Latest / Beyond the Summit with Amir Golshani / Stress Isn't Fight or Flight: The Vagal Withdrawal Secret | Dr. Richard Gevirtz
Transcript
- Richard Gevirtz: a lot of vagal withdrawal takes your frontal lobe offline and you're kind of at the dominance of your limbic system. So that would be addiction, that would be impulsivity, that would be irritability, that would be a lot of negative things that go on. If you don't have the balance between our more recently evolved frontal lobe, an limbic system, you're at risk for so many other problems. Amir Golshani: Welcome back. Today's guest is someone whose work quietly shaped how top performers, clinician, and everyday people learn to regulate stress, focus, and from the inside out. Dr. Richard Gevertz, a distinguished professor of psychology and one of the pioneers in applied psychophysiology and heart rate variability biofeedback. For decades, his research has helped reach hard science with lived experience, showing how the nervous system, breath, emotion, and performance all connect. His work has influenced clinicians, athletes, and researchers worldwide. And personally, I first heard his name come up through Forrest Knotson, author of Mastering Meditation, who has spoken very highly of Dr. Gevert's depth and clarity around HRV resonance and self-regulation. Today, we'll go deep, but keep it practical. We'll talk about health as the foundation of freedom, HRV resonance explained simply and what actually helps people function better in real life. Dr. Geverts, it's an honor to have you on Beyond the Summit. Richard Gevirtz: My pleasure to be here. Amir Golshani: Fantastic. Before we get into techniques and science, I always like to start with the human side because that's where real insight actually begins. What originally drew you to psychology and more specifically to the nervous system and how humans regulate themselves? Richard Gevirtz: Well, I was always fascinated with mind-body issues. And then went to the University of Wisconsin. I was a psychology major. But I was lucky enough to be a student of one of the pioneers of the field of psychophysiology, Dr. Peter Lang, who is actually still with us and is an amazing role model. This was back in the late 60s. He was very inspiring. His course was called Blood, Sweat and Tears. And I was an undergraduate, but he let me into the course. And then I worked with him on some projects, actually measuring heart rate in the early days. And that kind of triggered my interest. After that, I went to grad school and studied something unrelated to that because that's where they gave me money. But then I eventually came back to psychophysiology and applied psychophysiology, which is always the thing that my main interest was. And in the early days, that was limited by the technology. So we had very limited technology to measure much of anything. We could measure skin conductance, finger temperature, and heart rate. but and to some degree, electromyographic muscle activity, which was somewhat limiting. But as I moved, as the technology progressed and I began more involved, got more involved in this field, we discovered our ability to measure beat by beat heart rate and to get a window into the parasympathetic nervous system, which we really never had before. In fact, in early attempts to measure the parasympathetic activity, I had those dental cotton swabs in people's mouths and we would see how much they would drool saliva and then we'd weigh them. It was a complete disaster. It never worked at all. So Amir Golshani: Right. Richard Gevirtz: with the advent of better technology, we were then able to get a picture into not only sympathetic activity, but parasympathetic activity, which had long been ignored. Amir Golshani: I love that. What I hear already is curiosity, not certainty, and that usually leads to the most meaningful work. Early on, what confused you most about stress, behavior, or emotional suffering? Richard Gevirtz: Yeah, good question. when I went back and got clinical credentials and started seeing patients with stress-related disorders, what puzzled me at this time was it didn't seem to be in dominant sympathetic fight-flight mode. Their stress seemed to be something more subtle than that for the most part. I mean, sometimes you would see a firefighter or a police officer And they, but they would not complain about that kind of stress. mean, they would going into a fight or that's what they kind of lived for, but they would complain about paperwork, getting along with their colleagues and bureaucracy. And those were seemed to be the stressors that were driving their symptoms. And around that time, I, an old friend of mine, Steve Porges, who I had known a bit for, but I got to know better. came out with this article on kind of switching over to the parasympathetic, to the vagus, as the source of most ordinary stress. And that, his work and his papers, dramatically changed everything. Because then I started realizing that for most people, stress is not sympathetic arousal so much as it is vagal withdrawal. that is their vagal break, the parasympathetic break on the autonomic nervous system is off too much of the time. And that will attack the most vulnerable system in the body as a result of that. Amir Golshani: Right. Richard Gevirtz: So that was the first breakthrough. And then together with Paul Lehrer, we started experimenting with this slow breathing technique with biofeedback. and immediately got pretty good results. Although we realized this was a brand new idea that was 2,500 years old. But we were inspired a bit by yogis and swamis that we knew. At the Menager Clinic, the Greens had gone to India with equipment and measured the physiology of some yogis and swamis. And then later people did Tibetan monks as well. And we learned a lot about what they were doing during breathing techniques. They used all different kinds of breathing techniques, but the one that really was interesting to us was slow diaphragmatic breathing at a very specific frequency. And that kind of led to this biofeedback technique that we're gonna be talking about. Amir Golshani: Yeah, I love that. So fascinating. A lot of people who are watching or listening are probably in the same space, doing everything right, yet still feeling off. Was there a moment when you realized that the standard psychological approaches were missing something important? Richard Gevirtz: Yes, well, because then I got trained in cognitive behavioral therapy and that was frustrating to me. It didn't seem to me that that was doing what I, all that I wanted to do was somewhat successful, but it was frustrating. And it seemed to ignore the body completely and the brain body relationship. So again, my background was in psychophysiology. then it just was a natural fit for me to say, let's combine these kinds of things. that immediately started getting very good results with those things. And so the frustrations with just talk therapies went away pretty quickly once we kind of incorporated these things together. Amir Golshani: So it sounds like that realization shifted how you listen to people. Richard Gevirtz: Yes, but also what Peter Lange pioneered was three elements of observing people, their behavior, their cognition, and their physiology. So what was new was I was actually watching their physiology while I was talking to them. And I could somewhat discern, I could certainly discern their behavior, but it was in the session. But I could somewhat discern their cognitions by asking them questions about their thoughts. But oftentimes those three don't go along with each other. And sometimes I would see something that was completely different in the physiology. And I think now that's much more recognized than it used to be. But that was kind of a revolutionary idea that Peter had, that we ought to pay equal attention to the body as we do to space. to self-report and to behavior. Amir Golshani: Right. Richard Gevirtz: And strict behavioralism really did nothing but behavior. You were only supposed to pay attention to behavior. was the only measurable thing. And so they lost their mind, but they finally got their mind back. And then we put the body back into that process too. Amir Golshani: So that being said, I'm curious to know how did your thinking change once you started measuring physiology instead of relying on what people reported? Richard Gevirtz: Yeah, well, so then it was happening at the same time using biofeedback. We weren't quite as far along with HRV biofeedback, but with other kinds of biofeedback. So I immediately realized that I would never just do talk therapy, but always include the body in the therapy with a lot of homework for people doing it. And this is an idea now that Steve Borges is really pushing as for years and years, and I think it's really