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Health Talk 03: Biofeedback and How it Can Help: A Conversation with world class expert Dr. Gevirtz

bioAbout Health Talk

Living with a chronic condition can feel isolating. Health Talk by Flowly was born from wanting to bring often isolated voices into the fold, and connecting different ideas, experiences, and tools to your own health journey. 

We talk to health practitioners and chronic health patients to deconstruct the chronic condition journey— from how many have managed the challenging diagnosis experience, to new tools and tips that might help you. We cover conditions including chronic pain, anxiety, autoimmune diseases, and more.

Hosted by Celine, the founder of Flowly, this weekly podcast will dive into conversations with world class researchers, practitioners, and even more importantly, chronic condition warriors themselves.

Search “Flowly” on Apple Podcast or Spotify to find Flowly Health Talk!

This is an in-depth conversation about biofeedback with Dr. Richard Gevirtz, truly one of the most respected and pioneering experts in this space.

How does biofeedback work? What does it do? What does it have to do with Olympic level athletes? In this Health Talk, Celine tackles these questions with Dr. Gevirtz.

Dr. Gevirtz is a distinguished professor of psychology for the California School of Professional Psychology at Alliant International University. He’s been doing psychophysiology and biofeedback research and clinical work for the last 30 years. Dr. Gevirtz was also the former president of the Association for Applied Psychophysiology and Biofeedback. His primary research focus is in understanding the physiological and psychological mediators involved in conditions such as chronic muscle pain, fibromyalgia, and gastrointestinal pain. Dr. Gevirtz has studied applications of heart rate variability, biofeedback of pain, anxiety, cardiac rehabilitation, etc.

