Go behind the screen and watch Inna Khazan, PhD, faculty member at Harvard Medical School and author of Biofeedback and mindfulness in everyday life: Practical solutions for improving your health and performance, interview Erik Peper, PhD and Richard Harvey, PhD. coauthors of the new book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.
Dr. Inna Khazan interviews Dr. Erik Peper about his new book Tech Stress. We talk about some of the ways in which technology overuse affects our health and what we can do about it.
Dr. Inna Khazan interviews Dr. Rick Harvey about his new book Tech Stress, the way technology overuse can affect adults and children, and what we can do about it.
We are excited about our upcoming book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, that will be published August 25, 2020.
Evolution shapes behavior — and as a species, we’ve evolved to be drawn to the instant gratification, constant connectivity, and the shiny lights, beeps, and chimes of our ever-present devices. In earlier eras, these hardwired evolutionary patterns may have set us up for success, but today they confuse our instincts, leaving us vulnerable and stressed out from fractured attention, missed sleep, skipped meals, aches, pains, and exhaustion and often addicted to our digital devices.
Tech Stress offers real, practical tools to avoid evolutionary pitfalls programmed into modern technology that trip us up. You will find a range of effective strategies and best practices to individualize your workspace, reduce physical strain, prevent sore muscles, combat brain drain, and correct poor posture. The book also provides fresh insights on reducing psychological stress on the job, including ways to improve communication with coworkers and family.
Although you will have to wait until August 25th to have the book delivered to your home, you can already begin to implement ways to reduce physical discomfort, zoom/screen fatigue and exhaustion. Have a look the blogs below.
How evolution shapes behavior
How to optimize ergonomics
Hot to prevent and reduce neck and shoulder discomfort
How to prevent screen fatigue and eye discomfort
How to improve posture and prevent slouching
How to improve breathing and reduce stress
How to protect yourself from EMF
Adapted from the upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, by Erik Peper, Richard Harvey and Nancy Faass.
While working in front of screens, many of us suffer from Zoom/screen fatigue, iNeck, shoulder and back discomfort, tired eyes, exhaustion and screen addiction (Peper, 2020; Fosslien & Duffy, 2020; So, Cheng & Szeto, 2017; Peper & Harvey, 2018). As we work, our shoulders and forearms tense and we are often not aware of this until someone mentions it. Many accept the discomfort and pain as the cost of doing work–not realizing that it may be possible to work without pain.
Observe how you and coworkers work at the computer, laptop or cellphone. Often we bring our noses close to the screen in order to the text more clearly and raise our shoulders when we perform data entry and use the mouse. This unaware muscle tension can be identified with physiological recording of the muscles electrical activity when they contract (electromyography) (Peper & Gibney, 2006; Peper, Harvey & Tylova, 2006). In most cases, when we rest our hands on our laps the muscle tension is low but the moment we even rest our hands on the keyboard or when we begin to type or mouse, our muscles may tighten, as shown in Figure 1. The muscle activity will also depend on the person’s stress level, ergonomic arrangement and posture.
Figure 1. Muscle tension from the shoulder and forearm increased without any awareness when the person rested their hands on the keyboard (Rest Keyboard) and during typing and mousing. The muscles only relaxed when the hands were resting on their lap (Rest Lap) (reproduced by permission from Peper, Harvey, and Faass, 2020).
Stop reading from your screen and relax your shoulders. Did you feel them slightly drop and relax?
If you experienced this release of tension and relaxation in the shoulders, then you were tightening your shoulders muscles without awareness. It is usually by the end of the day that we experience stiffness and discomfort. Do the following exercise as guided by the video or described in the text below to experience how discomfort and pain develop by maintaining low-level muscle tension.
While sitting, lift your right knee two inches up so that the foot is about two inches away from the floor. Keep holding the knee up in this position. Did you notice your breathing stopped when you lifted your knee? Are you noticing increasing tension and discomfort or even pain? How much longer can you lift the knee up?
Let go, relax and observe how the discomfort dissipates.
Reasons for the discomfort
The discomfort occurred because your muscles were contracted, which inhibited the blood and lymph flow through the tissue. When your muscles contracted to lift your knee, the blood flow in those muscles was reduced. Only when your muscles relaxed could enough blood flow occur to deliver nutrients and oxygen as well as remove the waste products of metabolism (Wan et al, 2017). From a physiological perspective, muscles work most efficiently when they alternately contract and relax. For example, most people can walk without discomfort since their muscles contract and relax with each step. However, you could hold your knee up for a few minutes before experiencing discomfort in those same muscles.
How to prevent discomfort.
To prevent discomfort and optimize health, apply the same concept of alternating tensing and relaxing to your neck, shoulder, back and arm muscles while working. Every few minutes move your arms and shoulders and let them relax. Interrupt the static sitting position with movement. If you need reminders to get up and move your body during the workday or long periods sitting in front of a device, you can download and install the free app, StretchBreak.
For more information, read and apply the concepts described in our upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. The book explains why TechStress develops, why digital addiction occurs, and what you can do to prevent discomfort, improve health and enhance performance. Order the book from Amazon and receive it August 25th. Alternatively, sign up with the publisher and receive a 30% discount when the book is published August 25th. https://www.northatlanticbooks.com/shop/tech-stress/
Peper, E. & Gibney, K. H. (2006). Muscle Biofeedback at the Computer: A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. Amersfoort: The Netherlands: Biofeedback Foundation of Europe. ISBN 0-9781927-0-2. Free download of the the book: http://bfe.org/helping-clients-who-are-working-from-home/
Erik Peper and Richard Harvey
COVID-19 can sometimes overwhelm young and old immune systems and in some cases can result in ‘Severe Acute Respiratory Syndrome’ pneumonia and death (CDC, 2020). The risk is greater for older people, and people with serious heart conditions (e.g., heart failure, coronary artery disease, or cardiomyopathies), cancers, obesity, Type 2 diabetes, COPD, chronic kidney disease, hypertension, smoking, immune suppression or other health issues (CDC, 2020a) as well as young people who vape or smoke and those with immunological defects in type I and II interferon production (Gaiha, Cheng, & Halpern-Felsher, 2020; van der Made, 2020). As we age the immune system deteriorates (immunosenescence) that reduces the response of the adaptive immune system that needs to respond to the virus infection (Aw, Silva & Palmer, 2007; Osttan, Monti, Gueresi, et al., 2016). On the other hand, for young people and children the risk is very low and similar for Covid-19 as for seasonal influenza A and B in rates for hospitalization, admission to the intensive care unit, and mechanical ventilator ( Song et al, 2020).
