[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 have one of my favorite people and favorite guests on the show with me today, Doctor Nate Eagleman. Nate, welcome back to the show. I am so excited.
I love going to conferences, and I always find at conferences there is always a mix of a presenter who is well respected and liked, and people know that no matter what that presenter is talking about, they're going to get a really good workshop. And when that presenter hits a really hot topic and, you know, and I didn't go to all the workshops in AAPB. That was physically impossible to be in two spaces at once. But your workshop on interspection, and I'm working on saying that word right. It doesn't blow off my midwestern tongue for some reason, but I, it was packed. It was standing room only. It was. I felt a little bit bad for you because after a full workshop, my team just bombarded you.
But you deserved it because you gave such a great workshop. So I am excited to really bring this topic to our audience, and I can't think of a better person to do that with Nate, just in case, and I'll just say this for the audience, if you, you've got to go back and listen to Nate's previous podcast.
The dude seems to come up with a new revolutionary model about every six months or so.
So I just have learned so much from Nate over the year or two. We've known each other and I think some of the best podcast that we put out there. Nate's been a guest. So, Nate, just for those that may not have tuned in in the past, just a quick introduction of you and your work.
[00:02:34] Speaker B: Thank you, Matt. That's so gracious and kind.
So I'm a clinical health psychologist and I specialize in biofeedback. And I have a private practice in the Bay Area in California. And I also work at a, a hospital called San Mateo Medical center, which is a safety net hospital. And most of my patients are from Central or South America, but also all around the world. So a lot of the work that I do is in Spanish and biofeedback has just been one of those treatments that has been able to speak to people from all around the world and kind of cut across any barriers linguistically and from a health literacy perspective, that's a little bit of my background.
[00:03:20] Speaker A: Awesome. So let's bring up the topic. Let's just dive right in. So, introception, I think I'm saying it right.
Let's define our subject matter here. So I would love to get a definition from you, and I actually don't know the answer to this question.
How. When did it come on your radar? How did you sort of get this? Obviously, you hit a nerve at AApbach, but I'd love just to hear how this came onto your radar as something to pay attention to.
[00:03:55] Speaker B: Oh, sure. So, yeah, interoception. So I'll just start with a general definition that's used in one of the landmark papers from 2018 or 2019. And it's very colloquial, so I really like it.
Essentially, we have an ongoing conversation between our brain and every part of our body, even the bones, but certainly we focus on organs and muscles. Right. And that conversation, as you know, is bi directional, and it's always ongoing. And so interoception, a nice way to think about it, is just eavesdropping on that conversation, intentionally tying into that flow of data and information and felt sense. So my interest, and we can get more specific in terms of physiology later, if you want.
My interest in that, came from AAPB. Several years ago, Doctor Dick Gewirtz was talking about interoception in some studies that I believe he had done or he and some colleagues had done, and I had never really heard of it. I had heard of interoceptive exposure. Almost any clinical psychologist knows about that for a panic treatment, treatment of panic attacks or disorder.
But I'm not sure that I really knew what it was, and I think I realized that actually all of my clinical psychologist colleagues kind of felt the same. No one really exactly knew what it was. So if you know anyone's listening and this is new for them, or the word doesn't flow off of your tongue, that's a very.
It's a very normal experience to have right now because I think it's emerging, or probably more accurately, re emerging. Doctor Gewirtz talked about heart evoked potentials, which is just basically the brain signature for when you are sensing your own heartbeat. And that's one classic example of interoception, sensing one's own heartbeat. And that at least some studies point to the fact that people who are better at or have more advanced interoception, for example, they're better able to sense their own heartbeat or other body signals, have better mental health. And this is fascinating to me, and I went up to him afterwards and Doctor Paul there, and I said, well, can you train this up? Is this just a correlation or can you get better at sensing your own heartbeats? And I don't know that it was really clear at the time.
