Being in debt, broke, and unemployed can lead to depression but the converse is also true: Depression can precipitate financial meltdown. Read more, here.

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.

Welcome, Julie. We think most Americans are familiar only with a stereotype of Mormons and Mormonism. It’s possible that many of us are rather limited only because we don’t know any Mormons.  We may be slightly familiar with figures like the Osmonds and Mitt Romney on the one hand and sensational reports of some extremists, on the other.

We’re the first to say our own view may be somewhat limited due to lack of exposure and we don’t want to fall guilty of stereotyping, so can you reflect a bit on Mormon culture in general?  

Unfortunately, much of the media coverage on “Mormon” extremists, like Warren Jeffs for example, aren’t actually even Mormon and in no way represent Mormon culture or lifestyle.

Most practicing Mormon’s are fiercely dedicated to taking care of their families. They also generously donate time and resources, are conscientious community members, and genuinely trying to make the world better.

What does being a Mormon bring to your practice as a psychotherapist?

Being Mormon helps me to understand how a client’s spiritual beliefs and their emotional health are intertwined. I understand the importance for many clients of going to a therapist who will respect their religious beliefs and practices and not undermine them during the psychotherapeutic process.

Because of my spiritual beliefs I have a frame around the therapeutic relationship that allows me to view every person I work with as a valuable child of God, and as my spiritual brother or sister. It adds to the sacredness of the therapeutic relationship and the honor of helping my clients to navigate the deepest parts of their soul.

Where did you study? Were there any conflicts between your curriculum and your religion?

I received my MSW at the University of Utah. Yes, there were definitely things that were taught that I personally didn’t agree with. It was ironic that in my program the values of tolerance and acceptance of all faiths, cultures, and lifestyles were professed and yet there was some bashing of the religious majority. I found that odd.

Actually, we have heard instances of intolerance. And, we’re sorry to say, have even heard, from students, about the “bashing” you mention. Apparently this does occur in some academic programs, which when you think about it is rather shocking. In our opinion, an absolute prerequisite of being in the field is having a healthy respect for people’s sincere spiritual and religious beliefs.

I have and continue to work successfully with clients of all backgrounds and lifestyles. While I have strong religious convictions for my own life I don’t have an agenda for my clients in terms religious or spiritual participation.  Client’s self-determination is of utmost value to me and I meet each client where they are in their life.

Does talk about God tend to be frequent when you work with religious patients?

God is frequently a topic with religious clients, but only to the extent that God impacts their life, their emotional state, and their relationships.

Clients who have unresolved issue with authority figures, particularly with father figures, tend to transfer those issues onto their relationship with deity. If their father was critical and aloof they may experience God in a similar way. One of the most healing parts of therapy is when clients begin to experience God as a separate being from their flawed father figures which opens up new possibilities for spiritual connections.

That is a very valuable insight and one which we strongly agree with. Do you consider prayer an appropriate topic to explore or participate in during therapy sessions? Why or why not?

Prayer is an appropriate topic to discuss in therapy sessions if it part of a client’s practice and belief system. Often, religious clients who’ve previously connected to God through prayer stop praying as they work through shame, guilt, or worthlessness. I have suggested to religious clients that they challenge their feelings of worthlessness by continuing to talk to God even though they believe God doesn’t wants to hear from them.

I have participated in prayer during a therapy session once in 18 years of practice, at a client’s request.

Thank you sharing your insights about your faith and therapy, Julie. You really gave us food for thought. To see more entries in the God in Therapy series, click here!

Julie de Azevedo Hanks, LCSW, BCD is a psychotherapist specializing in women’s mental health, couples counseling, and is the owner and Clinical Director of Wasatch Family Therapy, LLC in Salt Lake City, UT. Utahns also know Julie as a favorite media contributor on NBC affiliate KSL TV’s morning show Studio 5, a relationship columnist for Wasatch Woman Magazine, and a former host of KJZZ TV’s Home Team. In addition to her therapy practice, Julie is an award-winning inspirational singer/songwriter recording recorded hundreds of songs and represent her process of integrating her faith into life’s challenges. Most notably, Gladys Knight recorded Julie’s song “Mercy’s Arms” on her Grammy nominated CD Many Different Roads. You can find her on Facebook and Twitter.

To us personally, the pinnacle of general spiritual development is belief in a God who wants something from us and one of the most important pieces of what He wants from us is to help others. (A parent loves those who love his children).  Even though this belief motivates us in our work, this motivation has mostly been internal—we don’t usually advertise it.  These blog posts in the God in Therapy series are a chance to talk with readers, professionals, and others about how this all fits into therapy, if it does at all.

