How can you demonstrate that yoga practices are beneficial?
How do you know you are tightening the correct muscles or relaxing the muscle not involved in the movement when practicing asanas?
How can you know that the person is mindful and not sleepy or worrying when meditating?
How do you know the breathing pattern is correct when practicing pranayama?
The obvious answer would be to ask the instructor or check in with the participant; however, it is often very challenging for the teacher or student to know. Many participants think that they are muscularly relaxed while in fact there is ongoing covert muscle tension as measured by electromyography (EMG). Some participants after performing an asana, do not relax their muscles even though they report feeling relaxed. Similarly, some people practice specific pranayama breathing practice with the purpose of restoring the sympathetic/parasympathetic system; however, they may not be doing it correctly. Similarly, when meditating, a person may become sleepy or their attention wanders and is captured by worries, dreams, and concerns instead of being present with the mantra. These problems may be resolved by integrating bio- and neurofeedback with yoga instruction and practice. Biofeedback monitors the physiological signals produced by the body and displays them back to the person as shown in Figure 1.
Figure 1: Biofeedback is a methodology by which the participant receives ongoing feedback of the physiological changes that are occurring within the body. Reproduced with permission from Peper et al, 2008.
With the appropriate biofeedback equipment, one can easily record muscle tension, temperature, blood flow and pulse from the finger, heart rate, respiration, sweating response, posture alignment, etc.** Neurofeedback records the brainwaves (electroencephalography) and can selectively feedback certain EEG patterns. In most cases participants are unaware of subtle physiological changes that can occur. However, when the physiological signals are displayed so that the person can see or hear the changes in their physiology they learn internal awareness that is associated with these physiological changes and learn mastery and control. Biofeedback and neuro feedback is a tool to make the invisible, visible; the unfelt, felt and the undocumented, documented.
Biofeedback can be used to document that a purported yoga practice actually affects the psychophysiology. For example, in our research with the Japanese Yogi, Mr. Kawakami, who was bestowed the title “Yoga Samrat’ by the Indian Yoga Culture Federation in 1983, we measured his physiological responses while breathing at two breaths a minute as well as when he inserted non-sterilized skewers through his tongue tongue (Arambula et al, 2001; Peper et al, 2005a; Peper et al, 2005b). The physiological recordings confirmed that his Oxygen saturation stayed normal while breathing two breaths per minute and that he did not trigger any physiological arousal during the skewer piercing. The electroencephalographic recordings showed that there was no response or registration of pain. A useful approach of using biofeedback with yoga instruction is to monitor muscle activity to measure whether the person is performing the movement appropriately. Often the person tightens the wrong muscles or performs with too much effort, or does not relax after performing. An example of recording muscle tension as shown in Figure 2.
Figure 2: Recording the muscle tension with Biograph Infinity while performing an asana.
In our research it is clear that many people are unaware that they tighten muscles. For example, Mcphetridge et al, (2011) showed that when participants were asked to bend forward slowly to touch their toes and then hang relaxed in a forward fold, most participants reported that they were totally relaxed in their neck. In actuality, they were not relaxed as their neck muscles were still contracting as recorded by electromyography (EMG). After muscle biofeedback training, they all learned to let their neck muscles be totally relaxed in the hanging fold position as shown in Figure 3 & 4.
Figure 3: Initial assessment of neck SEMG while performing a toe touch. Reproduced from Harvey, E. & Peper, E. (2011).
Figure 4: Toe touch after feedback training. The neck is now relaxed; however, the form is still not optimum. . Reproduced from Harvey, E. & Peper, E. (2011).
Thus, muscle feedback is a superb tool to integrate with teaching yoga so that participants can perform asanas with least amount of inappropriate tension and also can relax totally after having tightened the muscles. Biofeedback can similarly be used to monitor body posture during meditation. Often participants become sleepy or their attention drifts and gets captured by imagery or worries. When they become sleepy, they usually begin to slouch. This change in body position can be readily be monitored with a posture feedback device. The UpRight,™ (produced by Upright Technologies, Ltd https://www.uprightpose.com/) is a small sensor that is placed on the upper or lower spine and connects with Bluetooth to the cell phone. After calibration of erect and slouched positions, the device gives vibratory feedback each time the participant slouches and reminds the participant to come back to sitting upright as shown in Figure 5.
Figure 5: UpRigh™ device placed on the upper spine to provide feedback during meditation. Each time person slouches which often occurs when they become sleepy or loose meditative focus, the device provides feedback by vibrating.
Alternatively, the brainwaves patterns (electroencephalography could be monitored with neurofeedback and whenever the person drifts into sleep or becomes excessively aroused by worry, neurofeedback could remind the person to be let go and be centered. Finally, biofeedback can be used with pranayama practice. When a person is breathing approximately six breaths per minute heart rate variability can increase. This means that during inhalation heart rate increases and during exhalation heart rate decreases. When the person breathes so that the heart rate variability increases, it optimizes sympathetic/parasympathetic activity. There are now many wearable biofeedback devices that can accurately monitor heart rate variability and display the changes in heart rate as modulated by breathing.
Conclusion: Biofeedback is a useful strategy to enhance yoga practice as it makes the invisible visible. It allows the teacher and the student to become aware of the dysfunctional patterns that may be occurring beneath awareness.
Arambula, P., Peper, E., Kawakami, M., & Gibney, K. H. (2001). The physiological correlates of Kundalini Yoga meditation: a study of a yoga master. Applied psychophysiology and biofeedback, 26(2), 147-153.
Harvey, E. & Peper, E. (2011). I thought I was relaxed: The use of SEMG biofeedback for training awareness and control. In W. A. Edmonds, & G. Tenenbaum (Eds.), Case studies in applied psychophysiology: Neurofeedback and biofeedback treatments for advances in human performance. West Sussex, UK: Wiley-Blackwell, 144-159.
