Chapter 22: Listen to Your Heart and Gut

“Go to your bosom; knock there, and ask your heart what it doth know.” — William Shakespeare (1564-1616)

“Beauty is not in the face; beauty is a light in the heart.” — Kahlil Gibran (1883-1931)

Most of us are unable to localize the sensations of turmoil within our bodies. They compel us to harbor destructive thoughts and take self-destructive actions, though we usually have little awareness of the feelings themselves. This is especially true for the sensations from the thorax and abdomen. I was mostly blind to the constriction in the various organs within my chest and gut, which was unfortunate because recognizing individual sensations and tracing them back to their physical origin is key to disrupting them. And so, whenever you feel particularly stressed, take it as an opportunity to lie down and become immersed in the physical manifestations of your worry. Paying attention to the internal state of your body is called interoception. This chapter will teach you how to create an interoceptive watchtower from which to monitor your autonomic space.

Illustration 22.1: A. Digestive tract; B. Cross-section of the heart; C. Surface of the heart; D. Stethoscope.

How to Find and Quell the Pain in Your Heart and Gut

Your brain receives a continuous feed of sensory information from each muscle and most tissues in the body. In the cortex, this incoming information participates in and contributes to your conscious workspace and train of thought. Sensations of pain coactivate with whatever else is on your mind and influences it to be more negative. In other words, pain twists and distorts your thinking. Most of us don’t pay attention to these data streams and, as a result, develop a conscious blind spot (scotoma) for them. When you are blind to them, they control you without your awareness. But if you work on cultivating interoception, and combine this with relaxed diaphragmatic breathing, you gain the ability to send data back to these tissues. This feedback calms them while denying them a hold over you.
The insula and anterior cingulate cortex receive many of the interoceptive signals your body sends to your brain. Neuroscientists think of these areas as pain areas because they light up in a brain scanner when participants experience discomfort. These two areas respond to nausea, stomach pain, fullness, air hunger, food hunger, sexual longing, vibrations, menstrual cramps, butterflies in the stomach, shortness of breath, and much more. They also react to social pain triggered by separation, exclusion, persecution, or disapproval. You should be able to imagine these feelings. You are imagining them within your insula and anterior cingulate. Inhabit these brain areas and “watch” the imagery that unfolds there nonjudgmentally.
Focusing on the minutiae of your physical discomfort is the only way to rein it in. As we have seen, bodily pain involves partially contracted muscles that have reached a state of hyperfatigue. By paying attention to them, you can teach them to relax. Search for constriction, pressure, aching, and tingling. When you find them, remind yourself that they are just physical sensations. They are nothing to fear; they are “fear itself.” Remember the corpse pose and “body scan” activities that we performed in Chapter 5 to search for skeletal muscle bracing? Well, the next exercise will feel similar but focuses on bracing awareness for your smooth and cardiac muscle: your internal organs.

