In Your Pants with Dr. Susie G - Activating your parasympathetic nervous system

Episode Date: March 10, 2020

  Yoga postures give you more than a stretch or workout: you're actively changing your neurological platforms (aka how you experience the world) while moving your body. On today's episode with Marlysa Sullivan, we're sharing how yoga impacts the parasympathetic nervous system and how you can activate it at home. Everyone experiences the same benefits on the mat (which are starting to be noticed by the scientific community too!), and everyone who starts to practice yoga chooses to continue to roll out their mat because it makes them feel good physically, emotionally, and mentally. We'll also chat about polyvagal theory and what is its significance for physical, mental, behavioral health and physical therapy!

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to another In Your Pants podcast episode. I am so glad that you're here with us today and thank you so much for listening. Thank you. So on today's episode, we're going to be talking about yoga, but we're going to be tying in some of the science behind yoga because there's so much yummy research that shows yoga or other mind-body therapies actually impact our neurophysiology. It impacts our nervous system,

our immune system, our cardiovascular system, our respiratory system. I can go on and on and on, but I'm going to let our guests do that actually. Some of the topics that we'll be covering are polyvagal theory and what it is, how we can incorporate mind-body therapies like yoga to help with our overall well-being and also how it influences our pain and how we experience pain in the world. So such a great show. Our guests really take such a very, I think, complex topic and narrows it down so well into bite-sized information that you can understand. And also we're going to provide some practical tips that you can use in your everyday life to help integrate your world, really, and enhance your well-being. So without further ado, I'd like to formally

introduce Marlisa Sullivan, who is our guest today. She is an assistant professor of yoga therapy and integrative health sciences at Maryland University of Integrative Health. She's a physical therapist and a yoga therapist. She's also a researcher and author, and we'll be talking about her paper that she did with her colleagues, including Stephen Porges, who is the pioneer of polyvagal therapy, which we'll be getting into. And anyway, without further ado, I can't wait to bring Marlisa on the show. So I hope you enjoy this episode just as much as I did. Good morning, Marlisa. Thank you so much for being on the In Your Pants podcast show with me. Thank you. I'm happy to be here. Thanks for inviting me.

This is exciting because this is a topic that's near and dear to my heart as a yoga teacher now, and I've been practicing yoga for the past decade. I'm so excited to see that there's literature, evidence, research being done to support yoga as a philosophy and also as a practice for well-being. Well-being and also how it relates to the nervous system and your immune system and all those fun things that we'll probably talk about. But before we get into the details, Marlisa, tell me how you got into this work as a physical therapist yourself and a yoga therapist. How did you come across doing this research? Well, so I've been a PT for like a little over 15 years. And even when I started like physical therapy school, I was doing a little

bit of yoga, like practicing it at home. And then once I started practicing as a physical therapist, I did mostly like outpatient orthopedic working with pain conditions. And I was really interested in like the, I had studied medical anthropology before that. So I'd always been interested in and kind of like how our emotions and our beliefs about health and healing impact our well-being and our health and healing. So I wanted to find a way to approach like the psychological, the emotional, especially those components that were so apparent in people with chronic pain, like how I could do that as a physical therapist, not a psychotherapist. And so that led me into deepening my yoga practice and kind of seeking out yoga teachers and yoga trainings that

focused on more of the energetic, the psychological, the philosophical, so that I could really begin to see how I could do that within my scope of practice and within my place in someone's healing process as a physical therapist. So I became involved in the field of yoga therapy. And like you said, exactly. It's like this idea that the practices are within a philosophical context and when we practice them within that context they can be so much more powerful um and so i i sought out different yoga therapy trainings um i was on the standards committee that created the standards for yoga therapy for like the accreditation of schools and the certification of individuals um and then and um i just kept with my you know private