Mcphetridge, J., Thorne, E., Peper, E., & Harvey, R. (2011) SEMG for training awareness and muscle relaxation during toe touching. Paper presented at the 15th Annual Meeting of the Biofeedback Foundation of Europe. Munich, Germany, February 22-26, 2011.
Peper, E., Kawakami, M., Sata, M., Franklin, Y, Gibney, K. H. & Wilson, V.S. (2005a). Two breaths per minute yogic breathing. In: Kawakami, M. (2005). The Theses of Mitsumasa Kawakami II: The Theory of Yoga-Based Good Health. Tokyo, Japan: Samskara. 483-493. ISBN 4-434-06113-5
Peper, E., Kawakami, M., Sata, M. & Wilson, V.S. (2005b). The physiological correlates of body piercing by a yoga master: Control of pain and bleeding. Subtle Energies & Energy Medicine Journal. 14(3), 223-237.
**Biofeedback and neurofeedback takes skill and training. For information on certification, see http://www.bcia.org Two useful websites are:
Sedentary behavior is the new norm as most jobs do not require active movement. Sitting in a car instead of walking, standing on the escalator instead of walking up the stairs, using an electric mixer instead of whipping the eggs by hand, sending a text instead of getting up and talking to a co-worker in the next cubicle, buying online instead of walking to the brick and mortar store, watching TV shows, streaming movies, or playing computer games instead of socializing with actual friends, are all examples how the technological revolution has transformed our lives. The result is sitting disease which we belief can mitigate by daily exercise.
The research data is very clear– exercise does not totally reverse the health risks of sitting. In the NIH-AARP Diet and Health Study, researchers Matthews and colleagues (Matthews et al, 2012) completed an 8.5 year follow up on 240,819 adults (aged 50–71 year) who at the beginning baseline surveys did not report any cancer, cardiovascular disease, or respiratory disease.
The 8.5 year outcome data showed that the time spent in sedentary behaviors such as sitting and watching TV was positively correlated with an increased illness and death rates as shown in Figure 1. More disturbing, moderate vigorous exercises does not totally reverse the health risks of sitting and watching television (Matthews et al, 2012).
Figure 1. The more you sit the higher the risk of mortality even if you if you attempt to mitigate the effect with moderate vigorous exercise (Matthews et al, 2012). From: https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/
The harmful impact of sedentary behavior and simple ways to improve health have been superbly described and illustrated by Bonnie Berkowitz and Patterson Clark (2014), in their January 20, 2014, Washington Post article, The health hazards of sitting, Their one page poster should be posted on the office walls and given to all clients. http://www.washingtonpost.com/wp-srv/special/health/sitting/Sitting.pdf
As they point out, sitting disease increases the risk of heart disease, diabetes, colon cancer, muscle degeneration especially weaker abdominal muscles and gluteus muscles, back pain and reduced hip flexibility, poor circulation in the legs which may cause edema in the ankles and deep vein thrombosis, osteoporosis, strained neck, shoulder and back pain. The effects are not only physical. Sitting reduces subjective energy level and attention as our brain becomes more and more sleepy.
The solution is both very simple and challenging. To reduce the risks, do less sedentary behavior and sitting and do more physical movement during the day. Continuously interrupt sitting with standing and movement. After sitting at the computer for 30 minutes, get up and move. Even skipping in place for 30 seconds, significantly will increase your energy and mood (Peper and Lin, 2012). There are many ways to remind and support yourself and others to move. For example, use reminder programs on the computer such as StretchBreakTM to remind you to get up and stretch. Employees who do episode movements, report fewer symptoms and have more energy (Peper & Harvey, 2008). As one of the employees state after implementing the break program, “There is life after five.” Meaning he was no longer exhausted when he finished work.
Although challenging, wean yourself away from the addicting digital screen and being a couch potato at home. At those moments when you feel drained and all you want to do is veg out by watching another TV series, go for a walk. After walking for 20 minutes, in most cases your energy will have returned and your low mood has been transformed to see new positive option. Plan the walks with neighbors and friends who provide the motivation to pull you out of your funk and go out.
Berkowitz, B. & Clark, P. (Jan 20, 2014). The health hazard of sitting. The Washington Post. Retrieved July 29, 2017.https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/
Matthews, C. E., George, S. M., Moore, S. C., Bowles, H. R., Blair, A., Park, Y., … Schatzkin, A. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. The American Journal of Clinical Nutrition, 95(2), 437–445. http://doi.org/10.3945/ajcn.111.019620
Through millions of years, movement was part of our biological necessity.. Movement was necessary to hunt, to escape predators, to explore and to find a mate. Organisms developed a brain (nervous system) to coordinate movement as eloquently explain by neuroscientist Daniel Wolpert in his 2011 TED talk, The Real Reasons for Brains.
It is only recently that we limit movement by sitting, driving, taking the escalator, or controlling equipment that performs the actual physical labor. We interfere with our evolutionary developed physiology when we reduce or even eliminate movement for the sake of efficiency. Lack of movement, “sitting disease”, is a significant contributor and causal factor in illness. It also increases the stress response, negative mood and depression and reduces cognitive activity. Take charge and reduce illness when you integrate purposeful exercise (walking, running, dancing, etc.) into your life style.
Exercise is the most effective behavioral technique for self-regulation of mood in healthy people as summarized in the superb article, The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review, Dr. Julia C. Basso and Wendy A. Suzuki of the Center for Neural Science, New York University, New York, NY, USA. The robust research findings show that acute exercise improves mood, significantly reduces depression, tension, anger, fatigue, and confusion. In addition, acute exercise improves symptoms associated with psychological disorders such as depression, anxiety, schizophrenia, and post-traumatic stress disorder. Exercise decreases the risk of type 2 diabetes, coronary heart disease and stress-related blood pressure response by inhibiting the sympathetic nervous system response to stress. For a detailed summary, see the blogs, What is the best single thing we can do for our health and Healthy movement is the new aging.