After several minutes lying in the dark focusing on your heart and gut, you should experience your body as a pulsating sea slug, like the one we discussed in Chapter 2. Ride with the painful retractions, don’t fight them. Depersonalize and detach from them. Don’t accept them as part of yourself.
The autonomic nervous system is composed of motor neurons that send messages to “involuntary” muscles and glands. It was long described as functioning below the level of consciousness. This is why medical researchers believed there was no way to deliberately calm these organs. Thankfully, recent biofeedback research has shown that we can gain some voluntary control over autonomic governance.1 It has also shown that merely sensing these pains is key to relaxing them. At first, you will find that many of the sensations I am describing are impenetrable to introspection. This is because they are preverbal and nondeclarative. You don’t yet have words for them and how they affect you. But, just because you cannot articulate how they make you feel, doesn’t mean you can’t feel them if you concentrate.
Think about the aspect of you that is shocked when you are immersed in frigid water or woken up by an alarm clock set too loud. It should run down the midline of your body from your neck to your lower spine by way of your chest and gut. When you locate the physical borders of this sensation, you will have found your trauma core, the cause of internal agitation that makes you feel panicky, unbalanced, and demoralized. Once you have found it, console it. Usually, you try to rise above the pain, pretending that it is not there. Dive down into it. Incorporate the meditative and mindfulness practices from Chapter 7 into this search.
While alone with your pain, you will experience boredom and impatience. It will make this exercise frustrating until you realize that the boredom is restlessness stemming from the same visceral unease you are trying to dispel. Meditating on your bodily pain can be mundane, or it can be an exciting adventure if you approach it with “shoshin.” Shoshin is a concept in Zen Buddhism meaning “beginner’s mind.” It denotes an openness, curiosity, eagerness, and a lack of preconceptions when exposed to something familiar. Imagine yourself as a psychonaut, a “sailor of the soul,” exploring your mind and body. The more you map the territory and understand the “lay of the land,” the better you will control your emotions.
Scientists know babies to be experts at self-soothing. They “listen” attentively to their sympathetic nervous system. We forgot how because as we grew up, we realized that paying attention to our internal milieu demands attentive resources. And attention is limited. Babies cannot change their environment, so they are forced to change their response to it. They have no recourse but to calm themselves. Children and adults, on the other hand, learn to change their environment and manipulate people to fix a situation. Unfortunately, by age five, we think that the best way to self-soothe is to bring about an increase in our social standing. You can, however, revert to infancy, bypass the ego and the social machinations, and take a shortcut straight to the center of the problem by confronting the tumultuous activity within your body at its source.
Cats often sit close to a wall and stare at it for minutes at a time. I used to think this was absurd. However, since I expanded my interoceptive senses, I find myself doing this sort of thing frequently—staring blankly at nothing. It is not boring to stare at a wall if you are also gazing into your visceral milieu. The more time you spend surveying and relaxing the activity in your spine, stomach, heart, face, vocal tract, intestines, and genitals, the more you can cleanse them with peace.

Myofascial Release for the Gut

I used to get regular pangs in my stomach during social confrontations. These felt like electrical shocks a few inches behind the belly button. Such pangs are caused by the clenching of the abdominals along with smooth muscle of the gastrointestinal tract. They are responsible for the sinking sensation in the pit of the stomach, resulting in a strong predilection to submit. You lose all will to fight when intense gut pain kicks in.
This visceral pain is due to the activation of latent trigger points, resulting in the stimulation of pain receptors in and around the digestive pathway. These receptors span the thorax, abdomen, and pelvis. They respond to stretching, swelling, and oxygen deprivation. The areas are in chronic pain because they have been braced for so long. Some experts believe that irritable bowel syndrome and a host of other gastrointestinal problems are exacerbated by bracing.2 In the next exercise, we will use compression to massage these bracing patterns away.

This practice pulls stress out of your body by its roots. Once you use a basketball to rid your midsection of the aching, you will vastly reduce your potential for experiencing gut-wrenching pain. The first time I deeply compressed my abdomen, I was immediately reminded of the long-forgotten feeling of being kicked in the stomach in second grade. This indicated that I was finding and releasing points of tension that I had been harboring since early childhood. As I continued, the searing discomfort in my stomach caused me to have flashbacks to other long-forgotten traumatic episodes. My brain was asking, “Hey, are you sure it’s okay to relax the abdomen to this extent given these memories?” When your brain asks you this question, reassure it that it is a-okay. This gut compression technique is powerful because, if you can get rid of the pain in your gut, you will become far less susceptible to intimidation.
The gastrointestinal tract, from mouth to anus, is 15 feet long. It is lined by a vast network of neurons, which form a regional administrative center. This amounts to a miniature brain with over 100 million neurons. This is more than the brain of a mouse, which has around 70 million neurons. This miniature brain is needed to perform various digestive behaviors with which your mind cannot be bothered. Chances are your gut’s brain has an anxiety disorder, and it braces the muscles it controls endlessly. Compressing away its bracing patterns may be the best way to communicate to this entity that there is no reason for it to be anxious.