practice. And then eventually that led to, you know, becoming a yoga therapist and teaching in yoga therapy programs and my position at University of Maryland, Maryland University of Integrative Health. Wow. That, what an amazing journey. That's great. And could you tell our listeners what the difference is between yoga therapy? Is there a difference between being a yoga therapist or yoga teacher? Yeah, it's, um, and that's something that like both fields, yoga and yoga therapy are continuously defining right now but the um the difference is that a yoga therapist has 800 hours of training beyond their 200 hour yoga teacher training um and so they're really learning how to apply the philosophy and the practices um for the individual um and they're

learning about different kinds of medical conditions and the neurophysiology of of the person, of the human being, but also the effect of the practices so that they're integrating yoga philosophy practices and biomedicine to create an individualized plan. So there is like some overlap, but then there's yoga therapists just go into a really detailed training to really be able to individualize to different patient populations. Oh, that's so wonderful. It's probably on my bucket list next. I just finished my 200 hour. That was the beginning. So I'm super excited and I'm so glad we're talking about this. So speaking of the physiology and the biomedical aspects of the benefits of doing yoga and not just the asanas or the postures, right? It's the whole

framework of which yoga is, I guess, built upon and practiced. So could we probably go into that a little bit? You mentioned in your paper, and I'll state this paper, Marlisa was part of this paper called Yoga Therapy and Polyvagal Theory, The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. I mean, that topic alone, everyone like, amazing. And this was a study conducted with Stephen Porges, who is a pioneer in polyvagal theory. And Marlisa, I'm going to have you take it away. Let's kind of start there. what is polyvagal theory and why is it important? Yeah. So just interrupt me whenever or ask me any questions as I talk. And so one of the importances of understanding polyvagal theory is the idea that

the autonomic nervous system connects all the systems of our body. So from our autonomic nervous system, our digestion is affected, our cardiovascular system, our musculoskeletal system, like the amount of tension we're holding in our muscles. So our inflammatory immune processes. So it really connects all the systems of the body, but it also connects that with our emotions and our thoughts and our mind. So that it's this link between our mental processes and our physiological processes. And together that then connects our behavior. So for example, when we're in that fight or flight response, we're going to have the mobilization of our systems in order to act in order to act in a way that ensures our survival.

So our physiological systems are activated. Our emotions are going to be more like anger or fear or worry. And our behaviors are going to be such that we can mobilize and act out those emotions and activations. So the autonomic nervous system is this link between our behavior, our emotions, and our physiology. And there's a good body of research talking about how when we learn to regulate our nervous system, like to come into that parasympathetic response,

that we have a decrease in the stress response, decrease in allostatic load, and it creates greater health and greater well-being in many diagnoses. So it's kind of a link between chronic conditions and helping to decrease inflammation, support the immune system, support the digestive system, and create positive psychological experiences. So then polyvagal theory comes and really deepens that idea and says that we have these underlying neural platforms from which we affect our body systems, our mental processes, emotions, and behavior. And instead of just saying like the sympathetic and the parasympathetic, it's really looking at like they're not dichotomous or antagonistic. And there's

really this interplay between them. And one of the things that Stephen Porges found is that the vagus nerve actually has two origination sites that help to create two different parasympathetic responses so we have like what we consider this optimal parasympathetic response which he calls a social engagement system and so it's um a result of of the of um a part of the vagus nerve being activated but also some other nerves so like this whole neural network that allows us to have calm, optimal relaxation response in our body. And then we're more likely to experience things like compassion and empathy. It connects to our facial expression so that we can have more calm, connected facial expressions. It changes the contraction of our

throat muscles so we have greater vocal prosody. And it attunes our hearing to human sound out of white noise. So when that whole neural network is engaged, like when we perceive safety in our environment, that neural network engages. So we both can like connect to other people and then portray safety to other people. And then we have like the sympathetic, which is what we think of as a sympathetic, the fight or flight, that activation that I just spoke of. But there's also this interplay. So when we are doing a sport or dance, or when we're in some creative endeavor like painting we have some of that optimal safety parasympathetic response but we also have a little bit of mobilization of our system so we can have them interacting to create safety and mobilization