Finally, the authors also review the relevant neurophysiological, and neurochemical processes that are affected by exercise. What is most interesting are the findings that “acute exercise primarily enhances executive functions dependent on the prefrontal cortex including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control. These positive changes have been demonstrated to occur with very low to very high exercise intensities, with effects lasting for up to two hours after the end of the exercise bout.”
As the authors state, “We show that the three most consistent cognitive/behavioral effects of a single bout of exercise in humans are improved executive functions, enhanced mood states, and decreased stress levels.”
Even though the findings are clear that movement/exercise is a powerful “drug” to improve our health, most health professionals focus on sitting treatment and prescribing pharmaceutical agents. Possibly, a treatment session should start with fun physical exercise and followed by therapy. Remember, if you feel blah, have lower energy, feel frustrated or irritated, get up and move. Movement and exercise will change your mood. You will experience what Peper and Lin (2012), have shown that less than minute of skipping in place will significantly improve your subjective energy level and mood. Get up and skip in place, then observe how much better you feel. Then sit again read the article by Dr. Julia C. Basso and Wendy A. Suzuki, http://content.iospress.com/download/brain-plasticity/bpl160040?id=brain-plasticity%2Fbpl160040
Erik Peper, Lauren Mason and Cindy Huey
After having constant abdominal pain, severe cramps, and losing 15 pounds from IBS, I found myself in the hospital bed where all the doctors could offer me was morphine to reduce the pain. I searched on my smart phone for other options. I saw that abdominal breathing could help. I put my hands on my stomach and tried to expand it while I inhaled. All that happened was that my chest expanded and my stomach did not move. I practiced and practiced and finally, I could breathe lower. Within a few hours, my pain was reduced. I continued breathing this way many times. Now, two years later, I no longer have IBS and have regained 20 pounds.
– 21-year old woman who previously had severe IBS
Irritable bowel syndrome(IBS) affects between 7% to 21% of the general population and is a chronic condition. The symptoms usually include abdominal cramping, discomfort or pain, bloating, loose or frequent stools and constipation and can significantly reduce the quality of life (Chey et al, 2015). A precursor of IBS in children is called recurrent abdominal pain (RAP) which affects between 0.3 to 19% of school children (Chitkara et al, 2005). Both IBS and RAP appear to be functional illnesses, as no organic causes have been identified to explain the symptoms. In the USA, this results in more than 3.1 physician visits and 5.9 million prescriptions written annually. The total direct and indirect cost of these services exceeds $20 billion (Chey et al, 2015). Multiple factors may contribute to IBS, such as genetics, food allergies, previous treatment with antibiotics, severity of infection, psychological status and stress. More recently, changes in the intestinal and colonic microbiome resulting in small intestine bacterial overgrowth are suggested as another risk factor (Dupont, 2014).
Generally, standard medical treatments (reassurance, dietary manipulation and of pharmacological therapy) are often ineffective in reducing abdominal IBS and other abdominal symptoms (Chey et al, 2015), while complementary and alternative approaches such as relaxation and cognitive therapy are more effective than traditional medical treatment (Vlieger et, 2008). More recently, heart rate variability training to enhance sympathetic/ parasympathetic balance appears to be a successful strategy to treat functional abdominal pain (FAB) in children (Sowder et al, 2010). Sympathetic/parasympathetic balance can be enhanced by increasing heart rate variability (HRV), which occurs when a person breathes at their resonant frequency which is usually between 5-7 breaths per minute. For most people, it means breathing much slower, as slow abdominal breathing appears to be a self-control strategy to reduce symptoms of IBS, RAP and FAP.
This article describes how a young woman healed herself from IBS with slow abdominal breathing without any therapeutic coaching, reviews how slower diaphragmatic breathing (abdominal breathing) may reduce symptoms of IBS, explores the possibility that breathing is more than increasing sympathetic/parasympathetic balance, and suggests some self-care strategies to reduce the symptoms of IBS.
Healing IBS-a case report
After being diagnosed with Irritable Bowel Syndrome her Junior year of high school, doctors told Cindy her condition was incurable and could only be managed at best, although she would have it throughout her entire life. With adverse symptoms including excessive weight loss and depression, Cindy underwent monthly hospital visits and countless tests, all which resulted in doctors informing her that her physical and psychological symptoms were due to her untreatable condition known as IBS, of which no one had ever been cured. When doctors offered her what they believed to be the best option: morphine, something Cindy describes now as a “band-aid,” she was left feeling discouraged. Hopeless and alone in her hospital bed, she decided to take matters into her own hands and began to pursue other options. From her cell phone, Cindy discovered something called “diaphragmatic breathing,” a technique which involved breathing through the stomach. This strategy could help to bring warmth to the abdominal region by increasing blood flow throughout abdomen, thereby relieving discomfort of the bowel. Although suspicious of the scientific support behind this method, previous attempts at traditional western treatment had provided no benefit to recovery; therefore, she found no harm in trying. Lying back flat against the hospital bed, she relaxed her body completely, and began to breathe. Immediately, Cindy became aware that she took her breath in her chest, rather than her stomach. Pushing out all of her air, she tried again, this time gasping with inhalation. Delighted, she watched as air flooded into her stomach, causing it to rise beneath her hands, while her chest remained still. Over time, Cindy began to develop more awareness and control over her newfound strategy. While practicing, she could feel her stomach and abdomen becoming warmer. Cindy shares that for the first time in years, she felt relief from pain, causing her to cry from happiness. Later that day, she was released from the hospital, after denying any more pain medication from doctors.
