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We continue talking with Dr. Eric Chamberlin about Heart Rate Variability Biofeedback and it’s usefullness in psychotherapy. What have you noticed from working with your patients? 

A suburban mom comes in distraught after not sleeping the night before.  Very anxious, she has been ruminating unproductively about not being able to get her boys to camp this summer for trivial reasons.  The therapist’s attempts to encourage her to think about the situation differently are no match for her urgency and desperation.

She begins HRV to try to get her into a more balanced state where she can process more effectively.  After 12 minutes she states “I feel better…they can go next year…it’s no big deal right?”  With her balance and problem solving capacity restored, the solution was spontaneous and straightforward.

What followed was an emotional and very productive discussion about opportunities she had missed as a child because of her family’s dysfunction.  She realized that the feeling of desperation was from her experience, and didn’t apply to her children who were very well cared for. 

Have studies been done that support your observations?

Its an exciting time to be involved with HRV because it is in a “Translational Phase” meaning the basic neurophysiology has been well established and that knowledge is now being translated into clinical use.

Recent studies by Reiner at NYU, Karavidas and Lehrer at Robert Wood Johnson, and Zucker demonstrate the efficacy of HRV in clinical anxiety, depression, and PTSD respectively. A PhD Dissertation by Chaudri pending publication shows the efficacy of HRV combined with Psychotherapy in depressed patients with coronary artery disease. Specifically this study documented gains in focus, awareness, and emotional regulation.

 What does the biofeedback technology offer that stress reduction methods such as breathing techniques, guided visualization, and meditation don’t?

HRV allows an individual to stimulate the cardiovascular system at its resonant frequency for a sustained period of time. Deep breathing, visualization, and meditation are all useful complimentary clinical tools, however they lack this critical property. Stimulation at the resonant frequency strengthens the baro-reflex, resulting in enhanced physical and psychological resilience by influencing heart rate, blood pressure, vascular resistance, pain threshold, central nervous system processing, mood, and attention.  Analogous to physical conditioning, the baro-reflex can be thought of as the “muscle” of core Mind-Body strength.

We are very interested in creating a trauma program that makes use of these techniques as well as other emerging technologies. In many cases, trauma patients struggle with substance abuse and addiction and comprehensive treatment for this would need to be available. After trying various techniques myself,  I am teaching some of my addiction patients Dr. John M. Kennedy’s B.R.E.A.T.H.E. technique which, though designed for heart-related stress, has a palpable and relaxing mind-body effect.

Have you done any specific work with HRV biofeedback and psychotherapy for addiction/addiction treatment?

Trauma and addiction are ubiquitous in clinical practice.  With trauma comes difficulty in modulating arousal effectively, and people frequently resort to substance use to obtain relief. I have found HRV to be a very helpful tool for developing the capacity for self-regulation in clients who are seriously compromised.

Where is HRV biofeedback available?

The HRV devices currently available on the consumer level are the emWave “Desktop” (PC/Mac), emWave PSR (Handheld) and StressEraser (Handheld). This can be purchased from the manufactures directly, or authorized resellers.

An independent review of the StressEraser vs. emWave(s) is available at www.MindBodyTechnology.com.

Thank you for your time, Dr. Chamberlin. We look forward to learning more about HRV Biofeedback.

Eric Chamberlin, MD of Chamberlin Applied Neuroscientist is currently authoring a book about his work with clients employing an unusual tapestry of clinical tools.  Inspired by changes catalyzed by Heart Rate Variability Biofeedback, it describes the power of self-transformation that comes with balancing the nervous system at a deep level.  He has served on the faculty of Harvard and Dartmouth Medical Schools, lectures on Mind-Body Medicine, and has a full-time clinical practice in Glastonbury, CT.

Welcome, Dr. Chamberlin. Can you tell us about the genesis of your work with Heart Rate Variability Biofeedback and psychotherapy?

