Seeing is believing*

My arm did not move and yet the muscle tension from my forearm increased when I mentally rehearsed playing the piano. I did not notice anything. It really made me aware how my thoughts affect my body.                –25 year old woman psychologist

*This blog was adapted from: Peper, E., Nemoto, S., Lin, I-M., & Harvey, R. (2015).

Therapists and educators can demonstrate the mind/body interaction with physiological monitoring to change their clients’ illness beliefs and demonstrate how ruminating thoughts may affect mental and physical health (Peper, Shumay, Moss, & Sztembis, 2013). When clients see how their body’s physiological responses are affected by thoughts and emotions, they gain a perspective that allows them to KNOW that thoughts affect body—the objective physiological evidence is indisputable.

The concept that thoughts affect the body has been described by many researchers. For example, Whatmore and Kohli (1975) used the term “Representing efforts,” which are the efforts we bring forth within our self during thinking, remembering, anticipating, daydreaming and worrying. Similarly, Green, Green and Walters (1970, p.3) described a process of thoughts influencing human physiological reactions as the Psycho-physiological principle, where “every change in the physiological state is accompanied by an appropriate change in the mental-emotional state, conscious or unconscious, and conversely, every change in the mental-emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state.”

The mind/body connection can be demonstrated through recording physiological signals.  For example, when a volunteer had her skin conductance (SC) level monitored, and then another person was asked in the group to give the volunteer a kiss, there was an increase in skin conductance response just after the instruction was given even though the person did not actually kiss the  volunteer. The volunteer was responding to the instructions that a kiss might occur, as shown in Figure 1.

Fig 1 SCL kiss

Figure 1. The effect on SC level of hearing the instruction that someone will give her a kiss

For educators and psychotherapists, biofeedback can be used to demonstrate the connection between  positive or negative mental rehearsal, thoughts or visualization or recalling memories and physiological responses. This process can be  demonstrated with surface electromyography (SEMG) recorded from muscles that become activated when the person mentally rehearses a task as illustrated in the following case example.

The participant was a 25 year old female psychologist who had practiced playing the piano for more than 16 years. Muscle activity was recorded from her right forearm extensor muscles and displayed on a large screen so that other group participants could observe. The physiological data and  video recording of the volunteer were simultaneously recorded. The volunteer was asked to relax, imagine playing a musical piece, relax, and again imagine playing a musical piece and relax.

Results. Each time she imagined playing the piano, the forearm extensor muscle tension increased, even though  there was no observed finger and forearm movements, as shown in Figure 2.

Fig 2 Piano Mental rehearsal white

Figure 2. The covert SEMG increase in forearm SEMG as the participant imagined playing the piano.

After the recording, the session was replayed so she could see herself and her movements on the screen simultaneously with the SEMG signal. She reported being totally unaware that she had activated her forearm muscles and, was totally surprised when she saw the recording of the SEMG activity while her forearm appeared to stay in a relaxed position.

Discussion.The physiological monitoring  demonstrated that her body responded to here thoughts and imagtes. In the case example,  the arm muscle tension increased in tension when she mentally rehearsed playing the piano. This participant like most other people was unaware that her body reacted.If the thought of piano playing increased forearm tension,what would thoughts of anger, resentment, hopelessness, kindness or love do to the body. This concrete physiological demonstration illustrated that changing your thoughts changes your physiology. .

Once the person is aware how thoughts affect their body, it may motivate the person to become aware and change their cognitions. They can now understand that interrupting negative ruminations and behavior patterns and rehearsing  new behavior patterns, their health can be improved. We strongly recommend that cognitive behavioral therapists,  educators, psychologists, and other therapeutic practitioners include biofeedback monitoring for demonstrating the links between cognitions and physiological reactions.

After such a demonstration, the therapist may point out that what happens in the office setting is likely the identical process that occurs when a person worries, has negative cognitions, continuously reviews personal failures, or makes judgmental statements such as “I should not have done ________.”

When individuals think a negative statement such as “I should not have…………”, they are mentally rehearsing what they should not do and are unintentionally strengthening the negative behavior even more. Instead, whenever people becomes aware of the beginning of the negative cognitions, they can learn to stop and transform their negative cognitions to positive cognitions. In this way they can rehearse what they would want to do instead of what they do not want to do (Peper, Gibney, & Holt, 2002).

The more you rehearse what you want to achieve, the more likely it is to occur. This strategy is useful to change clients’ illness beliefs and motivate them to transform their cognitions from what they do not want to what they want to do. In addition, it offers cognitive behavior therapists documented evidence—the biofeedback recording provides the data which is necessary for evidence based medicine.

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

–Victor E. Frankle

 * Adapted from: Peper, E., Nemoto, S., Lin, I-M., & Harvey, R. (2015). Seeing is believing: Biofeedback a tool to enhance motivation for cognitive therapy. Biofeedback, 43(4), 168-172.  DOI: 10.5298/1081-5937-43.4.03


Green, E.E., Green, A.M., & Walters, E.D. (1970). Voluntary control of internal states: Psychological and physiological. Journal of Transpersonal Psychology, 11, 1-26.

Peper, E., Gibney, K.H., & Holt. C. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall-Hunt.

Peper, E., Shumay, D. M., Moss, D. & Sztembis, R. (2013). The Power of Words, Biofeedback, and Somatic Feedback to Impact Illness Beliefs. Somatics .XVII(1), 4-8.

Whatmore, G.B., & Kohli, D. R. (1975). The physiopathology and treatment of functional disorders: Including anxiety states and depression and the role of biofeedback training. New York: Grune and Stratton, Inc.







One Comment on “Seeing is believing*”

  1. […] From his blog, Dr Peper, summarizes the original study publication, Seeing is Believing: Biofeedback as a Tool to Enhance Motivation for Cognitive Therapy. […]

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