at the same time well and that's sorry i don't mean to interrupt you but um and that's it's very similar with sexual function okay right like so you have to be in that rest and um relaxation phase to feel safe to to have to to have sex or be aroused right it has to be relevant um if that's not happening where your environment isn't safe well then that there's no energy for that right now yeah um and then even you know going to um for men in particular ejaculation um that it's almost as it was said and i and i actually there's a paper that not too long ago came out that said the genitals or the erectile tissue are actually all driven by sympathetic processes, which is before we were thinking it was parasympathetic and sympathetic. But there was a paper that came

out that said that actually it's all sympathetically driven. And the inhibition of that process based on what you're talking about might be playing a role. But anyway, I thought I'd chime in about that because sexual function actually works on these same processes that you're talking about yeah and then one of the um so one of the other neural networks that steven talks about he actually links um to like um intimacy and sexual function as well which is safe immobilization where like there's this other um so it'd be interesting to see if that combination of safe mobilization and safe immobilization that um we can have that experience of safety but the other part of the vagus nerve is responsible for slowing down our systems to

the least amount necessary for survival so like um in its in its um imbalance form which is called uh uh defensive immobilization it's kind of like it's like the death feigning so when a cat catches a mouse the mouse will like lower it won't consciously do it but the mouse lowers its um body temperature heart rate um breath rate so much so that the cat thinks it's dead and the cat lets it go and then the mouse can run off um so that's in that's an extreme life threat but then there's this ability to where he talks about um possibly an intimacy and even orgasm that there is that that immobilization but in safety right right and the key word here being safety right being safe being safe to be vulnerable to be heard to be trusted it's it's it's not in a vacuum

needless to say yeah and you know yoga from a yoga standpoint like i was i was talking to deb dana who also she's worked with him a lot and she has a book um on clinical applications of polyvagal theory um and we were talking and she was saying that um like in meditative states we often come into those experiences of immobilization but safety at the same time And there's that similarity with that. Oh my gosh, that's awesome. Oh, and I just pulled up that paper. It's this called The Sacral Autonomic Outflow is Sympathetic. And that is by Espinosa Medina and colleagues. So if you're ever interested, it kind of goes into the science behind that. Yeah, I'd love to read that. Anyway, for any listeners who are wanting to geek out on some

and some science. Awesome. Okay, great. Well, so moving on to, okay, so that's all yummy. Let's kind of combine it with, well, how does, and you alluded to this a little bit already, but how does yoga therapy intersect with the polyvagal theory and why is that important? Yeah. So one of the things that yoga teaches is that everything that is material nature are the things that change. So anything that begins, is born, changes, fluctuates, and then falls away and decays or diminishes is what's called material nature or prakriti. And then, so we have our prakriti, which is our physical body, our thoughts, our emotions, the whole environment outside of us, everything that changes. And then we have our essential nature, which we could call purusha, which is this part of us that is unchanging, this non-changing essence of who we are. um and that all of prakriti material nature is made up of what are called the gunas or these

qualities um and the qualities are that of lucidity or clarity or luminosity which is called sattva um that of activation anything from creativity to anger and agitation which is rajas and then um the quality of stillness or tamas which is anything from stillness to like obscuration dullness so within that it's really like a very and so one of the similarities is that um instead of looking at um so one of the things that polyvagal gives us is that instead of having to um look at like what's happening behaviorally what's happening emotionally what's happening physiologically like we can focus on the autonomic platform and in the same way in yoga instead of looking at like what's how like you know all these different things that are happening in the body or

the mind or the world what's happening underneath so this the same idea that all substrates every physiological aspect of myself every mental process of myself every way i relate to the outer world is some balance of satva or clarity rajas or activation or thomas of stillness and so it's reflective of these same three neural platforms so we could say that when that like social engagement safety neural platform is activated there's more access to satva there's more access to lucidity luminosity or we could say it the other way when we increase satva when we increase those experiences of peace equanimity clarity luminosity we're more likely to activate that social engagement neural platform so that yoga has a very similar idea that underneath