Since then, there have been more studies showing that there are some promising results related to that and interoceptive training. In fact, a study just came out about six weeks ago from Japan, I think, that showed that interoceptive training changes the functional connection between the parts of the brain that control interoception. Just like heart rate variability changes functional connectivity between the prefrontal cortex and the amygdala as an example, this interoceptive training changes that part of the brain matrix, too, which, you know, we can talk more about why that's important. So that's Jerry. I just generally got fascinated by that, and I also practiced it on my own and wanted to see what could I actually do. And expanding my own felt sense of my heartbeat, for example, and other bodily systems. So that's kind of where the fascination came from.
[00:07:22] Speaker A: Well, I think it's so interesting because it really puts a label on especially, you know, and I think we could talk about HRV, biofeedback, and the realm that, that supports this work as well. But, like, it's. It's that experience of waking up in the morning and checking your heart rate variability. You know, it's sort of like a forced, maybe too strong of a word, but it's. It's a check in with, with yourself, right? Like, I. I've been taking that, throwing on a band, a strap, an ear clip for like five or six years now. And, you know, I wake up, I'm conscious, you know, and then I put on that strap and I get a number, and I kind of reflect on what that number means.
What does this mean to today?
Why am I this, and I was that yesterday?
You know, it gives that little bit of a check in. And so I, you know, as we look at, you know, how this might relate to heart rate variability. I guess my first question is, you know, I really believe HRV for so many people, give us insight to what's happening underneath our skin and connecting that, which I think is where you're, you know, part of this is going, is really coming into tune with that experience.
And I just kind of want to say that. And throw that out to you and get your.
Just get your reaction to.
I think about how I'm seeing this in my everyday life with HRV tracking.
[00:09:05] Speaker B: Yeah, it's a wonderful example.
So what I would say is, and maybe this is a natural segue into some of the physiology for those who are interested in that.
You know, you get. You get any type of body data from. From the body, right? And you know how you're feeling when you're doing that. When you're sitting down and doing that baseline HRV test, you have some general sense. You've done this so many times, it's kind of consistent each morning, right? So you say, okay, you probably some part of you is like, oh, you know, how is this feeling? How's the body doing right now? So you're doing that. Tune in already.
That information is going up, and the vagus, nerve and spinal nerves as well. It goes into the brainstem. The most important anatomical contributor, or hub, of interoception is the insula. That goes to the posterior or the back part of the insula. It actually creates a map of the body and has some sense of exactly in that moment, what's happening in the body gets sent to the front part of the insula. And the front part of the insula is much more connected to the emotional centers of the brain and the prefrontal cortex. So that attributes meaning and memory and thought and interpretation. Appraisal with interoception. So when you're telling me that you're sitting there, then you get a number, and then you start to reflect. That's the word that I really honed in on, is reflect. And you're getting that information subconsciously, shall we say, from interoception, because so many pieces of interception isn't fully conscious. I don't know what my mitochondria are doing right now, but I can feel my heart. So that reflection piece is actually the prefrontal connection to the insula. You're thinking, how am I feeling in my body? What is this number, this HRV number telling me about what's going on in my body? How do I feel about that? The cognitive, the emotional, the memory, from how many times you've done that, as well as that felt body sense, that is truly what interoception is. So it's a great example.
[00:11:17] Speaker A: I love that. And I know one of our shared interests and passions is around trauma and post traumatic growth. And I sort of wonder, in the trauma world we talk, the somatic therapies, the movement. Peter Levine, body keep score. VaNDER we're really coming, you know, aware in the treatment modalities about the connection of body based therapies.
Mind body connection is because we even say that word, we're separating those two as two distinct. And I don't know if those really are two distinct things. They're an integrated system. But there almost seems to be some disintegration of a lot of folks I've worked with, with trauma. And I would just say, even if it's not trauma, I run across a lot of stressed out professionals that their mouth and their mind seem to be totally disconnected sometimes from their nonverbal and body. And so I wonder, as you also bring that expertise in with trauma and the trauma work you do, where does this all kind of come into play of helping somebody, I'm assuming, reconnect in some ways to their body. And I may not even be using the right language to this, but as part of maybe their healing or just emotional regulation.
