[DAMIEN BLENKINSOPP]: Richard, thank you so much for joining us today.

[RICHARD GEVIRTZ]: Glad to be here.

[DAMIEN BLENKINSOPP]: I wanted to get a quick background behind what you do. How did you learn to do what you do, these studies and this area; how did you first get into it and learn to do it?
[RICHARD GEVIRTZ]: Well I started as an undergraduate studying with a famous psychophysiologist named Peter Lang, who was one of the founders of the field of psychophysiology, which is basically different from neurophysiology because we’re looking at physiological measures indicating psychological parameters. In those days we were measuring heart rate, but not beat-by-beat heart rate, just average heart rate, and muscle tension, temperature and respiration.

Then I went to grad school and got waylaid a little bit into another topic, but eventually I came back to psychophysiology and began working. I was in Minnesota at the time and I was near the Mayo Clinic, and I ended up working with a guy who’s been a lifelong friend, Marks Schwartz, at Mayo Clinic and doing biofeedback. It was the beginning days of biofeedback.

In those days we were doing just muscle tension and temperature and breathing, not even heart rate in those days. That was interesting; we were doing work on chronic pain mostly, and then relaxation techniques with finger temperature. I did that for a number of years but became a little unhappy with it because it seemed very limiting.

I had a background in heart rate, and as the technology got better, we realized that we could measure heart rate in a much more sophisticated way. Actually, in the beginning, I was collaborating with Paul Lehrer, my colleague at Rutgers University, and we were fascinated by this. Also we were good friends with Stephen Porges, who is this Polyvagal Theory guy. We were fascinated by this idea that the action wasn’t in the sympathetic nervous system as much as in the parasympathetic nervous system for day-to-day stress. That went against everything we had been doing up till then, which was really calming down the sympathetic nervous system.

So, as the technology built, and we realized it was really an incredible amount of information in the beat-by-beat heart rate, he and I began developing this idea of looking at beat-by-beat heart rate and feeding it back to people.

At the same time, in cardiology, the measurement of the beat-to-beat heart rate was growing rapidly, and so we benefitted a lot from all of the cardiology research showing a healthy heart as a very complex, somewhat chaotic-looking pattern to them, and that represented mostly the parasympathetic nervous system.
(0:06:12)[DAMIEN BLENKINSOPP]: Great. To take a step back a bit, what is biofeedback and what are the benefits that you’re seeking through using that?

[RICHARD GEVIRTZ]: Biofeedback, in general, is feeding back physiological information to a client or a subject and having them try to modify their physiology based on what they see, based on either wiggly lines on a screen or some analogue – a rocket ship going up or a train moving, or some other visual or other signal.

In the early days, what we were doing was teaching people to relax their muscles more profoundly than they might be able to do naturally, and we did that by feeding back information from voluntary muscle activity from electromyographs. Then we used finger temperature because it turned out that by learning to warm your hands, you could shut down the sympathetic nervous system. The sympathetic activity produces vasoconstriction. As you learn to vasodilate, it generally accompanies relaxation.

[DAMIEN BLENKINSOPP]: People would focus on their hands?

[RICHARD GEVIRTZ]: Yeah, they would focus on mental techniques to warm their hands.

[DAMIEN BLENKINSOPP]: It’s interesting.

[RICHARD GEVIRTZ]: And it turned out that they could both cool and warm their hands at will. A colleague of ours, Bob Freedman, in Detroit, was interested in Raynaud’s disease, so he was starting to look at biofeedback as a way that people could learn to warm their hands, even without getting relaxed they could learn to vasodilate. He studied the mechanisms of that and actually found fairly detailed mechanisms of how people could warm and cool their hands with different mechanisms. But they could definitely do it; medical students, even while playing a game of bridge, they could warm or cool their hands when a signal told them to do it at, will. Not a lot, but to some degree.

Everybody was fascinated by the plasticity idea that people could really control these supposedly non-controllable autonomic phenomena. So actually the original impetus was Neil Miller’s studies in ’69 that showed that animals and people could control all kinds of autonomic functions, although most of that has not been able to be replicated, interestingly enough. But it’s a famous study in ’69 and we knew Neil Miller. He was a great pioneer in his field. So even though it hasn’t been replicated, it’s still got us all thinking about control of autonomic phenomena.

At the same time, a colleague, Elmer Green, went to India and studied yogis, and showed that yogis have remarkable control of autonomic function. Though he didn’t exactly know how they did it at the time, they certainly could do all kinds of things. They could warm one hand and not the other hand, they could warm one ear and not the other ear, and they could do a trick that looked like they were stopping their heart, which is actually just a muscle tension that hid the ECG.

[DAMIEN BLENKINSOPP]: So the ECG wouldn’t pick it up because of the way they were beating their heart?

[RICHARD GEVIRTZ]: Yeah. It looks like they’re actually stopping their hearts – they weren’t. But it’s still pretty amazing. And they also had great control over heart rate and they could control heart rate, so it looked like maybe people could learn to control heart rate, and that was our first foray into that idea.

[DAMIEN BLENKINSOPP]: Did you ever look into how the yogis had learnt that? Was it meditation or mindful?

[RICHARD GEVIRTZ]: Purely meditation, yeah. It was various kinds of yogic meditation with a lot of breaths, a lot of pranayama.

[DAMIEN BLENKINSOPP]: Was this like the fire breathing, the fast breathing and things like that?

[RICHARD GEVIRTZ]: All kinds of breathing techniques: fast breathing, nasal, alternation with nasal breathing, slow breathing, but the thing we eventually discovered was if we asked the yogis to do what they do to get calm and centered, whatever language we could use for that, they always did the same thing. They always breathed very slowly, somewhere between four and a half and seven breaths a minute – whatever breath rate they chose, they always used exactly the same breath rate, within a half a breath, and they could do it even during distraction.

One of our colleagues had this one yogi who had put skewers through his tongue and through his arm and his neck, and still maintained this exact breath rate through the whole thing.

[DAMIEN BLENKINSOPP]: Wow. Was he making new holes in himself with those?

[RICHARD GEVIRTZ]: Yeah, little tiny holes, but he could prevent bleeding. It wasn’t a fake because I was right there next to him and I felt those skewers and I saw him do it. I think he learned certain places to put them that didn’t bleed and would quickly close up again, but they could do this without any outward sign of pain, without any physiology changing, is just remarkable.

We realized that there was some potential for control and that set us off on this pathway.
(0:11:05)[DAMIEN BLENKINSOPP]: I actually used a machine where they look at the blood flow in your forehead. I don’t know if you’ve seen that it’s a biofeedback mechanism – you can play this little computer game and it will go in the right direction when you’re increasing the blood flow.

[RICHARD GEVIRTZ]: Yeah. The question about that technique is whether it’s really just measuring forehead and dura blood flow, maybe peripheral blood flow, or is it really going deeper into the brain to measure cortical blood flow, and I think that’s still to be decided. The claims are that you’re getting the first centimeter of the cortex – I don’t think that has been shown, myself. But something varies, there’s no doubt about it, and people can learn to control it.

Blood flow was one of those techniques that yogis could control. Remarkably sometime there was one yogi who could make one ear get very warm and the other ear stay the same and then he’d switch ears. How he did that, he could never tell us. He just willed it. But that’s pretty remarkable. Physiologically, you’re not supposed to be able to do that. There’s no evolutionary reason why we should be able to control an autonomic function like blood flow, so somehow the brain could learn to do this through some remarkable meditative techniques.

[DAMIEN BLENKINSOPP]: This is pretty spectacular. I’d read a lot of the yogi books and some of the books on the science of yoga, and I wanted to try it but I wasn’t sure there were actual benefits and I didn’t know what the benefits were, and it went through all the history and stuff – quite interesting to see that some of that matches up, that’s spurred on your interest in the area.

[RICHARD GEVIRTZ]: Right. Actually we’re trying to encourage better science, because they think they know it all and they can cure everything, and I think the chances are that they are definitely on to some very remarkable things, but others probably not.

[DAMIEN BLENKINSOPP]: Yeah, because it’s interesting because it’s split into different types of yoga and all of this, and which came from the actual practices. I understand that some people injure their lower backs and things like that, so there are some parts which are seen as not good and other parts, which as you say, could be good. So there’s a way to go to figure that out.