catching out finally. that the body has to be in a certain state of what he calls neuroception, perception of safety in order to benefit from much of what goes on in talk therapy. And so you're limited in depending on the disorder. So suddenly we had this larger picture of what to do with folks. And of course that part of the, they love the biofeedback part more than they like the talk therapy oftentimes. since it was very dramatic and very objective. They could see their physiology right on the screen, right in front of them. Amir Golshani: That's a big shift from stories to signals. How did that change the way you personally understood health and resilience? Richard Gevirtz: a lot. So I started thinking about most, especially disorders of, medically unexplained disorders. That was our first focus. People who came in with physical symptoms, but no pathology. So this was immediately the model we started working on with things like chronic pain, fibromyalgia, especially gastrointestinal problems. So the early referrals, I was connected to medical settings, the early referrals were people with physical symptoms that had been cleared medically. And how to understand those? Well, psychologists sort of had this very vague model that somehow your brain was misinterpreting things or was having dysfunctional cognitions and that was creating symptoms. That didn't satisfy me. I wanted to know what the mechanism of that was. And then here was the mechanism right in front of me was the autonomic nervous system. And so once I saw that, it was a tremendous influence in understanding, especially those medically unexplained disorders. But then it moved into also anxiety and somewhat depression as well in terms of understanding those kinds of things. So that was a big shift and that's sort of been the shift in the field. In the meantime, the whole field of biofeedback was just coming into being and I was active in the beginnings of that. And we started, we created a certification program in biofeedback and the what was called the Biofeedback Society of America became the AAPB Association for Applied Psychophysiology and Biofeedback, which I'll put in a plug that's a great organization, has a wonderful meeting that is very, very friendly to participants. It's not like some of these big scientific meetings where you're lost. Everybody's very, very engaged and friendly. The next meeting is going to be in May in Baltimore, if anybody is interested in that. Amir Golshani: Fantastic. So I love that. Richard Gevirtz: Thank you. Amir Golshani: At this podcast, Beyond the Summit, we talk a lot about health as the base of everything else. Wealth, freedom, purpose. When you hear the word freedom, what does it mean through a psychologist lens? Richard Gevirtz: Well, psychology is probably different than my lens. My lens is having a fair amount of time in perception of safety. is freedom from the slings and arrows of vagal withdrawal and sympathetic activation. It's a funny way of thinking about freedom, but when you are in those other states, you don't really have a lot of freedom to be healthy, to feel healthy, to... to optimally operate. And so to me, it's sort of getting someone so that most of the time, or at least a lot of the time, they're in a state, in a healthy, autonomic state, which allows them to be in healthier psychological and physical state, also allows them to take better care of themselves physically. Amir Golshani: Right. Richard Gevirtz: So it's a positive cycle. Amir Golshani: So that definition feels very internal, not external. And I'd like to rephrase last part of my question through the lens of Dr. Goebbels rather than a lens of a psychologist. Yeah. Richard Gevirtz: Yeah, yeah, yeah, yeah. Yeah, Amir Golshani: So. Richard Gevirtz: I teach in a graduate program in clinical psychology, but I'm sort of an odd duck in that program because I have to fight for these Amir Golshani: right. Richard Gevirtz: ideas among my colleagues. Amir Golshani: Fantastic. Why do so many capable, intelligent people feel trapped even while life looks successful from the outside? Richard Gevirtz: Yeah, well, mean, life is hard. We kind of know that one of my heroes is Russell Harris, the happiness trap. So happiness is not normal in the human history, is his premise. And I think he has very good data for that. So basically, it's trying to overcome these problems that we have in life that have come from the evolution of this crazy brains that we have that were not evolved for the society we're living in. So if we were just in a survival mode, happiness is not a thought. Survival is all you're caring about if you're in primitive survival mode. But we're way beyond that. So now we have to find some way of dealing with that in the modern world. And that means taking some extra steps to try and deal with negative emotions in a way that's constructive. and basically trying to be resilient enough to get through the slings and arrows of outrageous fortune. And that's a little different than other kinds of things. Amir Golshani: And I believe stress seems to quietly shape so many of those choices. What happens to decision-making when the nervous system stays in a chronic stress state? Richard Gevirtz: Yeah, well, one thing is it kind of hacks your frontal lobe. So a lot of vagal withdrawal takes your frontal lobe offline and you're kind of at the dominance of your limbic system. So that would be addiction, that would be impulsivity, that would be irritability, that would be a lot of negative things that go on. If you don't have the balance between our more recently evolved frontal lobe, an limbic system, you're at risk for so many other problems. Addiction being the most obvious one. If you can't get happy any other way, except by substance abuse, people get into the trap of that kind of thing. It's very tempting to go that route if you're really kind of miserable. If you're more willing to deal with negative affect. And really this is kind of more of a Buddhist philosophy that really fits very nicely into what we do in acceptance and commitment therapy, which is what we use in our clinic, which is a more mindfulness-based cognitive behavioral therapy. But it emphasizes basically the nature of suffering and how you deal with suffering as in Eastern philosophies. And when you combine that with biofeedback, it's a very powerful way of helping people. Amir Golshani: So what you just mentioned reframes health as capacity, not comfort. So what do most people misunderstand about health when they think it's separate from freedom? Richard Gevirtz: Yeah, well they think it's feeling good instead of being good. So the pursuit of feeling good is the greatest danger to our species. And all you have to do is look at Hollywood stars, right? They get everything they want in life and they self-destruct at a very, very high rate. The only ones that don't are the ones that get out of that environment and try to... be someplace with real people all the time that don't treat them like gods. And so I think Truman Capote said, the worst thing that ever happened to a person is they get everything they want in life. That's where, Amir Golshani: I love that. Richard Gevirtz: yeah, we're not really built to be able to do that very well. And so I think that that's where things go wrong sometimes. And modern technology and modern and things sometimes give people the illusion that they never have to really feel bad about anything. But Amir Golshani: Right. Richard Gevirtz: they do. Amir Golshani: So Dr. Goebbels, now we hear this term everywhere, athletes, executives, apps, variables. In simple language, what is heart rate variability actually measuring? Richard Gevirtz: Okay, so the autonomic nervous system has two branches, the sympathetic, which is the fight-flight-fight, and the parasympathetic, which is a bunch of things, but the 10th cranial nerve, the most dominant part, is the vagus nerve, the 10th cranial nerve. So the vagus has a unique phenomena, which is that as you breathe in, there's a chronic breaking on your heart. from the brain stem. And when you breathe in, there's a reflex that takes that break off. And when you breathe off, that break goes back on. And that is completely mediated by the vagus nerve. If you cut the vagus nerve in an animal, there's no rhythm to their heart rates at all. They just get totally flat heart rates. So we know that this is a mechanism that allows us to kind of get a peek at how the parasympathetic system is actually operating by looking at how much does that heart rate change with each breath. And so we've developed a lot of sophisticated tools to measure that. And we were able to now, course, with modern technology that can all be done on your watch or on your phone. And we can now see basically there's some confusion about it. So we