[00:12:52] Speaker B: So not, I mean, interoception is interesting, of course, but it's really practically useful, right? And this is what you're getting at. And this is is useful in the trenches. And that's why I care about it, not just because it's fun to nerd out on, but it is also.
So every kind of mental disorder or person with mental or emotional difficulties has some signature, has some interoceptive signature. Everyone, every one of us has a relationship with our body, right? We tend to, when we have difficulties with that, we tend to either over focus on our body and we see that with health anxiety, some forms of PTSD, and then I'll begin to kind of focus more on PTSD.
And on the other hand, we can also completely disconnect from the body in a more dissociative presentation or in a non clinical sense. Just maybe if we let ambition drive the bus and hyper productivity, we can just ignore our body needs. Because, you know, what's up here is so much more important, right?
With the wink. And so those are some kind of common presentations of difficulties we have. It can kind of be a mixed presentation, overly connected in some ways, underly connected in others. So when it comes to trauma, what we see is kind of a mixed presentation. I mean, trauma, PTSD is, in a sense, bipolar.
Not in the sense that it's a bipolar disorder, but from a physiological standpoint, it's bipolar. It can present that way. So you can actually see that more dissociative, detached sense of the body. So, for example, I have patients that zero ability to sense their own heartbeat have no idea what's happening in their gut systems. When they experience pain, they don't really experience it because they've gotten so good at dissociating and compartmentalizing, which may have been a very important and actually skillful survival strategy for them.
Whereas in PTSD, you can also see that kind of over focus or experience what I call interoceptive threat, where even just changing my breathing a little bit is going to send me into a panic because there's just so much threat in the body. The body is not a neutral place. It's a scary place. Right. Yeah.
[00:15:28] Speaker A: Fascinating. So how. You mentioned training. So I would love to get more information on what that sort of looks like clinically in your practice.
You seem like somebody. We were actually talking about this before I hit record that probably, as you explore this, also have a lot of self reflection as well. So I'd love to just hear, when we talk about training, what does this sort of look like clinically, and if any of our listeners might be interested, maybe in a more informal way, if that's even recommended, what would this sort of look like?
[00:16:15] Speaker B: Okay, well, I'll start with the formal and the clinical, and then I'm more than happy to share about the personal kind of practices as well. So I think one of the biggest things that any clinician can do is talk to our patients about interoception, talk to them that this is a really important thing, your relationship with your body. What I've been saying recently that I kind of like is that, you know, a lot of people have had children and babies, and so they understand that, you know, they're pretty connected with their body. They may not be able to understand that what's going on in their bodily systems, you know, little kids, but I. But they're going to be really reactive to hunger or really reactive to being tired. Right. And they're just going to go with it. They are connected with their bodily systems, so that is more of the natural state of affairs. So then you find someone where they're disconnected from their body. And so to me, the logical question is, what happened?
What was it culturally or from a trauma perspective or in the family system, from a gender based perspective, whatever it was that had you going from this young human who was connected to your body system that then wasn't right. So helping them understand that the relationship that you have with your body really matters, that it's going to really help us with our. This is what the evidence suggests that it's really going to help us with our treatment, it's going to help you recover. If you can restore a healthy body awareness or healthy interoception, whichever you prefer. I think healthy body awareness is totally fine if interoception is not the multisyllabic word of choice.
Talking to them about that. There are different components of interoception. Now, research hasn't really agreed on exactly what those are, but as a clinician, I would divide those into two categories. One is interoceptive attention. How aware, generally, am I, of what's going on in my body?
What type of attention do I bring? Is it more of a mindful attention? Am I overly attentive? Am I underlying? Right, so just interceptive attention? And then once I get that information, what do I do with it? How do I appraise it? So it's interoceptive appraisal. How do I assign some meaning to it? Is it basically threatening? Do I have some, uh, belief about my body that isn't so helpful? So talking to patients about that, assessing where they're at, um, based on that, and then, you know, if you want, we can go into some kind of specific training.