[RICHARD GEVIRTZ]: It’s very tricky for science because they don’t have standardized methods. We just got a paper from a group about a kind of a yoga called reflective exercise. It’s got some Indian name and it’s claiming fantastic results with athletes. Here it’s just a completely different one – they use reverse diaphragmatic breathing – and with all kinds of claims, with really not much science behind it.

I’m an associate editor of the journal Applied Psychophysiology and Biofeedback and we try to encourage people to send us some good scientific papers. We would love to see what the mechanisms are. There is just a recent paper coming out in Frontiers, looking at the neurophysiological mechanisms of yoga – a pretty extensive review by a woman named Schmalzl. There’s lots to be learned, that’s for sure, but I think it’s an area that will be studied more frequently.
(0:14:19)[DAMIEN BLENKINSOPP]: Great. Thanks for the reference on that paper, too. That will be interesting to read.

So you’ve been focused on the heart rate variability biofeedback for a while. What is that in comparison to the other stuff we’ve been talking about?

[RICHARD GEVIRTZ]: Firstly, the important point for the listeners is that heart rate variability measurement is completely different than heart rate variability biofeedback. The measurement is a very big field, very dominant in parts of cardiology, and the underlying idea is that healthy hearts have tremendous complexity in their patterns of beat-to-beat activity – and you have to actually look at a beat-to-beat to see this. If you go to the gym and do your average heart rate, that doesn’t pick it up at all.

A beat-to-beat healthy heart rate is characterized by great amounts of complexity – many different oscillators that are contributing to the pattern. For some heart disease things, you need a non-linear message to look at these really complex patterns. Ary Goldberger is pioneering this in cardiology and has amazing results with different heart disease, in terms of seeing how it varies.

The measurement is of interest to us because we do measurements on people with different disorders. The disorders we are interested in are more psychophysiological or stress-related disorders and they do show up with poor heart rate variability quite often.

[DAMIEN BLENKINSOPP]: Are we talking about RMSSD here?

[RICHARD GEVIRTZ]: Yes. There are three classes of measurement. One is called time domain measures, which are fairly simple, they just look at the beat-to-beat variability. The most common one is SDNN, standard deviation of the normal to normal R-wave beat. A little more sophisticated and one of the same type is called RMSSD, root mean square of successive differences. The difference between the two is that the second is an integral measure that seems to be a little bit more dominated by the parasympathetic nervous system. SDNN is simply all forms of variability, it’s just the standard deviation of beat-to-beat differences.

It’s quite simple really. You just get a column of interbeat intervals in milliseconds and take the standard deviation. That’s still very widely used and is a powerful epidemiological measure. RMSSD is a little bit more sophisticated because it picks up a little bit more of the parasympathetic nervous system.

Then there are frequency domain measures, a second class of measures, and that’s where you look at what the frequencies are of different rhythms over time in the heart rate. It gets a bit more complex then. So you have to print out a sequence of beat-to-beat heart rates and then look at the frequency characteristics of them, and those frequency characteristics then can be sorted by how much of each frequency. The advantage to that is that in one realm, what’s called high frequency power, is a pretty good analogue to the vagal tone.

The tenth cranial nerve is the vagus nerve, which is the parasympathetic nerve that controls heart patterns. At rest, it’s the dominant source of heart patterns. By being able to measure the amount of vagal tone, we can look at things that are of interest to us, especially psychophysiological disorders or anxiety disorders, depression, because those things are all diminished in those disorders.

[DAMIEN BLENKINSOPP]: So better vagal tone is better, more control?

[RICHARD GEVIRTZ]: Exactly, yes, good vagal tone is, in general. A rebound vagal tone, like in asthma, which is too much vagal tone and it shuts down the airways, but that’s just a poor amount of flexibility in the autonomic nervous system.

The goal is very flexible, resilient, autonomic nervous system; not necessarily more tone overall. We do see less vagal tone, however, in a number of disorders.

[DAMIEN BLENKINSOPP]: I think another scenario where high vagal tone may not be a good thing is adrenal fatigue – we’ve discussed it on the show before.

[RICHARD GEVIRTZ]: Yeah, that could be, and as I say, asthma, if you get a sympathetic surge followed by a giant parasympathetic rebound, it shuts down the airways and that’s not healthy. There are some situations like that. Some kinds of stress are vagal stress. For instance, if you show somebody a video of a fake shop accident, where the shop teacher is putting a piece of wood through a circular saw and we see him just about to saw off his finger, people rate that as very stressful, but they don’t get a sympathetic surge, they get a parasympathetic surge from that.

[DAMIEN BLENKINSOPP]: Interesting.

[RICHARD GEVIRTZ]: Similarly for a vasovagal response, people faint when they see blood or needles; that’s a parasympathetic response, not a sympathetic response. So the system is adaptive to what’s important. The vagal system is trying to preserve blood and shut things down, but that can be a stressful response too, so we don’t want you to just think stress is sympathetic.

(0:19:26)[DAMIEN BLENKINSOPP]: Right. In terms of the heart rate variability mechanism you’re looking at, which approach have you been using?

[RICHARD GEVIRTZ]: The measurements we use are the same as everyone else. I’ll tell you an anecdote – it’s a fun anecdote. Paul Lehrer went to Russia; went to visit his son who works for the state department, and there met some people doing some of this heart rate stuff. They had kids breathing very slowly and improving their vagal tone in front of computers in St. Petersburg. He couldn’t understand why that would work because it seemed like it would kill them if they had asthma. These are all asthmatic kids – but they were getting better.

He tried to understand that better and eventually that led him to a guy named Evgeny Vaschillo, who was the cosmonaut physiologist. He was observing heart rates and respiration rates in the cosmonauts. By some chance, one of the cosmonauts was a bit of a meditator and every day in space he would suddenly see these patterns of heart rate that were completely unusual. Big peaks and valleys, very slow big peaks of waves and valleys. Again, he called up and thought the guy was dying or something, and he said, “No I’m just meditating.” So, luckily he was also an engineer and a physiologist and he began studying these patterns.

At the same time, we were doing the same thing, but we didn’t quite understand it. But he helped us understand that at certain slow breathing rates there is a resonance produced in the cardiovascular system, between several different oscillatory systems. The main one is called respiratory sinus arrhythmia. It’s like a brake accelerator and every time you breathe in, the brake goes off; when you breathe out, the brake goes on. If you think about it, it makes sense: the brake goes off, heart rate speeds up; when the brake goes on, heart rate slows down.

Why wouldn’t you want heart rate to be speeding up when you have oxygen available for gas exchange, and then when you’re breathing out, there’s no oxygen available? Actually it saves you something like 350 million heartbeats over a lifetime. This rhythm is called respiratory sinus arrhythmia, RSA, and it’s a normal pattern that we can see in a normal resting heart rate. But when you breathe somewhere between four and a half and seven breaths a minute, that pattern becomes greatly exaggerated.

What Vaschillo figured out, and we’ve built on, was that at those rates, you’re getting the phase angle between the baroreceptor, the blood pressure rhythm in your body, and the breathing rhythm in your body at exactly a 180 degree phase angle. What’s happening is you’re breathing in and heart rate is going up, then it’s going up even further because blood pressure is at the exact right angle for blood pressure to go down to make heart rate go up; and then when you breath out, the opposite happens in the other direction. So, these unexplainable shifts in the cosmonaut, where it was going from 65 beats a minute to 95 beats a minute in each rest cycle – giant peaks and valleys.

[DAMIEN BLENKINSOPP]: So you can’t get that by – people would think based on the description you gave – I breathe in and it goes up? So I can’t take a really, really big breath, hold it for 20 seconds and breath out, and get a higher peak and trough.

[RICHARD GEVIRTZ]: No because the timing isn’t right. It’s like a metronome, and you have to push on both ends of that metronome to make those big peaks and valleys. You’ve got to get exactly the right pace to do that.

There is an artifact in there. When you breathe more deeply, you do produce an artificial pressure that does affect the heart a little bit. It’s not really the one we’re interested in. We’re interested in what happens during restful breathing at certain paces. That’s where the benefits seem to come. In fact, the danger of really deep breathing is people hyperventilate and then that has negative effects on them. So we really try to prevent hyperventilation at all costs.

It turns out that everybody has their own unique pace, where breathing in and breathing out at that pace produces the biggest peaks and valleys, the exact right phase angle between respiration and heart rate, and when you go into that particular rhythm, it seems to have tremendously beneficial effects. Again, we often see this as a brand new idea that’s 2500 years old because this is exactly what these yogis were doing.