Severity of disease may depend upon initial dose of the virus
In a brilliant article, How does the coronavirus behave inside a patient? We’ve counted the viral spread across peoples; now we need to count it within people, assistant professor of medicine at Columbia University and cancer physician Siddhartha Mukherjee points out that severity of the disease may be related to the initial dose of the virus. Namely, if you receive a very small dose (not too many virus particles), they will infect you; however, the body can activate its immune response to cope with the infection. The low dose exposure act similar to vaccination. If on the other hand you are exposed to a very high dose then your body is overwhelmed with the infection and is unable to respond effectively. Think of a forest fire. A small fire can easily be suppressed since there is enough time to upgrade the fire-fighting resources; however, during a fire-storm with multiple fires occurring at the same time, the fire-fighting resources are overwhelmed and there is not enough time to recruit outside fire-fighting resources.
As Mukherjee points out this dose exposure relationship with illness severity has a long history. For example, before vaccinations for childhood illnesses were available, a child who became infected at the playground usually experienced a mild form of the disease. However, the child’s siblings who were infected at home develop a much more severe form of the disease.
The child infected in the playground most likely received a relatively small dose of the virus over a short time period (viral concentration in the air is low). On the other hand, the siblings who were infected at home by their infected brother or sister received a high concentration of the virus over an extended period which initially overwhelmed their immune system. Higher virus concentration is more likely during the winter and in well insulated/sealed houses where the air is recirculated without going through HEPA or UV filters to sterilize the air. When there is no fresh air to decrease or remove the virus concentration, the risk of severity of illness may be higher (Heid, 2020).
The risk of becoming sick with COVID-19 can only occur if you are exposed to the coronavirus and the competency of your immune system. This can be expressed in the following equation.This equation suggests two strategies to reduce risk: reduce coronavirus load/exposure and strengthen the immune system.
How to reduce the coronavirus load/dose of virus exposure
Assume that everyone is contagious even though they may appear healthy. Research suggests that people are already contagious before developing symptoms or are asymptomatic carriers who do not get sick and thereby unknowingly spread the virus (Furukawa, Brooks, Sobel, 2020). Dutch researchers have reported that, “The proportion of pre-symptomatic transmission was 48% for Singapore and 62% for Tianjin, China (Ganyani et al, 2020). Thus, the intervention to isolate people who have symptoms of COVID-19 (fever, dry cough, etc.) most likely will miss the asymptomatic carriers who may infect the community without awareness. Only if you have been tested, do you know if you been exposed or recovered from the virus. To reduce exposure to the virus, avoid the “Three C’s” — closed spaces with poor ventilation, crowded places and close contact—and do the following:
- Follow the public health guidelines:
- Social distance (physical distancing while continuing to offer social support)
- Wear a mask and gloves to reduce spreading the virus to others.
- Wash your hands with soap for at least 20 seconds.
- Avoid touching your face to prevent microorganisms and viruses to enter the body through mucosal surfaces of the nose mouth and eyes.
- Clean surfaces which could have been touched by other such as door bell, door knobs, packages.
- Avoid the person’s slipstream that may contain the droplets in the exhaled air. The purpose of social distancing is to have enough distance between you and another person so that the exhaled air of the other person would not reach you. The distance between people depends upon their activities and the direction of airflow.
In a simulation study, Professor Bert Blocken and his colleagues at KU Leuven and Eindhoven University of Technology reported that the plume of the exhaled air that potentially could contain the virus droplets could extend much more than 5 feet. It would depends upon the direction of the wind and whether the person is walking or jogging as show in Figure 1 (Blocken, 2020).
Figure 1. The plume of exhaled droplets that could contain the virus extends behind the person in their slipstream (photo from KU Leuven en TU Eindhoven).
The plume of exhaled droplets in the person’s slipstream may extend more than 15 feet while walking and more than 60 feet while jogging or bicycling. Thus. social distancing under these conditions is much more than 6 feet and it means avoiding their slipstream and staying much further away from the person.
- Increase fresh air to reduce virus concentration. The CDC recommends ventilation with 6 to 12 room air changes per hour for effective air disinfection (Nardell & Nathavitharana, 2020). By increasing the fresh outside air circulation, you dilute the virus concentration that may be shed by an infected asymptomatic or sick person (Qian & Zheng, 2018). Thus, if you are exposed to the virus, you may receive a lower dose and increase the probability that you experience a milder version of the disease. Almost all people who contract COVID-19 are exposed indoors to the virus. In the contact tracing study of 1245 confirmed cases in China, only a single outbreak of two people occurred in an outdoor environment (Qian et al, 2020). To increase fresh air (this assumes that outside air is not polluted), explore the following:
- Open the windows to allow cross ventilation through your house or work setting. One of the major reasons that the flu season spikes in the winter is that people congregate indoors to escape weather extremes. People keep their windows closed to conserve heat and reduce heating bill costs. Lack of fresh air circulation increases the viral density and risk of illness severity (Foster, 2014).
- Use an exhaust fans to ventilate a building. By continuously replacing the inside “stale” air with fresh outside air, the concentration of the virus in the air is reduced.
- Use High-efficiency particulate air (HEPA) air purifiers to filter the air within a room. These devices will filter out particles whose diameter is equal to 0.3 µ m. They will not totally filter out the virus; however, they will reduce it.
- Avoid buildings with recycled air unless the heating and air conditioning system (HAC) uses HEPA filters.
- Wear masks to protect other people and your community. The mask will reduce the shedding of the virus to others by people with COVID-19 or those who are asymptomatic carriers. This is superbly illustrated by Prather, Wang, & Schooley (2020) that not masking maximizes exposure, whereas universal masking results in the least exposure.