[00:18:54] Speaker A: Yeah, I would love to. Let's. Let's continue this, because I think that's. That's the excitement, the practicality of this workshop was, like, spectacular, uh, and so exciting.
[00:19:07] Speaker B: So I think it depends on what interoceptive deficits there are. What is it that we're trying to do? Right?
[00:19:15] Speaker A: And there are formal assessments. I know my colleague, Janelle messenger, is doing some research on this.
We'll have her on an episode soon as well, to continue this exploration. But it is something that has been studied enough to have, as I understand, some formal assessments as well.
[00:19:38] Speaker B: That's correct. And I think, you know, I'll really look forward to hearing her perspective on it. And I think there's a real hunger around this topic, which pleasantly surprised me at this year's conference, because I wasn't really sure, because it is kind of a dense topic, or it can be, but I think anyone who wants to try to simplify it and translate, that's kind of what we need right now, at least in the clinical world. There are formal assessments. I consider them a little bit more research oriented than clinically oriented. Personally, there's not 140 item questionnaire that I give any patient, so you can get that if you want to do a really nice assessment of it, but you can do it conversationally. Also, you can talk about generally, what systems of your body are you, how aware are you of those things. How accurate is that? Information coming in. How are you interpreting what's happening for you so it can be kind of informal? I also do this with biofeedback equipment, Matt. So whether it's breathing or heart rate or heart rate variability or muscle tension, I may turn the screen around so that they can't see it. Okay. Where do you think your level is at right now? Well, that's a test of interoceptive accuracy, and then you do that multiple times, you can train inter receptive accuracy. So that's one of the techniques for improving inter receptive accuracy.
So those are some general ways to assess it. I think we kind of need better ways to do that. I know Janelle's working on maybe more brief, clinically useful versions of that.
[00:21:18] Speaker A: Yeah. And so, like, if I. To bring this kind of heart rate variability back into this, you know, you led us in the workshop through a powerful exercise of really feeling our heartbeat. And, you know, just that. That experience, you know, to feel your heartbeat kind of in your fingers and my legs are too long. I didn't quite get them into my toes.
You know, I could at least get the. You know, it was a really powerful thing. And, you know, I think one of the things that, again, heart rate variability just tracking, I think we can get in the biofeedback piece of it here in a second. But it does, you know, it is kind of a fun game to kind of guess where you are at. And, like, I think, you know, it's one thing to do that first thing in the morning where maybe not all the synapses are firing at full force, but, again, you haven't had a lot of stressors in your life, including standing up, so you can get a good, accurate measure. But, you know, trying to track that kind of throughout the day and seeing what these things have an impact. I mean, it's giving you interesting data. And I think the thing that I took away, and I'm taking away from you is we offer in the optimal app, like, tags people can put on it, but really maybe some more reflective.
This, oh, I just worked out, or I just ate. Yeah, in hindsight, that might give you some data. But is there any kind of questions for the HRV nerds, like. Like me out there that, okay, I take a reading.
Is there maybe a question or two that you would encourage people to ask after they get that number to really maybe have a deeper reflection on what that number means for kind of the state they're in at that time?
[00:23:19] Speaker B: How embodied do I feel after I get a reading? How connected am I, with my body, do I have some sense? Is it actually easy for me right now to connect with the soles of my feet, or can I feel my pulse in my left ear? These are things that are possible. And of course, and so that could be one interesting correlate for people to develop over time. Another one that I particularly use a lot. And I suppose this gets into some of my personal practices. I do have a fitbit watch on, so I'm generally kind of aware of my heart rate at least.
And I know that when I'm sitting, I know that from observation when I'm sitting and I'm not thinking, I'm not overthinking. My mind isn't kind of overtaking what's happening. I'm more present. My heart rate is closer to 58 to 62. And when I'm overthinking about something, it's probably 65 to 67. So another question is that for reflection, for those folks in particular with HIV, could be what seems to be dominant right now? Is it the cognitive top down system that's dominant for me? Is there some kind of sense of presence that's there? And over time, I think that would be quite interesting to see HRV correlates. And then the final one would just be just emotional state, emotional state in general. So that's a wonderful practice because then you'll start to see your own mental patterns, your own emotional patterns, your own interoceptive patterns.