all of these like surface experiences of our body our mind and the world there's these underlying substrates that we can begin to affect and change in order to regulate in order to create resilience in order to create greater well-being that's wonderful so it sounds like this interconnectedness of just how we function in the world both from an internal and external experience kind of combining into one, that there is no essential, I guess, dichotomy, as you're saying, between the two. It's how do you create that inner experience that will definitely shape that outer experience. And you mentioned change, that these processes have the ability to adapt and change. And if we practice in this way and create those patterns, the neurological, I guess, processes, strengthen

them as one might say um then then your outlook and the way you live in the world might might become very different and and i think it's worth noting too maybe marley so you can speak to this that it doesn't just happen overnight yeah yeah it takes a it takes a while yeah and you one of the things i do find like um i will often uh teach people the language of the guna because because it's like we have less judgment around it so instead of saying i had i'm sympathetically activated or i have fight or flight or i have anxiety like being able to say oh this is like rajas arising it's the quality of agitation um then it takes a little bit of the judgment away from feeling anxious or worried or tired or lethargic yeah it's it's like identifying right

what is what is it that we're identifying with on a moment-to-moment basis and is that identification serving you, right? So I'm an anxious person is much different. Saying that is much different than saying, well, I just have feelings of anxiety that arise. Because if you really analyze your world and how you act and behave, you know that you're not constantly like that. These are changing processes, again, based on a culmination of factors of triggers and why those feelings arise in that moment. And they've been practiced. So it's really easy for those things to arise. And, and, um, but it's not the true, as you're saying, this true essence, the Purusha. Yeah. Purusha. Yeah. The true essence of your, your being or wellbeing or what,

whatever you resonate with in terms of that inner self. Yeah. And then you can begin to look into like, like the gifts of anxiety. So like, you know, anxiety is there for a reason it's helped you it's it's benefited you and so what are the ways that you can make friends with that experience and appreciate that aspect of yourself that has protected you yes and that's what I say with in the same with pain yeah pain is a protector it is not out to get you it is a human experience that we all get to be friends with and unfortunately sometimes that experience may last longer or be more dominant for some people and um but but it's not permanent and and i think just hearing you say these these processes are changeable and we can work with them and what is

it that we can learn from this experience you know why is this pain here why is this anxiety here which usually come hand in hand because pain is a stressor and increases anxiety and all those emotions and feelings that come with it but but yeah i always look at it's a message and um you what can you learn from this experience um and and if we look at it from a different perspective the things that we start to look at begin to change and and and then it doesn't take such a such a sticky velcro grip heavy grip on your life and your quality of life because there are many people who experience discomfort and we all do to some degree we are constantly in the state of balancing discomfort with ease and effort and ease and um you know it's always going to be there it's

just how do we respond? What do we do with it when it comes our way, right? How do we want to respond? And what have we been doing? Is it serving you? Is that the kind of life that you see yourself living? So there are many people who live with that discomfort on a daily basis, but still have a very meaningful life. Yeah, yeah. And yoga teaches us the methodology really to be able to discriminate, like to discriminate the neural platforms or the gunas whichever language you want to use from like you said that essence of who we are and um and you know we were talking about this idea of well-being and there was research around being connected to well-being especially in terms of meaning and purpose meaningful social

relationships is really powerful the effects on our inflammation our immune system the effects like you said on pain and pain interference um so the the idea of utilizing this um ability to be aware of the neural platform changing, we're constantly going to be activated sometimes and unactivated sometimes. We're constantly going to have experiences of extreme lethargy or extreme activation. And when we begin to really, like you said, disidentify them and really just allow them and to notice that they come and go, we can experience that equanimity and that that equanimity has real effect for our inflammatory processes. And so if anyone, I don't know, like I can always find this for you, but Stephen Cole has a lot of really amazing research. And he even has a