These yogis have remarkable cardiovascular systems. None of them are hypertensive – we’ve never found one that’s hypertensive. If you take them to high altitude, none of them get altitude sick. A colleague Luciano Bernardi, a cardiologist in Italy – it’s a funny story – he went to Bangalore and found twelve yogis and got them to agree to go up to high altitude. The first thing he found out is that yogis are prima donnas, they wanted to be pampered. He thought they were going to be really stoic and not care what material – no, they wanted a certain kind of cot, a certain kind of food. So as they drove up to the Himalayas, the Italian crew was all getting altitude sick, having a tough time, and these guys are just complaining about the food!

We realized that what they’re doing is they’re strengthening the baro reflex tremendously, by 30 percent. Practicing every day, you strengthen this reflex in the cardiovascular system that has really powerful benefits for cardiovascular health, and that’s why they all have fantastic cardiovascular health because they breathe tons of time at these slow breath rates. They also do other breathing techniques too, but they do – do this as well.

[DAMIEN BLENKINSOPP]: Are there any studies on heart disease, cardiac issues in yogis?

[RICHARD GEVIRTZ]: These yogis don’t have heart disease, but of course they’re also vegetarians, who knows.

[DAMIEN BLENKINSOPP]: Right, there are other co-factors.

[RICHARD GEVIRTZ]: Yeah, lots of factors, but it’s unknown in these people that do this. There is a lot of evidence now in cardiac rehab that people that get a lot of vagal stimulation – nowadays the big money is in vagal nerve stimulators – that’s healing to the heart. There’s a study at Cleveland Clinic where they’re using the HRV biofeedback instead of left ventricular assist devices for people who are getting a transplant, and when they harvest the heart for the transplant, the old heart is much healthier than they would have expected. It’s well known that vagal input to the heart repolarizes the cells and is healing to the heart and overloading sympathetic system is very detrimental to the heart.

[DAMIEN BLENKINSOPP]: I don’t know if you have done studies, but we tend to be higher sympathetic basis? Everyone talks about it but I was just wondering about the studies and if we’ve actually looked at that?

[RICHARD GEVIRTZ]: The more chronically stressed your life is, the more sympathetic dominance there is. That generally plays out in poor cardiovascular health. The veterans coming back from the Gulf Wars have horrible looking cardiovascular systems. They look like they’re 70 years old – and they’re going through 18 months of chronic stress – and that’s really bad for your heart. So there are efforts underway to try to teach them techniques to prevent that.

(0:26:54)[DAMIEN BLENKINSOPP]: Coming back to the metrics you’re using.

[RICHARD GEVIRTZ]: The metrics don’t apply anymore when you’re doing slow breathing, that’s a hard thing for people to understand. So when you’re breathing normally, you want most of the activity to be in the high frequency – between 12 and 20 cycles per minute. That’s what’s called high frequency HRV. But when you’re breathing slowly, you’re purposefully moving out of that, into a lower frequency range. At rest, a low frequency range is indicative of poor vagal tone and high sympathetic activity, but when you’re breathing slowly, you’re artificially moving into that period of time during that slow breathing.

It’s like any kind of exercise. If you measure someone’s physiology when they’re exercising physically, they look like they’re quite sick during the exercise – their heart rates are flying high, they’re sweating – but, of course, we know that when they stop, then everything gets more resilient and more fit. The same thing is true for the autonomic nerve system. This is a kind of exercise for the autonomic nervous system. On a regular basis, you produce quite a lot of resilience, flexibility and health in that system.

The metrics fall apart completely when we do the biofeedback. We have to completely ignore them and start looking at a different sort of metric then. So then what we want is actually all the activity in the low frequency range, which is in the four to seven range. The activity we look at, there’s one known as meditator’s peak in that range – it’s a single peak of great magnitude in that low frequency range. If that was your normal breathing, that would be a sign of ill health, but during this slow breathing, it’s a sign of accomplishment, of being able to do the technique.

[DAMIEN BLENKINSOPP]: So it’s a specific frequency? Basically, nearly all of your heart beats are within this specific frequency range?

[RICHARD GEVIRTZ]: It’s exactly where you’re breathing. Let’s say you’re breathing in five breaths a minute, then it will be a little less than 0.1 Hz. If you’re breathing in at six breaths a minute, it will be exactly 0.1 Hz. If you’re breathing in seven, it will be a little bit higher than that, or something in-between those. That’s exactly what you see – breaths dominate that peak and then you want that peak to be the exclusive peak in the heart rate, and as high as it can be, during slow breathing.

[DAMIEN BLENKINSOPP]: Does it matter exactly where it is?

[RICHARD GEVIRTZ]: Yeah, for each person it matters because they have to find their resonance frequency. What heart math calls the point of coherence, we call resonance frequency. We think coherence is not exactly the right word because it means two things going together. It is two things aligning together – breath and heart rate – but they don’t measure breath, so we think really what you are doing is producing true physical resonance in the system between the baroreceptors and the breathing rhythms, and that’s where the big benefits come during that slow breathing.

[DAMIEN BLENKINSOPP]: Is it different for different people?

[RICHARD GEVIRTZ]: Yeah. We get some people at four and a half breaths a minute, that’s where their peak is; some at five; some at five and a half; some at six; some at six and a half; some at seven. We’ve done various studies to see where the frequencies are. They tend to be in the five and a half to six range for most people. Smaller people tend to have a little bit higher frequencies, very tall people have lower ones – it’s like a violin versus a cello, with different resonances. That’s not a perfect relationship.

What we do in the biofeedback is we test at every breathing frequency. With the other systems, what you do is just trial and error to try and find something that produces the most coherence. We actually systematically don’t do that; we systematically go through in some order. I like to start at seven and we do a few minutes of breathing at seven, then six and a half, then six. At some point, the pattern falls apart – it’s too slow – so we go back up another half beat until we find somewhere within a half a beat of the proper frequency for that person.

[DAMIEN BLENKINSOPP]: Where they’re getting their highest peak and trough?

[RICHARD GEVIRTZ]: Exactly, and the phase angles are correct, and it’s also the one with the smoothest heart rate patterns. That does show up – at our school they’re using a seismograph just to look at the pulse beats, but I think it does hold up that the smoothest, biggest peak-valley differences is usually where it will be.

[DAMIEN BLENKINSOPP]: Does that work with smooth breathing as well?

[RICHARD GEVIRTZ]: Yes, and we try to teach diaphragmatic breathing – smooth, restful, diaphragmatic breathing works better. If you overdo it, you hyperventilate and then you lose the effect. If you can breathe with your diaphragm, it’s much easier to breathe more slowly if you actually get your diaphragm in the action.

[DAMIEN BLENKINSOPP]: I think some people would know the heart math device, the M wave, already, in a sense, because that’s very consumer focused. With that one you have a score – basically, you get to 11, 16, if you’re getting higher. So mapping that to what you’re saying is the higher the S-score just the higher the peak and the trough.

[RICHARD GEVIRTZ]: Yes, well, what they do is actually measure the frequencies and then they take the low frequency that’s in the range of their breathing divided by all the other frequencies, so it’s just a percentage of activity in the low frequency range, which correlates very highly to the peak-trough difference as well.
(0:32:25)[DAMIEN BLENKINSOPP]: I see. If we compare that to what you do, do you use a specific device or devices?

[RICHARD GEVIRTZ]: Yeah, so we use one of many different biofeedback devices. The advantage we have is we measure four channels usually or five: we measure heart rate beat-to-beat, based on EKG not a PPG. So you can either do it based on a pulse – the problem with a pulse is that you have to decide when the pulse starts and stops – versus an R-wave of an ECG, which is a very distinct event to start and stop the clock. If possible, it’s good to use an ECG, which we do. So we use beat-to-beat heart rate, we use respiration – we have strain gauges for respiration. We look at finger temperature and skin conductance – that’s sweatiness on the palms of your hands. All of those are useful indices for what’s happening.

If you can, the devices that just use the single channel heart rate – the emWave, MyCalmBeat, a number of other ones that are out now–are fine, they work, but it’s certainly not as good an information as if you’re using devices that have the four channels.

[DAMIEN BLENKINSOPP]: Right. So you’re using clinical machines?

