I'm, you know, people always eat steel cut oats in the morning, every morning instead of bacon and eggs. I don't know.
[00:27:01] Speaker A: Yeah, I'm with you on that. I'm with you on that. So I, the, the kind of final question I would love to ask is you mentioned you do some practice, eat every day and then you use it throughout the day, you use it as a tool. I just kind of wonder in that, especially those 10 minute blocks that you do. Are, are you able, are you one that kind of clears their mind? Do you have, do you use meta statements? Do you do guided meditation? I'm just curious, what is it?
[00:27:34] Speaker B: I tried meditation when I was younger, especially transcendental meditation. I was a total failure at it. I couldn't, I've got a monkey mind. I could not sit there and do that. So no, the, the breathing meditations is what saved me. As long as I, when my mind wanders, I go right back to the breathing again and do my counting of the breathing or else using, using a pacer. And that I can do for 10 to 20 minutes. But I can't, I, I can't just.
Your mindfulness by itself, I, I imply mindfulness many times in the day, but I cannot sit and do a full mindful meditation.
And I found that to be actually a useful clinical tool because many of our clients can't and feel like.
And so I, I can identify, I say, yeah, you know what? I can't do it either. However, mindfulness doesn't have to be a single sitting meditation. It's a, it's a way of looking at everything.
[00:28:32] Speaker A: Yeah.
[00:28:33] Speaker B: And so that I've been much more successful at is kind of something happens, an automatic thought, feeling, belief. I immediately launch into a mindful response to that and if need be some breathing and that could be some days, very few times, other times, a lot of times and political climate we're in now, I'm trying to do that a lot.
[00:28:56] Speaker A: Yeah.
[00:28:59] Speaker B: So. And that's a challenge. So, but otherwise, I don't know.
I wish I had been able to do regular daily full meditation. I think that's great if people can do that.
Although it's an interesting thing to talk about is when we look at transcendental meditators, only the very experienced ones breathe anywhere near the breath rate that we think you need to breathe. At.
[00:29:27] Speaker A: Right.
[00:29:27] Speaker B: And the same for mindful meditators.
[00:29:30] Speaker A: Yeah.
[00:29:31] Speaker B: So.
So this is a dilemma because you're not supposed to do anything with your breath in those kind of meditations. You're supposed to just be aware of it. Yeah. And then over time, mindful meditators, we found, do eventually kind of move their breath rate down because their body, their body kind of tells them that that's a better breath rate.
[00:29:51] Speaker A: Huh.
[00:29:51] Speaker B: But the newbies don't do that. And when I talk to mindfulness groups, they poo poo it because you're not supposed guide your breath. You're supposed to. Or, or even Shavasana and yoga. At the end of yoga, you're supposed to just be there mindfully breathing.
[00:30:06] Speaker A: Right.
[00:30:06] Speaker B: And I'm saying, yeah, mindful breathing at six breaths a minute. Yeah.
[00:30:10] Speaker A: Well, I always think about mindfulness is a focus on something, A, A singular focus on, you know, for me, like as being. I have the monkey mind too. I think the best piece of research I've ever found in my life was at least initially. And I'm still, I consider myself a new student of anything like mindfulness or meditation is when your mind wanders. Bringing it back is where you get a lot of the early benefits. And I like to say I'm still a beginner because the monkey mind has not. It's still there. And I think it's just how I'm wired. It's going to be there, but catching it, bringing it back with acceptance, as you put so gratefully, is where we were really almost doing those bicep curls at least early on for the prefrontal cortex and other the vagal breaks. So that was really interesting piece of research that I saw as well. But that's where I like my definition of mindfulness is really that limiting that focus. And to me, watching the pacer go up and down is an ideal thing to focus on. And then I'm just kind of just breathing naturally at my resonance frequency. Breathing rate.
[00:31:25] Speaker B: Yeah.
[00:31:26] Speaker A: I think that if you don't think too hard about it, it's pretty easy to integrate.
[00:31:30] Speaker B: Yeah, yeah, yeah. And then people are usually relieved because they feel, I mean, I felt like a total failure from the early first attempt. Like, what's wrong with me?
[00:31:39] Speaker A: I know. I share that.
[00:31:41] Speaker B: I think it's, it's comforting for people to say, well, yeah, you know, you, you seem to have been okay. Maybe, maybe I'm okay too. So.
[00:31:49] Speaker A: Yep. I love it.
[00:31:51] Speaker B: I love it.
[00:31:52] Speaker A: Well, this has been a, a delightful conversation, my friend. I, I knew there would be a wealth of knowledge. And I feel like there's like three or four other episodes we could jump off on with some of the research you mentioned. But I think the trigger point thing alone is such a fascinating, like I said, just another door in this amazing work that you have done over your career.
And I love that your wife makes you do it at parties. So as a mental health therapist, that's my personal nightmare is, you know, that you want my skill set to come out after, you know, a half bottle of wine. It's not going to turn out good for anybody. But having some tennis balls you can bring out, that's a nice gift that you can give to folks.
[00:32:40] Speaker B: That's right. A little easier.
[00:32:42] Speaker A: Awesome. Well, thank you so much again for your time and just your work. It has been a privilege to have interviewed you on this podcast. I think this is our third or fourth episode and looking forward to the next one as long as. And coming to your hometown of San Diego for AAPB will be a joy as well. And I just want to, as we end, just reinforce what you said.
It's one of those conferences that it's big enough to give you. Every workshop slot has about three different workshops I'd like to attend. So it's big enough to give you that variety. Well, I remember like the first day as I'm sitting at a table with you and I'm like, is this the Dick Averts? Like, is this. Is this the Gewurtz? Like, Ian is like, this is the. Is this the layer? It's like, that's the layer. Like, you know, and you all are so welcoming. And I see you extend that especially to newbies like myself who come in with a lot of energy and not a lot of knowledge and have just been such a great teacher to me. So if you can make it to San Diego with us, it is an absolute joy. And we're just huge fans of AAPB here at the podcast. So, my friend, thank you so much. And as always, you can find show notes information on Dr. Gewurtz and his
[email protected] until next time, my friend, thank you so much for your work and Sharon, how you utilize it in your own life as well.
[00:34:13] Speaker B: Yeah, thank you for what you do and it's great, the great promotion of the field.
[00:34:18] Speaker A: Thanks everybody. We'll see you next week.