Cindy continues to practice her diaphragmatic breathing as much as she can, anywhere at all, at the sign of pain or discomfort, as well as preventatively prior to what she anticipates will be a stressful situation. Since beginning her practice, Cindy says that her IBS is pretty much non-existent now. She no longer feels depressed about her situation due to her developed ability to manage her condition. Overall, she is much happier. Moreover, since this time two years ago, Cindy has gained approximately 20 pounds, which she attributes to eating a lot more. In regard to her success, she believes it was her drive, motivation, and willingness to dedicate herself fully to the breathing practice which allowed for her to develop skills and prosper. Although it was not natural for her to breathe in her stomach at first, a trait which she says she often recognizes in others, Cindy explains it was due to necessity which caused her to shift her previously-ingrained way of breathing. Upon publicly sharing her story with others for the first time, Cindy reflects on her past, revealing that she experienced shame for a long time as she felt that she had a weird condition, related to abnormal functions, which no one ever talks about. On the experience of speaking out, she affirms that it was very empowering, and hopes to encourage others coping with a situation similar to hers that there is in fact hope for the future. Cindy continues to feel empowered, confident, and happy after taking control of her own body, and acknowledges that her condition is a part of her, something of which she is proud.
Watch the in-depth interview with Cindy Huey in which she describes her experience of discovering diaphragmatic breathing and how she used this to heal herself of IBS
Video 1. Interview with Cindy Huey describing how she healed herself from IBS.
“Why should the body digest food or repair itself, when it will be someone else’s lunch” (paraphrased from Sapolsky (2004), Why zebras do not get ulcers).
From an evolutionary perspective, we were prey and needed to be on guard (vigilant) to the presence of predators. In the long forgotten past, the predators were tigers, snakes, and the carnivore for whom we were food as well as other people. Today, the same physiological response pathways are still operating, except that the pathways are now more likely to be activated by time urgency, work and family conflict, negative mental rehearsal and self-judgment. This is reflected in the common colloquial phrases: “It makes me sick to my stomach,” “I have no stomach for it,” “He is gutless,” “It makes me queasy,” “Butterflies in my stomach,” “Don’t get your bowels in uproar,” “Gut feelings’, or “Scared shitless.”
Whether conscious or unconscious, when threatened, our body reacts with a fight/flight/freeze response in which the blood flow is diverted from the abdomen to deep muscles used for propulsion. This results in peristalsis being reduced. At the same time the abdomen tends to brace to protect it from injury. In almost all cases, the breathing patterns shift to thoracic breathing with limited abdominal movement. As the breathing pattern is predominantly in the chest, the person increases the risk of hyperventilation because the body is ready to run or fight.
In our clinical observations, people with IBS, small intestine bacterial overgrowth (SIBO), abdominal discomfort, anxiety and panic, and abdominal pain tend to breathe more in their chest, and when asked to take breathe, they tend to inhale in their upper chest with little or no abdominal displacement. Almost anyone who experiences abdominal pain tends to hold the abdomen rigid as if the splinting could reduce the pain. A similar phenomenon is observed with female students experiencing menstrual cramps. They tend to curl up to protect themselves and breathe shallowly in their chest instead of slowly in their abdomen, a body pattern which triggers a defense reaction and inhibits regeneration. If instead they breathe slowly and uncurl they report a significant decrease in discomfort (Gibney & Peper, 2003).
Paradoxically, this protective stance of bracing the abdomen and breathing shallowly in the chest increases breathing rate and reduces heart rate variability. It reduces and inhibits blood and lymph flow through the abdomen as the defensive posture evokes the physiology of fight/flight/freeze. The reduction in venous blood and lymph flow occurs because the ongoing compression and expansion in the abdomen is inhibited by the thoracic breathing and, moreover, the inhibition of diaphragmatic breathing. It also inhibits peristalsis and digestion. No wonder so many of the people with IBS report that they are reactive to some foods. If the GI track has reduced blood flow and reduced peristalsis, it may be less able to digest foods which would affect the bacteria in the small intestine and colon. We wonder if a risk factor that contributes to SIBO is chronic lack of abdominal movement and bracing.
Slow diaphragmatic abdominal breathing to establish health
“Digestion and regeneration occurs when the person feels safe.”
Effortless, slow diaphragmatic breathing occurs when the diaphragm descends and pushes the abdominal content downward during inhalation, which causes the abdomen to become bigger. As the abdomen expands, the pelvic floor relaxes and descends. During exhalation, the pelvic floor muscles tighten slightly, lifting the pelvic floor and the transverse and oblique abdominal muscles contract and push the abdominal content upward against the diaphragm, allowing the diaphragm to relax and go upward, pushing the air out. The following video, 3D view of the diaphragm, from www.3D-Yoga.com by illustrates the movement of the diaphragm.
This expansion and constriction of the abdomen occurs most easily if the person is extended, whether sitting or standing erect or lying down, and the waist is not constricted. If the arches forward in a protected pattern and the spine is flexed in a c shape, it would compress the abdomen; instead, the body is long and the abdomen can move and expand during inhalation as the diaphragm descends (see figure 1). If the person holds their abdomen tight or it is constricted by clothing or a belt, it cannot expand during inhalation. Abdominal breathing occurs more easily when the person feels safe and expanded versus unsafe or fearful and collapsed or constricted.