For some, belief changes and morphs and moves up and down, forward and back. When people are in pain, especially from with mental illness or addiction, it is easy to vacillate in spirituality. The trials of suffering, especially emotional suffering, cause one to be overwhelmed, forgetting the revealed good in their lives. Sometimes, though not always, as people weather emotional storms or other dramatic happenings in their lives, the spirituality goes from level to level to level. Emotions can overwhelm the intellect or vice versa.

Is truth evidenced by a faith that rides the waves of stormy emotions yet remains strong? Perhaps. One thing that most of the people we have spoken with about this series agree on, including many Therapy Soup readers (and a couple of the interviewees in the series): To believe or not to believe? That is the ultimate question.

Look for more God in Therapy (the whole series is here at Therapy Soup on PsychCentral.com where this post originally appeared–see the comments!)

 Honest (warts and all), interviews, coming soon.

Welcome back, Karol. In your opinion, what is therapy able to offer patients who believe they are truly powerless to overcome the effects of living in what seems to be an increasingly polarized country? How do you suggest they cope with their fears about the negative political and economic situation?

Therapy provides the space for patients to slow down and gain perspective.  When patients feel powerless, it is often because their fear (valid or irrational), has them stuck in particular mindset or emotional state.  They see the worst and imagine the worst.  They lose sight of their own innate abilities to take charge of the areas of their life that they truly can control. 

No matter what type the therapy is, it is my belief that a therapist provides mirroring, support, reality checking, and the place to “think and feel out loud”.  I have found that helping patients complete the “incomplete picture”, meaning where they get stuck and what keeps them from moving forward, gets them back in charge.  Completing the incomplete picture has them really imagine and talk through their worst-case scenario fears, which moves it from the unknown to the known.  Usually they come to the realization that they are much more resilient than they ever imagined.

We are in the middle of a series of posts on God in Therapy with an emphasis on Western (rather than Eastern) spirituality and so we can’t resist asking the following: How do you and your patients work together to make sense of these issues? Do you or your patients ever discuss Judeo-Christian prayer, God or religion as part of the response?

I do have patients who use prayer and talk about their relationship with God as a way to handle anxiety and depression.  They attend church and talk to God as a way to find answers.  Sometimes they question their faith and relationship God when things are emotionally rough.  I have found that when they allow themselves to “feel their feelings” they are able to hear God’s voice and support more clearly.   They find great comfort in reclaiming their connection with God once more.  

We haven’t done a survey, but it seems that we have been hearing more about big-picture issues such related to the meaning of life and God and religion far more than even a few years ago.

Karol, please tell us about your new book. I think many of our readers will be interested to hear how you came to write it.

 My new book, Worried Sick: Break Free From Chronic Worry to Achieve Mental & Physical Health (Berkley, 2010), was the result of seeing how worry and anxiety was increasing in my practice.  In addition, I had my own significant worry to deal with due to the deteriorating health of my mother. 

With a diagnosis of Alzheimer’s and vascular dementia, my bright, articulate mother began to decline in what seemed to be a short period of time.  I had to use every tool I had ever used as a therapist to keep myself stable while I cared for her.  This made me contemplate what I had used in my practice to help my patients combat and manage their worries.  I found it interesting that writing my book would be parallel to the journey I was having with my mom. 

As a therapist who really believes in the importance of the body-mind connection, I know that addressing how worry effects us on the physical, psychological and behavioral level is a key to making changes.  I wanted to offer the techniques that I had seen reduce worry and anxiety with my patients.

Using a body, mind, spirit approach was important because in my experience they are related.  When the body is relaxed, the mind is affected and when the mind is clear, we are open to the possibilities of life, which helps our spirit.  In turn, having a spiritual life helps us feel better in our mental outlook and that in turn helps us feel less physically tense.  Everything is interrelated.  I wanted to have readers remember that when they got worried all they had to focus on what the three C’s.  Calmness, Clarity and Community.  

Calmness-Using techniques that help release physical and mental tension.

Clarity-Utilizing the logic of the mind to address irrational fears.

Community-Tapping into the people and recourses that offer ongoing support when you are worried and anxious. 

These three Cs are quite important, Karol. Upon reflection it seems that everybody finds one of these comes more naturally to them than the others but all of them must be explored and cultivated. In big cities such as NY, the third one, Community, is often a real challenge for people.

The purpose of my book was to not condemn worry because it will always be part of our lives.   Rather my goal was to offer guidance and solutions so that readers can get unstuck, find support and keep going when worrisome situations enter their lives.   

 Thank you.