- Avoid long-term exposure to air pollution. People exposed to high levels of air pollution and fine particulate matter (PM2.5) are more at risk to develop chronic respiratory conditions and COVID-19 death rates. In the 2003 study of SARS, ecologic analysis conducted among 5 regions in China with 100 or more SARS cases showed that case fatality rate increased with the increment of air pollution index (Cui, Zhang, Froines, et al. , 2003). The higher the concentration of fine particulate matter (PM2.5), the higher the death rate (Conticini, Frediani, & Caro, 2020). As researchers, Xiao Wu, Rachel C. Nethery and colleagues (2020) from the Harvard T.H. Chan School of Public Health point out, “A small increase in long-term exposure to PM2.5 leads to a large increase in COVID-19 death rate, with the magnitude of increase 20 times that observed for PM2.5 and all cause mortality. The study results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis.“
- Breathe only through your nose. The nose filters, warms, moisturizes and slows the airflow so that airway irritation is reduced. Nasal breathing increases nitric oxide production that significantly increases oxygen absorption in the body. During inspiration through the nose the nitric oxide helps dilate the airways in your lungs and blood vessels (McKeown, 2016). More importantly for dealing with COVID-19, Nitric Oxide, produced and released inside the nasal cavities and the lining of the blood vessels, acts as an antiviral and a secondary strategy to protect against viral infections (Mehta, Ashkar & Mossman, 2012).
How to strengthen your immune system to fight the virus
The immune system is dynamic and many factors as well as individual differences affect its ability to fight the virus. It is possible that a 40 year-old person may have an immune systems that functions as a 70 year old, while some 70 year-olds have an immune system that function as a 40 year-old. Factors that contribute to immune competence include genetics, aging, previous virus exposure, and lifestyle (Lawton, 2020).
It is estimated that 70-80% mortality caused by Covid-19 occurred in people with comorbidity who are: over 65, male, lower socioeconomic status (SES), non white, overweight/obesity, cardiovascular heart disease, and immunocompromised. Although children comprised only a small percentage of the seriously ill patients, 83% of those children in the intensive care units had comorbidities and 60% were obese. The majority of contributing factors to comorbidities and obesity are the result of economic inequality and life style patterns such as the Western inflammatory diet (Shekerdemian et al, 2020; Zachariah, 2020; Pollan, 2020).
By taking charge of your lifestyle habits through an integrated approach, you may be able to strengthen your immune system (Alschuler et al, 2020; Lawton, 2020). The following tables, adapted from the published articles by Lawton (2020), Alschuler et al, (2020) and Jaffe (2020), list factors that support or decrease the immune system.
Factors that decrease immune competence
Factors that support immune competence
Phytochemicals and vitamins that support immune competence
An ounce of prevention is worth a pound of cure. Thus, to reduce the risk of covid-19 disease severity, implement strategies to reduce viral dosage exposure and strengthen the immune system. Many of these factors are within our control. Thus, increase fresh air circulation, reduce stress, decrease foods that tend to increase inflammation (the industrialized western diet that significant contributes to the development of chronic disease), and increase foods, vitamins and nutrients that support immune competence.
These factors have been superbly summarized by the World Health Organization Director General Dr. Tedros Adhanom in his presentation, Practical tips how to keep yourself safe.
Brandhorst, S., Choi, I.Y., Wei, M., Cheng, C.W., Sedrakyan, S., Navarrete, G., Dubeau, L., et al. (2015). A Periodic Diet that Mimics Fasting Promotes Multi-System Regeneration, Enhanced Cognitive Performance, and Healthspan. Cell Metabolism, 22(1), 86-99.
Campbell, J.P. & Turner, J.E. (2018). Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Frontiers in Immunology, 9, 648.
Conticini, D., Frediani, F., & Caro, D. (2020). Can atmospheric pollution be considred a co-factdor in the extremely high level of SARS-CoV-2 lethality in Northern Italy. Environmental Pollution, available online, 4 April 2020, 114465.
Furukawa, N.W., Brooks, J.T., & Sobel, J. (2020, July). Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. [June3, 2020]. https://doi.org/10.3201/eid2607.201595
Ganyani, T., Kremer, C., Chen, D., Torneri, A, Faes, C., Wallinga, J., & Hensm N. (2020). Estimating the generation interval for COVID-19 based on symptom onset data doi:https://doi.org/10.1101/2020.03.05.20031815
Gaiha, S.M., Cheng, J. & Halpern-Felsher, B. (2020). Association between youth smoking, electronic cigarette use, and coronavirus disease 2019. Journal of Adolescent Health. Published online August 11, 2020. doi: https://doi.org/10.1016/j.jadohealth.2020.07.002
Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 10(2), 227-237. doi:10.1177/1745691614568352
Jaffe, R. (2020). Reduce risk, boost immunity defense and repair abilities, and stay resilient. PERQUE Integrative Health.
Martineau, A.R., Jolliffe, D.A., Hooper, R.L, Greenberg, L., Aloia, J.F ..(2017). Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. British Medical Journal; 356:i6583 | doi: 10.1136/bmj.i6583
Mehta, D. R., Ashkar, A. A., & Mossman, K. L. (2012). The nitric oxide pathway provides innate antiviral protection in conjunction with the type I interferon pathway in fibroblasts. PloS one, 7(2), e31688.
Neupane, B., Jerrett, M., Burnett, R.T., Marrie, T., Arain, A., Loeb, M. (2018). Long-term exposure to ambient air pollution and risk of hospitalization with community-acquired pneumonia in older adults. Am J Respir Crit Care Med, 181(1), 47‐53.
Ostan, R., Monti, D., Gueresi, P., Bussolotto, M., Franceschi, C., & Baggio, G. (2016). Gender, aging and longevity in humans: An update of an intriguing/neglected scenario paving the way to a gender-specific medicine. Clinical Science, 130(19), 1711-1725.
Qian, H., & Zheng, X. (2018). Ventilation control for airborne transmission of human exhaled bio-aerosols in buildings. Journal of thoracic disease, 10(Suppl 19), S2295–S2304. https://doi.org/10.21037/jtd.2018.01.24
Price MA, Butow PN, Bell ML, et al. Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?. Support Care Cancer. 2016;24(6):2627‐2634.