[RICHARD GEVIRTZ]: Right. But some of those clinical devices are getting down into the 600-700 dollar range now. The ones we use range from about 3000 dollars to about 11,000 dollars.

[DAMIEN BLENKINSOPP]: Very clinical!

[RICHARD GEVIRTZ]: That’s not for consumers. But, there are a number of devices now that are coming out that are going to be with those four channels, that will be ECG, that will be in the 600-700 dollar range. But for everyday people, the emWave device that really works well is the Inner Balance, the one that runs off an iPhone. It’s a beautifully designed device and you can have it on an iPhone and it’s tremendous to manage.

[DAMIEN BLENKINSOPP]: Yeah, because it’s convenient.

[RICHARD GEVIRTZ]: It works well but you’ve got to be sitting in front of a PC, which is a big difference, but it’s cheap and it works well.

[DAMIEN BLENKINSOPP]: I’ve had both the emWave and the Inner Balance – is it Inner Balance or the Inner Sense?

[RICHARD GEVIRTZ]: The Inner Balance is a Hearth Math device; it’s the one that goes on the iPhone. The other Heart Math ones either run on a PC or they have a handheld stand alone.

[DAMIEN BLENKINSOPP]: I find it so much more convenient, I basically keep it in my jacket pocket. I’ll be on a train or anywhere where I’ve got a bit of free time and I’ll just pop it on.

[RICHARD GEVIRTZ]: Right, absolutely. There are also some free apps. What we do usually is we don’t advise people to buy those devices because we find their resonance frequency with our instruments and then we give them one of three or four different ways of practicing at that pace.

MyCalmBeat has a free app for pacing. There’s another one we like called Breathe2Relax – these are free apps – or there’s a musical pacer, that does cost some money but it’s very nice, called Breathe Sync. It has five different musical tracks at your particular pace, so we have a separate CD for each person. We let people choose the ones they want, whatever is the most convenient. It’s really important that it’s something they can practice with.

[DAMIEN BLENKINSOPP]: So this isn’t biofeedback – this is once you have done the biofeedback, you’re just giving them the timer?

[RICHARD GEVIRTZ]: Exactly. And some people just count. I can do it now – I’ve done it enough that I can get exactly to my resonance frequency pace just by counting.

[DAMIEN BLENKINSOPP]: And then you become like a yogi basically, you’ve just learned a lot quicker to do it.

[RICHARD GEVIRTZ]: Yeah, I learned to do it but I don’t do it hours a day so I’m not quite like a yogi. I do it ten minutes a day.

[DAMIEN BLENKINSOPP]: Is there any danger of overdoing this, like if you did too much of it?

[RICHARD GEVIRTZ]: Not that we know of. Some people do get anxious when they try to do it, but usually that only takes a bit of practice until they get out of that. As far as we know, there doesn’t seem to be any ill effects of this, but people have worried about it and perhaps overstimulating the parasympathetic system. But it doesn’t really do that – it just gets you better balance in the system.

[DAMIEN BLENKINSOPP]: Right. Because when you said it was like exercise, like hormesis in a way, right? I’m just wondering as we can overdo exercise.

[RICHARD GEVIRTZ]: Well, the yogis are the ones who overdo it. They breathe many hours a day and they don’t seem to be in bad shape from it. I don’t know. There’s tens of thousands of the emWave devices that have been used and I’m sure some people must overuse them, but I know of no reports of any really ill effects of it. There might be but I don’t know.

[DAMIEN BLENKINSOPP]: It sounds like a very simple approach you have, just covering a slightly low and a slightly high and then just finding the optimum by moving around by testing. One of those devices – the 600-700 dollar ones – are there any names of those that are coming out?

[RICHARD GEVIRTZ]: The two companies that make them, they’re not quite out yet, they’re coming soon, one is J&J Engineering, which has a new device coming out in that range that will do those four channels, but it’s not a portable device – it’s a PC device. The other company is called Thought Technology, that’s a big biofeedback company. They’ve got a little device that’s coming out that’s a fingertip PPG, just a pulse amplitude but it also measures temperature and skin conductance, and it bluetooths it to a tablet. Then it has an accelerometer so you can put it on your chest and it will also give you the breaths measurement. So those two are in that range of price and they’re coming out fairly soon. I think one is out but not with all the channels yet, so I’m not sure where they are exactly.

The other company that doesn’t have a cheaper one yet is called Nexus, a Dutch software package. Thought Technology and Nexus have very expensive systems, but they do many more things than that – they do all kinds of bells and whistles.

J&J is a bit cheaper, it doesn’t have as many bells and whistles, but they also have a 3000 dollar device that measures many channels as well, but it doesn’t have as many displays, so probably for the consumer, none of these are of interest.

I’d say right now, the consumer device that is far and away the best for portability, is Inner Balance from Heart Math. They’ve mastered some things that nobody else has mastered. That system seems to work extremely well. I have yet to find someone that doesn’t get an adequate pulse from their earlobe, whereas we used to get a lot of problems with pulses and not everybody could get a good pulse.

[DAMIEN BLENKINSOPP]: The only problem I’ve ever had with – I think it was the emWave – was I was living in Spain – very, very bright sunlight – and if I was in the sun, it wasn’t working. I had to be in some kind of shade. That’s the only thing I ever came up with.

[RICHARD GEVIRTZ]: That’s true for any of the PPG devices. I haven’t ever really tried it in a really bright sunlight. So those are the devices, but we’re not sure that people need to spend the money on those things if they can figure out what their pace is and then just practice on a regular basis. Twenty minutes a day is ideal but people will practice ten minutes a day.

[DAMIEN BLENKINSOPP]: What are other ways? If I don’t want to buy the device, do some physicians have these kits or some other kind of specialist, so I could basically go for a session? I don’t know how long it takes to do this, an hour or something, and they would figure out my perfect?

[RICHARD GEVIRTZ]: Yeah, there’s a guy near you in St. Albans at the Open University who does it. There are people around who do this. We do a lot of trainings with people all over the world. I was just in Rome training people from all over Europe, so there are a lot of people who do this. And probably even more people who aren’t very well trained but who have the emWave devices who probably give close to enough to be quite beneficial.

[DAMIEN BLENKINSOPP]: For you, would it be worthwhile one session even if you’ve been doing emWave? Would it be worthwhile doing one session? It depends how extreme we are about these things.

[RICHARD GEVIRTZ]: Well you know what, it’s very convincing when you see it on the screen. So even if you were able to get exactly the right pace yourself, seeing the actual physiology change is amazingly persuasive.

With our clinical clients, we take a baseline at normal breath rates and then show it to them again after they’re done with the training, and they get emotional. They’re seeing that their physiology really has changed; their baseline physiology has changed dramatically over the course of six or seven weeks of training. That’s one big advantage of it.

[DAMIEN BLENKINSOPP]: And, of course, you’re cross-referencing lots of different data, so you’re seeing the change across the whole body. Is there ever a case where you see the change in just the EKG and you don’t see it in the other areas? Are you cross-referencing that data or is it more just to make sure?

[RICHARD GEVIRTZ]: We do cross-reference it with fingertip temperature and skin conductance. Sometimes we don’t get those, that’s true. Sometimes they don’t click and that may just be they’re being nervous in the session or something while we’re measuring them. And some people get very small changes in heart rate variability, especially older people. It’s actually a very small quantitative change, but they seem to get the same clinical benefits.

As we get older, those peaks and valleys definitely go down. Even if you’re quite fit – I’m a bicyclist, I ride 110 miles a week. I’ve been monitoring mine for twenty years – it’s going down despite my best efforts.

[DAMIEN BLENKINSOPP]: Even with all the training. So you’re not able to get the same peaks anymore?

[RICHARD GEVIRTZ]: Right. It used to be 15 – the value of the peak for me, 16. Now it’s 11, it just little by little by little it goes down. But, the good news is that in terms of the clinical benefits, it doesn’t seem to matter, as long as you’re training at that right frequency, you seem to gain the clinical benefits of it. It doesn’t necessarily mean you’ll live forever, but it seems to help with a lot of parameters.

[DAMIEN BLENKINSOPP]: So that’s similar to RMSSD, which declines over age as well.

[RICHARD GEVIRTZ]: Exactly, and that’s exactly why it does. Any of those indices would be measuring somewhat the same thing.
(0:42:31)[DAMIEN BLENKINSOPP]: So you spoke about people doing this for a number of training sessions. For someone wanting to do this, how long would it take? What’s the typical protocol you’d put them through to learn when you take them on?

