22. Interoception for the Heart and Gut

Interoception for the Heart and Gut

Most of us are unable to localize the sensations of turmoil within our bodies. They compel us to take self-destructive actions and have destructive thoughts, but we have very little awareness of the sensations themselves. This is especially true for the sensations from the thorax and abdomen. I was mostly blind to the constriction in the various chakra-like modules within my chest and gut. Developing awareness is necessary if you want to gain the ability to quell your stress response. Whenever you feel particularly stressed, take the opportunity to lie down and become immersed in it. Being able to recognize individual sensations, and trace them back to their physical origin within your body, is key to disrupting them. Paying attention to the internal state of your body is called interoception. This chapter will teach you how to create an interoceptive watch tower from which to self-monitor your autonomic space.

How To Find and Quell The Pain in Your Heart and Gut

There are many scientifically recognized senses beside the 6 senses. In fact, your brain’s neocortex receives a continuous feed of sensory information from each muscle and most tissues in the body. In the cortex this information participates in and contributes to your conscious workspace and stream of thought. Sensations of pain coactivate with whatever is on your mind and influences it to be more negative. Pain twists and distorts your thinking. Most of us don’t pay attention to these data streams and thus develop a conscious blind spot (scotoma) for them. When you are blind to them they can 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 will help you calm them.

Focusing on the minutia of your physical discomfort is the only way to rein it in. These pains involve partially contracted muscles that have reached fatigue. By paying attention to them you teach yourself to let them relax. This is autonomic learning. Remind yourself that they are just physical sensations. They are nothing to fear, they are “fear itself.” With time you will overcome them. Search for constriction, pressure, aching, tingling. Think of it as soul searching. Remember the corpse pose and “body scan” activities that we performed in Chapter 5 to search for skeletal muscle bracing? Well, the next exercise is very similar but focused on awareness of bracing for your smooth and cardiac muscle: your internal organs.

Interoception Exercise #1: Listen to Your Heart and Gut
Find a dark room where you can lay down on the floor and feel totally secure. Bring a breath metronome with you. Bed down and try to relax completely. Notice that partially contracted and quivering muscles in your chest and abdomen keep you from being able to relax. Build as much mental imagery around these sensations as you can. Imagine their location in space. Track their changes through time. Notice how separate modules interact and affect each other. Pay close attention to how paced breathing calms them. Work on gaining bidirectional control over these modules in the same way that you are able to tense and relax your hand.
Duration: Five minutes. Proficiency: Two sessions per week for six weeks. Maintenance: Once per month.

Not only does autonomic space take skill to perceive, it takes skill to control. The autonomic nervous system was long described as functioning below the level of consciousness. It is composed of motor neurons that send messages to “involuntary” muscles and glands. Medical researchers were convinced that there was no way to deliberately affect them. But biofeedback research in the last few decades has shown that we do have voluntary control over autonomic governance (Schwartz & Andrasik, 2003).

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 are not able to put into words how they affect you. But just because you cannot articulate how they make you feel doesn’t mean that you can’t feel them if you concentrate.

Many of the interoceptive signals sent to the brain are received by the insula and anterior cingulate cortex. Neuroscientists think of these areas as pain areas because they light up in a brain scanner when participants experience discomfort. These two brain areas respond to nausea, stomach pain, fullness, menstrual cramps, food hunger, air hunger, sexual longing, vibrations, butterflys in the stomach, shortness of breath, and much more. They also respond to social pain triggered by separation, exclusion, persecution, or disapproval. Inhabit your insula and anterior cingulate and “watch” the imagery unfold there. After several minutes lying in the dark focusing on your heart and gut you should experience your body as a retracted, pulsating, sea slug similar to the one we discussed in Chapter 2. Ride the pain, don’t fight it. Depersonalize it, detach from it, and don’t accept it as part of yourself.

Think about the aspect of you that is shocked when you are woken up by an alarm clock that is set too loud. It should run down the midline of your body from your neck, through your chest and gut, to your lower spine. Locate the physical borders of this module. This is your trauma core, the cause of internal turmoil that makes you feel panicky, unbalanced, and demoralized. Find it and console it. Usually you try to rise above the pain, pretending that it is not there. Dive down into it. Incorporate the meditative practices from Chapters 5 and 7 into this search.

While alone with your pain you will experience boredom. It will make this exercise frustrating, until you realize that the boredom is actually restlessness stemming from the same visceral unease that 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 is an attitude of openness, curiosity, eagerness, and lack of preconceptions when exposed to something familiar. Imagine yourself as a psychonaut, a “sailor of the soul,” exploring your own mind and body. The more you map the territory and understand the “lay of the land” the better able you will be to control your emotions.