Shekerdemian L.S., Mahmood N.R., Wolfe, K.K., et al (2020). International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.JAMA Pediatr. Published online May 13, 2020. doi:10.1001/jamapediatrics.2020.1948
Uchino, B. N., Vaughn, A. A., Carlisle, M., & Birmingham, W. (2012). Social support and immunity. In S. C. Segerstrom (Ed.), Oxford library of psychology. The Oxford handbook of psychoneuroimmunology (p. 214–233). Oxford University Press.
Witek, L, Tell, J. D., & Mathews, L. (2019). Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control. Brain, behavior, and immunity, 80, 358-373.
Zachariah, P., Johnson, C.L., Halabi, K.C., et al (2020) Columbia Pediatric COVID-19 Management Group. Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York. JAMA Pediatr. Published online June 3, 2020. doi:10.1001/jamapediatrics.2020.2430
Adapted from the upcoming book, Peper, E., Harvey, R., & Faass, (2020). Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.
Numerous people report that working at the computer at home is more tiring than working in the office. Although there are obvious advantages to working at home, there are also disadvantages (e.g., no space to work, challenging ergonomics, no escape from the family, lack of nonverbal cues used to communicate, less informal sharing at the water cooler, increased multitasking by working and having to take care of the children).
A major challenge is having a comfortable work space in your home. This may mean finding a place to put the computer, keyboard and screen. For some it is the kitchen table, desk in the corner of the bedroom, or coffee table while other it is in a totally separate room.
Incorrect ergonomic arrangement and stressed work style often increases neck, shoulder discomfort and aggravates eye strain and tiredness. Regardless how your digital work space is organized, implement the following life and work style suggestions and ergonomics recommendations to promote health.
LIFE AND WORK STYLE SUGGESTIONS
Take many, many, many breaks. Movement breaks will reduce the covert static tension that builds up as we sit in static positions and work at the computer.
- Every few minutes take a small break such as stand up and wiggle or role your shoulders. When performing the movements, stop looking at the screen and look around the room or out the window.
- Every 30 minutes get up walk around for and move your body. Use timers to notify you every 30 minutes to take a break (e.g., cellphone alarms or personal digital assistants such as Hey Google, Siri, or Alexa).
- Take vision breaks to reduce eye fatigue.
- Every few minutes look away from the screen and into the far distance and blink. If at all possible look outside at green plants which relaxes the near vision induced tension.
- Blink and blink again. When working at the computer we reduce our blinking rate. Thus, blink each time you click on a new link, finishing entering a column of numbers, etc.
- Close your eyes by letting the eye lids drop down as you also relax your jaw. Imagine a hook on top of your head which is pulling your head upward and at the same time drop your shoulders.
- Reduce glare and bright backgrounds
- Arrange your computer screen at 90 degrees to the brightest light source.
- Have a darker background behind you when participating in video conferencing (e.g., Zoom, Skype, GoToMeeting, WhatsApp, FaceTime). Your face will be visible.
- When stressed remember to breathe. As you inhale let your stomach expand as you exhale let the air flow out slowly.
- Stop watching and listening to the negative news (check the news no more than once a day). Watch positive and humorous movies.
- Get fresh air, go for a walk, and be in the sun
- Reconnect with friends and share positive experiences.
- Remind yourself, that this too shall pass.
ERGONOMIC RECOMMENDATIONS: MAKE THE WORLD YOURS
Good ergonomics means adapting the equipment and environment to you and not the other way around. Optimizes the arrangement of the chair, desk, keyboard, mouse, camera, screen and yourself as shown in Figure 1.
Figure 1. Recommended arrangement for working at the computer.
Arrange the laptop
The laptop is challenging because if your hands are at the right height for data entry on the keyboard, then you must look down to see the screen. If the screen at the right height, then you have to raise your hands to reach the keyboard. There are two solutions for this challenge.
- Use an external keyboard and mouse, then raise the laptop so that the top of the screen is at eye level. Use a laptop stand or a stack of books to raise the lap top.
- Use an external monitor for display, then use the laptop as your keyboard.
If these solutions are not possible, take many, many, many breaks to reduce the neck and shoulder stress.
Arrange the computer workstation
- Adjust the chair so that your forearms can rest on the table without raising your shoulders. This may mean sitting on a pillow. If the chair is then too high and your legs dangle, create a foot stool on which you can rest your feet.
- Adjust the monitor so that the top of the screen is at eye level. If the monitor is too low, raise it by putting some books underneath it.
- If possible, alternate standing and sitting while working.
Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics provides insight in how discomfort, symptoms and media addiction develops and what you can do about it. It incorporates the role of evolutionary traps, how biofeedback makes the unaware aware, experiential physical and cognitive practices, and ergonomic recommendations to optimize health and productivity. A must book for anyone using digital devices. Peper, E., Harvey, R., & Faass, (2020). Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.
Ergonomic suggestions for working at the computer and laptop.
11 tips for working at home
How our digital world activates evolutionary response patterns.
How posture affects health
The coronavirus which causes coronavirus disease 2019 (COVID-19) appears to be a highly contagious disease. Some older people and those who are immune compromised are more at risk. The highest risk are for older people who already have cardiovascular, diabetes, respiratory disease, and hypertension. In addition, older men over 65 years are much more at risk; however, many are smokers who have a compromised pulmonary system. Previous meta analysis showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection. Nevertheless, it is reasonable to assume that over time all most all of us will become exposed to the virus, a few will get very sick, and even fewer will die.
The preliminary data suggests that most people who become infected may not even know they are infectious. Make the assumption that everyone could be contagious unless tested for the virus or antibodies to the virus since people appear to be infectious for the first four days before experiencing symptoms.
The absolute risk that one would die of this disease is low although if you do become very sick it is more dangerous than the normal flu; however, the fear of this disease may be out of proportion compared to other health risks. For detailed analysis and graphic summaries see the updated research reports on the Coronavirus disease (COVID-19) by Our World in Data and Information is beautiful. These reports make data and research on the world’s largest problems understandable and accessible.