can see kind of how it works just during baseline conditions. So one of the problems I think with some of the devices around is they don't really get it that the measurement during slow breathing is completely different than during normal breathing. But during normal breathing, we have developed metrics that gives us a peek into how well the autonomic nervous system is working. How well is the sympathetic shutting down? Is the parasympathetic coming on? How does it deal with resilience in that case. And those metrics are have, you know, thousands and thousands of studies with norms on them that allow us to get a peek into that. So there's a fascination with that because as you get towards because optimal performance and most anything where you could care about is associated with really good autonomic homeostasis or balance. So we have a we now have technology that allows that to happen pretty well. People do get confused because they look at those metrics while they're the biofeedback or slow breathing and the metrics no longer apply there. That's a whole different way of looking at it during the slow breathing. So we Amir Golshani: Right. Richard Gevirtz: have to try, we're always battling, I guess, people's misconception about that. Amir Golshani: So that explanation alone already clears up a lot of confusion. Thank you for that. So why isn't heart rate by itself enough to tell us how resilient or regulated someone is? Richard Gevirtz: It's just not sensitive enough to those autonomic functions. Certainly when we have a big sympathetic surge, our heart rates go up. And when we're really, really stressed in a sympathetic situation, we can see something in heart rate. But generally, it's not sensitive to that. oftentimes the heart rate measurements don't tell us anything, whereas the heart rate variability measurements tell us a lot about what's going on. person. They may have a completely normal heart rate, but when we look at their HRV, that may be terrible. I just saw a client yesterday that had a 73 heart rate, but one of the measures we use is called RMSSD, Root Mean Square of Successive Differences. It was 18, is 50 is the norm. So the very stressed person with some trauma. And so it picked up on on a whole different part of their physiology that their heart rate really wasn't giving us at rest. Amir Golshani: Right. So is that fair to say HRV isn't about being calm all the time? Richard Gevirtz: Yes, it's about balance. the healthy HRV indicates that you are making the adjustments to what you need to make to, which means in emergencies, the break is off. When you need a sympathetic boost, you get a sympathetic boost. Fight flight is a very useful part of life without it, where we would be very dull. unmotivated. So what we're looking for not is a high or low levels of anything but an indicator of how resilient the system is in adjusting to what it really should be adjusting to. Amir Golshani: Right, in a tangible example, what happens when you have a watch or variables that measures HRV automatically and you have a very normal heart rate, but after consuming alcohol, heart rate is still normal, but you will get a warning that you're under tremendous stress or something. What happens to HRV when... Richard Gevirtz: If you're looking at the heart rate pattern, it would be going up and down, up and down with your breath. And what happens is it gets flat. So the vagus nerve just withdraws. We published one study with kids with gastrointestinal problems not due to any pathology. And we put a wearable, very sophisticated wearable on them for a day of school. And then we looked for periods of time when they weren't moving, they were just sitting around quietly in study hall, listening to lectures and measure this relationship between breathing and heart rate. And the kids with the GI problems had lower responsivity to breathing than the asymptomatic kids. And then we treated them with the biofeedback and we found that we restored their vagal. and the balance in their autonomic nervous system and a correlated .68 with are their symptoms reducing. So as soon as they adjusted their autonomic nervous, this was with no other therapy, all they did is learn through the biofeedback to get better resilience, get better recovery in their autonomic nervous system and their symptoms went away. So you can see it in that pattern, although it's, you can't see it by eye, you need software to do it for the most part. I wouldn't trust most of the wrist or ring watch techniques. They give you a rough estimate, but they're not really a great estimate. But there are devices that you can use that clip on your ear or your finger that aren't very expensive that can give you much better data than that. Or if you really want good data, you need an electrocardiogram. but that's not practical. know, Amir Golshani: Right, how about these chest bands? Richard Gevirtz: our chestbands are great. Yeah. So like the fuller chestbands, they're kind of expensive, but they're great. Yeah. Amir Golshani: Thank you for sharing that. So if someone wants to improve HRV, you know, and has got only five minutes a day, five, 10 minutes a day. So in a very, I know it's complicated. takes much longer than that, you know. So what are the basic steps they need to take in order to work on that? So. Richard Gevirtz: Well, one simple thing they can do is, even without any equipment, if they just make a guess at their slow breathing resonance frequency rate, without equipment you won't know exactly. But if you just make a guess at about five and a half or six breaths a minute, breathing diaphragmatically, and do that 10 minutes a day, five minutes is not quite enough. Most people say 20 minutes a day, we found that we can get away with 10 minutes a day. And that actually most people will, are willing to do 10 minutes a day, even if not, even though 20 is a, I if you think about it on your lunch break, taking 20 minutes out of your lunch break is a big deal. 10 minutes isn't such a big deal. So we say, um, 10 minutes a day of, uh, effortless, slow diaphragmatic breathing. That would be for someone like my, my resident frequency is six. So I breathe in four seconds in to my belly. and through my nose. and six seconds out through my mouth Amir Golshani: Right. Richard Gevirtz: with pursed lips. It's good to use pursed lips because it keeps you from hyperventilating. Some people just can breathe just through their nose and that's fine too, but if you're having any problems with the breathing, breathing through your pursed lips really helps the technique a little bit. And what we found is that people Like just with ordinary students, they get about a 25 to 30 % gain in their resting level HRV over about five weeks of training. Amir Golshani: Lover. Richard Gevirtz: And my colleague Mara Mathur at University of Southern California did a big study with MRIs on 61 people in a control group that got something they thought was really, but it wasn't really the right breathing and biofeedback. And the other group did, and she showed massive differences in brain networks over five weeks of training and reduction in amyloid plaque and tau tangles in both Amir Golshani: Wow. Richard Gevirtz: middle-aged and older people. So that is the amazing work that she did. was a thrill that she took up. We were trying to get her to do this for years. She got a big grant to do it. And so amazing work that came out of that. So it's a very powerful technique if you can do it regularly, do it correctly, and do it 10 minutes a day. More is better, but 10 minutes a day, if you do that on a regular basis should give you some concrete benefits. We have many published studies and other labs have studies showing, so we look at the benefits, we look at the baseline levels for the benefits, not during the breathing. But the breathing does get better as well. You see some different things in the breathing over time. The Amir Golshani: Right. Richard Gevirtz: way people, the way the heart rate pattern goes during the breathing, it's a whole different technique. But if you just look at their baseline levels, just sitting quietly for five minutes, watching TV or reading, 25, 30 percent. And in some populations, way bigger. We just did a study with mild traumatic brain injury and we had like 40 and 50 percent increases over five weeks and no changes in the control groups at all. So it's a very, mean, so it is changing the nature of your autonomic nervous system over the course with daily practice over the course of five weeks. It doesn't happen without daily practice. Amir Golshani: Right. Is it Richard Gevirtz: Thank Amir Golshani: possible to become kind of normal, automatic, let's say, so after a period of training that you get kind of adaptation to this rhythm and then automatically you're breathing in