Cats, including my own cat, often sit close to wall, and stare at it for minutes at a time. I thought this was absurd and I couldn’t understand why a cat would do this. However, since I have 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 staring into your visceral milieu. The more time you spend surveying the activity in your spine, stomach, heart, face, vocal tract, and genitals the more you are able to cleanse them with peace.

Babies are known by scientists 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 attentional resources are limited. Babies cannot change their environment, so they have to change their response to it. They must calm themselves. But children and adults learn to change their environment, and manipulate people, in order to fix a situation. Unfortunately, by the age of 5 we think that the best way to self-soothe is to bring about an increase in our social standing. But you can revert to infancy, skip the ego, take a shortcut straight to the source of the problem, and confront the tumultuous activity within your own body at its source.

Myofascial Release for the Gut

I used to get regular pangs in the stomach during social confrontation. It feels like an electrical shock a few inches under the belly button. This is caused by the clenching of smooth muscle in the abdomen and gastrointestinal tract. It is responsible for the sinking sensation in the pit of the stomach. It results in a strong predilection to submit. You lose all will to fight when gut pain kicks in. This visceral, nociceptive pain is due to the activation of pain receptors in and around the digestive tract. 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 this form of bracing (Whatmore & Kohli, 1968). In the next exercise we will use compression to massage this pain away.

Interoception Exercise #2: Compressing the Internal Organs
Lay over a basketball and press it gently into your stomach. You can do this lying on the floor or in the bed. You can also stand or kneel by the corner of a bed, place the basketball in that corner and drape the upper half of your body over it. Either way you want to be able to have good control of how deep you press the ball into your abdominal cavity. It is important to be stable and comfortable. The discomfort that this causes in your stomach may be very intense at first. Proceed gently and focus on applying pressure to the abdomen from the bottom of the ribs to the pelvis. You should notice that the tension here will not give unless you are breathing slow, smooth breaths. Relax, pace breathe, and unwind the vice clenching your innards.
Duration: Five minutes. Proficiency: One session per week for six weeks. Maintenance: Once per month.

This practice pulls stress out of your body by its roots. Once you use a basketball to rid your gut 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 sensation of being kicked in the stomach in elementary school. This indicated to me that I was finding and releasing points of tension that I have been harboring since early childhood. This technique is powerful because if you can get rid of the pain in your gut, you will become nearly impossible to intimidate.

The gastrointestinal tract from mouth to anus is 15 feet long, and 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. The miniature brain in your gut performs various digestive behaviors with which your mind cannot be bothered. Chances are your gut’s brain has an anxiety disorder, and causes the muscles it controls to brace tediously. 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 a hollow muscular organ that pumps blood through blood vessels by repetitive rhythmic contractions. 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 have multiple hearts. The human heart beats slightly more than once every second, about 1,000 times per day, as many as 3.5 billion times in the course of a life. Each beat is powerful enough to send blood spurting up to three meters if the aorta is severed. And every hour it dispenses around 260 liters of blood. It works relentlessly. It works so much, and so hard that it is imperative that it work efficiently.

The heart is composed of a special type of muscle called cardiac muscle which works involuntarily. Unlike skeletal muscle, and the smooth muscle of the gut, heart muscle is myogenic which means that it is able to contract and relax without any input from the brain.  It accomplishes this coordination of contraction and relaxation through the use of two groups of tissue, the sinoatrial and atrioventricular nodes. These pacemakers are controlled by the sympathetic and parasympathetic systems which act as accelerator and decelerator respectively. An accelerated heart is an inefficient heart.

Any type of sympathetic upregulation results in persistent over-activation of the cardiovascular system causing your heart to beat too fast. Aggression, anger, hate, fear, scary movies, simulated violence, drugs all push your heart further from its ideal rate. The faster it beats the more fatigue it experiences. The short rests between beats gives your heart the microbreak it needs to regenerate its strength. But if your heart is always beating fast, it misses out on these breaks. When stress is chronic, the microbreaks are very short, or nonexistent, and the heart can never rest. This places excessive pressure on the muscles of the heart and the surrounding blood vessels. Unremitting stress literally forces the heart to destroy itself. It slowly tears itself 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, and the extent to which we have one foot in the grave. Watching that scary movie, doing that line of cocaine, 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 pectoris. This pain (Miller, 2011) as well as heart problem in general (Clark, 1997; Fanfulla, 1998) have been strongly associated with hyperventilation.