It is worthwhile to look at the absolute risk of COVID-19. To read that more than 332,000 people world wide have died in the last five months is terrifying especially with the increasing death rate in Europe and New York; however, it needs to be understood in context of the size of the population. The epicenter of this disease was Wuhan and Hubei Provence, China with a total population of about 60 million people. Each year about 427,200 people die in the Wuhan and Hubei Province (the annual death rate in China is 7.12 deaths per 1000 people). Without this new viral disease, about 71,200 people would have died during the same two month period. The question that has not been discussed is how much did the total death rate increase. Would it be possible that some of the people who died would have died of other natural causes such as the flu?
The World Health Organization (WHO) and governments around the world should be lauded for their attempt to reduce the spread of the virus. On March 6, 2020, the United States Congress allocated $8. billion dollars to fight and prevent the spread of COVID-19.
This funding will only partially prevent the spread of the virus because some people have no choice but to go to work when they are sick–they do not receive paid sick leave! This is true for about 30 percent of the American workers who have no coverage at work or the millions of self-employed workers (e.g. gig/freelance workers, waiters, cashiers, drivers, nannies, house cleaners).
To reduce the risk of the spreading COVID-19, anyone who feels sick or thinks they have been exposed, should receive paid sick leave so that they can stay home and self-isolate. The paid sick leave should be Federally funded and provide basic income for those whose income would be lost if they did not work. Although it is possible that a few people will cheat and take the paid sick leave when they are well, this is worth the risk to keep the rest of population healthy. To provide possible relief, at the moment the House and Senate are working on a greater than $2 trillion dollar stimulus package.
Personal and government responses to health risks are not always rational.
Funding for health and illness prevention is driven by politics. For example, gun violence results in more than 100,000 people being injured each year and more than 36,000 killed—an average of 100 per day. Gun violence is a much more virulent disease than COVID-19 and more than 1.7 million Americans have died from firearms since 1968.
The Federal Government response to this gun violence epidemic has been minimal. For the first time since 1996 did the 2020 federal budget include $25 million funding for the CDC and NIH to research reducing gun-related deaths and injuries.
It is clear that the government response does not always focuses its resources on what would reduce injury and death rates the most. Look at the difference in the national response to COVID-19 virus that has killed more than 120,000 people in the USA ($8.5 billion for the initial response and then $2 trillion stimulus package) as compared gun violence that kills 36,000 people a year in the USA ($25 million funding to study the causes of gun violence).
Be realistic about the actual risk of COVID-19 without succumbing to fear.
COVID-19 is a pandemic and I expect that 30% to 70% of us will be infected this year. Hopefully, in the next 18 months an effective vaccine will be developed. In the mean time, there is no known treatment, thus optimize health and reduce the exposure to the coronavirus.
- How to reduce exposure to the coronavirus
- Optimize your health and immune function by eating healthy, getting enough sleep, enjoying some exercise/movement and reducing stress.
- Increase social distance when with other people–greet people by staying separated by at least six feet or more from each other instead of a handshake or a kiss on the cheek.
- Wash your hands after touching surfaces that others may have touched or after going out for shopping, work, pleasure and/or meeting other people.
- Avoid touching your face especially your mouth, nose and eyes.
- Sanitize hard surfaces. Malia Jones, PhD, MPH points out that you can make your own inexpensive antimicrobial spray by mixing 1 part household bleach to 99 parts cold tap water. Spray this on surfaces and leave for 10-30 minutes. (Note: this is bleach. It will ruin your sofa).
- If you think you have the disease or have symptoms, contact your healthcare provider. Wear a mask and self-isolate to reduce spreading the virus to others.
- Increase fresh air circulation and avoid room that have poor ventilation.
- Reliable information about COVID-19
- World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
- Centers for Disease Control (CDC): https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
- Graphic representation of the background of the COVID-19 infection and relationship to other diseases
- Summary of what is the corona virus: https://ourworldindata.org/coronavirus#citation
- Graphic representation of coronavirus in context to other diseases: https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/
- Accurate information on number of infections, new cases and deaths: https://www.worldometers.info/coronavirus/
To make sense of the danger of COVID-19, look at it in context to the flu. The risk is the greatest for people with co-morbidity (obesity, diabetes, emphysema, immune suppressed illnesses, and people who smoke and vape). While the risk for young people and children is no different for being infected with Covid-19 or influensa A and B in hospitalization rates, intensive care unit admission rates, and mechanical ventilator (Song et al. 2020). Depending upon the severity the flu, 9,000,000 to 45,000,000 people get sick from flu and between 12,000 to 61,000 die from its complications as shown below in Figure 1.
Figure 1. The estimated U.S. influenza burden by year (from: https://www.cdc.gov/flu/about/burden/index.html)
Evolutionary traps: How screens, digital notifications and gaming software exploits fundamental survival mechanismsPosted: January 17, 2020
Erik Peper and Richard Harvey
If athletes, psychologists, business executives, actors, students, politicians, job seekers and others use mental and actual rehearsal to improve their performances, would repeated watching of violent and aggressive streaming-videos, or playing hours and hours of first-shooter computer games be a form of rehearsal for aggressive behavior?
Arguably, mental and actual rehearsal is positively associated with improving health, such as preparing for an athletic competition or an academic exam and is negatively associated with health when playing aggressive, violent first-person shooter video games, or continuously watching aggressive or violent content on a variety of streaming platforms. Rehearsal–whether physical or in our imagination–impacts our health and performance in school, sports, therapy, politics, business and health. Choose to rehearse activities that improve health and well-being.
- Athletes use mental rehearsal to improve sports performance (Peper & Aita, 2017; Schenk & Miltenberger, 2019).
- Surgeons use mental rehearsal and actual practice to improve performance (Spiotta et al., 2018).
- Psychologists use cognitive behavioral therapy (CBT) rehearsal techniques to reduce anxiety and depression (Dobson & Dobson, 2018; Yamada et al, 2018; Cook, Mostazir, & Watkins, 2019)
- Successful business executives rehearse presentations before a staff meeting (Couch & Citrin, 2018).
- Actors and performers spend hours and days rehearsing their roles so that they portray and act it realistically during the performance .
- Students take practice exams so that they will perform better on the actual exam.
- Politicians, lawyers, and many others rehearse and practice being able to answer unexpected questions.