that rhythm that you mentioned, maybe four seconds, six seconds, and then maybe less than seven, six. breathing cycles in a minute. Does it happen over time automatically or just there are other techniques for that? Richard Gevirtz: Yeah. What happens automatically is people learn to use the technique when they need it automatically. So for instance, I had an MRI for something I needed and I didn't think anything was going to be stressful. They put you in this thing and this thing is pounding right in your head. And I realized, wow, I'm not claustrophobic, but this is kind of stressful. So I just immediately went into my six per minute breathing. my knee-jerk reaction to deal with it. And I almost fell asleep then. It was great. was completely took away my stress. So people do get really, we call that rescue breathing. So people get really good at that and they can do that very quickly. And in the clinic or in the lab, we actually measure how quickly they can do that and encourage them to do that when they need to. And that's really a big part of the technique, I think, that people learn. But you really shouldn't be breathing at that pace in normal life. We were devolved to breathe at six per minute all day long. That's just an unusual thing to do. And it just so happens that it tweaks the right reflexes in the body to do something that would, again, was discovered 2,500 years ago. So it's not like we discovered that. But I wouldn't say the goal is for you to breathe that way all the time. only when you really need it. Amir Golshani: This is very helpful. Thank you. And you mentioned number six for you. How do people get to that number for different individuals? How they measure that? Richard Gevirtz: Well, you do need equipment to do that. So then you have to be hooked up. However, if you have a polar strap or there's a very inexpensive device called a keto sensor, KYTO, and there are a number of free apps that you can get on your smartphone. Elite HRV is one that we use a lot. Amir Golshani: Right. Richard Gevirtz: Very, very good guys who decided that. Then you can use the, they kind of instruct you in the technique to discover what we call your resonance frequency. And that's a frequency that is, optimizes the relationship between your blood pressure reflexes and your breathing. And it's unique for every person. It's pretty stable over time. Once it's really established, it's pretty much not going to change. And you can discover that with equipment. If you don't have equipment and you just make a guess over many months or years, you probably will tweak that to where it should be because your body kind of feels it when you're doing it right. I don't really need equipment to to mine to do that. I can go right into that frequency. I've done it so much. Amir Golshani: Right. Richard Gevirtz: But at first, no, you need it's kind of helpful to have and really for people to see it, to see objectively how this works. is very powerful. So even though you could say, well, why not just breathe slowly? Yes. But when you really see physiologically, what it does is really, really has a great influence. Amir Golshani: It is interesting before this interview, I have a Garmin chest strap and Richard Gevirtz: Uh-huh. Amir Golshani: a Garmin watch, you know, so, the watch alone doesn't work. There is an app it's called HRV stress. And Richard Gevirtz: and Amir Golshani: I measured that for myself before this interview. And there was a scale of one to 100. For me, after three minutes of slow breathing, you know, so it showed one very low stress. So, and I thought I was in that. Richard Gevirtz: Yeah, I wouldn't put too much faith in that. I would do, however, the technology is perfect, is I would measure yourself just on ordinary circumstances when you're reading the paper or watching TV or without any meditation, without any breathing and get the number they're going to give you from that is probably a reasonable number. I don't know what, who knows what number they're giving you on these things. You have to kind of find out. But if you If you use one of the, if you use a lead HRV, they'll give you a number called RMSSD, which is the best general number. And then practice for five weeks, slow breathing, and then do it again. And that's when you'll see the gains. During the slow breathing, those numbers don't mean too much. It doesn't really mean your stress is down. It just means you're, cause you're manipulating your heart rate patterns with your breathing dramatically. doesn't necessarily mean, a little bit means that, but it doesn't really mean that you're getting a good index. However, the other thing you can do is to go even further than that is get a baseline and then try to stress yourself. Take a look at your taxes or something. For a few minutes and then Try to just calm down quietly without slow breathing just to see how quickly you recover. That's pretty meaningful because that gets better with more practice. And if in fact you find that your numbers before and after are almost the same, then your practicing really did a good job or your autonomic nervous system is doing a good job of recovering from what it's supposed to do, which is take the break off when you're worried about money and put it back on when you're not worried about Amir Golshani: I love that. So that being said, what does higher versus lower HRV usually reflect in everyday life? Richard Gevirtz: It just means, well, it's correlated with thousands of things, higher with positive, lower with negative. It's not very specific. So almost anything negative will lower heart rate variability. A mild traumatic brain injury, anxiety, stress, depression, gastrointestinal problems, just chronic stress, burnout. People in general have lower HRV within those conditions. People who are in healthy conditions have high HRV. Every Tibetan monk, every Swami we ever measure in have very high, usually very fit, healthy athletes have very high HRV. Amir Golshani: I like what there is a range for that. Richard Gevirtz: Yeah, the arm SST is an average of around 40 to 50 is the kind of average number. And you'll see in the hundreds sometimes with people. When we were looking at astronauts at one point or really elite athletes, they have very high levels usually if they're, but if they're stressing, they won't have those. know, so it gives you a little bit of an idea in terms of how resilient your autonomic nervous system is. It's not very specific. It's not going to tell you that you have this problem or that. Amir Golshani: Got you. So as we are talking about breathing a lot, breathing keeps coming up in this conversation. Why does HRV response so strongly to breathing patterns? Richard Gevirtz: Yeah, it does actually respond to anything at the resonance frequency, but not very strongly. So for instance, if you just do any kind of stimulus from every 10 seconds for me, if I just had something that did something every 10 seconds, I would get a little change in my HRV from that, but it's pretty small. Breathing, however, has a very powerful effect because of that vagal withdrawal during inhalation. So what's happening is that you're lining up your blood pressure rhythms and your breathing rhythms for this 10 minutes a day in a very unique relationship, like pushing a kid in a swing in both directions. So what happens when you're doing that is your heart rate goes way up in the inhalation and way down in the exhalation, way up in the inhalation, way down in the exhalation. Our colleague who really helped us understand this is a Russian named Evgeny Vashilo, who sadly just passed away recently. But Paul and I, Paul met him in Russia, we came to the US and worked and we picked his brain endlessly. He was a brilliant, brilliant guy. Well, he got this insight by watching the cosmonauts in the early days of the space race. And one of the cosmonauts that so happened was a breathing meditator, and nobody knew that. And every day, again, he was watching his heart rate to be kind of normal. And then for 20 minutes a day, would be, whoa, whoa, whoa. And they thought, my God, this is, he's having a heart attack. This is space sickness. And says, Yuri, Yuri, what's going on? He says, shut up, I'm meditating. Amir Golshani: Wow. Richard Gevirtz: So he was a very experienced breath meditator. it's very, when you look at the heart rate patterns during that slow breathing, they're very dramatic. Big. So when you inhale your heart rate, let's say your heart rate is low, mine was fairly low. it's 60, it might go to 85, back down to 60, to 85 beats a minute, back down to 60, in line with your breathing. And that's the power of that particular stimulus. to trigger the reflexes and make them stronger in your body and your brain. By far the strongest is through breathing. However, almost anything