Figure 1. Erect versus collapsed posture note that there is less space for the abdomen to expand in the protective collapsed position. Reproduced by permission from: Clinical Somatics (http://www.clinicalsomatics.ie/
When a person breathes slower and lower it encourages blood and lymph flow through the abdomen. As the person continues to practice slower, lower breathing, it reduces the arousal and vigilance. This is the opposite state of the flight, fight, freeze response so that blood flow is increased in abdomen, and peristalsis re-occurs. When the person practices slow exhalation and breathing and they slightly tighten the oblique and transverse abdominal muscles as well as the pelvic floor and allow these muscles to relax during inhalation. When they breathe in this pattern effortless they, they often will experience an increase in abdominal warmth and an initiation of abdominal sounds (stomach rumble or borborygmus) which indicates that peristalsis has begun to move food through the intestines (Peper et al., 2016). For a detailed description see https://peperperspective.com/2016/04/26/allow-natural-breathing-with-abdominal-muscle-biofeedback-1-2/
What can you do to reduce IBS
There are many factors that cause and effect IBS, some of which we have control over and some which are our out of our control, such as genetics. The purpose of proposed suggestions is to focus on those things over which you have control and reduce risk factors that negatively affect the gastrointestinal track. Generally, begin by integrating self-healing strategies that promote health which have no negative side effects before agreeing to do more aggressive pharmaceutical or even surgical interventions which could have negative side effects. Along the way, work collaboratively with your health care provider. Experiment with the following:
- Avoid food and drinks that may irritate the gastrointestinal tract. These include coffee, hot spices, dairy products, wheat and many others. If you are not sure whether you are reacting to a food or drink, keep a detailed log of what you eat and drink and how you feel. Do self-experimentation by eating or drinking the specific food by itself as the first food in the morning. Then observe how you feel in the next two hours. If possible, eat only organic foods that have not been contaminated by herbicides and pesticides (see: https://peperperspective.com/2015/01/11/are-herbicides-a-cause-for-allergies-immune-incompetence-and-adhd/).
- Identify and resolve stressors, conflicts and problems that negatively affect you and drain your energy. Keep a log to identify situations that drain or increase your subjective energy. Then do problem solving to reduce those situations that drain your energy and increase those situations that increase your energy. For a detailed description of the practice see https://peperperspective.com/2012/12/09/increase-energy-gains-decrease-energy-drains/
Often the most challenging situations that we cannot stomach are those where we feel defeated, helpless, hopeless and powerless or situations where we feel threatened– we do not feel safe. Reach out to other both friends and social services to explore how these situations can be resolved. In some cases, there is nothing that can be done except to accept what is and go on.
- Feel safe. As long as we feel unsafe, we have to be vigilant and are stressed which affects the GI track. Explore the following:
- What does safety mean for you?
- What causes you to feel unsafe from the past or the present?
- What do you need to feel safe?
- Who can offer support that you feel safe?
Reflect on these questions and then explore and implement ways by which you can create feeling more safe.
- Take breaks to regenerate. During the day, at work and at home, monitor yourself. Are you pushing yourself to complete tasks. In a 24/7 world with many ongoing responsibilities, we are unknowingly vigilant and do not allow ourselves to rest and relax to regenerate. Do not wait till you feel tired or exhausted. Stop earlier and take a short break. The break can be a short walk, a cup of tea or soup, or looking outside at a tree. During this break, think about positive events that have happened or people who love you and for whom you feel love. When you smile and think of someone who loves you, such as a grandparent, you may relax and for that moment as you feel safe which allows regeneration to begin.
- Observe how you inhale. Take a deep breath. If you feel you are moving upward and becoming a little bit taller, your breathing is wrong. Put one hand on your lower abdomen and the other on your chest and take a deep breath. If you observe your chest lifted upward and stomach did not expand, your breathing is wrong. You are not breathing diaphragmatically. Watch the following video, The correct way to breathe in, on how to observe your breathing and how to breathe diaphragmatically.
- Learn diaphragmatic breathing. Take time to practice diaphragmatic breathing. Practice while lying down and sitting or standing. Let the breathing rate slow down to about six breaths per minute. Exhale to the count of four and then let it trail off for two more counts, and inhale to the count of three and let it trail for another count. Practice this sitting and lying down (for more details on breathing see: https://peperperspective.com/2014/09/11/a-breath-of-fresh-air-improve-health-with-breathing/.
- Sitting position. Exhale by feeling your abdomen coming inward slightly for the count of four and trailing off for the count of two, then allow the lower ribs to widen, abdomen expand–the whole a trunk expands–as you inhale while the shoulders stay relaxed for a count of three. Allow it to trail off for one more count before you again begin to exhale. Be gentle, do not rush or force yourself. Practice this slower breathing for five minutes. Focus more on the exhalation and allowing the air to just flow in. Give yourself time during the transition between inhalation and exhalation.
- Lying down position. While lying on your back, place a two to five-pound weight such as a bag of rice on your stomach as shown in Figure 2.
Figure 2. Lying down and practicing breathing with two to five-pound weight on stomach (reproduced by permission from Gorter and Peper, 2011.
As you inhale push the weight upward and also feel your lower ribs widen. Then allow exhalation to occur by the weight pushing the abdominal content down which pushes the diaphragm upward. This causing the breath to flow out. As you exhale, imagine the air flowing out through your legs as if there were straws inside your legs. When your attention wanders, smile and bring it back to imagining the air flowing down your legs during exhalation. Practice this for twenty minutes. Many people report that during the practice the gurgling in their abdomen occurs which is a sign that peristalsis and healing is returning.
- Observe and change your breathing during the day. Observe your breathing pattern during the day. Each time you hold your breath, gasp or breathe in your chest, interrupt the pattern and substitute slow diaphragmatic breathing for the next five breaths. Do this the whole day long. Many people observe that when they think of stressor or are worried, they hold their breath or shallow breathe in the chest. If this occurs, acknowledge the worry and focus on changing your breathing. This does not mean that you dismiss the concern, instead for this moment you focus on breathing and then explore ways to solve the problem.