[RICHARD GEVIRTZ]: We need one session to make sure we have the right frequency. Then we send them home with the practice techniques, any of the ones they want. Then they come back the next week and we just make sure we’ve got everything right, because sometimes one week of practice will change it a half a beat and we want to just fine tune it. Some people are very sensitive to that, others are not. The rest of the time is depending on what they’re coming in for, so if they’re athletes, we now start to use some sports psychology to integrate it into sports psychology.

I work with a lot of rhythmic gymnasts who get very nervous before they go on – those are the ones with the hoops and the clubs, that funny sport; these are little girls basically and they get nervous.

[DAMIEN BLENKINSOPP]: You mean they’re quite young?

[RICHARD GEVIRTZ]: Yeah they’re 11 or 12. The coaches are Bulgarian usually.

[DAMIEN BLENKINSOPP]: They’re quite tough on them.

[RICHARD GEVIRTZ]: So we teach them the technique, they come back, make sure they have the technique–these kids are fantastic at it, they get giant peaks and valleys. They’re so fit and good at this stuff. Then we sort of integrate it into the cues in their routine where they tend to get nervous, pairing them together with some sort of sports psychology intervention, so that might take a few more sessions.

[DAMIEN BLENKINSOPP]: Are you getting them to trigger it at just the right moment where they would normally get a bit more anxious, but you trigger it just before something?

[RICHARD GEVIRTZ]: Exactly, and we have to work out how to do that. But for somebody who just wanted to do it for their own benefit, we probably could do it in two sessions, as long as they keep practicing, they’d do very, very well.

[DAMIEN BLENKINSOPP]: So they come back for a session of half an hour, an hour?

[RICHARD GEVIRTZ]: They come back for an hour. That’s what our standard session is, but we usually talk about other things during that hour. We also want to get a baseline again and so we try to distract them and just get them breathing normally. One of the problems is that if people don’t breathe normally, you can’t get an adequate baseline from them. So if they breathe slowly, it messes up their RMSSD data. It messes up all their data, so suddenly they don’t have any high frequency data. You have to make sure they’re breathing at their normal breathing pace when you’re getting baseline or follow-up data, and then when they do the slow breathing, then that changes everything.

[DAMIEN BLENKINSOPP]: Right, just to make sure you’re comparing to that – you’re getting a real control basically.

[RICHARD GEVIRTZ]: Exactly.

[DAMIEN BLENKINSOPP]: This is how they are in real life or this is how they are just before they’re going to compete, in the other example.

[RICHARD GEVIRTZ]: Yeah.

[DAMIEN BLENKINSOPP]: So would you give them a heart strap and monitor their athletic when they’re actually doing it?

[RICHARD GEVIRTZ]: We do do that, and that would be just for research purposes. We don’t do it for them. They’re not usually allowed to have that in a real competition anyway. It depends how they are, and it depends on what we’re doing.

Another application that’s not biofeedback but it’s an interesting HRV technique is for detecting over-training. FC Barcelona has got Leo Messi every morning doing five minutes of heart rate variability measurements, right in bed in the morning, and the training director monitor that. When they see dips in heart rate variability, they decide that it’s over-training and they ease up his training protocol. So if he has a couple of games in a week, they’ll monitor that and try to see, because over-training generally produces poor performance.

[DAMIEN BLENKINSOPP]: Absolutely.

[RICHARD GEVIRTZ]: So that’s catching on like crazy. The sports psychologists are so competitive- if anybody gets anything, they all do it, just immediately.

[DAMIEN BLENKINSOPP]: They see it as a competitive advantage. I was thinking, you said they’re not allowed to wear those during competitions. Well I can understand why – if you’re getting biofeedback, it’s kind of like cheating. I don’t know if it’s cheating but you’ve got a competitive advantage.

[RICHARD GEVIRTZ]: Could be, yeah.
(0:46:33)[DAMIEN BLENKINSOPP]: What’s the performance benefit of being able to put yourself in this restful state? Say I’m just about to compete; is there a study showing there’s a performance benefit or another benefit, or is it just keeping their mental focus?

[RICHARD GEVIRTZ]: Yeah. It has to be for sports that are single action kind of sports, so golfing, gymnastics, baseball hitting, cricket batting, possibly penalty kicks in football; things like that. For aerobic sports, there’s no parasympathetic at all – they’re all in the aerobic range. It probably doesn’t make much difference for those, although it gives them a little bit of a psychological edge – it’s hard to detect the benefits there.

For baseball, one of my former students is in whole practice dealing with Major League Baseball players for hitting, because you’ve got a split second to make up your mind. The ball is coming at 95 miles an hour, and you have to be in exactly the right arousal level to be able to flow through that swing. It’s a way of getting an optimal flow state in things like that. Also in dancing and music, there’s a guy in London, John Gruzelier, who does it with dancing and music and combines it with brainwave feedback, and gets benefits for recitals and dance performances and things like that.

[DAMIEN BLENKINSOPP]: So it sounds like it’s eliminating nerves, is that the application?

[RICHARD GEVIRTZ]: Well, trying to get people into their optimal – to try to get them from over-aroused to the medium level. There’s a famous curve called Yerkes-Dodson Law, which is an inverted U-shape and the y-axis is performance, on the x-axis is arousal. Imagine an upside down U – people do the best in the middle, too high or too low isn’t good. We don’t want them to be relaxed, we want them to be psyched, but if they’re over-aroused then opposing muscles don’t work well, they began to get a certain choking mentality, they start thinking “What if I screw up?”, things like that.

[DAMIEN BLENKINSOPP]: I don’t know if you know about the science of flow and the books around flow. I can never pronounce the guy’s name, it’s very long and complicated – Csikszentmihalyi.

[RICHARD GEVIRTZ]: We think that we’re trying to go for the same thing. But it turns out, I was just at this conference in Rome and there were a lot of sports psychologists. One of the points they made, and it’s actually rare for athletes to be in the flow state during a performance, it’s definitely the ideal. These are people dealing with Olympic athletes, the most elite athletes in the world, and their experience is that maybe ten or fifteen percent of the time they actually get into their flow state. Now they’re saying the important part is if you don’t get into the flow state, don’t panic and go into the complete opposite quadrant where you’re really choking completely. But work on getting through the routine and the best arousal you can. That’s the first I’d actually heard that – I thought it was pretty interesting.

[DAMIEN BLENKINSOPP]: Right, so that’s more like limiting the downside, or focusing on not getting the troughs?

[RICHARD GEVIRTZ]: Exactly. There’s a guy working in London with FC Chelsea doing that, Tim Harkness. Chelsea has got a big room full of expensive biofeedback equipment, called “the Mind Room”. He works with all these multi-millionaire players. So it’s interesting to see.

Try to be self-observant, non-judgmentally observing your thoughts and breaths as you do it
[DAMIEN BLENKINSOPP]: One of the things I’ve done with Heart Math – you can tell me if this fits with exactly what you said – is I’ve tried many things to get my peak higher, of course, and get my highest score. I do think that what you’re doing with your mind seems… For me personally, I’ve had the biggest peaks and troughs over time by actually focusing on the wave in the device, so just watching the wave go up and down and then I breath at a specific point in that curve, which I found works for me.

[RICHARD GEVIRTZ]: Yeah, and I should have said that, so for some people, we don’t use the pacing at all – we do exactly what you do. We just show them their heart rate and respiration, we have the advantage of one more channel for them to look at, because you can see their breathing.

[DAMIEN BLENKINSOPP]: When you say one more channel, what would that be showing?

[RICHARD GEVIRTZ]: It’s showing a wave form of breathing, just a nice, smooth wave form of the breathing rate – so when you breathe in, it goes up; when you breathe out, it goes down.

[DAMIEN BLENKINSOPP]: In addition to the heart?

[RICHARD GEVIRTZ]: It could be smooth or jumpy and you want it to be smooth.

[DAMIEN BLENKINSOPP]: Right.

[RICHARD GEVIRTZ]: We would say exactly the same thing for a certain percentage of people: just make those two go up as high as they can, and down. Some people absolutely prefer that, they get their best results. I think partially because it takes away any performance anxiety, you’re just trying to match it as opposed to trying to breathe to a pacer. Some people really have a hard time breathing to a pacer, so we absolutely leave that as an opening – just do that, kind of thing.