will do that if it's at the resonance frequency. So Paul Lerard did a study with pilots in a simulator where they had them every 10 seconds, they had them go up, go down, this way, that way, everything. And if you watch the pattern in their heart rate, it does produce a little bump at the resonance frequency, but tiny compared to breathing. Amir Golshani: I'm so fascinated by your explanation. I love it. So why doesn't slow breathing work the same way for everyone? Richard Gevirtz: Well, if they get the right frequency, works for pretty most people. I mean, for the people that doesn't, we don't really know for people it doesn't work for, we don't know. Sometimes there's an overlay of some major pathology of some kind. And of course, if they're not physically healthy, it might be difficult to breathe that slow. People with COPD have a very difficult time doing that slow breathing, although they do seem to benefit from it, but still. So Generally, we don't find too many people that can't do it. Most people seem to benefit if they practice. Amir Golshani: So this brings us to a word that sounds technical but is actually very much human. Resonance. We talked about HRV. What is HRV resonance? Explained in a way that anyone can understand. Richard Gevirtz: Well, so resonance occurs in any kind of a system that has frequency characteristics to it, right? So I'm going to show you a demonstration if I can here. So in a pendulum, let's call this a pendulum. if it's triggered it has a specific frequency. I can change that frequency by making a longer one, right, that's much slower, much faster. So that's a characteristic of the system itself. It's a physical characteristic of the system. So anything that triggers, if I want to do this, I have to do it in kind. I have to do my pushing the right way, right? I can't just do it. So I have to really, so what happens with the biofeedback, with the HRV biofeedback is we find the exact right push in both directions from blood pressure and breathing that gets those big oscillations. Similar to those oscillations are heart rate oscillations. And it so happens that we actually aren't sure exactly where all the benefits come from, but Those signals are dramatically signaling to the nucleus tractus solitarius in the brainstem. It's very sensitive to those rhythms going back up. 80 % of vagal fibers are afferent. They go from the body to the brain, not efferent. So there's something about those patterns that have a really powerful effect on the reflexes for blood pressure. And then now we know they have a big effect on brain function too. by going up into the brain and those very unique patterns of resonance. So we call that resonance frequency because of that notion that we're looking at two oscillating systems and during the biofeedback you bring them into the right relationship, like pushing your kid on a swing in both directions. And that combination produces these big swings in heart rate, which seem to be beneficial in so many different ways to be. Amir Golshani: Right. That idea of alignment feels important. How did you first discover that each person has an individual resonance frequency? Richard Gevirtz: Well, Paul and I kind of thought that, but Evgeny and Rush actually did a systematic study within the Academy of Sports Sciences in Moscow. So he was mostly dealing with cosmonauts and athletes, and we weren't sure that would apply, but it does. And so he was testing them all separately. So what you do is you put a pacer on and you started at say seven and a half. cycles per minute and then you do it at seven then you do it at six and a half then you do it at five and a half then you do it at six five and a half and you look at the patterns of the waves of the heart rate and one of those frequencies will produce the maximum frequencies so again he he published that in 1988 or something but it was in russia and nobody no one knew about it but when he came here we Paul and I got it out in the public and he published with Paul a whole bunch of studies that are very famous studies now. And it was very clear-cut science. You could just see, he was an engineer as well, he could see the transfer functions to show that it worked like a mechanical system. He was able to show that if you do these functions, it was like measuring a radio frequency or a pendulum frequency. It was actually very, very powerful science to see. And among the athletes, they ranged from four and a half breaths a minute to six and a half, I think. And whatever the pace was for that person was mostly dependent on just their physical height more than anything else. But that that seemed to be the same pace forever. Once once they once you figured it out, it was a characteristic of their body. And so then from then we developed the biofeedback saying, so people need to train at that specific frequency to get the maximum benefit. Amir Golshani: This explains Why copying techniques online often fails. Richard Gevirtz: Yeah, especially Amir Golshani: Yeah. Richard Gevirtz: if there's a strong physiological component to it. You know, to take something like panic disorder. You know, the cognitive psychologists say, well, this is just a misinterpretation of normal physiology. No, it's not. Physiology is not normal in panic patients. Their cardiorespiratory signals are way different than normals. And there's a lot of literature, but it's not well-known in those fields. And so, Dealing with somebody saying, just stop panicking about your heart rate speeding up is ridiculous. They need to really learn to change their physiology. And when they do, it's tremendously powerful. There's a researcher in Texas, Alicia Murray, who's done very nice studies, just having breathing frequencies and entitled CO2 changes in panic patients. And gets like 70 % of people panic free in six months. with three year follow ups, way better than any other cognitive behavioral therapy. But it's slow to catch on. are, I think we're getting there because people like Bessel van der Koke and C. porgis are getting popular and they're, you know, they're saying we need to put the body back into this. This isn't just a psychological. Amir Golshani: What goes wrong when people try to mimic someone else's breathing or meditation practice? Richard Gevirtz: Well, they may not be at the right frequency. So they have to, and they may be forcing it too. So we really emphasize, we never say deep breathing. We always say slow breathing. We always say effortless breathing. You have to kind of learn and you have to get your diaphragm in. It's really important to get the diaphragm working. In our clinic, we see tons of kids from our children's hospital. And there's a whole group of them that have something called rumination syndrome, where they throw up their food in their mouth immediately after they eat. And it's really just purely that they have a very dysfunctional diaphragmatic reflex. And we teach them how to breathe diaphragmatically and I get better very quickly. So we really want to emphasize that for most people, should try to do slow, effortless breathing into their diaphragm and try not to push it. For some people we find that when you actually give them a pace or they don't do as well. So for those folks, we just show them the signal on the screen and say, do whatever you need to do to make this go together. You're breathing and your heart rate. And then they just beautifully do that. They get to the right pace on their own. That's really true biofeedback instead of pace breathing. Amir Golshani: So it's not about forcing relaxation. Richard Gevirtz: Right, yeah, it has to feel safe and effortless and you have to get used to doing it that way. So for some people we have to start them at a much higher frequency till they're comfortable and then we move them, then we eventually move them to the resonance frequency. Some people just hyperventilate at the resonance frequency, but we almost always can get them into the right frequency. Amir Golshani: Right. What is the most important thing that people should actually be paying attention when they're training resonance? Richard Gevirtz: Well, things I've said, think to make sure they're using a diaphragm, make sure that it's feeling safe and comfortable and effortless. Don't push yourself too hard and use whatever stimulus works for you. We have a website at our clinic that's free for people. So if they just Google, Govertz Wix site, W-I-X-S-I-T-E, there's a option for music, pacing music there, free for anybody to use. And they can just start with one that's too fast and just see how it feels. And then maybe you'll eventually kind of settle on one that feels good to you. Without equipment, you might not get it exactly right, but if you're in the ballpark, it's going to definitely help. then that's the most important