If you observed that under specific circumstance you held your breath or breathed shallowly in your chest, then whenever you anticipate that the same event will occur again, begin to breathe diaphragmatically. To do this consistently is very challenging and most people report that initially they only seem to breathe incorrectly. It takes practice, practice and practice—mindful practice– to change. Yet those who continue to practice often report a decrease in symptoms and feel more energy and improved quality of life.
Changing habitual health behaviors such as diet and breathing can be remarkably challenging; however, it is possible. Give yourself enough time, and practice it many times until it becomes automatic. It is no different from learning to play a musical instrument or mastering a sport. Initially, it feels impossible, and with lot of practice it becomes more and more automatic. We continue to be impressed that healing is possible. Among our students at San Francisco State University, who practice their self-healing skills for five weeks, approximately 80% report a significant improvement in their health (Peper et al., 2014).
Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. Jama, 313(9), 949-958.
Chitkara, D. K., Rawat, D. J., & Talley, N. J. (2005). The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. American journal of Gastroenterology, 100(8), 1868-1875.
Dupont, H. L. (2014). Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Alimentary pharmacology & therapeutics, 39(10), 1033-1042.
Gibney, H.K. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31(3), 20-24.
Gorter, R. & Peper, E. (2011). Fighting Cancer-A NonToxic Approach to Treatment. Berkeley: North Atlantic.
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49.
Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.
Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. New York: Owl Books
Sowder, E., Gevirtz, R., Shapiro, W., & Ebert, C. (2010). Restoration of vagal tone: a possible mechanism for functional abdominal pain. Applied psychophysiology and biofeedback, 35(3), 199-206.
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Each week I look forward to listening to a new episode by Malcom Gladwell’s podcast Revisionist History. Malcolm Gladwell is the author of five New York Times bestsellers — The Tipping Point, Blink, Outliers, and David and Goliath. In the podcasts he goes back in history and reinterpret something from the past. He offers a new perspective which illuminates the present. Take time to listen to the podcast on your cellphone or computer. His revisionist’s interpretation will shed a different perspective on present days’ events. It even gave me a new understanding why some people vote against their own self-interest. His podcast can be downloaded from: http://revisionisthistory.com/seasons
“It was the best meet of my life.” -Jo Aita
Setting a personal best and winning the Gold medal is a remarkable feat. Jo Aita, age 46 and weighing 58 kg, set the Masters World Records and Masters Games Records in Snatch, Clean & Jerk and Total Olympic weight lifting at the World Masters Games in Auckland, New Zealand, April 26th, 2017. She lifted 71 kg in the Snatch and 86 kg in the Clean and Jerk Olympic lifts in the 45-49-year-old age group (see video in figure 1). What makes this more remarkable is that her combined lifts were 3 kilograms more than her life-time best in previous competition. She refuted the conventional wisdom that weight lifters peak in their mid to late twenties. There is hope for improvement as aging may not mean we have to decline.
Figure 1. Video of Jo Aita successful lift at the World Masters Games in Auckland, NZ., April 26, 2017.
There are many factors–and many more which we do not know–which contribute to this achievement such as genetics, diligent training and superb coaching at the Max’ Gym in Oakland as a member of Team Juggernauts. In the last three years, Jo Aita also incorporated biofeedback and visualization training to help optimize her performance. This report summarizes how breathing and electromyography feedback combined with imagery may have contributed to achieving her personal best. As Jo Aita stated, “I recommend this to everyone and hope that you can work with athletes in my gym.”
Components of the 30 sessions of biofeedback, internal language and visualization training program
The training was started in September 2014 to reduce anxiety and improve performance. The components embedded in the training are listed sequentially; however, training did not occur sequentially. They were dynamically interwoven throughout the many sessions and augmented with homework practices, as well as storytelling of other people achieving success using similar approaches. The major components included:
1. Mastering effortless slow diaphragmatic breathing in which the abdomen expanded during inhalations and constricted during exhalation. The respiration feedback and training was recorded with BioGraph Infinity respiration sensors and recorded from the abdomen and upper chest. Her homework included monitoring situations where she held her breath and then anticipate breath holding by continuing to breathe. She also practiced slower breathing with heart rate variability feedback from a Stress Eraser. Practicing these allowed her to become centered and regenerate more quickly. As she stated, “It helped me during the day when I am anxious to calm down.” Throughout the training, the focus was to use breathing to rapidly regenerate after exertion especially after training.
2. Learning to relax her shoulder muscles with electromyography (EMG) feedback to regenerate and learn awareness of minimal trapezius muscle tension. She could use this awareness to identify her emotional reactivity (Peper, Booiman, Lin, & Shaffer, 2014). Often emotional reactivity increases muscle tension. She learned to relax here muscles quickly after muscle contractions to allow regeneration
3. Experiencing how cognition affect performance. This was initially demonstrated by arm resistance test. In this experiential practice, she extended her arm and attempted to resist the downward pressure applied to her wrist while she recalled either a hopeless, helpless, powerless or defeated memory or an empowered positive memory (for detailed description see, Gorter and Peper, pp 186-188, 2011). When she recalled the powerless memory she was significantly weaker than when she recalled the empowering memory. This experience demonstrated to her the power of her thoughts.
4. Rewriting failure into success. Each time she missed the lift, she would think, “I should not have done that,” or “I was doubtful or nervous during competition,” she shifted her focus to:
- Accepting what happened by acknowledging she did the best she could have done under the circumstances.
- Exploring how she could have done it differently and imagine herself doing it in the new optimum way.
- Using the trigger of the beginning thought of failure or defeat to evoke the new empowering memory thus interrupting the chained behavior.