Heart Rate

The heart is another entity within your body that you need to convince to loosen up and simmer down. Like the gut, the heart has its own neural network containing over 40,000 neurons. This is less than a fruit fly (100,000) but more than a snail (20,000). This mini-brain allows the heart to perceive and process information, make decisions, and even demonstrate a form of learning and memory.3[i] More than likely, your heart’s brain (like your gut’s brain) has become convinced that your environment is life-threatening. We need to trick our hearts into believing the opposite.
The heart is a hollow muscular organ that uses repetitive rhythmic contractions to keep blood pumping through the body’s blood vessels. Even some of the simplest invertebrate animals have hearts. Mollusks like clams, arthropods like insects, and even many types of worms have them. Some animals even have multiple hearts. The human heart beats slightly more than once every second, as many as 3.5 billion times over one’s lifetime. Each beat is powerful enough to send blood spurting up to three meters if the aorta is severed. Every hour, it dispenses around 70 gallons of blood. That’s 1,680 gallons per day. It works relentlessly. It works so much and so hard that it is imperative that it works efficiently.
The heart is composed of a special type of muscle called cardiac muscle, which operates involuntarily. Unlike skeletal muscle and the smooth muscle of the gut, the heart muscle is myogenic, which means that it can contract and relax without any input from the brain. It accomplishes this coordination of contraction and relaxation through the sinoatrial and atrioventricular nodes. These pacemakers are controlled by the sympathetic and parasympathetic systems which act as accelerator and decelerator, respectively. A heart that is biased toward acceleration is inefficient. In a sense, your life’s trauma is manifested to the extent that your heart beats faster than it should. This is expressed in the following formula:

Your current heart rate – Your optimal heart rate = Accumulated life trauma

The average resting heart rate is 60 to 80 beats per minute. Stress and anxiety cause the heart to receive too much adrenaline, which increases heart rate. Chronically high levels of circulating adrenaline cause “tachycardia,” meaning that the heart beats at an unsustainably fast rate. There is a single maximally efficient heart rate for your body size and body composition. Unfortunately, because nearly all humans are inveterate worriers, our hearts beat well above this optimal rate. Clinically, tachycardia is defined as a resting heart rate above 100 beats per minute,4 but most of us are on a “tachycardia continuum.” Even though your heart rate may be well under 100 beats per minute, it is likely above its optimal rate.

Elevated heart rate is perhaps the most detrimental form of sympathetic upregulation. Technically it is a type of stress cardiomyopathy. Aggression, anger, hate, fear, guilt, violence, and drugs all push your heart further from its ideal pace. The faster it beats, the more fatigue it experiences. Fascinatingly, the short rests between beats give your heart the microbreaks it needs to regenerate its strength. But, if your heart is always beating quickly, it misses out on these breaks. When stress is chronic, the microbreaks are vanishingly short, and the heart can never rest. The absence of downtime places excessive pressure on the muscles of the heart and the surrounding blood vessels. This becomes a never-ending marathon, during which the heart’s tissues accumulate physical damage. Unremitting elevated rate forces the heart to destroy itself. It slowly tears its own tissues apart. Chances are, right now, you are overworking your heart.

The strain of chronic accelerated heart rate causes morbidity. Morbidity is the condition of being diseased by ailments that reduce longevity. It is the extent to which we have one foot in the grave. Morbidity from elevated heart rate, excessive cortisol, and stress-related bracing is eating your body (and soul) alive. Watching that scary movie, doing that line of cocaine, and throwing a tantrum against your coworker all contribute to terminal decline. When the heart is made to work harder than it should for extended periods, it does not receive adequate oxygen or nutrients, and this can result in pain known as angina. Heart pain5 and the accompanying heart problems6 have been strongly associated with hyperventilation. This provides you with yet another good reason to breathe slowly and smoothly through your nose.
Diaphragmatic breathing may be the best way to get your heart to assume that your present reality is safe. When you take deep breaths and override the body’s preferred breathing style, you may feel small bursts of panic and a strong impulse to switch back to shallow breathing. An acceleration in heart rate is partially responsible for this panic. Resist the temptation to revert to shallow breathing. As you notice your heart speed up, mentally reassure it, “Hey, there’s nothing wrong. I’m just taking deeper breaths.”
As you breathe at longer and longer intervals, your heart will try to warn you that what you’re doing is dangerous. It assumes that you are ignoring the hostilities of your environment and overriding its defense mechanisms. This is why many patients relive past trauma while performing diaphragmatic breathing in clinical settings. In fact, therapists ask their patients to discuss the psychological associations that come to mind during abdomen expansion, including self-image, emotional release, and vulnerability. As you calmly and assuredly breathe through these, you heal yourself. By teaching your heart that long, deep breaths are safe, you also teach it that a slower heart rate is safe.