[00:25:03] Speaker A: And I got this question in my head, and it's one of those, you can just say, no, no, Matt, you're way too far in left field. But there's an interesting, I would. There's an interesting subset of.
When you talk about question of what activates or. I know the vagal nerve is always activated, but what improves our repairability. Let's use that language.
One of the realms that I think are very tangible, two folks, and I'll just pick one. But you can, you can do the opposite of it. But it's. It's cold showers or cold immersion therapy. And, you know, for me, if I've got a big presentation to do, like at two in the afternoon, where my energy, like, naturally drops, I'll do. And I do hot and cold shower because I'm not giving up my hot showers. Those are, that's, that's. Yeah, that's for me, that's mat time now I will go hot at the end of. And I just see my heart rate variability jack up, but I also see my energy level. It's just like, so refreshing. And I'm wondering. I guess my wonder in all this is, are these practices that force us, in many ways to get in touch with our bodies, like, going into a cold immersion scenario. I just kind of wonder if there's something there that, like, okay, I'm now, like, because I shocked my body with this cold water. Like, I'm more in touch with it coming out of that. And I'm not. I'm not saying the introspection of that whole situation is giving me the energy, but I'm curious about, like, these heart rate variability increasing. They're often short term things that a cold immersion or even a. A hot infrared sauna where I'm putting maybe a form of stress on my body, we see great results with heart rate variability from that. I don't know, I just like, when you're talking, it's like, oh, this is almost like the extreme way to get into touch with what's going on in your body.
[00:27:20] Speaker B: Yeah. Yeah. It's a great question, actually. There's a few things that I would say about it. One is that it tends. This is early on, so we don't know scientifically, but some studies suggest that when. That people with higher heart rate variability and when you induce higher heart rate variability, and this is a key take home, I assume, especially for your listeners, when you induce higher heart rate variability, you are improving interoceptive ability. So that's huge.
That is a very gentle method. Of course, HRV biofeedback is quite gentle.
[00:27:55] Speaker A: Yes.
[00:27:56] Speaker B: And so you can improve your interoceptive capacity that way. And so I think there is that correlation. There is that tie. What I will say, and this is probably my bias as someone who's maybe more influenced by mindfulness techniques and that kind of whole world is, I think, to really connect with the body, it needs gentleness and quietness. And are there ways that we can force it to happen? Yes. I wonder how sustainable those are. And maybe that's a great thing. Maybe an incredibly intense exercise just gets me really in touch with my body or that cold shower, just really. And those maybe are really great examples. But I would say, in general, learning to quiet the mind, the overly emotional system, learning to quiet that in a. In a softer, gentler, more subtle way, I believe is probably what represents one of the mechanisms in mental health treatment that help people recover and that work on so many different types of systems. Does that make sense?
[00:29:07] Speaker A: It absolutely does. Absolutely. And I would totally support that gentle aspect of it where you're nothing necessarily shocking yourself. I think there is still an athlete that lives inside of me at times and says, oh, but go to the extreme. And it is a nice way to get a little boost of energy in a non drug induced way at two in the afternoon to keep my sarcadian rhythms there. But definitely. And that leads me to another question, too, because I'm assuming, and I think you mentioned this obviously, being at AAPB, that heart rate variability, biofeedback is a great support, and you can change that word to support to whatever might make more sense. I'm just kind of wondering, we talked on this podcast about the interesting research coming out on self compassion as sort of a independent stream of research from mindfulness. Interrelated, but independent. There's enough independent findings to say something else is going on here. When you do a guided self compassion meditation, and obviously in my world, during doing residence frequency while you're doing a guided meditation, are we seeing some of this, do you think we're seeing, or will see maybe some of these same things happening with introspection that we're measuring? Maybe something unique that. Yeah, mindfulness HRV biofeedback might strengthen the brain areas that support this or give us an opportunity. Are you seeing any kind of guided meditation or any other practices specific to interoception coming in the field?