We do try to promote a mindful mental set as well, so we try to say, “Try to be self-observant, non-judgmentally observing your thoughts and breaths as you do it.” I think there are some real benefits to doing that. I’m not sure it shows up exactly in the heart rate patterns, as we said earlier. I think that remains to be seen. If it does, it’s a pretty subtle difference.

[DAMIEN BLENKINSOPP]: If I started thinking about something stressful, like work, some problem I had at work, would that tend to put me off or would you think that would have a minimal impact compared to breathing, as long as your breath remained the same?

[RICHARD GEVIRTZ]: Right. It probably would be very hard to see as long as your breath stayed exactly in that same pattern. Oh, of course, it might interfere with your breath pattern too. Then you’d see it for sure; but if you maintained your breath pattern exactly the same, you’d probably have a very hard time seeing very much in there. Whatever it is – is subtle. If there is something to that, it’s probably quite subtle.
(0:52:35)[DAMIEN BLENKINSOPP]: What do you think about the connection between the brain and the breathing pattern in this case? By taking on this physiological breathing, do you think it will naturally affect the brain? I don’t know if there’s any research related to that, that it will put you in a different state of mind as well, as long as you maintain that.

[RICHARD GEVIRTZ]: We’re working on that now and we’re definitely finding pretty dramatic effects. Eighty percent of the vagal fibers are afferent – they go from the heart to the brain; only 20 percent of them are efferent – from the brain to the heart. This is something Heart Math has definitely pointed out and we agree with them on this completely, and it’s interesting. So the brain is listening to the heart more than the heart is listening to the brain, which seems counterintuitive. But they’re both part of a central autonomic system that integrates frontal lobe and some limbic system activities into the brain function. So really, it’s silly to treat them as separate systems – they’re an integrated system.

It appears that this technique has a powerful effect on the vagal afference going into the brain, so the brain states are quite dramatically affected. We recently published one study, and we’re just about to publish another, where we look at a brain wave called an evoke potential, it’s a very short – just for 800 milliseconds, and you do it for repeated stimuli. In this case, we take the filters off. Usually when they do EEG, you put a big filter on to get rid of that R-wave and the heart rate, because it messes up the EEG. But we take that off and let it mess it up, and you can see a very giant spike in the EEG for every heartbeat. Well there’s another wave that comes right after that – 250 milliseconds after. It appears to be the brain processing the information from the heart and it’s called a heart period evoked potential.

We measured that during positive emotions, negative emotions, baseline, slow breathing and resonance breathing. Resonance breathing had by far the biggest effect on it. Negative emotions did diminish that wave, so if your brain is busy thinking about the worst thing that ever happened to you, it doesn’t pay attention to your heartbeat anymore. During the slow breathing we got a dramatic improvement in this processing of the R-wave. It also correlates with people’s ability to be able to detect their heartbeat. There are some German studies that had people try to guess what their heart rates where. They were much better at it if they had that big wave at the 250 milliseconds.

So yes, I think the other powerful part of this is that we’re bombarding the parts of the brain that I think are beneficial to us with a very positive wave form – it goes up into the frontal cortex and the part of the brain we think that controls depression possibly – and this would be the basis for the claims of positive mental states coming from the heart rate itself. I think there’s a lot to that – we’re continuing to do more research on that. The results we got from both studies were very dramatic.

[DAMIEN BLENKINSOPP]: You mentioned a few use cases. What are the other most beneficial use cases that you have been working on over the years and you feel like the best applications for it are?

[RICHARD GEVIRTZ]: We mostly focus on autonomically mediated disorders, which are giant amounts of medical disorders. That would be things like functional gastrointestinal disorders like irritable bowel syndrome, reflux, functional abdominal pain, diarrhea, constipation. Those are massive familiar disorders and they’re greatly affected by the autonomic nervous system. There’s actually an institute right there in London, Wingate Institute (it might be a good thing for one of your podcasts actually), where they actually look at esophageal pain thresholds, with a nasal tube down the throat, and how they’re affected by autonomic function. They’re dramatically affected, and slow breathing changes the pain thresholds: it protects you from lowered pain thresholds. That probably is the low-hanging fruit in terms of applications.

We see about 15 kids a week with functional abdominal pain from our children’s hospital and we get tremendous results with those kids.

[DAMIEN BLENKINSOPP]: Is it therapeutic or is it just lowering the pain?

[RICHARD GEVIRTZ]: No, it’s therapeutic because the functional abdominal pain is actually caused by an imbalance in the autonomic nervous system. There’s no pathology that’s detected, these kids have been scoped, there’s nothing wrong they could find, but your gut needs a lot of parasympathetic input to function, and if you take that away… The kids that get this are all “internalizers,” they’re a little bit anxious kids – they’re great kids, they’re achievers, but they tend to be a little bit nervous, they worry about getting into a good university in third grade and things like that.

[DAMIEN BLENKINSOPP]: The famous insecurity overachievers.

[RICHARD GEVIRTZ]: Yeah, they’re lovely kids to work with, we love them, and they do very, very well. Adults don’t do as well but they still do well.
(0:57:55)[DAMIEN BLENKINSOPP]: You mentioned IBS as well. I think this is becoming a lot more common these days, a lot of people are getting these kinds of conditions and gut issues. Is it therapeutic also for those areas? Because a lot of people talk about probiotics, the microbiome, gut lining damage, gluten intolerance and all of these kinds of things related to these disorders, so I’m just wondering if you have had therapeutic benefits there.

[RICHARD GEVIRTZ]: Yeah, the relationship between the biome is complicated. I don’t think we know it, but it is definitely a parasympathetically connected system. We’re not quite sure whether we’re correcting it or whether it corrects us. The problem is the probiotics – there was a Cochrane Review on probiotics – apparently they are not near enough probiotics to have much effect, to really change the biome. But the biome definitely affects the brain, there’s no doubt about that, and probably through the autonomic nervous system. In fact we know it does through the vagal afferent system. So I think in the future, we will be pairing up with better techniques for improving the flora of the gut with these kinds of techniques that we use.

[DAMIEN BLENKINSOPP]: To kind of come at it from two different angles.

[RICHARD GEVIRTZ]: Both ways, I think that would be quite powerful.

(0:59:09)[DAMIEN BLENKINSOPP]: So you are seeing a permanent improvement in these cases, like IBS and stuff? But do they have to keep up the practice in order to maintain it?

[RICHARD GEVIRTZ]: We thought they did but then we did a follow-up and we asked them more in-depth questioning, and it turns out they just use the technique whenever they feel symptoms coming on – they don’t actually continue to practice very often. Some kids do, but a lot of them said, “Oh yeah, I keep on practicing,” and we asked them, “So what does that mean?” and they said, “Well, whenever my stomach gurgles, I do my slow.”

[DAMIEN BLENKINSOPP]: Okay, but that’s a good thing. That means that there is something that you’re fixing, basically, and so you don’t have to constantly – just maintain the practice in order to maintain it.

[RICHARD GEVIRTZ]: The kids with these disorders are at much greater risk for adult IBS – a lot of studies show that. We don’t know if we’re preventing that risk, but we think we are. We’ve had some five or six year follow-up with some kids and they seem to be doing just great at that point, so hopefully that will move on through their lives to be quite beneficial.
(1:00:01)[DAMIEN BLENKINSOPP]: Are there areas that you’ve looked at where it wasn’t effective? You mentioned depression – has it been effective in those kinds of neurological things?

[RICHARD GEVIRTZ]: I didn’t think it would be, but my students wanted to try it – I have a lot of doctoral students and we keep on consistently seeing beneficial effects on depression, probably through that vagal afference system. We are consistently seeing that and we’re doing more studies, and I think every study so far has shown a beneficial effect on depression. Sometimes they’re combined with psychotherapeutic techniques – in most of the studies they are. In one study they weren’t, they just did nothing but the biofeedback, and they got improvements, though there was no control group in that study. But the other studies, they are just adding it to cognitive behavioral therapy or one of the mindfulness-based therapies, and it seems to add a definite benefit to it.

In one study in China, they compared just slow breathing, without finding the right frequency, to finding the right frequency, and the frequency finding had better results than just slow breathing, even though that did help.