The underlying concept was that what we mentally rehearse is what we may become and that our thoughts affect performance which she previously experienced by the arm resistance test. If you keep thinking about a defeat you are training the physiological pattern of defeat. This practice of transforming self-defeating thoughts into empowering thoughts can be applied to all phases of one’s life and was continued throughout the training sessions. The focus was to acknowledge and realize that whatever you did, it was the only thing you could have done because you did not yet have the skills to do it differently. She would then create a new strategy of mental rehearsal that lead to a positive outcome (for detailed description of this practice see Peper, Harvey, Lin, & Duvvuri, 2014).
5. Identifying whether imagery rehearsal is somatically connected. It is our bias that imagery rehearsal is useful if the body responds in a similar pattern when the person images the task as it would during an actual activity (Hall, 2001; Peper et al, 2015). The concurrent physiological activity would indicate that the person is experientially involved in the task and not just observing as a witness/second party.
Her performance is weightlifting and this would involve major muscle activity. Surface EMG was recorded from muscles that would be activated during the actual performance of the task to identify if they would be activated during mental rehearsal. The muscle activity during mental rehearsal is usually at a much smaller amplitude than that occurred during actual physical performance; however, should follow a similar timing sequence. In our experience there are three responses:
- Muscle activity in the appropriate muscles that are in the same timing as in and actual performance. This implies that mental rehearsal is actually training the motor pattern and facilitate performance. Thus continue practicing with mental rehearsal.
- Muscle activity in the appropriate muscles are not generally in the same timing sequence as the actual performance. This may mean that the person was performing too slow or was skipping sequences in the mental rehearsal and mental training may not be useful. The person needs to master and exhibit the same muscle pattern during mental rehearsal as during actual performance of the task.
- No muscle activity or inappropriate muscle activity during the during the mental rehearsal. This implies that during mental rehearsal there is no motor pattern training and the approach would not be useful unless the person learned to activate appropriate motor activity. It is possible that some people who have experienced past traumas may have coped by shutting off feelings and sensations in their bodies.
When Jo Aita initially practiced mental rehearsal while being monitored with surface EMG recorded with Myoscan Pro sensors (filter set narrow 100-200Hz) from the right and left upper trapezius muscles, there was no corresponding muscle activity as shown in Figure 2. Although she imaged, she did not feel/experience the lifting. The training focused upon reconnecting imagery and body experience.
Figure 2. Left and right upper trapezius EMG showed no increase in activity while Jo Aita mentally imaged performing her lift.
6. Integrating imagery and body experience with EMG. After identifying that imagery did not elicit concurrent muscle activity, the training focused on developing the imagery muscle connection. The training consisted of:
- Monitoring EMG activity from her right and left quadriceps and right and left upper trapezius muscle and have her simulate her actually lifting in practice and competition by going through the complete sequence which included standing and waiting till her name was called, caulking her hands, performing a ritual activity to be ready to lift the weights, lifting the weights, and releasing them. The pattern is shown in Figure 3.
Figure 3. Simulating the actual Snatch and Jerk lift (Clean is lifting the weights to the chest and punching Jerk is pushing the weigh upward is labelled).
- Practicing imagery by going through the same procedure and purposely slightly activating the movements which were necessary to lift the weight. As she stated, “I learned to do mental rehearsal in a more structured way and visualized the total sequence from chalking up to doing all six lifts”. This was monitored by the EMG to see that there occurred EMG activation of the muscles. This was repeated numerous times till, the activation occurred in imagery as shown in Figure 4.
Figure 4. EMG activity during mental rehearsal.
She then reported that imagery was a real experience.
7. Training mental rehearsal and imagery for peak performance (Cumming, Hall, & Shambrook, 2004). The major components of the mental rehearsal focused upon performing perfectly, visualizing lifting more weight easily than actually lifted in the gym, performing in the gym as she would during competing, practicing performing when interruptions occurred, and punching the weight through the ceiling.
- Performing perfectly. During the day she would mentally rehearse practicing lifting perfectly. In addition, as part of her readiness routine she would image performing the lift perfectly.
- Practicing recovery and being centered when interruptions would occur. For example, she was asked to role play competition and waiting for the judge to give the signal to start, I delayed giving her the signal to begin and told her the weights had to be adjusted because they had miss-loaded the bar. This way there would be no novelty during actual competition. This concept of coping with the unexpected was illustrated by Michael Phelps swimming the 200-meter butterfly in 2012 Being Olympics when his googles filled up with water when he dove in. Michael still won his 10th gold medal even though he swam part of the race blind (Fanning, E., June 25, 2012). He could do this because numerous time in the past, his coach had purposely trained Michael to swim with leaking googles
- Imagining lifting 10 kg more while competing. The concept of feeling/imagining yourself performing more that you can do at this moment creates the possibility for improvement since the limits of imagination may limit the experience/performance. As she reported, “This was incredibly helpful last year in competition when I needed to lift more than I had done before to qualify for the American Open, so I had mentally done it so often, then I just did it and made the qualifying lift.”
- Feeling your arms extending way up into the ceiling. Extending beyond your mental boundary of the test allows more power because the body tends to stop at the boundary. For example, when running 100 meters you want to see the finish line at least ten meters beyond the actual finish line this way you continue to run at maximum speed through the finish. If you focus on the actual finish line, you often slow down before reaching it. I told her how we used this concept with young male gymnasts to be able to do the iron cross for the first time by thinking of their arms being an iron beam and extending through the rings into the wall. In the case of lifting, you want to feel yourself punching the weight through the ceiling instead of just driving it upward. This portion of the lift when punching up into the ceiling is call the Jerk. This concept was experientially demonstrated by the following Aikido exercise of the iron arm.