[00:31:03] Speaker B: Yeah, well, not. Well, yes, some are coming in, but some are 2600 years old also, and have been done.
[00:31:12] Speaker A: Love about our field, my friend.
[00:31:13] Speaker B: Right. I know. It's really. It's really straddling both of those worlds, and hopefully it's a hope at its best. It's a continued conversation just with different cultural paradigms.
So, yeah, you know, there. And some of these are practices that I do and that I do with patients.
Breath focused, concentration based meditation would be a classic. Yeah. There are also a lot of body scans that are wonderful, and those come from ancient traditions.
There's a body scan of the anatomy that is a traditional meditation that actually gets you in touch with different parts of your body and actually wakes those parts up interoceptively.
And so that's a wonderful one. Another one is called the elements meditation, which is, again, just a different view on what's happening in the body, runs you through your whole body and helps you try to find solidity and movement and differences in temperature and things that ways that we don't normally view the body. So it just gives you different angles on that, which I think there's no clinical studies that I'm aware of, but in my experience, that definitely taps into the interceptive system. So those are kind of two other examples. When it comes to self compassion, I kind of tend to. So I love that work. I'm so grateful for that work. I think the definition of essentially being kind, being mindful, and knowing that your suffering is not alone or isolated as a definition of is of self compassion kind of borders on brilliance.
But I think essentially any intervention that helps you approach your body in a skillful way helps you approach your mind. And emotion in a skillful way is going to result in the body relaxing. And when the body relaxes, you're going to see higher hiv, you're going to see more parasympathetic dominance, and experientially, you'll have a quieting. And when you have a quieting, you get more in touch with what's going on in the body. When you're more in touch with what's in the body, you have a much richer sense of what an emotion is. It's not just a thought and a feeling. It's actually, oh, this part of my heart hurts a little bit, or, oh, I could feel that in this part of my stomach and this muscle within my upper trapezius.
And the level of specificity is so much greater. So it fills out what is an emotion, and it also changes your view on it. So it's not so personal, it's not so like self compassion says, that's kind of the mindfulness versus over identification. So you're just seeing an emotion exactly what it is, which is its somatic components, some felt experience components, and maybe some mental components, as opposed to something that dominates you. That's confusing and you don't understand.
[00:34:24] Speaker A: I love it. So I want to dig a little deeper on that, too, because one of the things that, you know, I shared with you before we hit record, that led to, like a two hour conversation well into the evening, the night of your workshop is I was just hanging out with some amazing folks at the APB conference. Is the idea of an observer of, like, how do you observe yourself? Is there, you know, with Descartes, I won't nerd out too much, but Descartes, like, separated the mind and the body.
I love the work of, if I pronounce it right, Antonio Dimasio about this, I believe his book the self comes to mind just blew.
If I have a mind, which after reading that book, I wasn't sure if I did or not, it blew whatever remnants I had in there. So I find that the idea of an observer within the mind body system, that is, I would maybe separate enough to be somewhat objective of observing itself is just a fascinating concept. And I won't throw on you. It does the mind really existential.
That's for the after hour conversations.
I won't throw you out, but I guess I'd love to get your. Like, when you think about this clinically, of what is observing kind of what in this biology, mind body system that we have. And I think if we have a conception of that.
It allows us to position these concepts in a more model based kind of system. So I just. I'd love to shut up and hear what you have to say about it.
[00:36:28] Speaker B: No, I appreciate the question and the limb you want to go on together, Matt.
I love it. So all I can share is my perspective. And I actually think that there's a lot of mystery to this. And I'm pleased by that. I don't necessarily need to have all the answers, you know, myself personally. So what I would say is that it gets confusing because of how we define self.
[00:36:58] Speaker A: Yeah.
[00:36:59] Speaker B: And so we have this from my perspective, which, you know, is shared by many and not everyone, is that the self is kind of a process. You know, we talked about this before that it's like a river, not a rock. It's not a solid thing, necessarily. It's a process. And that, speaking of Antonio Damasio, he's one of the first neuroscientists.