Using a Stethoscope to Find Inner Peace

Because your ticker is overworked, it hurts. Nature programmed our hearts to transmit a pain signal when beating at a higher-than-optimal rate. It communicates to the animal that it is functioning at a level of output that cannot be sustained indefinitely without serious functional compromises. The painful sensations emanating from your heart make it a fly drowning in ointment. This is the discomfort that we try to use liquor, smoking, shopping, unhealthy food, risky sex, and overstimulating media to cover up. But because the brain interprets your heart’s pain as delocalized and diffuse, you don’t even recognize it as coming from the heart.
As with the diaphragm, normally, you cannot hear or feel your heart consciously, so you are blind to your own nervous system’s two most fundamental signals. Heart rate controls and modulates behavior in countless ways, but for some reason, nature decided to mask its rate from our awareness. We can only feel it if it is beating in response to intense fear or excitement. Even then, we usually do not pay attention. How can we follow our heart if we are completely habituated to it?
Spend $10 and buy yourself a stethoscope online. Use it as a direct line to your heart. As you listen to your stethoscope, you will come to realize that your heart is like a fearful little animal inside your chest. Cravings for dopamine cause us to excite it, abuse it, poke at it, and sensitize it further to fearful stimuli. However, merely listening to it beat will desensitize you to the negative sensations emanating from it.

At first, the pain of listening to my heart made me project my discomfort onto the stethoscope itself. I felt like I hated it. Many people that I have worked with experience this, too. This happens because whatever you think about when you feel pain in your heart can easily become an object of animosity. Your mind will appraise this external object as the problem, transferring the pain onto it. Stop the overreacting. Face the pain. Coexist with it non-resistantly. Eat it with a knife and fork. When I started, each heartbeat felt like a mousetrap snapping shut inside my chest. After several weeks of Exercise 22.3, my heartbeat became the pleasurable and uplifting thump of a drumbeat.
As you listen to your heart, try focusing on your “interbeat interval.” This is the length of time between successive heartbeats. With time, you will start to notice when two heartbeats have a longer interval between them than the beats that came prior. This is when you have relaxed. Other times, this interval collapses and becomes shorter. The interval will decrease after a stressful thought. Concentrate on making the interval as long as possible. In doing this, you will be programming yourself for a slower resting heart rate and providing your heart with a longer rest period.
As you listen through the stethoscope, notice that the sound of each heartbeat coincides with a faint feeling in your chest. The stethoscope makes this invisible sensation apparent. This pairing constitutes a form of biofeedback that allows you to understand what your heartbeat feels like so that you can recognize it in the future, even without the auditory cues of the stethoscope. This will help you develop a sense of how fast it is beating. You’ll be able to compare the magnitude of the stressors in your environment to the rate of your heart to determine whether the two are commensurate. You should find that your heart is beating in a way that is out of proportion with most experiences. Unless you are having lots of fun or getting lots of exercise, you can allow your heart to beat as slowly as possible.
You can use breath-holds, like those in Exercise 11.5, to accentuate the sensations coming from your heart. Studies show that meditative breath holding makes participants more aware of their heartbeat and helps them calm the sympathetic nervous system’s reaction to it by activating the vagus nerve.7
The more time you spend listening, the more you will ask yourself, “There is nothing here for me to be afraid of, so why does it hurt and why is it beating so fast?” This is the magic question, and if interrogated enough, you will have an emotional epiphany that only this experience can provide. Repeatedly inhaling smoothly through several heartbeats in a row, then exhaling through several in a row teaches the heart, and your psyche, to let go of trauma. I recommend performing diaphragmatic breathing for at least five minutes every night before bed with your stethoscope on. I find this helps me fall into a deep, restful sleep.

To Overcome Rapid Heartbeat, You Must Overcome Fear of Death

“Think of the life you have lived until now as over and, as a dead man, see what’s left as a bonus and live it according to Nature. Love the hand that fate deals you and play it as your own, for what could be more fitting?” – Marcus Aurelius (121-180)

Interoceptive exposure to your own heart can be dreadful. In attending it, you will come face to face with your instinctual fear of death. Fear of dying perpetuates much of your heart’s unnecessary exertion. The way to escape this situation is to reach full peace with the idea of dying. Do it now. “Die before you die.” Then, you will have already done it and won’t have to spend a lifetime in fear of it. The pain in your heart, warning you of impending death, will no longer be informative.
Meditate on your mortality. Take the time now and convince yourself that you have had a good life, that you have done many worthwhile things, and if you were to have a fatal heart attack this instant, you would still feel whole, complete, and satisfied with your time on the planet. In Hinduism, it is common to look forward to death, and the liberation it brings is known as moksha. Death is thought to release us from our mundane, mortal minds and introduce us to our permanent essence. Moksha and the concepts in the next activity helped me come to grips with my own eventual demise.