thing is find something that you can do that's comfortable, that you can manage on a regular basis. Because without practice, it doesn't work. This is not a one-time technique. During the pandemic, were having, they closed our clinic, so we had to do everything virtually. And the kids were sending us their patterns of breathing and they were claiming they were using a pacer at seven breaths a minute. We could see they were breathing at 12 breaths a minute. They were watching TV or something. And those are the kids that didn't get better. So the challenge is, to really be disciplined and do it on a regular basis. Once you get your right technique down, it gets more and more pleasant over time to do it. Amir Golshani: The sweetest part is 10 minutes at least. Richard Gevirtz: Yeah, yeah, well that's what we don't really know. No, I haven't been able to convince a grad student to base their whole dissertation on this. It's not a very sexy topic. But just in our clinical experience, when we asked for 20 minutes, we saw a lot of people not practicing. When we said at least 10, we saw many more people doing it. And those people seem to all benefit when they do it pretty regularly. They seem to benefit. So we Amir Golshani: Fair enough. Richard Gevirtz: have a kind of a pretty good idea that that's true. Amir Golshani: Right, so this is where biofeedback becomes really powerful. What does HRV biofeedback add? That meditation or relaxation alone often doesn't. Richard Gevirtz: Well, other kinds of meditation that are not breath meditations do have, apparently have some benefits in terms of MRI measures, like mantra meditations. They have their purpose, but they're much more ethereal and spiritual and not very much in terms of the basic health stuff. mean, certainly I wouldn't say anything negative about them. Anybody who wants to do it. But if you really want to affect your autonomic nervous system, you have to do breath meditation, what I would say. And you can do it through yoga. You can do it through Tai Chi if you want to. You can do it. know, those things are great. But if you don't get close to those right frequencies, we don't see the changes in the HRV. Like for instance, we looked at mindful meditators and you know, in mindful meditation, you're not supposed to pace it. You're supposed to just be mindfully aware of your breath. So we went in and kind of just counted their breath during mindful meditation. And the beginners were breathing 10, 11 breaths a minute. The really experienced meditators are breathing more closer to six. And we measured their heart rate variability. Sure enough, it was much better in the people. Of course, they were more experienced too, but also in the slower breath. I have a student now who is gonna do a study on that actually. So it is... It is pretty important to get down into those slower breath rates, not terms of all benefits, because there may be some very strong psychological or spiritual benefits from other kinds of meditation. I'm not saying anything negative about those at all. But in terms of, I think we're pretty clear that in terms of autonomic function, the breath meditation is really much more powerful. Amir Golshani: Right. So why does real time feedback accelerate self regulation so much? Richard Gevirtz: I think it's just because it's so objective, you can really see your body in action. We also measure more things. We measure your finger temperature and your palms sweating and your respiration. So on a typical screen, that person is seeing a whole bunch of their physiology. And let's say they've learned to do this breathing properly. I had this with like yesterday. This is a kid that had some terrible trauma. And so we then I were doing some exposure. So I'm saying, okay, now think about the name of the guy who was stalking you. And you know, her physiology goes crazy. Her skin, her palms get sweaty, her hands get cold, her heart rate variability goes away. She breathes irregularly. And then I say, okay, now, here we go. Let's see how quickly you can recover. And then she's looking at the pacer. In her case, actually, she likes music. So she, I put on the music, she closed her eyes with the music and took five breaths for everything to get normal. And then suddenly her hands start getting warm and dry. So she basically turned on and turned off her sympathetic nervous system very quickly with this technique. And being able to see that is so much more powerful than just someone telling you that. Right. So. So I think there's real advantages Amir Golshani: So amazing. Richard Gevirtz: of that. Amir Golshani: I love it. It's so fascinating. So with popularity comes misuse. What are the most common mistakes you see when people start HRV training? Richard Gevirtz: The most common one I mentioned before, they think the numbers mean something during slow breathing and they don't. So even if they're using a polar strap or a PPG technique, I don't know. The rings and the bracelets and the watches, they won't give us the raw data for us to evaluate that. So they're all very secretive about it. So I don't know really what they're measuring, but I'm suspicious that they're not. capturing the data properly. But when we get proper data capture and we put it into a good software program, we can see, but then people get confused. They think the numbers mean something when I'm doing like you did actually when you did your relaxation. Those numbers, I mean, they're not completely irrelevant, but they're not really the right numbers to look at during the slow breathing. And that is the, that's by far the most common mistake. People don't get that there's two sets of conditions you need to do baseline, normal breathing. That's where the real measurements come in. And then there's a different kind of measurement during, if you're using one of the techniques, there is a measurement during slow breathing that really helps. It's called low frequency peak, where it actually does Amir Golshani: Okay. Richard Gevirtz: a spectral analysis, shows you the peak around 0.1 Hertz. And that's a good Amir Golshani: Is there Richard Gevirtz: indicator of good practice when you get that. Amir Golshani: Gotcha. So is there any accurate at the same time affordable kind of equipment that people can use for measurement? Richard Gevirtz: Yeah, so the most affordable, the Keto sensor is about $30. That's by far the most affordable. The Garmin or the Polar straps are great. They tend to be a hundred and some dollars, right? I don't know what you paid for your Garmin strap. It's $130 maybe or something. There Amir Golshani: Yeah. Richard Gevirtz: is a free software program for anybody. It's pretty sophisticated, but it's called Cubios HRV. KUB iOS HRV and they have a expensive version but they have a free version. It's a finished program and they make it available to anybody who wants it on the free version called Scientific Light. And that will give you all the measurements that anybody ever could want about what's going on. if you get, it's a little more complicated and sophisticated but for somebody who is really interested in it. you can download the data from your phone. So you take your polar strap, you get it to your phone, you download that data into the software program, and then you can get the same kind of data that the most advanced scientists in the world get basically. Amir Golshani: Wow, I love that. Thank you for sharing that. So on the flip side, we talked about some mistakes or the common mistakes that people have. What signs tell you someone is training in a healthy, sustainable way? Richard Gevirtz: Yeah, well, that's what I was saying. What we try to do is get them to send us the data when they're practicing. And then I put it into the software program. what we've noticed is that there's a very specific, this gets a little technical, but there's a very specific peak that they're breathing during the slow breathing, around 0.1 hertz. And the height of that peak is an index of how well they're doing in the practice. And there's a, we have one study that was using that with people who were depressed. And we looked at their peaks over time and their peaks going up over time during the slow breathing were pretty good predictor of their depression going down. So it's a bit tricky, but that would be if you wanted a technical indicator of how well you're doing. But for most people, their symptoms go away and they feel good. They're less stressed, they sleep better, so they don't really need anything more to convince them. It's a pretty powerful technique for a whole variety of disorders. Amir Golshani: All right. So let's talk about high performers for a moment. Why do athletes, executives, and traders often struggle the most with regulation? Richard Gevirtz: Well, they're very high stress