video cast on the NIH about the effects of that wellbeing on genes and things like that. That's amazing. And so could you define just briefly what you mean by equanimity? Because just in case, I mean, I know exactly what you're saying, but how would you define from a polyvagal theory and from a yogic philosophy what is the state of equanimity um so so if i'm going to use the word equanimity for a second um i would say that it is that ability to maintain an equilibrium maintain a balance maintain a steadfast contentment amidst whatever is arising um and so you know i do really like the term from aristotle of eudaimonic well-being or eudaimonic happiness which is about like this idea of experiencing a level of fulfillment and meaning and purpose

steadfast contentment um and and in in the research on eudaimonic well-being they differentiate that from hedonic which is like the transitory emotional experience of happiness which is also really beneficial but it's just different it's just you know like we can um so like equanimity is more that steadfast non-changing connection to um peace or balance yes and and i think um just to add to that a little bit if i may it's more of this is an internal experience correct yeah yeah this is coming from the side of you not from the external world or situation or circumstances that may arise it is finding that peace from within the contentment as you said no matter what adversity may arise in that moment. And that in itself can kind of trickle into

resilience. Yeah. And if you can imagine from a polyvagal standpoint, when someone is in a sympathetic state, they're not able to easily access that. So the idea that instead of trying to have people do meditations about feeling equanimity, which feels fake and forced and it often doesn't work. And the idea of what polyvagal theory offers is let's shift their autonomic states. And as we shift their autonomic state, they're going to be able to be more in tune with that experience and it can naturally emerge as part of it. So yeah, that social engagement neural platform is important to help increase the accessibility to that. Okay, great. That's a good question that came up for me right now. How does one or how can one start to shift that

that autonomic state? So one of the things that research talks about with yoga and other mind body therapies is that it does something called top-down and bottom-up regulation. So top-down meaning we can use practices that start in the mind to affect physiological state and we can bottom-up we can do practices that start in the body to affect mental emotional states. So and really like both are important. So we can take the portal that is more accessible to the person so for example someone that has a lot of chronic pain in the body i find it very helpful to go outside the body for a moment and to really use those top-down practices like um you know what is an image a memory um a um uh an image usually like an image a memory that has culture that has

been um that brings them a sense of that well-being or happiness or contentment and then can they bring that into their body. So I usually like kind of go out and then come back in. Whereas for other people, they might be experiencing a lot of agitation in their body. And so then using the body to create a different experience. So like, for example, we can use movement to create a parasympathetic state. And so that would be things like, for some people, it's not stillness, it's like slow rhythmic motion um and so slow rhythmic motion to take them from like agitation to gradually into calmer states of the body um and or like still restorative supportive positions and even with someone in pain when you give them an experience in the body through movement that

that is accessible to them then they can like believe that it's there you know they can find it again um we can also use breath techniques so like using um the research has demonstrated that slowing the exhalation helps to activate the parasympathetic response as well as alternate nostril breath or even left nostril breathing so using different breathing practices to help cultivate a parasympathetic state so we can use both like the bottom up through movement or breath or the top down using visualization imagery or some kind of intention setting oh my gosh those are great ideas everyone i hope you wrote them down okay awesome okay great and i think this goes into the last topic of of you know how do physical

therapists utilize these ideas and techniques i think you summarized it just beautifully if there anything else that you'd like to add for maybe the practitioners working with people who are in pain or have chronic illnesses yeah i think you know the um the idea of the top down and bottom up is like usually there's one portal that is more accessible to the person but it's really the combination that is most effective so that um because you can have physiological restoration and still have a lot of mental angst and emotional angst and vice versa you can have mental emotional calm but a physiologically activated system so when we um as physical therapists are looking at people and doing our intake our interview our assessment someone has