- Job seekers rehearse elevator pitches so that they transmit in a few words what is important
Mechanisms of rehearsal
Both mental and physical rehearsal strengthens neurochemical connections in the brain so that the rehearsed behaviors become more automated, fluid and unconscious. There is a saying in neurosciences, “Neurons that fire together wire together.” –the more you rehearse a task, the more those specific neurological pathways are strengthened, leading to automatic and efficient outcomes.
We now spend hours a day being exposed to digital displays on our phones, computers, gaming consoles and other digital devices, immersing ourselves in content reflecting life promoting, positive behavior and sometimes violent, negative behavior. Children and adults spend much of their free time looking at screens, texting, playing computer games, updating social media sites with moment by moment accounts of sometimes trivial activities, or going down the rabbit hole by following one hyperlinks after another. As we do this, we are unaware how much time has frittered away without actually doing anything productive. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.
- Facebook about an hour per day
- Instagram just under an hour per day
- Texting about 45 minutes per day
- Internet browsing, about 45 minutes per day
- Snapchat, about 30 minutes per day
- Twitter, about 25 minutes per day
Adolescents interact with media for over 40 hours per week, or around 6 hours per day!
In spending much of our time with the screens, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional and social health. Many researchers have lamented the loss of some social skills that develop during physical face-to-face contact. The colloquial phrase, Use it or lose it, raises several questions about what is being lost when we spend so much of our waking time interacting with screens instead actually with other people?
It is almost impossible not to be distracted by the digital screen. The powerful audiovisual formats override our desire to do something different that some of us become enslaved to watching streaming videos, playing computer games or texting. Moreover, the ongoing visual and auditory notifications from our apps interrupts and/or capture our attention. Why is it difficult to turn away from visual or auditory stimuli? The answer has roots in our survival.
To attend to stimuli is an automatic evolutionary survival response. If we did not attend, we would not survive–Is the slight movement to the far right, just at the edge of our peripheral vision, a predator ready to attack?
Each time a stimulus occurs, we need to check it out to see if it is friend or foe, safety or danger. The response is so automatic that we are unaware that we have reacted until after we have responded. We all have experienced this. When a computer screen or cellphone screen is held by the stranger next to us, we automatically look at their screen and we may even begin to read their emails. Although we know that peering at some else’s screen is not proper, we are still feel compelled to do it!
Similarly, screens displaying computer games and other media can capture or hijack our attention by the rapid scene changes, primarily because the content is programmed so we receive intermittent rewards for our responses. For example, the sound or visual notifications from our apps, cellphone messages, or social media trigger an impulse to scan the environment for information that may be critical to our survival. Even without receiving notifications, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notifications is long. One student talking to another might say: “Don’t worry, they’ll respond; It’s only been 30 seconds.” Anticipating responses from the media can interrupt what we are otherwise doing. For example, rather than finish our work, we check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.
The mechanisms that help us survive by scanning our environment for predators may now become an evolutionary trap and is exploited to capture as many eyeballs as possible to increase market share, advertising revenue, and corporate bottom line.
We usually blame the individual for lack of self-control instead of blaming the designers of the digital apps, games and displays who have exploited this biological survival mechanism. We expect that children have voluntary control as their brains are developing–but how could they not react to the stimuli that for thousands of generations, helped them to survive. It is similar to asking children to have control and say “No” to fast foods and sweets. The foods that were previously necessary for survival represented by moderate amounts of ‘salt, fat, acid, heat and sweet’ tastes are often found in excess in our modern commercial or packaged ‘fast food nation’ making it likely that people may fall into an evolutionary trap related to what they eat.
Presently, high levels of exposure to violent and aggressive streaming videos and computer games can be harmful as they provide the practice to rehearse violence, killing and aggression mentally. It would be too strong a statement to assert that everyone who plays violent video games will become delinquent, criminal or homicidal in an extreme form of aggression. According to the American Psychological Association Task Force on Video Game Violence in 2017, it may be asserted that high frequency, long duration, high intensity interactions with violent video games or similar media content is highly associated with angry and aggressive thoughts, desensitization to violence, and decreases in empathy or helping others (Calvert et al., 2017). Some forms of social media interactions also lead to a form of social isolation, loneliness (phoneliness) (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020; Kardaras, 2017). Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested include not only media, but junk food as well .
The negative impact of watching digital media was prescient by Jerry Mander, one of the leading visionaries of the 20th century, in his 1978 book, Four Arguments for the Elimination of Television, as well as by Joseph C. Pearce, author of books on human development and child development, in his 1993 book, Evolution’s End.
More recently, two superb books detail the harm that the digital revolution has brought, along with recommended strategies for how to use modern technologies wisely and live successfully in an e-world. We are not saying to avoid the beneficial parts of the digital age. We are saying to be aware how some material and digital platforms prey upon our evolutionary survival mechanisms. Unfortunately, most people —especially children– have not evolved skills to counter the negative impacts of some types of media exposure. It may take parental control and societal policies to mitigate the damage and enhance the benefits of the digital age. We highly recommend the following two books.
Calvert, S. L., Appelbaum, M., Dodge, K. A., Graham, S., Nagayama Hall, G. C., Hamby, S., Fasig-Caldwell, L. G., Citkowicz, M., Galloway, D. P., & Hedges, L. V. (2017). The American Psychological Association Task Force assessment of violent video games: Science in the service of public interest. American Psychologist, 72(2), 126–143. https://doi.org/10.1037/a0040413
Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A. (2020). Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis. Journal of Adolescence, 78, 24-32.
Cook L, Mostazir M, Watkins E, (2019). Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res, 21(5):e11349
Spiotta, A.M, Buchholz, A.L., Pierce, A. K., Dahlkoetter, J., & Armonda, R. (2018). The Neurosurgeon as a High-Performance Athlete: Parallels and Lessons Learned from Sports Psychology. World Neurosurgery, 120, e188-e193
Yamada, F., Hiramatsu, Y., Murata, T., Seki, Y., Yokoo, M., Noguchi, R., … & Shimizu, E. (2018). Exploratory study of imagery rescripting without focusing on early traumatic memories for major depressive disorder. Psychology and Psychotherapy: Theory, Research and Practice, 91(3), 345-362.