About Karol Ward Karol Ward, L.C.S.W. is a licensed psychotherapist, nationally recognized speaker and the author of Worried Sick (Berkley, 2010) and Find Your Inner Voice (Career Press, 2009).  Karol combines her training as a psychotherapist with her passion for communication and has appeared as a psychological media expert on CNN, NBC, ABC, and in magazines such as Cosmopolitan, Experience Life, Black Enterprise, Readers Digest , Idea Fitness Journal and The New York Daily News.  She has also been featured on MSNBC.com, Sheknows.com, DivineCaroline.com and the Examiner.com as well as numerous radio shows.  The core of her work is the importance of the body.

Karol Ward. LCSW

Some people appear to be experiencing what can only be described as an epidemic of hopelessness in the past several months. On an anecdotal level, only, this general hopelessness seems to be manifesting in some individuals as increased anxiety and to a certain extent, depression. Rather than sharing just our own views on what appears to be a growing phenomenon Therapy Soup is speaking about the situation with Karol Ward, L.C.S.W., author of the new book, Worried Sick: Break Free From Chronic Worry to Achieve Mental & Physical Health (Berkley, 2010).

Welcome to Therapy Soup, Karol. Have you experienced any changes in the number of people contacting you regarding depression or anxiety?  

Yes, I have definitely experienced an increase in the number of people contacting me for therapy.  In general, I would say there was a 30 percent increase.

This started around the time the worsening economy began to have a real impact in people’s lives.  I practice in New York City and I think there were many people who were caught off guard when they were laid off by their companies. 

I also had an increase in my couples therapy work as the impact of the economy started to affect how couples were relating to each other.  The roles in their relationship that had been so firmly in place were now shaken up.  The couples had to adjust to new ways of coexisting together.  Sometimes on half of the couple was depressed over a job loss while the other had to find an inner strength to keep the finances going. 

Have you had any patients who have openly disclosed that they believe their depression or anxiety to be at least partially related to or compounded by world events? What world events?

Yes, there has been a correlation between, “situational anxiety and depression” from outside events. This type of mood disorder is prompted by external events that then affect the mood and perception of the patients I am working with. 

Initially it was the economy, with those patients who have also struggled with money issues being triggered even more so.   Then there were people who had been let go and found that they were struggling to look for and find work. 

There was also another group who felt anxiety because they had kept their jobs and felt upset that their colleagues had lost their positions.  This particular group had an underlying anxiety because “they could be next”.  They often feel powerless and pressured to work harder because times are tough.  Sometimes that is the message in the work place and sometimes it is an internal self-created pressure.

That is an excellent point—but having an employer who is compassionate and supportive can be a big help in helping people cope with this anxiety. Also, having an employer who openly discusses the situation with employees also helps them feel less powerless. But, I am sorry to say, I have heard instances of employers taking full advantage of the situation and actually using it to “control” their employees by creating an atmosphere of fear.  

There are, of course, other issues that seem to be affecting people’s anxiety levels and one that I hear about frequently is the tragic oil spill and the fact that it appears to still be gushing with no end in sight. Have any of your patients spoken of the oil spill and how it has affected them personally?

There is now upset occurring with some patients now about the current oil spill and interestingly it is more about the animals being affected.  The patients I see relate to the vulnerability of the birds, mammals and fish that they perceive are innocent victims.  Feelings of depression have come up around this particular issue.  These patients connect this back to their own issues around be powerless or victimized.  No one has expressed a direct connection with the oil spill such as living in that particular area but feel a general hopeless about the state of the environment.

I think what’s uncomfortable for lots of us is that there doesn’t seem to be a future point where we can look forward and say: Okay, by such and such a date, this will all be cleaned up. Also, though the oil spill is devastating and it is important for people to be aware and share the tragedies that other Americans are going through, the constant media images and stories might not be healthy focus for some people.  

Thanks, Karol. We’ll continue next time with a discussion on how you believe therapy can help, as well as learn some more about your book! 

About Karol Ward

Karol Ward, L.C.S.W. is a licensed psychotherapist, nationally recognized speaker and the author of Worried Sick (Berkley, 2010) and Find Your Inner Voice (Career Press, 2009).  Karol combines her training as a psychotherapist with her passion for communication and has appeared as a psychological media expert on CNN, NBC, ABC, and in magazines such as Cosmopolitan, Experience Life, Black Enterprise, Readers Digest , Idea Fitness Journal and The New York Daily News.  She has also been featured on MSNBC.com, Sheknows.com, DivineCaroline.com and the Examiner.com as well as numerous radio shows.  The core of her work is the importance of the body-mind connection.

(Read the original interview here, at Therapy Soup at PsychCentral.com)

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.