I really enjoy seeing people get better, and am always looking for tools that will increase efficiency and enhance outcome.  In 2006, HRV Biofeedback devices became available on the consumer level. Having practiced Mind-Body Medicine since the early 90’s, I was intrigued by the possibility of individuals being able to fine-tune their nervous systems at a very deep level.  When the so-called “Autonomic Nervous System” was discovered it was erroneously believed to be out of the realm of voluntary control.

HRV represents an exciting leap forward by helping people learn to balance the two branches of the ANS—the Sympathetic “Fight or Flight” and Parasympathetic “Rest and Digest” systems.  And with balance of the ANS comes greater balance in life.

Psychotherapy can be extremely powerful, however the progress is often uneven.  A common factor is clients not being in the “right mood” or “frame of mind” to be able to engage and benefit from treatment.  For example, a person may be so anxious and preoccupied that she can’t focus effectively.  Or, in talking about emotionally charged issues she may become overwhelmed, frozen and shut down. My hope was that by using HRV to balance the nervous system that it would be possible “to keep the train on the tracks,” moving toward resolution of the problems that brought them to treatment.  It works.

Meditative techniques, breath-work and medication can all be used to address this, however, there are drawbacks/limitations to each of those methods. HRV Biofeedback doesn’t appear to have the same kinds of limitations. Can you describe the HRV technology and how you employ it?

HRV devices all work by measuring the pulse from a fingertip or earlobe. The heart rate is calculated and the data undergoes processing which is used to provide visual and auditory feedback. The client uses breathing (to control her heart rhythm), and then uses the feedback to enter a balanced state.

Clients use HRV before sessions; in the waiting room, car, etc., to balance and optimize readiness to engage in the challenging work to follow. If needed, clients will use HRV for 5 to 10 minutes to “get back on track” during a session.  (It’s disturbing to realize how much time was wasted in the past when clients “derailed,” and the rest of the session was spent just trying to get them back on track.)

In the hours and days after a session, clients use HRV to help “digest” the experience and make change.  It is a very effective “force multiplier.”

Thanks, Dr. Chamberlin. We are looking to hearing more about HRV Biofeedback in Part Two.

Eric Chamberlin, MD is currently authoring a book about his work with clients employing an unusual tapestry of clinical tools.  Inspired by changes catalyzed by Heart Rate Variability Biofeedback, it describes the power of self-transformation that comes with balancing the nervous system at a deep level.  He has served on the faculty of Harvard and Dartmouth Medical Schools, lectures on Mind-Body Medicine, and has a full-time clinical practice in Glastonbury, CT. His website is Chamberlin Applied Neuroscience.

We could begin by making “Jewish guilt” jokes or jokes about neurosis a la Woody Allen, but the truth is that the fundamentals of psychoanalysis, psychology, psychotherapy have very strong connections with very ancient teachings of Judaism. In fact, they go back as far as Adam and Eve!

In part that’s because character analysis and character improvement are a way of life in traditional Judaism. There is a densely interwoven theme of self-knowledge and self-improvement in ancient—and modern—Jewish commentaries on the Bible (aka Torah). These topics are also overtly discussed in Kabbalah, numerous ancient ethics manuals, and numerous other sources. There are several schools of thought and different approaches and virtually every major scholarly work either focuses on or touches on the subjects of what it means to be human and what it means to work on one’s character.

Because all these teachings are regularly studied by observant Jews today as they have been for thousands of years, they are ingrained in our outlook.

Of course, psychology itself has Jewish roots. Others have commented on this, but we’ll leave that to Freud’s biographers and the many authors, both Jewish and not, who have written volumes on this subject.

I find it natural that the deepest of Jewish teachings as well as common-sense life lessons of Judaism inform my clinical work but then again, they inform every sphere of my life, just as being male, being born in America, and being very tall do, too. It’s hard to dissect and pull out what is the Judaism and what is the Richard, but there are several Jewish concepts that really do keep cropping up. We’ll start with one, “teshuva”.

Teshuva means “return” (though it is often translated as repentance).  Judaism teaches that when one errs or does something harmful, one is able to “return” to the state he or she was in before the error. This return is ideally a return to one’s true self.