That stated his belief. That one of the foundations of consciousness is interoception.
[00:37:30] Speaker A: Yeah. Yeah.
[00:37:31] Speaker B: So when you change interoception, you change some basic sense of consciousness. So if you accept the idea that the self is something that's kind of a construct. Something that's created in each moment. And is made up of component parts. Like sensations and thoughts and feelings and memories. And all of these things that make us human.
And let's say we can call that the self. And let's say that when you were doing whatever sport was kind of your thing. You're probably in the flow at times.
And when you're in the flow, your sense of self is really not so strong. You're not really thinking about yourself at all. But maybe when you're in a meeting and you're trying to get your point across. You may really be thinking about yourself. So I only use those examples because the sense of self actually does fluctuate and vary. That's what I mean by it's more of a river than a rock.
So if we kind of accept that that's some sense of self.
Then you have the ability to observe that some sense of self. You could say during this sport, you could just mindfully touch in and say, oh, this sense of self is not so strong right now. Or in this meeting where I'm feeling a little defensive because someone didn't like my idea. Yeah.
You say, oh, the sense of self is quite strong right now. So if you accept that idea, then you do have something that observes. You have something that is beyond the self, something that is mindful of the self. Right?
[00:39:06] Speaker A: Yeah.
[00:39:07] Speaker B: So this idea is, of course, a very ancient one. It pervades all religious spiritual traditions. But we've also seen it in psychotherapy emerge into the third wave of cognitive behavioral therapies. Most particularly. You see it a little bit in dialectical behavioral therapy, as in wise mind, but maybe not so deeply. You see it in acceptance and commitment. Therapy with self is context versus self is content. Or an observer self would be another way to say that. And then you definitely also see it in internal family systems.
And I believe they call it the true self or something like that. So there's lots of words for this, right? But we have this self, we have an observer. And it seems clinically that if we tap into that observer as opposed to the self, which is probably more correlated with a default mode, network and stress physiology, then we seem to do better when we tie into that kind of observer place. Yeah.
And so clinically.
[00:40:11] Speaker A: Oh, go ahead.
[00:40:13] Speaker B: Yeah. Clinically, I would just say what really resonates for me, because this can feel really abstract and philosophical. But what really resonates for me just to try to really bring this home is when I have people who are experienced, who have experienced so much trauma and they've never had in their lives some sense of safety and well being and ground state, stable ground, if there is any way, whether for them, through its spirituality or religion, or in our sessions, through tapping into some relational sense of safety or physiological sense of safety through biofeedback or emotional sense of safety through psychotherapy, if they can tap into that, that kind of gets a little closer to that sense of observer self that has not been touched by trauma.
And so just even holding that idea, which doesn't have to be a spiritual idea, even though I want to source it adequately, and I think it does come from those traditions as well as philosophy, bringing that into some kind of psychotherapeutic standpoint, helps in biofeedback. The last point that I'll make, Matt, is I love watching people do biofeedback. I love my patients watching their mystery grow about themselves, about their own bodies, their connection with their bodies grow. But they realize there's so much more that's happening under the surface for me. And so I think that's another way to connect into that kind of sense of observer.
[00:41:47] Speaker A: Beautiful. So my final question to you, because, boy, what you did, we could dig in for another 6 hours on just that answer. But let me, let me. I'll avoid that for now, and hopefully we can bring you back and keep exploring this. But where do you see this term going? Like, I'd heard of it, but honestly, it was really. It was kind of like, yeah, I heard about heart rate variability a few times, and then Stephen Porges came in and like, oh, there's, there's.
I need to start a nonprofit and a tech company, and I need to figure this out in a different way with my trauma work. And I'm sort of. You were sort of my Stephen Porges in this world because you took it and you said, kind of gave me Matt, this is really how you should start thinking about this. And I'm like, yeah, Nate is. Nate is really on to something here. Where do you see us going with this?
Because I do think one of the things, ever since your workshop is I train a lot of outreach workers and medical professionals, not necessarily the mental health.