Two people pair up and face each other. One stretches his arm straight out and rests the wrist and back of the palm on the shoulder of his partner. The partner put both hands on the elbow and then then pulls down trying to bend the elbow while his partner is try resist the downward force and try not to bend it as shown in Figure 5.
Figure 5. Testing the effect of imagery on resisting downward pull at the elbow with wrist facing palm up.
Then relax, and repeat the same exercise except the person imagines that his arm is like a metal bar extending from their shoulders out through his hand into the wall. Once the person is imaging this, then the partner again attempts to bend the arm.
In almost all cases, when the person imagines the arm extending like an iron bar into the wall, it is much stronger and much more difficult to bend. Jo integrated this felt imagery in her lifting during practice and she experienced increased strength while imagining/feeling the iron bar and reported that she had the “best Jerks in her life.”
Achieving a new world and personal record at age 46 in the master’s competition is a remarkable tribute to the athlete’s dedication and coaching. Although I (EP) may think I contributed, and hopefully what I taught was beneficial, in the end it is the athlete herself who has to perform in the competition–she is alone stands on the platform to lift the weights. When I (EP) asked whether the biofeedback visualization training was useful, Jo inequitably said, “Yes, and I would recommend this approach and training to everyone!” Watch the in-depth interview with Jo Aita in which she describes her experience of integrating imagery techniques and biofeedback to enhance performance on May 26, 2017.
What is interesting to ask is, how come a 46-year-old woman could lift 3 kg more than at any other time during her competitive career of Olympic lifting? It gives hope that loss of strength that commonly occurs as we age may be due less to aging than to learned disuse, injuries and lack of recovery. Most important factors are personal motivation and hope—you want to perform your best and know/believe that it is possible (Wilson and Peper, 2011). As Jo stated, “It helped for me to focus on doing my personal best.” I love Olympic lifting, I like taking care of my body, and I like feeling strong.” Finally, Jo is a recent athlete in her sport. She started lifting when she was 33 and competed one year later. She then took time out to give birth to her son and in a couple of months came back quickly and continued to become stronger. As she stated, “I always wanted to get stronger no matter what my age was.”
From a performance perspective it is interesting that she lifted more than ever before. Would it be possible that she is similar to many performers who achieve maximum performance after about 10 to 15 years of dedicated training? As she gets older, she improves her skills, increases efficiency of here muscles and neural connections. Is a possible that loss of performance as we age less due to aging than loss of motivation after years of practice, competition and achieving your goal. At that point life may offer other challenges and new opportunities.
Cumming, J., Hall, C., & Shambrook, C. (2004). The influence of an imagery workshop on athletes’ use of imagery. Athletic insight, 6(1), 52-73.
Fanning, E. (June 25, 2012). 50 stunning Olympic Moments No 42: Michael Phelps goes big in Being. Downloaded May 30, 2017 from https://www.theguardian.com/sport/blog/2012/jun/25/50-stunning-olympic-moments-michael-phelps
Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic.
Hall, C. (2001). Imagery in sport and exercise. In R. Singer, H. Hausenblas, & C. Janelle (Eds.), Handbook of Sport Psychology (pp. 529 – 549). New York, NY: John Wiley & Sons, Inc.
Peper, E., Harvey, R., Lin, I-M, & Duvvuri, P. (2014). Increase productivity, decrease procrastination and increase energy. Biofeedback, 42(2), 82-87.
Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. (2014). Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback.42(1), 16-23.
 Correspondence: Erik Peper, Ph.D., Institute for Holistic Health Studies, Department of Health Education, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132. email: firstname.lastname@example.org; web: www.biofeedbackhealth.org; blog: www.peperperspective.com
 We thank Dr. Sue Wilson for her helpful and constructive feedback.
 We purposely use the word “may” because it is a case report and not a controlled study. Coaches, sport psychologist, or anyone who has had contact with an athlete who does extremely well usually claims that their suggestions were the magic ingredient; however, it could be synchronicity and not due to the actual skills taught. It may be due to unidentified factors or covert factors embedded in the coaching or teaching such as transforming hope and belief.
 Be aware that when people learn to reconnect with their body or learns slow diaphragmatic breathing and allow their lower abdomen to relax and expand, it is possible that past traumatic memories could be released. This release is a healthy process and we usually adapt an Autogenic Therapy/Training perspective by which the person accepts, allows discharge and continues with the task at hand.
Joy and laughter are healing and contagious (Wang, 2006). When we laugh, our mood lightens, we feel better and our health improves (Bennett & Lengacher, 2006a; Bennett & Lengacher, 2006b; Bennett & Lengacher, 2008; Bennett & Lengacher, 2009). As Norman Cousins, who had ankylosing spondylitis (a degenerative disease causing the breakdown of collagen) which left him in severe pain that even morphine couldn’t touch, claimed that 10 minutes of belly laughter would give him two hours of pain-free sleep. He documented his remarkable recovery in his book Anatomy of an illness (Cousins, 2005). Laughter and joy has the ability to transform your health.
Despite the challenges you may face, the actual troubles that may occur during the day, or feeling frustrated or depressed, treat yourself to a moment of joy and laughter. Through laughing, we relax and support the intrinsic self-healing processes in our body. Even in suffering we have a choice of what to feed our brain. Enjoy watching the following videos.
Finally, watch Norman Cousins describe his own healing experience: https://www.youtube.com/watch?v=0LwKd68S15I
Also see the embedded videos posted on: http://www.laughteronlineuniversity.com/norman-cousins-a-laughterpain-case-study/
Bennett, M. P., & Lengacher, C. (2006b). Humor and laughter may influence health: II. Complementary therapies and humor in a clinical population. Evidence-Based Complementary and Alternative Medicine, 3(2), 187-190.