I was dragged around by a large Rottweiler as a four-year-old. The dog grabbed me by the hood of my jacket and pulled me around a backyard forcefully for a few minutes. I believe the dog assaulted me because I didn’t act afraid of it. While the dog was dragging me, I realized that I might die or be badly hurt. I felt that if I surrendered, it might let up. Because I was cringing and my heart was racing, my body language caused the dog to sense that I submitted and that it won. It stopped shortly thereafter. It is common for dogs to stop attacking people that fully capitulate. Frightful situations like this one impel an archetype deep in our nervous system: “Full submission can save me from death.”
The ultimate source of submissiveness is that we feel the need to display fear of physical attack so that our attacker will decide to be merciful. We are afraid that if our heart stays slow and calm, our persecutor will kill us for our insolence. This is because when our heart speeds up, we involuntarily choke up, tremble, and give numerous other nonverbal signals of submission.
We must renounce the belief that submissive fear will buy us leniency. To do so, imagine being viciously attacked by a stranger or a predator. Neither panic nor submit. Simply imagine yourself swiftly but calmly, taking the steps needed to extract yourself from the danger. Imagine someone or something trying to kill you while you retain total peace. Your tormentor is stabbing you, and you speak to them plainly and honestly while forcefully grabbing the wrist that holds the knife. The beasts are taking bites from your body, and you deftly deliver carefully placed blows to their noses. Your attitude need not be defiant or combative. It must simply be valorous and lionhearted. Right now, commit to dying fearlessly.
Chronic accelerated heart rate is a state of vigilance guarding against impending death. But we generalize this to everyday life by resorting to high resting heart rates with our bosses, friends, and family. We are living as if we are about to die. Using the stethoscope, you are feeling the very essence of your apologetic submissiveness. Know that your racing heart is not helping to keep you alive. Rather, it is keeping you in the land of no tomorrow. Surrendering your cardiac unrest will extract you from a world of death, struggle for survival, and animals ravaging and annihilating each other.
The next time you feel your heart beating out of your chest, focus on it. Accept it, befriend it, love it. It is not there to hurt you. It is literally giving you energy and power. Within a few moments, you can transform that throbbing feeling of impending doom into motivation. People with anxiety tend to be afraid of the sensations involved in stress. Don’t let adrenaline scare you. Desensitize yourself to the discomfort by not overreacting to it, as you did in Exercise 5.2. Learn to delight in it and feel comfortable in uncomfortable physiological states. Rather than being afraid of the energy, think about how you are going to channel it.
Vigorous exercise can raise your heart rate to around its maximum. But when you exercise vigorously, you don’t feel crushed by panic. Instead, you feel vitalized. It feels normal for your heart to speed up during exercise. But when your heart speeds up in the absence of exercise, you become afraid. When this happens, tell yourself that your body preparing for exercise is nothing to fear. The more you exercise, the more comfortable you become with the sensations involved in rapid heart rate. Keep in mind that athletes have lower resting heart rates, often as low as 30 to 40 beats per minute. Consistently training the heart muscle causes it to push more blood out with each beat meaning that it does not need to beat as often. The more exercise you get, the slower your heart will beat.
Take the warrior approach to panic. Luxuriate in the thumping. Instead of causing you to withdraw in resignation, the beating should make you approach in ascendency. As discussed in the last chapter, appraise it as rising to a challenge rather than descending to a threat. Afterward, if you need to, take a run around the neighborhood to burn up any remaining negative energy.

Vagal Tone is a Measure of Calm

This section and the next will introduce two more medical concepts, vagal tone and HRV. They add detail to the present discussion and highlight the physiological benefits of paced breathing.
Vagal tone is a measure of the activity of your vagus nerve, the nerve responsible for calming you. The vagus nerve transmits a relaxing signal from the brainstem’s medulla oblongata to much of your body. This large, diffuse cluster of nerves branches out from the brainstem down to the bladder, affecting several organ systems along the way.8[i] It affects the heart, spleen, bronchioles, lungs, stomach, pancreas, liver, gall bladder, intestines, ureters, and more.
The vagus nerve also connects the head’s brain with the gut’s brain and the heart’s brain. It calms them. Its name comes from the Latin word “vagus,” meaning “vagrant” or “wanderer,” because it is so long and has so many branches. The activity of this nerve, calming multiple organ systems, is called vagal tone. High vagal tone is associated with autonomic balance, emotional stability, lowered inflammation, and better cardiovascular health. Low vagal tone causes the opposite.