The heart has its own nerve nuclei 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 sense, process information, make decisions, and even demonstrate a form of learning and memory. More than likely, your heart’s brain (much like your gut’s brain) has become convinced that your environment is life-threatening. We need to trick our hearts into believing the opposite. Again, paced breathing is the answer.

When you take deep breaths and override the bodies preferred breathing style, you feel small bursts of panic and a strong impulse to switch back to shallow breathing. This panic is caused by an acceleration in heart rate. Resist the temptation to revert to shallow breathing. As you notice your heart speed up mentally reassure it, “Hey, there is nothing wrong, I am just taking deeper breaths.”

As you breathe on longer and longer intervals, your heart will try to warn you that what you are doing is dangerous. It assumes that you are ignoring the hostilities of your environment and overriding its defense mechanisms. Many patients re-experience past trauma performing diaphragmatic breathing in clinical settings. In fact, the therapist will ask their patient 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 little bursts of panic, 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

Your ticker hurts. The painful sensations emanating from your heart make it a fly drowning in ointment. This is the discomfort that you try to use drink, smoking, shopping, food, sex, and overstimulating media to fight. The emotions that arise due to it possess you to do bad things. But because your heart’s pain is interpreted by the brain as delocalized and diffuse you don’t even recognize it as coming from the heart.

Stress and anxiety cause the heart to receive too much adrenaline, which increases the heart rate. This adrenaline causes “sinus tachycardia,” forcing our heart to beat at an unstable, 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 heartbeat above 100 beats per minute, 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 far above its optimal rate. Nature programmed our hearts to transmit a pain signal when beating at a rate that is higher than optimal. It communicates to the animal that it is functioning at a level of output that cannot be sustained indefinitely without serious functional compromises. This pain in your chest is the signal of compromise.

Normally, you cannot hear or feel your heart consciously, so you are mostly blind to the most fundamental signal of your own nervous system. Your heart rate controls and modulates your behavior in countless ways, but for some reason, nature decided to mask its rate from our conscious awareness. We can really 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’ll come to realize that your heart is like a fearful little animal inside your chest, and that you are constantly doing things to excite it, abuse it, poke at it, and to further sensitize it to fear stimuli. Listening to it beat will desensitize it and desensitize you from the negative sensations emanating from it.

Exercise #3: Listen to a Stethoscope to Desensitize Yourself to Your Heartbeat
Find a dark, safe place to listen to your heart with a stethoscope. What is your first impression of your heartbeat? Does it hurt? Does it feel like it is beating too fast? Practice paced breathing while being exposed to your heartbeat. Imagine that you are breathing in and out through the area surrounding your heart. This will bring awareness to the heart beat. Notice your tendency to switch to shallow breathing whenever your heart speeds up. Ignore this inclination and continue to breathe calmly no matter what you heart does. Next notice how a particularly heavy or painful heartbeat has a tendency to cause you to switch from exhalation to inhalation or vice versa. Don’t let these small bursts of pain control your breathing. Your inhalations and exhalations should be influenced by air hunger, not by heart rate.
Duration: Five minutes. Proficiency: Seven session per week for six weeks. Maintenance: Four times per month. Five stars.

At first, the pain of listening to my heart made me project my discomfort on to 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 becomes an object of animosity. Your mind will appraise this external object as the problem, transfering the pain onto it. When I started, each heartbeat felt like a mouse trap snapping shut in my chest. After several weeks of Exercise 3 my heartbeat became the pleasurable and uplifting thump of a drum beat.

As you listen to your heart, try focusing on your “inter beat 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 your mind and body for a slower resting heart rate.

As you listen through the stethoscope, you will notice that the sound of each heartbeat is paired 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 help of the stethoscope. As you listen you will be able to tell exactly when it is beating, and 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 in order to determine whether the two are commensurate. You should find that your heart is beating in a way that is out of proportion with the experience. Unless you are having lots of fun or getting lots of exercise, you can allow your heart to beat as slowly as possible. In a sense your life’s trauma is manifested in 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 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. You will realize that your body is in a form of anxious overdrive and that you can allow your heart, and the entire sympathetic branch of your autonomic nervous system to reset to a lower, more peaceful level.

Inhaling smoothly through several heartbeats in a row and exhaling through several in a row repeatedly teaches the heart –and with it 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 that after 5 minutes of this, I fall into a deep and restful sleep.

To Overcome Rapid Heartbeat You Must Overcome Fear of Death

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 your heart’s unnecessary exertion. The way to escape this situation is to reach full peace with the idea of dying right now. Die before you die. Then you have already done it and don’t have to spend a lifetime in fear of it. Then the pain in your heart is no longer informative.

