Psychosomatic medicine in relation to cardiovascular disease
gevirtz on hrv
1. Mediational Models in Psychophysiological Disorders Richard Gevirtz, Ph.D. CSPP at Alliant International U.-San Diego [email_address] Website: WWW.Alliant.edu/faculty/gevirtz 12/19/09 Gevirtz
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6. Estimates of Primary Care Visits 12/19/09 Gevirtz
13. Mediational Model of Psychophysiological Disorders 12/19/09 Gevirtz Physical Symptoms Physiological Systems Cognitive/Emotional Factors Early Developmental Factors Genetics Social & Cultural Factors “hysteria”
29. 12/19/09 Gevirtz “ As a consequence of hyperventilation, the decrease in PCO 2 will reduce the caliber of the arteries and thereby impede the flow of blood to body tissue (ischemia), and the increase in blood pH will reduce the amount of oxygen that hemoglobin can release to the body tissue (hypoxia). Therefore, the heart must pump more frequently and with greater vigor in order to compensate for the decrease in pCO 2 and increase in pH.” { Ley, 1987, p.309}
59. Phylogenetic Hierarchy in Cardiovascular Response to Stress 12/19/09 Gevirtz *Allows rapid regulation of metabolic output:useful in social regulation DMNX=dorsal motor nucleus SNS=sympathetic nervous system NA= nucleus ambiguous
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62. 12/19/09 Gevirtz Cortex Brainstem Cranial Nerves V, VII, IX, X, XI Bronchi Heart Head turning Pharyanx Larynx Facial muscles Middle Ear muscles Muscles of mastication Environment
71. 12/19/09 Gevirtz “ Rather, Levine looks to the process of what happens when we experience trauma. He sees recovery as getting past a series of mental vortexes that can block our ability to continue traveling down life's stream. As we travel down the stream, our relationship with the traumas changes, just as our relationship with a loved one who has died changes as we continue to live, and they do not. When we get caught in the vortexes created by our traumatic histories we become struck, and whirling within the vortexes, we can relive the traumas - through flashbacks, anxiety, or actual repetitions of particular aspects of the trauma. Levine doesn't minimize the importance of our memories, but emphasizes the primacy of our feelings, of our body states, and of our body's need to physically remove the traumas in order to heal. In this sense, he reminds me of Stan Grof's work on healing the body through breathwork. But the methods proposed here are considerably gentler.”
72. Bessel van der Kolk 12/19/09 Gevirtz Abnormal psychophysiological responses in PTSD have been demonstrated on two different levels: 1) in response to specific reminders of the trauma and 2) in response to intense, but neutral stimuli, such as acoustic startle. The first paradigm implies heightened physiological arousal to sounds, images, and thoughts related to specific traumatic incidents. A large number of studies have confirmed that traumatized individuals respond to such stimuli with significant conditioned autonomic reactions, such as heart rate, skin conductance and blood pressure (20,21,22,23, 24,25). The highly elevated physiological responses that accompany the recall of traumatic experiences that happened years, and sometimes decades before, illustrate the intensity and timelessness with which traumatic memories continue to affect current experience (3,16). This phenomenon has generally been understood in the light of Peter Lang's work (26) which shows that emotionally laden imagery correlates with measurable autonomic responses. Lang has proposed that emotional memories are stored as "associative networks", that are activated when a person is confronted with situations that stimulate a sufficient number of elements that make up these networks. One significant measure of treatment outcome that has become widely accepted in recent years is a decrease in physiological arousal in response to imagery related to the trauma (27). However, Shalev et al (28) have shown that desensitization to specific trauma-related mental images does not necessarily generalize to recollections of other traumatic events, as well.
73. 12/19/09 Gevirtz Stephen Porges started off the day with a lecture on his research: "Application of Polyvagal Theory to Clinical Treatment". Most of it was in understandable English, because Porges is a U of Illinois professor and knows how to teach. According to the conference bio, "his polyvagal Theory of Emotion led to the discovery of an integrated neural system that regulates social engagement behaviors." His lecture today focused on the need for face-to-face interactions for bonding to occur. When there’s a violation of the interaction—someone doesn’t make eye contact, when a supposed intimate is speaking, the speaker experiences distress: anger/shame/alienation. Safety creates proximity creates contact creates bonding. There might be more bonding in sleeping together than in sex. Porges commented on the dysfunction in the Seinfeld rule, "No sleepovers!“ (We know that those people were all attachment disordered!) I can’t recount the whole lecture, but I can give you tidbits: Facial muscles go down to the heart. Talking, listening, and smiling calm us down. Two vagal nerve systems. The old one, from lizard days, shuts us down completely. It’s the one from which we can swoon, be literally scared shitless, or become selectively mute, when distressed. The new vagus is linked to face and is protective of mobilization systems.
74. 12/19/09 Gevirtz It works socially. Our nervous system can relax us through the meyelinated vagus, if we are experiencing safety; mobilize us, through the sympathetic and adrenal system, if we sense dangere, or completely immobilize us, through the old, lizard unmeyelinated vagus, if we think our life is in danger, feigning death like a mouse fooling a cat. (Doug, out birding during the day, caught and pet a horned lizard, who didn’t move at all. It was in the immobilization vagal phase.) Social behavior enables us to function better. Social engagement systems: prosody (tone and music of our voices), gaze, facial expressivity, posture during social engagement, mood, affect, and behavioral state regulation.
75. 12/19/09 Gevirtz Environment can be interpreted, based on our state. Borderline cutters, in a study, lost vagal control of their hearts while watching emotional videos. Controls, did fine. Very autistic kids attend to low (more frightening) tones. They stay scared and "mobilized" most of the time and try to soothe by doing weird stuff, not be connecting with others. If you play them music with all the low tones filtered out, over time, they will become socially engaged, like normal kids. I saw the video, it was way cool.