There are some indications that technique specifically might be beneficial. It probably is no more helpful than palliative techniques for chronic pathology like nerve pain, probably not very beneficial for people with Crohn’s or chronic IBD, inflammatory bowel disease. There is possibly an effect on the inflammatory system. There’s a guy called Kevin Tracey that has traced this cholinergic immunological system. There’s a lot of interest in that now, but we have not been able to show yet that it has any benefit on immunological function, but it may be.

There’s research coming out now that is indicating it might have an effect on one part of the immunological system. There’s a vagal part of that system that may help, and if it does work, it would probably be that it would be helping the system from going bonkers. Sometimes people’s immunological system turns on and doesn’t turn off again – autoimmune diseases – and nobody knows quite why that is, but it looks like strengthening this vagal system might prevent that. That would be that it might help to reset it; there are some claims of that. I would say the evidence is just beginning now.

Other disorders, it doesn’t seem to help for atrial fibrillation for some reason, that’s kind of a nerve induction of the heart itself. Pacemakers aren’t involved. At my age, all my friends are getting atrial fibrillation. I’ve tried it on all of them and it doesn’t seem to help very much. Then there are probably a number of physical disorders that it doesn’t really help. If it’s an autonomically-mediated disorder it seems to be quite effective.
(1:02:52)[DAMIEN BLENKINSOPP]: I guess what we haven’t spoken about is people’s emotional happiness and things like that. Are there any evidence that it improves satisfaction or happiness or stops angry outbursts?

[RICHARD GEVIRTZ]: Yeah, we have a couple of studies that show it helping with urge control. The pathway back up into the brain seems to go through the places that have inhibitory neurological control of emotion, so we have some reason to believe that if you can improve those inhibitory circuits, that would help a lot with anxiety, help a lot with urge.

We’re doing one now with smoking, people who are in smoking cessation programs, to try and help them with their cravings. There’s a food craving study that showed benefits for food craving and we’re doing another one of those right now actually. So there’s some reason to believe it might help with some of those kind of impulsive urge kinds of things.

I’ve used it with clients with anger control and they’ve reported the results, but there are no studies that I’ve seen, so it may be helpful for anger control. But we don’t just do it alone; we always combine it with a lot of other techniques. It’s going to be hard to show that by itself it’s a beneficial technique.

Heart Math has all kinds of studies on stress, self-reported stress, and self-reported life satisfaction that always show benefits but it’s hard to know how much of that is placebo and how much of that is the actual technique. I think it helps people, but the studies are hard to do and it’s self-reported – you have to put in a sham control of some sort to make them think they’re getting something that they’re not – but it’s hard to do those.
(1:04:30)[DAMIEN BLENKINSOPP]: Right, that is hard. Have you seen anything with cortisol levels or something like that, hormonal?

[RICHARD GEVIRTZ]: There’s a little bit of data in burned out cortisol patients with long periods of rehab – they do better. But there again, we don’t just do that, we do it with integrated exercise, with activity management, with sleep management. Those are the things that all go together in these syndromes and I would never just do the biofeedback. But biofeedback is the part they like the best.

[DAMIEN BLENKINSOPP]: There are benefits to that if they’re actually interested in coming into the physician’s office.

[RICHARD GEVIRTZ]: Exactly. We say it’s the “Trojan horse technique” – it gets people in, they don’t resist it. That’s true for a lot of disorders. With veterans we get them in by saying we’re doing biofeedback before we do any psychotherapy with them.

(1:05:16)[DAMIEN BLENKINSOPP]: The part you brought up about resisting impulses, so impulse shopping; we can think about lots of things we do on impulse. Personally, for performance at work and with my businesses and everything, I find that extremely important. Basically, in the morning, if I do some meditation, perhaps do some Heart Math, I do feel more in control and I’m less likely to work on something that is a waste of time for a couple of hours, rather than exactly the right thing that was going to bring the best results. So I find it from a performance perspective to be very, very important.

There’s a big trend in meditation. I also have a device which I can use – I don’t know if you’ve seen this – the Muse. It’s an EEG, you place it on your head and it tells you how calm you are in terms of alpha waves and so on. I’ve used both and I’m not sure, sometimes I’m left wondering “Which one shall I use today?” or “Which one shall I do this morning?”. I’m not exactly sure which one would be the most beneficial, so I’m just wondering if you have any perspective on it, or if it’s worth doing both, or one on one day and one the other day?

[RICHARD GEVIRTZ]: If you hook then both up, I think you would see that your optimal alpha state will come very quickly when you’re in resonance frequency, which to me is much easier to do. But, and I’m interested in your feedback, do you think the feedback on the EEG is as beneficial to you as on the emWave?

[DAMIEN BLENKINSOPP]: I feel like it’s different, honestly. I’m actually using Inner Balance on that now. I used to use the emWave before. With that one, I tested meditating, so I’m doing mindfulness meditation, and I didn’t get good scores in the Heart Math device. However, I definitely used breathing when I’m using the alpha wave thing and it definitely does help. So, it’s interesting, and I’ve heard that from other people using this – if they use their standard meditation, they don’t tend to do well on the Heart Math.

[RICHARD GEVIRTZ]: No absolutely. It’s because you’re not breathing in the low ranges with that. What is your standard meditation, is it a mantra-based one?

[DAMIEN BLENKINSOPP]: I’ve tried different ones. I’ve tried the mantra, and just the breathing mindfulness. The worst I would say, mantra is worse.

[RICHARD GEVIRTZ]: We get nothing from mantra people, even with years and years of mantra work – it doesn’t tend to train their breath. We did transcendental meditation with 30 year meditators and we were looking at brain scans at the same time. They had dramatic effects on their brain scans. Their mantras really affect their [unclear 1:07:45] a lot. But, we saw no effect on their breathing whatsoever, which is sort of good for the scanner because if you change your breath, it changes the BOLD response in the FMRI, which is an artifact. So then suddenly you don’t know what the heck you’re measuring. But in breath meditators, it just seems to vary a lot, so some of them do breath in the resonance range so they absolutely get both going together.

The Muse will definitely teach you how to get into an alpha state, independent of breath. Those are two separate things, so it’s interesting that you say that. To me though, if I hook myself up to an EEG, it’s so much easier for me to get into alpha by just breathing slowly than it is by paying attention to the EEG feedback that I don’t bother with.

[DAMIEN BLENKINSOPP]: Right, because you’ve potentially learnt. I’d love to run them both, but I need two phones because they both interface with the iPhone and you can only run one app at a time, unfortunately. So I’ll have to get an additional phone. It will be interesting to see how that works out.
(1:08:47) The last thing is–we did touch on it just before the interview – there’s a lot of people talking about gratitude types of meditation and empathy and that kind of thing, and that having an impact. How do you feel that connects or it doesn’t connect?

[RICHARD GEVIRTZ]: I think it only mildly connects, but I think it’s an independent, important thing to do. In our clinical training, we start with the biofeedback and we end up with mindfulness-based techniques, that’s pretty much all we do. We don’t do cognitive behavioral therapy at all anymore – the kind we like is called “acceptance and commitment therapy,” ACT. It’s another one of many, and it has a strong compassionate meditation, strong mindfulness component. I think most of those have the same kind of strong component.

I think it’s important for your brain functioning to learn those things. It doesn’t seem to have much impact on the heart rate variability, as we were saying before. I don’t see a ton of impact on heart rate variability and that’s mainly because breath is such a dominant factor in what we’re saying on that screen. As we get more sophisticated, we might be able to tease out some non-linear components or something once your brain is in a mindful state – it should show up somewhere.

The thing right now is like you walk into a room full of people talking loudly and trying to hear someone across the room whisper. It’s hard to pick it out because it’s a small component in the overall picture of heart rate. But, certainly there’s a lot of evidence now from brain scanning type techniques and EEG techniques that people do benefit from repeating it. It’s a skill, it’s very important to know it’s a skill, and the more you practice those mindfulness, compassion and forgiveness type skills. The evidence is strong that for instance forgiveness produces beneficial health outcomes, no doubt about it, and so does compassion. Those are things that we know are beneficial in some ways but probably in somewhat independent channels.
(1:10:48)[DAMIEN BLENKINSOPP]: Great. What’s coming next? You mentioned a few things, so in the future, are there any things you are looking forward to in this area or directions you’re moving in to? You mentioned a couple of things over the period.