This return will necessitate the use of various processes including but not limited to: confession (to God and self—not through intermediaries), honest reflection and assessment, self-education, sincere regret, apology—if another was harmed and if appropriate–prayer, implementing practical courses of reparative action, and resisting repeating harmful future actions.

In fact, sincere teshuva can bring a person to a higher spiritual state of being than before. According to Jewish teachings, teshuva can literally transform the actual harmful deed into a positive event. In other words, through corrective action one can actually change reality. There is even a saying that what a true penitent (one who achieves a rectification of his actions and himself), achieves spiritually, a saint (one who has done no wrong), isn’t able to achieve.

I find that sharing this general concept, especially when working with substance abusers or those who have harmed others or themselves, to be incredibly powerful. To believe that one has the power to change and repair not only himself but the world itself is a theme that to me is worth emphasizing in virtually every course of psychotherapy or addiction treatment.

Does this minimize the harmfulness of actions that have hurt others? No. It does not because there are consequences to one’s actions and teshuva does not generally negate consequences.  But it does transform self.

It’s the 21^st century. You can talk about—and do—it all. Infidelity, sexuality, violence. Drugs, suicide, gambling. Perjury, double-standards, politicizing. Hey, even taxes are a hot topic. However… if you want to talk about God or “do” religion, well, just about everybody’s knee jerks. Sometimes it seems that we don’t so much have a culture of freedom of religion as freedom from religion.

Therapy culture is no exception. And, with very good reason, in many cases. In therapy, the therapist must do his or her best to not (implicitly or explicitly) force his or her morality or religious viewpoint on the patient. The general rule is to avoid instigating any discussion of codes of conduct or sets of beliefs that don’t reflect the mores of a purely secular-cultural way of life. (This is nearly impossible for mere mortals to do in totality, by the way).

Still, this doesn’t mean that the therapist cannot have his or her own deeply held religious and moral beliefs and viewpoints. And it doesn’t mean that basic morality, such as preventing someone from committing a violent or self-destructive act, can’t come into play in therapy. It can and should.

But there is a blurred line—so blurred as to be a hazy, foggy mess—between a therapist not bringing his moral or religious viewpoints into therapy overtly, and not having them.  By the very nature of their being, deeply held beliefs color each and every therapeutic choice he makes.

The ability to relate to people from “where they’re at” is helpful, and is a skill that can be cultivated.  And, with practice, this strong leaning towards non-judgmentalism can be implemented much of the time. Still, we contend that our moral/religious/spiritual outlook is so much an integral part of who we are that there is truly no such thing as a “blank-slate viewpoint”—we aren’t, after all, robots or computers.

In fact, if we are honest, we’ll acknowledge that secularism, too, is a moral/religious/spiritual outlook. Non-religion, like religion, has its own system of weights and measures, its own values, its own set of deeply held beliefs. Secularism isn’t, as some believe, a plain-vanilla blank slate. Atheism is as much a part of a person’s worldview, impossible to prevent from filtering into one’s every thought, word, action, as is Christianity, Judaism, Islam or any other religion.

When comparing one’s beliefs with someone else’s, we naturally think that we are the ones who are free from bias—(that “we” includes you and me by the way)! It is very challenging to step back and see that our beliefs are utterly interwoven into the fabric of our being, especially if we are convinced by majority viewpoints or passionate minority viewpoints, that our particular way of thinking is the only one that is free from bias.

If we value being bias-free (and that is a whole other topic—because that may not be the most desirable state), and we want to be really honest, we are obligated to examine our knees very carefully when they start to twitch.

Here’s one story: Author and PsychCentral blogger Therese Borchard frequently writes about her Catholic faith and how her relationship with God has profoundly helped her. Yet upon recommending her books to someone who we felt would find comfort in reading them, we were told, “Oh, you recommended her to me because she believes in God.” Actually, we recommended her for her honesty, her commitment to her family, her willingness to share her life with others, her bravery, and many other reasons. We personally hold quite different beliefs about God, and don’t agree with her on several fundamentals—but that doesn’t mean we don’t find her work valuable.