chronic pain or they have um recurrent pain like that it's always their back or it's always their shoulder so beginning to help someone find ways to regulate their nervous system through movement and breath and mindful or meditation techniques and then teaching them resilience is equally as important which we kind of briefly talked about like um light uh and and just because there was something else you said that i had wanted to go back and that was what it was is um the life is naturally um like as long as we're alive we're going to experience the different neural platforms we're going to have times where we're activated we're going to have times that we're really lethargic we're going to have thomas rogers all of those things so um the idea of resilience is

that we can teach someone to regulate but it's still symptom management that they get activated but they learn that they have that capacity to come back into calm psychological states and calm physiological states um so which is really important and i would use i usually spend like a lot of time just developing that um capacity but then if we want to teach them how to like be in life um then we want to teach them how to um in that in that article we talk about first traversing the neural platforms so being able to do practices that are really relaxing and calming to the body and mind and then something that's a little activating and then coming back down So that activating posture or activating thing might be a posture that is physiologically

activating like bridge or balancing postures, or it could be something more emotionally activating, like even supported backbends, which can be, or supported forward holds. So being able to go back and forth. And then we can learn to what's called like widen the window of tolerance. So we can teach the person how to stay in a relative calm state, even as they're physiologically activating. I saw that there was one term I learned called anxiety sensitivity, and it talked about using aerobic exercise as that, where like if someone's walking on a treadmill or running on a treadmill

or a bike or whatever, their heart rate increases, breath rate increases. So it mimics anxiety. Yeah. And so they, were you going to say something? Yeah. Oh my gosh. I was just going to say, I just had that like euphoric moment. I just had that like epiphany of my own, like on my own self. So everyone has anxiety, you know, comes and goes, but it particularly for me is, believe it or not, everyone speaking in public, you know, doing a podcast. And I realized, I just out of the blue, just realized, I was like, it is the same. My heart rate goes up in the same way when I exercise, but I do not get the same feelings or emotions associated. So if I can just feel my heart rate go. Cause that was what, what would really kind of increase that anxiety is

when my heart rate, my, I would feel like my heart was trying to jump out of my chest and moments, particularly if I have to express maybe, um, you know, a conflict, I have to address conflict in, in some way, then, then it's like, I have to speak my truth, but my heart would just like boom boom boom boom right and then I'm like you know it almost becomes this like maladaptive or negative state of being but then I realize like wait a second when I'm exercising my heart does the same thing and if I can relate to it in that way that is a physiological response how can I maintain my sense of calmness despite having this internal physiological experience yeah yeah yeah exactly and that's what like that whole idea of safe mobilization is about like we

can learn to um and even that idea of like oh like it's completely like like the idea of normalization where it's completely normal if you're going to go into a confrontive or like conflicting conflictive situation that your heart rate is going to go up and that your mind is going to worry like that that's actually like completely normal so the more we can begin to say oh like of course i'm feeling that way and then we can begin to notice our heart rate and all those things we can be in those activated states but still experience relative calm relative equanimity and then we don't activate as deeply so whereas before we might have gone from here to here we then just go from here to here so it's like widening that window of tolerance to be with

stimuli so if you think about like chronic pain like fibromyalgia where there's all this sensitization and um and and people will often report patients will often report not being able to really handle any kind of stressors in life um so they can begin if they practice on the yoga mat or the physical therapy room um they learned how to um uh be experience the activation but maintain relative calm then that can translate out to life and what i would say yoga does it goes a little deeper to add another aspect of resilience which is being able to see all and experience all of those stimuli as equanimity itself so instead of just like maintaining equanimity within the stimuli like actually seeing like that conflictive experience as part of um

like the totality of experience of who we are and experiencing that as eudaimonic well-being which is like you know enlightenment yes oh we're working on that that's like much later but we're working on it baby steps right how do you eat an elephant one bite at a time okay like right yes and oh my gosh so if if so not all physical therapists are going to do yoga training right i mean i think we can we can assume that so what piece of advice like so so for a physical therapist who isn't doing yoga or practicing yoga yeah could they still be just as effective if they use other strategies to help kind of um bridge that autonomic i guess regulation or still challenge the system, but then back off. Like, do you have any ideas? Yeah. I mean, I think in a way