Illustration 22.2: Path of the vagus nerve from brain to intestines.

Mammals have a unique branch of the vagus nerve that supports social engagement. It connects with the larynx to modulate your tone of voice and with the head to make facial expressions emotionally appropriate. When active, your vagus nerve makes your voice and face friendly and approachable.9[i] When it is at its most active your voice relaxes and you may notice an improved ability to use melody and prosody. When the vagus nerve is active, we enjoy a physiological state that supports spontaneous social engagement and intimacy. We feel outgoing rather than introverted and vibrant without being overly aroused.        

As you might have guessed, the vagus nerve is a pivotal component of the parasympathetic system and is largely responsible for lowering heart rate, breathing rate, and blood pressure. Vagal tone decreases heart rate by inhibiting the firing rate of the sinoatrial node (the heart’s pacemaker). Vagal tone also acts through the phrenic nerve to slow and smoothen the strokes of the diaphragm. When it is active you stop bracing, stop feeling the need to send submissive displays, and regain your composure.
Low vagal tone makes you feel irritated and restless. Vagal tone is reduced when the amygdala sounds its alarms. Many people who live lonely lives also have shorter lives. This may be because loneliness is associated with chronic low vagal tone. High vagal tone is the calm, pleasurable feeling you get when petting an animal, taking care of small children, or looking after a loved one. High vagal tone is correlated with purpose, love, friendliness, compassion, affection, and tenderness. If you have felt these things before, then you know exactly what vagal tone feels like. Imagine that you can feel this branching structure inside you, descending from your emotional brain down to your heart, gut, and diaphragm. You want it to feel warm and fuzzy as often as possible. Allow this feeling to help you debrace.
Vagal tone decreases with distressed breathing and increases with diaphragmatic breathing. Slow, deep breathing is one of the best ways to stimulate the vagus.10 A range of biometric responses indicates this. For instance, diaphragmatic breathing elevates hand temperature, reduces electro-dermal response, reduces high-frequency beta brainwaves, and increases calming alpha brainwaves.11 It also increases heart rate variability, which is our next topic.

Heart Rate Variability (HRV)