situations, right? And so the ones who are, who can stay balanced during the high stress are the ones who perform better. So there's a whole literature then using this technique with, generally it's with situations where you have some situation where you can control ahead of time, like golfing, baseball batting, gymnastics. or in musical performance, dance performance. There are some in executive settings too, in terms of decision-making. And people who have good heart rate variability are better able to manage those situations, those high stress situations. So I've worked with a whole bunch of professional golfers and think about what they're going through. If it's a really a high level pro, They've got a 12 foot putt that will cost them $300,000 if they don't make it. That's not unusual for it at the higher level. And it could even be millions for the very highest level for that putt. Well, I mean, that's the kind of stress that is really tricky. So those guys really all have psychologists and they have a lot of them use these techniques, try and get themselves a little bit more into a balanced mode before they actually perform in that setting. I've had great success with kids in rhythmic gymnastics. So this is kind of living sport where you know with the ball and the hoop and the ribbon. And so these are typically cute little girls who, and what essentially it's tumbling to music with these apparatus. You throw a ball in the air, do a bunch of flips, catching the back of your neck. Well, the Amir Golshani: Right. Richard Gevirtz: coaches tend to be Russian or Bulgarian. Russian, they're very high stress. Yeah, Amir Golshani: Really good at it. Richard Gevirtz: but they went, you know, they got there because someone was tough on them and they're going to be tough too. These kids get stressed. So I just taught them, they would put their music on and I just taught them to get into resonance frequency right before they went on. And we had great improvements in performance. One of the kids made it into the top 10 nationally, just by changing that particular way in which he did it. Because think about the All it takes is a little bit of stress to mess you up when you're doing three flips and catching the ball in the back of your neck and then throwing it up way high and doing something else. It doesn't Amir Golshani: Absolutely. Richard Gevirtz: take much to mess up. So it's kind of fun. It's kind of fun to work with people in those settings. And that's catching Amir Golshani: Yes, as you mentioned, pressure. Richard Gevirtz: on. The other application that's a little more, we don't know as much about it, but it looks like it's a pretty good way of... monitoring fatigue. So when Leo Messi was at Barca, the strength and conditioning coach took their HRV five minutes every morning. And then they would plot that every day. And what they would see is that when they were after a really tough game or after really tough practice, the heart rate variability would dip a little bit. And it was just like a fatigue phenomena. And so then they would tell the coach, you know, he needs some recovery time and coaches sometimes did it, sometimes not. Soccer coaches are their own people. don't necessarily listen to the other coaches. But in general, and there is a whole bunch of people online that kind of do this. Like for instance, if you run a competitive marathon, which is a crazy thing to do, it's a distance that why we like, you know, some Greek ran 26.2 miles and died. So why we do this, I don't know. But Amir Golshani: You Richard Gevirtz: anyway, it's a really tough thing on your body. takes three weeks for your heart rate variability to recover from. competitive marathon. It'll be your heart rate variability down. I mean, these are very healthy guys, right, or women. And it takes that long for it to kind of just come back up. That's why they have the Olympic trials for the marathon, like six or eight weeks before the event. They need that much time to recover. Amir Golshani: I love it. So one of the things that I have seen a lot that people want to know how this HRV biofeedback helps sleeping disorders, Richard Gevirtz: Yeah, there's some literature on it. It's not, it's not universal. So for some people it's fantastic. And I've had clients that just say they've mastered this technique and that was the end of their sleep problems. I've also had some that said, well, I get to sleep, but then I wake up in the middle of the night and my mind racing and the breathing doesn't work. And so for those folks, I try to combine the breathing with some other mental phenomena like a podcast or some music, if music works, or very repetitive, something to repeat. And then usually that combination is pretty powerful of doing it. Unfortunately, by itself, it's been, I'd say results are a bit disappointing compared to some of the other things that we do with it. But for those that it works for, it's fantastic. I mean, I can... I have testimonials from people and said, my God, this was the greatest thing. And then the next guy comes in and said, no, it didn't work. Amir Golshani: I see. So pressure moments reveal a lot. Physiologically, what happens right before a high-stake decision. Richard Gevirtz: Your vagal brake goes off. And if it's a really high stake, your accelerator, your sympathetic goes on. So you go into a full fight flight state. That's our evolutionary heritage for that. Now, you know, we got that way Mike, because there was a saber tooth tiger outside the cave where it was very functional to either run or fight. Now it's like a boss or a wife or a kid or, you know, who knows what it's causing them. Generally though, the more common is not the full fight-flight response, but just the vagal withdrawal. So if you're watching those heart rate waves, when people go into vagal withdrawal, those waves get flatter and higher. And that means that their sense of safety is gone, there's threat physiology, but it's at a pretty low level unless they are in a full flight, full... real danger situation. So, you know, somebody walks into an auditorium with a machine gun, there's no vagal tone at all. Everybody goes into full-fledged fight-flight. You know, everything, every part of your body is in a full survival mode. But that isn't the most common in modern life. So in modern life, stressors are these more subtle ones. And if you understand that, And don't let that vagal withdrawal go on too long. You can maintain much better health. That's kind of our bottom line that we kind of understood that. Amir Golshani: Let's talk about emotions. Why can't we simply think our way out of stress or dysregulation? Richard Gevirtz: I think that from an evolutionary point of view, humans are very bad at changing automatic thoughts and feelings and beliefs. There was no reason for us to be able to think our way out of it in ancient times. And even though we've evolved in a whole bunch of different ways, we're terrible. Humans are terrible at that. There's a famous white bear phenomena that famous psychologists did where he told people, don't think about a white bear. And people are completely unable to not think about it. They have to, you know, want to do it. Or if you say, okay, I want you to picture cutting a lemon, a juicy lemon with a knife. Everybody salivates when they think that. You can't stop it. So this is the basis of these more modern mindfulness based therapies. They recognize that we don't really have any control over those things, but how we cope with them is what matters. Amir Golshani: Right. Richard Gevirtz: not the emotions themselves, they're normal. And they may be quite unpleasant and that's bad, that's too bad. But if you don't struggle with them and you learn how to cope with them, then you can move on nicely. Amir Golshani: That reframes emotional intelligence. How does unresolved emotions show up physiologically? Richard Gevirtz: Vagal withdrawal. It's a real clear cut pattern. So if we're lucky enough to have equipment on people, you where they can monitor them all day long, we can see people with problems that are just going, they're ruminating, they're worrying, they're fretting all the time. And whenever they do that, their heart rate gets flatter and higher. So they are staying out of, and our bodies are really evolved to be in parasympathetic dominant state most of the time. We can certainly do long periods of time without it, but we really are supposed to be in those states most of the time. We weren't really evolved to be in them. So the worst cases are people in combat. they are, the poor military folks coming back from Afghanistan where they were never safe. You know, there are home camps that were being bombarded. They were in a constant threat state. They came back with cardiovascular systems of 60 year olds. I mean, those that