we're always doing that, right? Like, cause we will put people on the bike for 10 minutes to do something or we'll do active postures like bridge or, um, and then we'll do relaxing things as well. So, um, I think kind of orienting when you're seeing someone with a chronic or complex or persistent pain type of condition, like bringing your awareness to not only are they having these musculoskeletal issues and movement issues they're having an autonomic system issue and so how can i relax the nervous system so some nice soft tissue work that relaxes the nervous system and the musculoskeletal system things like electrical stem like i remember going to a continuing ed training a while ago as a pt and people were talking about how the meaninglessness

of electrical stem but if it's helping but if it's helping create a parasympathetic response And she could say, oh, like I'm doing this to help really help the person experience a sense of safety, a sense of calm, relaxing the musculoskeletal system, relaxing the autonomic nervous system. So any of those like modalities that we use or manual techniques that we use or even beginning to use postures and movement that creates relaxation. So a lot of times we don't as PTs do postures for like to experience relaxation. So adding those into what we do and then working with that idea of resilience is like maybe someone with complex chronic conditions, like only doing one posture that's activating for them and then coming back to what's relaxing for them and being able to just move back and forth and helping them build that resilience. Right, right. And that's beautiful because yes, when people are in pain, they're really afraid to move and do certain things. It's part of a graded exposure, graded activity. You're knocking on the edge, you're nudging to but not through, and you're challenging. You have to get some sort of arousal and then teach the system that it's okay. Safety is right behind there. Let's go there, but then let's come back. Let's go there, let's come back. and then as you're saying that window of tolerance gets greater and greater and greater that's beautiful oh my god yeah and i think yeah and i think like just shifting our perspective of

like we're not just doing that for their mind we're actually doing it for their autonomic nervous system so that it's more than their feelings it's like in their body their autonomic nervous system is part of that dysregulation and if we keep our lens on that there's a way that we can approach it a little bit differently right right um what are your thoughts on on apps like or modalities like heart rate variability training um heart math is one yeah yeah i haven't done the heart math training um but i've heard really good things about it and there are different like apps like you said so heart rate variability is the way people measure on the vagal tone and it can be a picture of that social engagement neural platform so if you um have an app like that and notice if

there's a way of breathing that helps them access that state which usually there is and then a way of and that's another thing us as pts can do is like work with diaphragmatic breathing techniques and um but you but um those apps are nice because it gives someone an outer thing or stimulus to know when they're in that state when they're not used to it within themselves right oh that's great well thank you for answering that awesome okay well marlisa can you tell our listeners where they can learn more about you? I mentioned your paper, but if there's any other resources or connections that you'd like to share? Well, so I work at Maryland University of Integrative Health. So we have our website, muih.edu. I'm in the middle of doing a website, that's

marlisasullivan.com. We also have our new pain book. I thought I had it right here, but I don't. it's called yoga and science and pain care treating the person in pain um so we have that book um i am also on facebook under my name um and right now the website i use is center for integrative yoga studies and i can send that to you oh that's wonderful thank you so much marlisa this was so enlightening and enriching i really appreciate you taking the time to not only speak to me but all our listeners and share your wisdom this is amazing and and i i know it'll help so many so thank you so much for that and for all the contributors to the paper i didn't mention you all but you know um thank you so much and i really look forward to seeing what the future holds in

terms of polyvagal theory yoga science and all that fun stuff yeah thank you so much i really appreciate getting the talk and like you said that paper's open access so you can get it on the internet even better thank you more lisa thank you thanks for listening to today's episode be sure to head on over to drsuzyg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast and leave us a rating and review we'd love to hear feedback thanks again I would feel like my heart was trying to jump out of my chest