This post has been adapted from Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy. NeuroRegulation, 6(3), 153-169. doi:10.15540/nr.6.3.1533-1
When locked into a position, options appear less available. By unlocking our body, we allow our brain to unlock and become open to new options.
Changing positions may dissolve the rigidity associated with a fixed position. When we step away from the conflict, take a walk, look up at the treetops, roof lines and clouds, or do something different, we loosen up and new ideas may occur. We may then be able see the conflict from a different point of view that allows resolution.
When stressed, anxious or depressed, it is challenging to change. The negative feelings, thoughts and worries continue to undermine the practice of reframing the experience more positively. Our recent study found that a simple technique, that integrates posture with breathing and reframing, rapidly reduces anxiety, stress, and negative self-talk (Peper, Harvey, Hamiel, 2019).
Thoughts and emotions affect posture and posture affects thoughts and emotions. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies respond to the negative thoughts and emotions by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are much more at risk to:
- Feel helpless (Riskind & Gotay, 1982).
- Feel powerless (Westfeld & Beresford, 1982; Cuddy, 2012).
- Recall and being more captured by negative memories (Peper, Lin, Harvey, & Perez, 2017; Tsai, Peper, & Lin, 2016),
- Experience cognitive difficulty (Peper, Harvey, Mason, & Lin, 2018).
When we are upright and look up, we are more likely to:
- Have more energy (Peper & Lin, 2012).
- Feel stronger (Peper, Booiman, Lin, & Harvey, 2016).
- Find it easier to do cognitive activity (Peper, Harvey, Mason, & Lin, 2018).
- Feel more confident and empowered (Cuddy, 2012).
- Recall more positive autobiographical memories (Michalak, Mischnat,& Teismann, 2014).
Experience how posture affects memory and the feelings (adapted from Alan Alda, 2018)
Stand up and do the following:
- Think of a memory/event when you felt defeated, hurt or powerless and put your body in the posture that you associate with this feeling. Make it as real as possible . Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Think of a memory/event when you felt empowered, positive and happy put your body in the posture that you associate with those feelings. Make it as real as possible. Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Adapt the defeated posture and now recall the positive empowering memory while staying in the defeated posture. Observe what you experience.
- Adapt the empowering posture and now recall the defeated hopeless memory while staying in the empowered posture. Observe what you experience.
Almost all people report that when they adapt the body posture congruent with the emotion that it was much easier to access the memory and feel the emotion. On the other hand when they adapt the body posture that was the opposite to the emotions, then it was almost impossible to experience the emotions. For many people, when they adapted the empowering posture, they could not access the defeated hopeless memory. If they did access that memory, they were more likely be an observer and not be involved or emotionally captured by the negative memory.
Comparison of Posture with breathing and reframing to Reframing
The study investigated whether changing internal dialogue (reframing) or combining posture change and breathing with changing internal dialogue would reduce stress and negative self-talk more effectively.
The participants were 145 college students (90 women and 55 men) average age 25.0 who participated as part of a curricular practice in four different classes.
After the students completed an anonymous informational questionnaire (history of depression, anxiety, blanking out on exams, worrying, slouching), the classes were divided into two groups. They were then asked to do the following:
- Think of a stressful conflict or problem and make it as real as possible for one minute. Then let go of the stressful memory and do one of the two following practices.
- Practice A: Reframe the experience positively for 20 seconds.
- Practice B: Sit upright, look up, take a breath and reframe the experience positively for 20 seconds.
- After doing practice A or practice B, rate the extent to which your negative thoughts and anxiety/tension were reduced, from 0 (not at all) to 10 (totally).
- Now repeat this exercise except switch and do the other practice. (Namely, if you did A now you do B; if you did B now you do A).
Overwhelmingly students reported that sitting erect, breathing and reframing positively was much more effective than only reframing as shown in Figure 1 and 2.
Figure 1. Percentage of students rating posture, breath and reframing practice (PBRP) as more effective than reframing practice (RP) in reducing negative thoughts, anxiety and stress. Figure 2. Self-rating of reduction of negative thoughts and anxiety/tension
Stop reading. Do the practice yourself. It is only through experience that you know whether posture with breathing and reframing is a more beneficial than simply reframing the language.
Implications for education, counseling, psychotherapy.
Our findings have implications for education, counseling and psychotherapy because students and clients usually sit in a slouched position in classrooms and therapeutic settings. By shifting the body position to an erect upright position, taking a breath and then reframing, people are much more successful in reducing their negative thoughts and anxiety/stress. They report feeling much more optimistic and better able to cope with felt stress as shown by representative comments in table 1.
|Reframing||Posture, breath and reframing|
|After changing my internal language, I still strongly felt the same thoughts.||I instantly felt better about my situation after adjusting my posture.|
|I felt a slight boost in positivity and optimism. The negative feelings (anxiety) from the negative thoughts also diminished slightly.||The effects were much stronger and it was not isolated mentally. I felt more relief in my body as well.|
|Even after changing my language, I still felt more anxious.||Before changing my posture and breathing, I felt tense and worried. After I felt more relaxed.|
|I began to lift my mood up; however, it didn’t really improve my mood. I still felt a bit bad afterwards and the thoughts still stayed.||I began to look from the floor and up towards the board. I felt more open, understanding and loving. I did not allow myself to get let down.|
|During the practice, it helped calm me down a bit, but it wasn’t enough to make me feel satisfied or content, it felt temporary.||My body felt relaxed overall, which then made me feel a lot better about the situation.|
|Difficult time changing language.||My posture and breathing helped, making it easier to change my language.|
|I felt anger and stayed in my position. My body stayed tensed and I kept thinking about the situation.||I felt anger but once I sat up straight and thought about breathing, my body felt relaxed.|
|Felt like a tug of war with my thoughts. I was able to think more positively but it took a lot more brain power to do so.||Relaxed, extended spine, clarity, blank state of mind.|
Table 1. Some representative comments of practicing reframing or posture, breath and reframing.
The results of our study in the classroom setting are not surprising. Many us know to take three breaths before answering questions, pause and reflect before responding, take time to cool down before replying in anger, or wait till the next day before you hit return on your impulsive email response.