[RICHARD GEVIRTZ]: I have a slew of students so we’re all doing this kind of research, so we generally focus on maybe three things. One is just outcome data from heart rate variability biofeedback. We keep on doing studies and trying to see what it works for, and we’ve got a bunch on those going so we’re always looking at how does it work compared to other techniques and compared to other controls, and we tend to get very positive results out of that. I just published a literature review on that and we have quite a number of applications where it looks like it works. We don’t have much big funding so we have to do little small studies – big pharma is not too interested in this technique, as you might guess, as “skills and not pills” is our motto.

The second one is mechanisms, so we make reference to how does it work? What are the other mechanisms here? There’s a whole bunch of new stuff on that. Vaschillo, that Russian guy, is looking at rhythms in the very low frequency range and seeing what happens to the blood pressure systems when you breathe at like three per minute, and there’s some really interesting data coming out on that. We’re trying to understand both psychological and physiological mechanisms of why this works, how does it work – we’re going to do many more studies looking at how the brain is affected.

The third one is, I’ve sort of been dragged kicking and screaming into this by my students, but looking at yoga and trying to standardize yoga and see what are the mechanisms by which yoga works. The other mechanism that I think is important but we have not been able to pin down, is the postures. We know the pranayama component of yoga is very important–that’s what we study, and it’s real easy to study that–but when we look at the postures, the body was evolved for movement so there are massive afferent pathways from muscles back to the brain and we’re quite interested in what are those pathways and how does the movement complement the breathing. The thousands of years of looking at movement-breathing complementarity – there’s probably something to it, but it’s very hard to study that and it’s very hard to figure out how to study those afferent muscle pathways. There’s not a good way to study it non-invasively – so that’s an issue.

We’re doing yoga studies for IBS right now, seeing how much heart rate variability changes. These are students who are very proficient in yoga, they were instructors and they beat me up until I let them [unclear 1:13:27] on yoga. There are assorted other topics that come up.

There are a lot of parametric things we don’t know, like [check 01:13:36] Hubbard inhalation-exhalation ratio: is it important to breathe 40% in, 60% out? That’s what everyone thinks but now there’s one study that shows that no that’s not very important, 50/50 is okay. Another study showed that 40/60 is better, so we want to look at that. We want to look at lying down versus sitting up. So these are little studies we do, parametric studies, so the students can get a scientific poster out of it and we present it at a meeting, and if it comes out, then we try to publish it. These are things that really nobody is studying and we really need to know those things.

Tight-fitting clothing – it looks like women who wear very tight-fitting waists don’t breath diaphragmatically at all, and it looks like it has a detrimental effect on them.

[DAMIEN BLENKINSOPP]: These are useful things. You find the answers to these, you can improve a whole bunch of lives.

[RICHARD GEVIRTZ]: Right.

(1:14:27)[DAMIEN BLENKINSOPP]: Mass market kinds of lives. I came across you first in a presentation video. I’m just wondering, what are the best ways to learn more about you and your work? Are there presentations you have got up online? Are you on Twitter? Do you have a website? Where’s the best place to connect with you?

[RICHARD GEVIRTZ]: We have some YouTubes out there. I avoid Twitter like the plague. One of my students, Mark Stern, did a very nice YouTube explaining heart rate variability biofeedback – it’s fairly recent. If you just Google “Mark Stern HRV BSC” (Biofeedback Society of California), it’s the first one that pops up as it’s got a long address. He goes through and explains how the biofeedback works and some of the stuff we’ve been talking about.
HeartMath has a lot of stuff too, so a lot of their stuff is really good.
(1:14:27)[DAMIEN BLENKINSOPP]: Great, so I’ll put all of that in the show notes.

Is there anyone besides yourself – you’ve mentioned a few people already, but is there anyone else you would recommend that people look up to learn more as well?

[RICHARD GEVIRTZ]: There are websites – the one you saw probably was from Thought Technology, because they keep on doing things with me and putting them up there. My website – I have a hard time keeping it recent, but there’s a lot of stuff from the Association for Applied Psychophysiology and Biofeedback, AAPB. We’re just coming out with another magazine, a whole magazine and all the articles on HRV, and they tend to be lower level, not quite as scientific. And we publish things in regular journals all the time.

There’s a woman named Inna Khazan in Boston who published a book of combining biofeedback with mindfulness techniques. That’s a really nice book. I hope to review it for the publisher, and she did a very nice job on that book. She’s using our techniques pretty much, she’s taken our workshops, but she’s quite an accomplished mindfulness-based therapist and she put that altogether in a book that she has published.

[DAMIEN BLENKINSOPP]: That sounds great. Thank you for that. So just a little bit about you and how you approach data in your life. I’m just wondering if there are any biomarkers or anything you track in your life – could be HRV, could be other things – and use it to make decisions or just to keep track of where you are at personally?

[RICHARD GEVIRTZ]: Well, I do check HRV but it’s kind of discouraging since it goes down as I get older. I do it sometimes because it’s easy just to hook myself up. I do the breathing on my own, I don’t need the devices anymore to do it so I do the breathing myself. I have a heart rate monitor for my bicycling, which is a little bit useful actually. By now I know exactly which hills produce which heart rates, so I actually don’t bother with it a lot of times. I know exactly where my heart rate is from my bicycling.

I monitor my blood pressure regularly, just because it’s a risk with aging. But that’s all I do; I don’t monitor any other biomarkers. I suppose I could do over-training, but I don’t think I’m in danger of over-training. Possibly I do; sometimes on Saturday I ride with a group that pushes me too far. I probably would have lower heart rate variability on Sunday morning, but I know that because I feel crappy.

[DAMIEN BLENKINSOPP]: We’ve talked a lot about HRV on this show, as you’ve probably seen, and there are some situations where I find I’ll have a low HRV in the morning and I feel okay and it will hit me probably at lunch or a little bit later. So at four in the morning I was okay, and my HRV says “You’re not okay.” There are a few times like that it’s been a – how do you say – a forerunning signal for me.

[RICHARD GEVIRTZ]: Yeah because what it’s picking up is vagal withdrawal. One of the implications of this is what makes people have ill effects, unless they’re in war or something, is not sympathetic over activation as much as vagal withdrawal. So the minute you get up and you have a big busy day of stressful things in front of you, you don’t get a big surge of sympathetic activity usually, and maybe during a presentation you might, but what happens is your brake goes off, so your vagal brake is off. If it’s off for about 90 minutes, your body doesn’t like that so it will show up in whatever the most vulnerable body system you have is.

For the gut problems, it shows up in gut problems for those people, but if you have a trigger point, it will show up in trigger point pain. Or if you have performance issues, it will show up with not feeling sharp in your performance. So I think that’s what you’re picking up. Probably it would be a good idea if you wake up with it to do some biofeedback, try to get yourself back on track. Or break up the morning sometime with ten minutes of slow breathing, maybe combined with some alpha, and just to do that as a middle of the day break is really powerful. That will put you back in balance and then you’ve got another 90 minutes of messing it up again before it will start to affect you again. 90 minutes is a total guess but that’s what we say.

[DAMIEN BLENKINSOPP]: That’s great, thanks. There are some very useful tactics there to keep me performing.

Just the last question here, what would be your number one recommendation for people if they want to use data in some way in their life to improve their health, what would be the one way you would recommend doing that?

[RICHARD GEVIRTZ]: Well, the Inner Balance actually has a – it’s tricky but you can get heart rate variability data out of it. If you wanted to monitor your heart rate variability on a daily basis, this would probably be interesting to some people; it’s a lot of trouble. There’s a free software program that you can load it into called Kubios HRV. It’s a Finnish program – it’s free, you can download it on your PC. Then you can actually export Heart Math data or any of those device’s data to that–for resting level data – and it will give you, actually a very respectable heart rate variability profile with all the measures we talked about and many more.

If somebody was really into it, they could do that on a regular basis. It’s a little tricky how to get the Inner Balance to output that data. You have to write to Rollin McCraty and he’ll give you something to load that’s not meant for that, but you can do it. Or if it’s one of the other devices, it will do it easily. That might be something that would be worth keeping track of, although I think really, in the long run, just how you feel, you know what’s going on and if you know what’s going on and you just intervene properly, you’d probably be just as well off.

[DAMIEN BLENKINSOPP]: Yeah, self-awareness. Great. Well thank you so much for your time. I’ve found it really interesting. There were some things I wasn’t expecting–the yogis, a great story as background to how you got into this and the 1000 year old knowledge was an input into all of this. Thank you so much for your time, it’s been a lot of fun.