I've got the traditional 50 minutes, hour sort of thing, but I'm trying to get you in housing, but at the same time, you're so disconnected from the world in your body that it's hard to get you to focus.
Where do you think with all of this, where we're kind of going? Where do you see this topic in maybe three or four years? Because there's something contagious about this I think is gravitating folks to it. So I just love to see, when we talk four or five years from now, where do you think this field progresses in that timeframe that we might be?
What are we going to be contemplating about in a few years?
[00:43:54] Speaker B: My hope is that, well, answer that in terms of three areas. In terms of research, I don't think that we need whole new therapies. I don't think there needs to be a fourth wave therapy. That's an interoception. I think what we need is interoceptive enhanced therapies, whether it's biofeedback or whether that's psychotherapies. I think that is what we need. From a research perspective, what I think that would look like are head to head trials around interoceptively enhanced therapies and traditional therapies to see if this is a practice change. That we should do, that we could do, that should become part of graduate training for mental health professionals or physicians or just anyone in healthcare at all.
From a research perspective, that's what I hope happens from a psychotherapeutic or interventional standpoint, what I hope happens right now, we have these, you mentioned these somatic based therapies, and then way on the other side of the playground is like these top down, more cognitive therapies. I like both of them. I'm a fruit salad person, but there has been some kind of disagreements between them. And I think it's just because we're there, to use an old metaphor, touching different parts of the elephant, it's the same elephant, but they're just. And it's all important. It's all important. And so I think what we should take the wisdom from somatic therapies and import that into more traditional therapies and vice versa, and be able to have interventionally with biofeedback. With. Although biofeedback is a step ahead because it is so somatic, and it is also top down.
So integrating those two things interventionally. And then I think culturally, what I would love, what's so amazing is it wasn't that long ago that people didn't know what the amygdala was. Right? Right. And I think HRV is still emerging, and the prefrontal cortex and the default mode network is maybe one of the newer ones. And so I think as a culture, we are hungry for expanding our vocabulary for wellness. And. And I think this is a way to do that interoception and healthy body awareness. And when people get more in touch with their bodies, that changes relationships in a positive way. You know, it allows for boundaries, or it allows for compassion and kindness. It allows us to be more in touch with our emotions. It allows to, I believe, prevent. I'd like to see studies on this, but prevent mental health issues and recover from them more quickly. So having people that understand that being embodied is important and can be helpful to them and to other people would be where what I'd hope we'd be talking about in a number of years.
[00:47:00] Speaker A: Well, beautifully said, my friend. And I really appreciate you and your work. And like I said, I think you probably. I wasn't the only one leaving your workshop absolutely obsessed with this idea. And I excited to be a part and watch how your work evolves over the next few years as well. And I'm already spinning about, I know our app, and you can find this out there, the muscle relaxation. I think that like said, that connection, I think, is a great starting point that's safe for so many people. Like, I always hesitate with a lot of mindfulness because, like you said, you change. You know, breathing can be a trigger for some folks, and probably there's a muscle relaxation could also be. But I think to get it ways, tangible ways, to get in touch with this and bring this into people's practices is really exciting work that you're doing. So I'm just thrilled to be on the ride with you and just appreciate you for sharing this with our audience. I'll reach out to Gebert's, too, and see if he'll come nerd out about it. But I did want to. I kind of wanted to start and introduce this with your work because I think it's so powerful. And I just appreciate you, my friend, and bringing this to our attention.
[00:48:25] Speaker B: Right back at you, Matt. Thanks for having me on.
[00:48:28] Speaker A: Awesome. And we'll put some information about me and Nate in the show notes, which is always, you can find the optimalhrv.com dot Nate, I'm so excited because every time I have you on, you just. You bring it, my friend.
I love how you think. I love how you structure.
You bring the practicality with the science, with the theory, and I don't know, and I'm not saying you own this by any chance, but someone who's a spokesman for this to get the information out, I couldn't think of a more perfect person than you, my friend, and I'm excited to help give you this little microphone to get it out there to a wider audience. Thank you so much for your work.