*This transcript is auto-generated

hey y'all my name is Celine and i'm the

founder of Flowly and your host today

for health talk by Flowly

as some of you might know Flowly is a

mobile platform for chronic pain and


and we use biofeedback to help you train

your relaxation system your nervous


and really help you manage all the

symptoms around it

in our health talk we talk to chronic

pain patients

advocates mental health warriors as well

as professionals in the industry and


to really learn from their expertise

today's guest is someone our whole team

has looked to for guidance

because he's such a foremost expert in

the biofeedback space

and we have Dr. Richard Gevirtz he's a

distinguished professor

of psychology for the california school

of professional psychology at alliant

international university

he's been doing psychophysiology and

biofeedback research

and clinical work for the last 30 years

dr Gevirtz was also the former

president for the association for


psychophysiology and biofeedback his

primary research focus

is in understanding the physiological

and psychological mediators

involved in conditions such as chronic


fibromyalgia gastrointestinal pain

and dr rivers has studied applications

of heart rate variability

biofeedback for pain and anxiety and

cardiac rehabilitation

just to name a few so welcome to health

talk richard

thank you good to be here so i wanted to

jump into

the interview first by asking you what

is biofeedback because i think some of

our community members know it but

many people have never had contact with

biofeedback so what is it

so biofeedback is a field that started

about 45 years ago when we started

getting a good enough technology to

measure physiology in a way that we


show it to the subject or client

and so biofeedback predicated on the on


um plasticity of the nervous system was


that if somebody could see what their

physiology was doing maybe they could

change it

and little by little we've understood

the field better and better as time was

going on

started off with very crude measurements

finger temperature

muscle tension uh just basic heart rate

but as technology has gotten better

we've been able to measure more and more

things about

physiology and feed them back including

eeg feedback heart rate feedback or

reliability feedback

as well as the traditional ones like

skin conductance

and temperature so it's a field that is


steadily um it has the disadvantage of

being in

space between traditional

science and alternative medicine

nih considers this alternative medicine

and when we apply for it they say no no

it's established science it shouldn't be

an alternative medicine

so it little by little it's kind of

finding its own

niche in that space but it has grown

steadily over those many years

what does biofeedback actually look like

like let's say today someone wants to

try traditional biofeedback um where do

they go

and what does a session actually what

does it look like

well there's a there's a certification

institute called

biofeedback certification international


bcia and they

certify the expertise of practitioners

and so it would vary depending on what

the problem was but

they would go to a practitioner who has

equipment that they would put

finger finger leads on ecg leads maybe

ec g leads on um

other kinds of things like that and then

after an assessment the person would

look at a screen

and they would see some aspect of the

physiology that there

that the clinician is trying to get them

to change

and then they would work on that using

relaxation breathing

uh or just straight um mental techniques

to try and change these things

and it would vary tremendously it might

be an athlete trying to

you know pro golfer trying to be able to

make 12-foot putts

just to learn a very specific skill to

do that it could be someone who's

depressed who has to learn to kind of

change their whole physiology

together with their mental uh techniques

or it could be physical disorders like

irritable bowel syndrome where they want

to change their physiology to be able to

alleviate the symptoms

so most practitioners use some

combination of some

psychological techniques as well as the

biofeedback but some only use


there's a whole series of techniques

called neural feedback that uses

eeg electron cephalogram feedback

which takes many many sessions but it's

a it's an up-and-coming area

not as much good solid data yet as there

are any other areas but

certainly of great interest with many

people yes

so you mentioned there's a lot of

different types of leads and

data you can get from biofeedback i know

that for us at flowley we focus on


heart rate variability about feedback

most accessible because it's also a

great entry point i think for people

that have

no access or experience with biofeedback

so i'd love to get your take on um

explaining what is heart rate

variability and what is

hrv biofeedback because it's an

education process for us to try

and share you know what are the benefits

and what does hrv biofeedback actually

do for you

okay so first hrv is separate from the


feedback is an intervention technique

hrv has been around for a while

and it refers to the differences in

beat to beat heart rate um so basically

when most of us are familiar with heart

rate from the gym where we just measure

our average heart rate heater from a


but if you measure beat by beat one our

wave to the next to the next

those distances between those airways


in healthy individuals and strangely the

more they differ the better

more healthy they are opposite of what

mostly would think we think variability

would be bad but here variability is


reason for that is that the variability

is being controlled by

a branch of the nervous system called

the autonomic nervous system

it has two branches the sympathetic

which is the fight flight fright

and the parasympathetic which is the

rest the gesture restore branch

they're like accelerators and brakes the

sympathetic's like an accelerator

a parasympathetics like a brake and they

work together

mostly reciprocally not always

reciprocally to kind of

manage both the environment of your


environment of your body making

adjustments for changes in blood


or blood flow but they also in in

adjustment to

external stimuli so when you're faced

with a very large threat

the break goes off the parasympathetic

goes off and the sympathetic goes on and


everyone's sort of familiar with the

fight flight response

that you get in a real major emergency


people can kind of think about it if

you're riding on the freeway

and suddenly the traffic stops and you

slam on the brakes and miss the car in

front of you by

two inches what's your physiological


a few seconds later after that you get

butterflies in your stomach

you get sweaty your hands get colder

your heart rate speeds up like


everybody kind of knows what that flight

response is

that only really applies during major


for the most part most of the day our

heart rate variability is controlled by

the breaking

of the parasympathetic which is making

adjustments for blood pressure

and in thinking processes and things

going on

so that's where the measurement of that

comes from and it

became important because it's really the

only way we can measure

the parasympathetic nervous system

sympathetic we can measure we've been

able to measure for a long time like

like palmer sweating

and putting electrodes on the palm and

right you get a sympathetic reaction you

your palm sweat and it shows up on this

on a scale

which is a pretty simple kind of

feedback but uh the but the

parasympathetic was much more elusive

until we had technology that allowed us

to look at

beat by the changes in heart rate and

what we know is that

the b by b changes are dominated by one

rhythm specifically

that comes from breathing and that is

when you breathe in

the brain goes off and when you breathe

out the brain goes on

so it makes sense if you think about it

when you're breathing in oxygen is

present in the alveoli

so you want your heart rate to be a

little faster take advantage of the


but then when you breathe out there's no

oxygen there so the brake

slows the heart down and gives you

a and over a lifetime it saves you like

450 million heartbeats

because of that rhythm and that rhythm

is the major

draw is a major drive of carbon

variability but not the only one but the

once we were able to measure that we

started studying

uh swamis and gurus and tibetan monks

and asked them to do what they do when

they get centered and calm

and what we found what they all do is

they breathe at a very slow specific


somewhere between four and a half and

seven breasts a minute

and their physiology is remarkable when

they do that

and we little by little came to

understand why that physiology works

that way is because they're using all

the different rhythms in their body are

lining up

becoming in a very specific coherent

fashion so that they line up so the

rises and falls and heart rate becomes

exaggerated during this

role what we call resonance frequency


and that's what the biofeedback is once

we kind of realized that the

swamis were using it we just sort of

modernized it for the

uh western market and it's basically

kind of high-tech

specific kind of meditation that comes

from this kind of visual breathing

with the technology though we can find

that resonance frequency very

easily now and uh

as your product is doing and once we

find that and people practice that on a

regular basis

we get some of the same benefits that

the swami's got that the guru's got

which is

very good blood pressure regulation very

good anxiety regulation very good

emotion regulation these are things that


with that kind of thing that's why we

always say it's a brand new idea it's

been that's 2500 years old

yeah yeah i love that and i remember