Want to know your level of vagal tone? Unfortunately, directly measuring vagal tone requires inserting electrodes into the nerve to test its level of activity. Since that requires invasive surgery, scientists indirectly, but accurately, measure vagal tone using the body’s ability to synchronize heart rate and breathing. This is known as heart rate variability, or HRV.
The concept of HRV, along with its relationship to health and relaxation, is strongly scientifically supported12 and it has become prevalent in stress reduction and self-improvement circles. The idea is that during negative emotions, the heart’s rhythm is erratic and disordered, resulting in low HRV. During positive emotion, the heart’s rate increases slightly during inhalation and decreases during exhalation. This equates to high HRV. Many psychophysiologists call this ordered pattern “coherence.”
Heart rate variability is used as an index to measure autonomic imbalance due to trauma.14 Vagal and HRV dysregulation are among the main clinical features of complex traumatic syndromes following early-life relationship trauma.15 Calm infants have high vagal tone and high HRV. They tend to be less irritable than other infants and have a secure attachment to their mothers. Children with high vagal tone and high HRV have less social inhibition, improved mental health, and better emotional regulation.
Having a higher HRV is associated with a healthier cardiovascular system, improved executive brain function, decreased stress, increased immune function, improved mood, and overall greater health and longevity.16 HRV declines with age and predicts future health problems.17 People with relatively low HRV are less likely to recover after a heart attack.18 Low HRV amplitude correlates with a highly elevated risk of sudden cardiac death, coronary heart disease, and mortality from a range of causes.
There are accepted ways to raise your vagal tone and HRV. First, stop obsessing and ruminating about negative things. Studies have found that daily worry is strongly associated with low HRV.19 Science also recognizes that you can increase HRV by focusing on happy thoughts, deliberately curtailing anger, and exercising regularly. But there is another way.
You can increase your HRV through biofeedback. To do this, you can purchase a pulse sensor and the accompanying software for your computer or mobile device. The application shows your heart rate variability and positively reinforces you for bringing it into coherence. This HRV biofeedback has been shown to decrease depression, anxiety, and stress.20 Take a guess at how these electronic devices coach you to raise your HRV. They do it by providing you with a breath metronome. Breathing deeply at long intervals is effective at increasing HRV. I want to encourage you to look into them, but you probably don’t need to buy an HRV biofeedback device. I believe that the paced breathing regimen set out in this book can dramatically improve your HRV.
Many scientists believe that heart rate variability is maximized at around five breaths per minute (i.e., five-second inhalations and seven-second exhalations).21 Breathing deeply at this rate allows your heart rate to drop 10 to 20 beats per minute at the end of every exhalation. This drop in heart rate during exhalation gives your heart the microbreak it needs to regenerate properly and beat sustainably. Breathing shallowly at something like 15 breaths per minute decreases HRV by keeping your heart rate from dropping with every exhalation, sacrificing the critical rest period.
Bracing the diaphragm during the exhalation may also cause us to miss that rest period. Breathing Exercise 5.1 asks you to allow your diaphragm to go limp throughout each exhalation. After you do the work of inflating your lungs, the air pressure itself should do the work of deflating them. I believe that allowing your lungs to deflate passively during exhalation may not only give your breathing muscles a short respite, but may also allow your heart to slow down during the exhale, increasing HRV.
The relaxing effects of paced breathing on the heart are also seen in blood pressure.  Several experimental studies have published results showing blood pressure to be reduced when participants breathe at a rate of six breaths per minute, with the exhalations longer than the inhalations. In one study, paced breathing for merely 15 minutes resulted in elevated mood, higher HRV, and lower blood pressure.22 Another study had patients perform paced breathing twice a day for three months. They experienced significant drops in blood pressure that would be expected in an individual taking one or two blood pressure medications.23
Don’t drive your heart like it’s a car that you stole. Stop redlining, downshift, and put less wear and tear on the vehicle.


The commotion of distressed breathing causes so many sensations within your chest that it completely obscures your heartbeat. If you can’t feel the pain in your heart, you can’t correct its overreactions, and they will continue to mount. When you are ignoring the pounding in your chest, your body is going to assume that this is because your current situation is so desperate. Like running on a broken leg, this should only happen during life-or-death situations, never on a daily basis.
Paced diaphragmatic breathing is so smooth and quiet that it allows you to feel your heart beating in your chest. In other words, long, deep breaths make your heart rate apparent to you so that you can tell whether it is beating too fast and make the necessary corrections. Of course, paced breathing with a stethoscope magnifies this even more. Find the pleasure in slow breathing, find the bliss in a slow heartbeat, and find the combination of the two as nourishment.

Chapter Twenty-Two: Bullet Points

  • Interoception is the ability to perceive the sensations going on within your body. Developing interoception will allow you to learn how to unbrace your internal organs.
  • Preexisting tension in your abdomen combined with stress causes that sinking feeling in the pit of your stomach.
  • Compressing your abdomen with a basketball will relieve this tension and make you immune to gut-wrenching episodes.
  • Your heart chronically beats too fast, causing cumulative damage to it.
  • If you listen to your heart with a stethoscope, you should be able to sense that it is beating too fast and out of proportion with environmental demands.
  • Listening to your heart with a stethoscope while paced breathing provides a form of relief that you cannot get anywhere else.
  • As you do this, imagine breathing into and out of your heart.
  • Paced diaphragmatic breathing causes your heart to slow, your vagal tone and HRV to increase, and your blood pressure to decrease.
  • Tell yourself that you are the kind of person whose heart beats slowly.
  • Your thought process is playing a game of table tennis with your diaphragm. Your heart is the ping pong ball. Each time the ball strikes a paddle, you have a heartbeat. Right now, they are playing at a furious pace and none of the players are enjoying themselves. You want to slow them down. You want them to be lobbing the ball to each other, keeping an easy volley going, and having a fun, non-competitive game.


  1. Schwartz, M. S., & Andrasik, F. (Eds.). (2003). Biofeedback: A practitioner’s guide (3rd ed.). Guilford Press.
  2. Whatmore, G. B., & Kohli, D. R. (1968). Dysponesis: A neurophysiological factor in functional disorders. Systems Research and Behavioral Science, 13(2), 102–124.
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