I was drug 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 think 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. However, I knew its owner and assumed that trying to fight the dog would only make the situation worse. 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 act fearful. Situations like this one activate an archetype deep in our nervous system: “Full submission can save me from death.”

The ultimate source of everyone’s fear and pain is that we feel the need to display fear of physical attack so that our attacker will take mercy on us. We are afraid that if our heart stays slow and calm that our persecutor will kill us. We must renounce this submissive heart posture. To do this imagine being attacked to death by a stranger or predator. Neither panic nor submit. Simply imagine yourself swiftly, but calmly, taking the steps you need to take to extract yourself from the dangerous situation. 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 wolves are taking bites from your body and you are deftly delivering carefully placed punches to their noses. Your attitude need not be defiant, or angry. It must simply be unafraid.

Chronic panicked heart rate is a state of being afraid of impending death. We are living as if we are about to die. Using the stethoscope, you are feeling the core of your apologetic submissiveness. Know that your racing heart is not helping to keep you alive. Surrendering the visceral unrest will extract you from a world of death, struggle for survival, and animals ravaging and annihilating each other.

Return to the breath holding exercise (Breathing Exercise 8) in Chapter 11 to accentuate this feeling. I should mention that studies show that meditative breath holding makes participants more aware of their heartbeat, and helps them calm the sympathetic nervous system reaction to it by activating the vagus nerve (McKeown, 2015).

Exercising vigorously can raise your heart rate to around its maximum rate. But when you exercise vigorously you don’t feel crushed by panic. Instead you feel good. The more you exercise the more comfortable you become with the sensations involved in rapid heart rate. Take the warrior approach to panic. Relish the thumping. Instead of causing you to withdraw in submission the beating should make you approach in dominance. The next time your heart blasts off from confrontation or the threat of violence, tell yourself, “This is just how I feel before I get some real exercise. Maybe I am about to really exert myself. This should be interesting. Let’s see.” …And then whether you end up having to act in self-defense or not, take a run around the neighborhood and burn up all that negative energy.

Anxiety is also associated with cognitive morbidity. People with anxiety disorders have decreased reaction time on complex cognitive tasks and this is thought to derive from noise in the anxious individual’s information processing stream. Stress causes instability in basic cognitive operations. When you are in the dark try to quiet this mental noise with proper breathing, zero reactivity, and a nonjudgmental awareness of the pressure on your mind to keep switching between neurotic thoughts and impulses.

Vagal Tone is a Measure of Calm

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 medulla oblongata of the brainstem to much of your body. This large, diffuse cluster of nerves branches out from the brainstem all the way down to the bladder effecting a number of organ systems along the way. High vagal tone is associated with autonomic balance, lowered inflammation, lowered heart rate, cardiovascular health, and emotional stability. Low vagal tone, the opposite.

Mammals have a unique branch of the vagus nerve, which no other animals have, that supports the “social engagement system.” It connects with the larynx to modulate the tone of voice, and with the head to guide the facial expressions. This brings our voice and our facial expressions in line with our underlying emotions (Porges, 2001). This is why when you are anxious it is apparent in your face and voice, whereas this is not the case in lizards. The vagus nerve also connects the head brain with the gut brain.

As you might have guessed, the vagus nerve is a key component of the parasympathetic system and is largely responsible for lowering heart rate and blood pressure. Heart rate is normally controlled by multiple centers in the brainstem, one of these, the nucleus ambiguus, increases parasympathetic input to the heart (calming it). It does so via the vagus nerve. Vagal tone decreases heart rate by inhibiting the firing rate of the sinoatrial node (the heart’s pacemaker). It also interacts with the phrenic nerve, the nerve that controls the movement of the diaphragm.

You probably already know what high vagal tone feels like. It is the warm, fuzzy feeling you get when petting an animal, taking care of small children, or looking after a loved one. Low vagal tone on the other hand makes you feel irritated and restless. Vagal tone is reduced when the amygdala sounds its alarms. Many people that live lonely lives also have shorter lives. This may be due to the fact that the loneliness is associated with chronic low vagal tone. On the other hand, studies have suggested that caring for small children results in high vagal tone. Vagus activity is correlated with purpose, love, friendliness, compassion, affection, and tenderness. Imagine that you can feel this branching structure inside of you descending from your emotional brain to your heart and gut. You want it to feel warm and fuzzy as often as possible.