really, your body is really not meant for long periods like that. For most of us, it's more subtle. Once that safety of the vagus is gone, our most vulnerable systems may show up. Like you might get stomach problems or headaches or just be stressed or insomnia. And so it's not as dramatic, but. Those are typically what I think are going on. That's the model we're using anyway. And then the talk therapy that goes along with that is kind of an Eastern based, like life is full of suffering. You can't do anything about that. What you can do is learn how to cope with it better. And I think that works really well with the biofeedback. Amir Golshani: Some people resist the slowing down. Why do people push against regulation even when it helps them? Richard Gevirtz: I guess just some wiring in their brain. don't know. There are people that just are wired to keep them run, run, run, run. That's their comfort level. It may not be a for them. It may be a problem for people around them, but they may not be a problem for them if that's their normal physiological state. But I don't think we really know. I don't think we really know what to make of those people unless it's at a very pathological level. Amir Golshani: love it. This feels like a maturity question. What does learning to regulate teach us about self awareness and growth? Richard Gevirtz: I don't think we really know, but anecdotally it seems like people do increase their self-awareness and are more willing to, in our case we're combining it with those other talk therapies, there's a lot of growth that comes from acceptance and commitment. Meaning that you accept the fact that you have no control over these thoughts, feelings, and beliefs, but you make a commitment to valued behaviors. And that's where you get growth from. So you get better relationships, you get better health behaviors, you get better work performance, because you're not self-sabotaging yourself based on these automatic thoughts and feelings. considering, you know, the myth is, there's a great book called The Happiness Trap by Russ Harris. And the myth is that everybody's happy but me. Everyone thinks they're happy. But it's a myth. When you look at the data, People are generally not happy. The ones who are happiest are the ones who kind of define happiness by eugenics, meaningful relationships and meaningful life, doing something that's meaningful, not by feeling good. So feeling good is kind of our enemy in this one. And I think the breathing is helpful for that. It helps you get into a more mindful state, helps you... with the acceptance process. We found that to be a very useful combination with our clients. But I think for everybody, the benefits of mindfulness are definite. There's definitely the benefits for mindfulness. And this is just another way of kind of getting you into a mindfulness, especially for people who have a tough time with mindfulness. So we have a lot of engineers here in San Diego at Qualcomm. These are generally South Asian guys who don't, their touchy feely stuff is not for them, they're engineers. And, but by doing this technical stuff with them, they get, they totally get that. So they practice that for a while. And then we just sort of say, introduce some concepts of mindfulness and they say, I think I get know what you mean. That it's kind of a Trojan horse approach, right? They, if you present, Amir Golshani: Alright. Richard Gevirtz: you said in the beginning, want you to sit down 20 minutes a day. and just be in a mindful state. They'll say, you're crazy. don't do that. That's woo-woo stuff. That's not for me. Amir Golshani: I see. So what does HRV science reveal about deeper meditative states? Richard Gevirtz: Well, we don't know about all of them. So I'm saying there's other meditative states that seem to have profound effects in the brain, but they're not related to this kind of stuff. what we think is that it's affecting your emotion regulation and it's affecting your brain's ability to inhibit unwanted things. And we don't really know beyond that exactly what it does, but it's people say all kinds of things of mindfulness and we think this is a way of promoting mindfulness too. So we don't see that as incompatible. Amir Golshani: And I want to acknowledge Forrest Knotson here. How do you see HRV biofeedback supporting or accelerating meditation practice? Richard Gevirtz: Well, Forrest had the right idea and wanted to know just what we've been talking about, what's the science behind it. And I think it just really helped him to know the science behind what he was doing anyway. He was doing the right stuff, but he didn't really know the science. And it's really helpful to kind of know and fine tune it, knowing what the science is. And that's why I think he found it to be valuable. I mean, what he was doing was very good stuff anyway, but it's really helpful to kind of know. what the physiology is behind it. Amir Golshani: Yes, absolutely. Thank you. I want to make this very practical. If someone does just one thing daily, apart from that 10 minutes, starting today, what should it be? That's one thing that absolutely, you know, so recommended apart from that. Richard Gevirtz: Well, they first need to do the 10 minutes a day for a while until they get good at it. Then what I would say is they need to be aware of vagal withdrawal. So don't let your day go on with too much vagal withdrawal. That's the secret, I think. It's completely normal. Vagal withdrawal is completely normal. We all have it all the time. We're not meant to be mellow. and not worry and not do anything. That's all part of our physiology. But if it goes on too long, you'll pay the consequences for it. So I would say once you're aware of what that feels like in your body, and you will be aware if you do this breathing for a while, that, yeah, this feels like however it feels to you, then the clock is ticking then. Don't let that go on for five hours. Find a time. to spend a little bit of, even just seven or eight breaths, slow breaths, or just a little bit of refocusing on, okay, I've got to get myself to a sense of safety. Sometimes that would be to find a loved one, a best friend that you can talk to. Because during the vagal activity is enhanced by strong positive relationships. That's part of the evolution of it. So whatever it takes to kind of not have prolonged periods where that break is off is what I would say is a practical kind of thing that I try to teach my patients anyway. Amir Golshani: why does chronic stress push people toward short-term thinking? Richard Gevirtz: Yeah, because they're not willing to tolerate the discomfort of what's ever going on. What you need to be able to do is be put up with some bad stuff in order to make good decisions in the long run, So Amir Golshani: Right. Richard Gevirtz: we know that people who are too impulsive make terrible decisions. remember what Mara found is that the pathway in the brain that is for emotional regulation is greatly strengthened by this. And that means you're making a lot better decisions in all different kinds of ways. Amir Golshani: Dr. Goertz, you have spent decades studying this. Looking back, what do you believe matters most? Richard Gevirtz: think that the way of thinking about physiology and health, to me, the switch over to looking at vagal withdrawal instead of sympathetic activity was a monumental change in the way I thought about things. So, I mean, just putting physiology back into the equation has been the biggest thing for me. Amir Golshani: love that. So what does Beyond the Summit mean to you? Richard Gevirtz: For me, it would probably be unusual because I would say learning to put up with negative emotions is the way you go beyond the summit. Instead of saying we move above to some greater higher state of great enlightenment or something, I don't see that as as an important goal as learning how to live life with the slings and arrows of outrageous fortune that we have to live with. And to me, guess beyond Amir Golshani: I loved it. Richard Gevirtz: the summit, that would be for me beyond the summit. Amir Golshani: Thank you for sharing that. No, it's lovely. If Richard Gevirtz: Okay. Amir Golshani: someone remembers one thing from this conversation, what should it be? Richard Gevirtz: That's probably what we were saying just to think about vagal withdrawal instead of sympathetic. Think about your rest adjust system, not your fight flight system. Honor your rest adjust system, not your fight flight system. And I think if you Amir Golshani: I love that. Dr. Gubberz, thank you for sharing your time, your depth, and your clarity with us today. Richard Gevirtz: Okay, my pleasure. Keep up the good work. I think you're telling people good stuff. Amir Golshani: I appreciate that. And until next time, keep climbing your summit.