On the flip side, we haven’t yet been in the situation where we’ve recommended a book and the recipient says, “Oh, you recommended that book because the author is an atheist.”

Another thought worthy of trembling-knee examination: More than a handful of therapists openly speak about incorporating Buddhism, Taoism, Yoga* and other eastern religions and spiritual philosophies and practices into their therapy methods. Many offer up suggestions based on these religions and philosophies. Why are some sets of beliefs given a pass and allowed to be openly suggested to patients but not others? That’s an invitation for you all to share your comments, by the way!

Also, going back to an earlier question: Is a lack of bias even always desirable? If a set of beliefs is to have real meaning, does this mean we have to praise beliefs that openly contradict ours? We have invited therapists, patients, and others to discuss these topics with us in this new Therapy Soup series, “God and Therapy”. Over the next few weeks we will post interviews and discussions.

We want to open up a serious conversation where everyone can be honest, even if that means being politically incorrect. We touched on this subject in our first book, Therapy Revolution (now finally available in Kindle), and we’re also addressing this in our next book).

Let’s talk about God and Therapy–we invite your comments!

We are in the process of interviewing therapists and patients about this topic. Next: Interview with Michigan-based therapist Wendy Young, coming soon.

*Here we refer to Yoga as the general name for several physical and meditation practices that were developed as a part of Hindu worship and currently regarded in India, though not by most American proponents, as still being an integral part of that religion.

Mental Health Education & Awareness at Valley National Bank

By Richard Zwolinski, LMHC, CASAC

How do we know when mental illness has truly become less stigmatized? When a bastion of corporate respectability hosts an event that encourages open discussion of mental illness and related issues!

Although we speak and do workshops for a variety of organizations, usually sponsors are either in the mental health and addiction fields or corporations looking to learn about mental and emotional well being and addiction prevention in the workplace. Last week, that all changed. In honor of the end of National Mental Health Month, 2010, Valley National Bank, the largest bank headquartered in New Jersey (with many branches in the NY metro area), broke charitable ground and hosted a community mental health awareness and education event at one of its Brooklyn branches on 13^th Avenue.

VP and assistant branch manager Anna Gelardo came up with the idea to host the free event which took place during regular banking hours. She and her team opened their doors to all who passed by, sent out dozens of news releases and personal invitations, handed out fliers, and set up a free, lavish dessert buffet. There was a table in the lobby where free educational materials were available including the Therapy Patient Bill of Rights developed with the help of PsychCentral readers on this blog. The bank also raffled off several copies of our book, Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money.

Most of the bank’s customers joined us when they were done with their banking business. Also, many people stopped in just to schmooze with us about mental health issues and enter the raffle. They stayed for the warm atmosphere and the buffet—not a typical day at the bank! A large number of guests had family members with mental illness or were mentally ill themselves, but many were simply curious. The entire bank staff, including the tellers, was genuinely welcoming.

We hope to do many more stigma-busting, awareness and education events—the more that people feel that the topic of mental illness (and addiction, too), can be discussed openly and brought into the public consciousness, the less they have to struggle with the additional burdens of shame and blame.

Many thanks to Valley National Bank and their wonderful team including Reetu Chokshi; Jr. Graphic Designer; Anna Gelardo, VP and Assistant Branch Manager; Inderia Ram, District Manager; Vincent Demeo, Regional Manager; Marc Piro ,Vice President, Marketing/Public Relations;  Maureen Zegler, Senior First VP; and Gerald Lipkin, Chairman, President, and CEO. (Please accept our apologies if we overlooked anyone).

Dr. Hal Urschel

We are very excited to introduce you to Dr. Harold C. Urschel, MD, the acclaimed author of the New York Times Bestseller, Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program.

In his book Dr. Urschel shows readers the state-of-the-art, scientifically proven addiction treatments and helps them tap into the approaches to treatment that really work.

Here are Part One and Part Two of our interview with Dr. Hal Urschel.