Vagal tone decreases with thoracic breathing and increases with diaphragmatic breathing. It is thought that slow, deep breathing stimulates the vagus nerve (Lichstein, 1988). In fact, the stimulation of the vagus by diaphragmatic breathing can be shown by a range of biometric responses. For instance, diaphragmatic breathing elevates hand temperature, reduces electro-dermal response, reduces high-frequency beta brainwaves, and increases calming alpha brainwaves (Elliott & Edmonson, 2006). It also increases heart rate variability, our next topic.

Heart Rate Variability

Want to know your level of vagal tone? Unfortunately, vagal tone cannot be measured directly without invasive surgery. You would have to insert electrodes into the nerve to test its function. However, the body’s ability to synchronize heart rate with breathing is an indirect but accurate measure of vagal tone. This is known as “heart rate variability” also known as HRV. HRV is strongly scientifically supported and it has become very popular in stress reduction and self-improvement circles.

During negative emotions, the heart’s rhythm is erratic and disordered resulting in low HRV. During positive emotion, the rhythm is ordered in a very specific way. The beats per minute increase during inhalation and decrease during exhalation. This results in high HRV. Many psychophysiologists call this ordered pattern “resonance” or “coherence.”

Heart rate variability is used as an index to measure autonomic imbalance due to trauma, and is considered an important marker of stress resilience (Thayer & Brosschot, 2005; Appelhans & Luecken, 2006). Autonomic, vagal, and HRV dysregulation are among the main clinical features of complex traumatic syndromes following early-life relationship trauma (Van der Kolk, et al., 1996). Calm infants have high vagal tone and high HRV. They tend to be less irritable compared to other infants and have a secure attachment with 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 (Luskin et al., 2002; McCraty et al., 2003). HRV declines with age, and is a predictor of future health problems. People with relatively low HRV are less likely to recover after a heart attack (Kristal-Boneh, et al., 1995). Low HRV amplitude correlates with highly elevated risk of cardiac sudden death, coronary heart disease and mortality from a range of causes. Luckily you can change your HRV. Science currently 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 biofeedback. To do this you have to purchase a pulse sensor and software for your computer or mobile device. The program shows you your heart rate variability and positively reinforces you for bringing it into coherence. HRV biofeedback has been shown to decrease depression, anxiety, and stress (Suarto et al., 2012). Take a guess at how these electronic devices raise HRV. They do it by providing you with a breath metronome. Breathing deeply on long intervals actually increases your HRV. You don’t necessarily need to buy an HRV biofeedback device. According to the medical literature I have read, and I have read a lot, the paced breathing regimen set out in this book should improve your HRV.

Breathing Exercise 13 from Chapter 11 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 think that controlling the exhale by bracing the diaphragm keeps the heart from slowing down during the exhalation, and thus keeps HRV low. Allowing your diaphragm to go limp during the exhalation may provide the relaxation necessary to slow down your heart.

Many scientists believe that heart rate variability is maximized at around 5 breaths per minute (i.e. five second inhalations and seven second exhalations) (Elliott & Edmonson, 2006). Breathing deeply on long intervals allows your heart rate to drop 10 to 20 beats per minute at the bottom of every exhalation. This drop in heart rate during the exhalation gives your heart the rest, or microbreak, it needs to regenerate properly and beat sustainably. Breathing shallowly at 15 breaths per minute decreases HRV and thus keeps your heart rate from dropping with every exhalation, sacrificing this important rest period.


Tumultuous thoracic breathing causes so many sensations within your chest that it completely obscures your heartbeat. When you can’t feel the pain in your heart, you can’t correct its overreaction, and it will continue to mount. The rest of your body doesn’t know that you can’t hear your heart, so it assumes that you are simply ignoring it because the current situation is so desperate. Like running on a broken leg, this should only happen during life or death situations.

Diaphragmatic breathing is so smooth that it allows you to feel your heart’s rhythm. In other words, long deep breaths make your heart rate apparent to you so that you can tell if it is beating too fast. Once you can feel it, you can perform corrections to its overreactions. A stethoscope magnifies this even more. Find the pleasure in slow breathing, find the bliss in slow heartbeat, and find the combination of the two as nourishment.

Chapter 21: Bullet Points

  • 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 these gut wrenching episodes
  • Your heart chronically beats too fast and this causes accumulating damage to it
  • Diaphragmatic breathing causes your heart to slow, and your vagal tone and HRV to increase
  • If you listen to your heart with a stethoscope you will be able to hear that it is beating too fast, and out of proportion with the environment
  • Listening to your heart with a stethoscope while paced breathing may provide relief
  • As you do this imagine breathing into and out of your heart
  • Tell yourself that you’re the kind of person whose heart beats slow