101. 12/19/09 Gevirtz Synthesis of interactions among some of the important reflexes of the cardiovascular and respiratory systems (Francis et al. 2002) Baroreceptors Increased BP Increased Sympathetic nerve activity Cardiovascular integration center Ventilatory integration center Lung Stretch Lower pCO 2 Higher PO 2 Peripheral Chemoreceptors Central Chemoreceptors Increased Ventilation + + + + - - - - - Cardiovascular system Respiratory system
141. 12/19/09 Gevirtz Determinants of Heart Rate (IBI) Intrinsic Pacemaker 1-2 Hz (110-120 b/m) Sympathetic Influences on the Sino-Atrial Node A paced accelerator Parasympathetic Influences on the Sino-Atrial Node A paced brake Baroreceptor Feedback System IBI Medullary Influences Vascular Influences
160. Fig. 2. Note the high level of VLF activity accompanying rumination, worry or performance anxiety. 12/19/09 Gevirtz
161. Fig.3. The “meditators peak” in the .08-.11 range. Note that the patient has learned to both “quiet her mind” while breathing slowly and diapragmatically. 12/19/09 Gevirtz
162. Early stages of Resonant Frequency Acquisition 12/19/09 Gevirtz
169. 12/19/09 Gevirtz Ordinary Breathing produces three HR frequencies, HF,LF,&VLF Progression to approx. 6 BPM, (Diaphragmatically) in experienced breathers produces single summated peak at about .1hz: RESONANT FREQUENCY Daily practice in this state increases homeostatic reflexes Vaschillo’s Resonant Frequency Theory
177. 12/19/09 Gevirtz Resonance in Physiological Systems Resonance is a property of an oscillating system in which perturbations at specific frequencies produce large increases in oscillation amplitudes. A system has resonance properties if two processes (functions) of the system interplay against each other in a feedback relationship. Resonce system
178. Reaction of Aperiodic and Resonance Systems to Perturbation Stimuli 12/19/09 Gevirtz Aperiodic system Resonance system Perturbation Stimuli Output Function (Response to stimuli) Time Time Time Time T[s] Resonance frequency : F[Hz] = I/T[s]
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180. The Human Body Consists of Many Resonant Systems 12/19/09 Gevirtz To understand why human beings are more sensitive to some frequencies than to others, it is useful to consider the human body as having sub-systems, where each sub-system has its own resonant frequency.
181. 12/19/09 Gevirtz EACH BODY SUB-SYSTEM HAS A RESONANCE FREQUENCY BAND Mechanical Resonance
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186. 12/19/09 Gevirtz HR and BP Reactions to Stimuli if the Baroreflex Does Not Work Blood Pressure Heart Rate Delay~5 sec Stimuli Time Time Time
187. 12/19/09 Gevirtz Stimuli Heart Rate Blood Pressure Delay~ 5 sec HR and BP Reactions to Stimuli if the Baroreflex Works Time Time Time Functional Resonance Stimuli elicit HR changes which, after a delay, change BP. BP changes, in turn elicit, HR changes due to baroreflex activity.
188. 12/19/09 Gevirtz Respiration Heart Rate Blood Pressure Delay~ 5 sec Time Time Time HR and BP Oscillations Elicited by the Stimulus of Respiration
189. Two Closed-Loop Baroreflex Model 12/19/09 Gevirtz W(HR-target) Blood pressure (BP) control system Heart rate (HR) control system Baroreceptors Vascular tone (VT) control system Brain HR VT W(BP-HR) BP Closed loop of HR baroreflex VT HR BP
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191. 12/19/09 Gevirtz The highest HR oscillations are at a target frequency of ~ 0.1 Hz The phase of HR and the stimulus (breathing?) at that frequency is ~ 0 o
193. 12/19/09 Gevirtz Transfer Functions of Blood Pressure with Regard to Heart Rate (Baroreflex Effect of BP) and HR with Regard to Stimulus Max HR Oscil is at ~0.1 Hz (180 o HR:BP Phase) Min HR Oscil is at ~0.03 Hz (0 o HR:BP Phase)
202. 12/19/09 Gevirtz Resonant Frequency Height Weight Age The correlation coefficients (r) between resonant frequency and age, height, and weight r=-0.6 P<.0001 r=0.01 P<0.9 r=0.02 P<0.82
210. 12/19/09 Gevirtz HRV and Pulse Oxyimetry Biofeedback for COPD Giardino, et al, 2004, App Psychophysiology and Biofeedback, 29,121-133
211. HRV and Pulse Oxyimetry Biofeedback for COPD Giardino, et al, 2004, App Psychophysiology and Biofeedback, 29,121-133 12/19/09 Gevirtz RSA ms 2 /Hz Lower scores indicate higher function
212. BUT 0 o phase relationship in intact humans occurs only during resonant-frequency breathing 12/19/09 Gevirtz
237. Heart Rate RSA Biofeedback Training: A Treatment Manual Resonant Frequency (RFT) Training Based on Lehrer, Vashillo, & Vashillo (2000) Applied Psychophysiology and Biofeedback, 25, 177-191 Richard Gevirtz, Ph.D. CSPP at AIU, San Diego, CA 12/19/09 Gevirtz
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239. 12/19/09 Gevirtz Peak 78 Valley 65 LF Power Fig. 1. J&J Screen showing HR, Resp,temp, Skin Cond, and a spectral analysis. Peak valley differences are about 14 B/M (79-65), LF is .1. Breath Pacer
* 07/16/96 * ## Fig. 1. J&J Screen showing HR, Resp,temp, Skin Cond, and a spectral analysis. Peak valley differences are about 14 B/M (79-65), LF is .1.
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