Currently, counseling, psychotherapy, psychiatry and education tend not to incorporate body posture as a potential therapeutic or educational intervention for teaching participants to control their mood or reduce feelings of powerlessness. Instead, clients and students often sit slightly collapsed in a chair during therapy or in class. On the other hand, if individuals were encouraged to adopt an upright posture especially in the face of stressful circumstances it would help them maintain their self-esteem, reduce negative mood, and use fewer sadness words as compared to the individual in a slumped and seated posture (Nair, Sagar, Sollers, Consedine, & Broadbent, 2015).
THE VALUE OF SELF-EXPERIENCE
What makes this study valuable is that participants compare for themselves the effects of the two different interventions techniques to reduce anxiety, stress and negative thoughts. Thus, the participants have an opportunity to discover which strategy is more effective instead of being told what to do. The demonstration is even more impressive when done in groups because nearly all participants will report that changing posture with breathing and reframing is more beneficial.
This simple and quick technique can be integrated in counseling and psychotherapy by teaching clients this behavioral technique to reduce stress. In Cognitive Behavioral Therapy (CBT), sitting upright can help the individual replace a thought with a more reasonable one. In third wave CBT, it can help bypass the negative content of the original language and create a metacognitive change, such as, “I will not let this thought control me.”
It can also help in Acceptance and Commitment Therapy (ACT) since changing one’s body posture may facilitate the process of “acceptance” (Hayes, Pistorello, & Levin, 2012). Adopting an upright sitting position and taking a breath is like saying “I am here, I am present, I am not escaping or avoiding.” This change in body position represents movement from inside to outside, movement from accepting the unpleasant emotion related to the negative thoughts toward a “commitment” to moving ahead, contrary to the automatic tendency to follow the negative thought. The positive reframing during body position or posture change is not an attempt to color reality in pretty colors, but rather a change of awareness, perspective, and focus that helps the individual identify and see some new options for moving ahead toward commitment according to one’s values. This intentional change in direction is central in ACT and also in positive psychology (Stichter, 2018).
CONCLUSION AND RECOMMENDATIONS
We suggest that therapists, educators, clients and students get up out of their chairs and incorporate body movements when they feels overwhelmed and stuck. Finally, this study points out that mind and body are affected by each other. It provides another example of the psychophysiological principle enunciated by Elmer Green (1999, p 368):
“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 findings of this study echo the ancient spiritual wisdom that is is central to the teaching of the Zen Master, Thich Nhat Hanh. He recommends that his students recite the following at any time:
Breathing in I calm my body,
Breathing out I smile,
Dwelling in the present moment,
I know it is a wonderful moment.
Adapted from: Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133.
Disruptive thoughts, ruminations and worrying are common experiences especially when stressed. Numerous clinical strategies such as cognitive behavioral therapy attempt to teach clients to reduce negative ruminations (Kopelman-Rubin, Omer, & Dar, 2017). Over the last ten years, many people and therapists practice meditative techniques to let go and not be captured by negative ruminations, thoughts, and emotions. However, many people continue to struggle with distracting and wandering thoughts.
Just think back when you’re upset, hurt, angry or frustrated. Attempting just to observe without judgment can be very, very challenging as the mind keeps rehearsing and focusing on what happened. Telling yourself to stop being upset often doesn’t work because your mind is focused on how upset you are. If you can focus on something else or perform physical activity, the thoughts and feelings often subside.
Over the last fifteen years, mindfulness meditation has been integrated and adapted for use in behavioral medicine and psychology (Peper, Harvey, & Lin, 2019). It has also been implemented during bio- and neurofeedback training (Khazan, 2013; Khazan, 2019). Part of the mindfulness instruction is to recognize the thoughts without judging or becoming experientially “fused” with them. A process referred to as “meta-awareness” (Dahl, Lutz, & Davidson, 2015). Mindfulness training combined with bio- and neurofeedback training can improve a wide range of psychological and physical health conditions associated with symptoms of stress, such as anxiety, depression, chronic pain, and addiction (Creswell, 2015, Khazan, 2019).
Mindfulness is an effective technique; however, it may not be more effective than other self-regulations strategies (Peper et al, 2019). Letting go of worrying thoughts and rumination is even more challenging when one is upset, angry, or captured by stressful life circumstances. Is it possible that other strategies beside mindfulness may more rapidly reduce wandering and intrusive thoughts? In 2015, researchers van der Zwan, de Vente, Huiznik, Bogels, & de Bruin found that physical activity, mindfulness meditation and heart rate variability biofeedback were equally effective in reducing stress and its related symptoms when practiced for five weeks.
Our research explored whether other techniques from the ancient wisdom traditions could provide participants tools to reduce rumination and worry. We investigated the physiological effects and subject experiences of mindfulness and toning. Toning is vocalizing long and sustained sounds as a form of mediation. (Watch the video the toning demonstration by sound healer and musician, Madhu Anziani at the end of the blog.)
COMPARING TONING AND MINDFULNESS
The participants were 91 undergraduate college students (35 males, 51 females and 5 unspecified; average age, 22.4 years, (SD = 3.5 years).
After sitting comfortably in class, each student practiced either mindfulness or toning for three minutes each. After each practice, the students rated the extent of mind wandering, occurrence of intrusive thoughts and sensations of vibration on a scale from 0 (not all) to 10 (all the time). They also rated pre and post changes in peacefulness, relaxation, stress, warmth, anxiety and depression. After completing the assessment, they practice the other practice and after three minutes repeated the assessment.
The physiological changes that may occur during mindfulness practice and toning practice was recorded in a separate study with 11 undergraduate students (4 males, 7 females; average age 21.4 years. Heart rate and respiration were monitored with ProComp Infiniti™ system (Thought Technology, Ltd., Montreal, Canada). Respiration was monitored from the abdomen and upper thorax with strain gauges and heartrate was monitored with a blood volume pulse sensor placed on the thumb.
After the sensors were attached, the participants faced away from the screen so they did not receive feedback. They then followed the same procedure as described earlier, with three minutes of mindfulness, or toning practice, counterbalanced. After each condition, they completed a subjective assessment form rating experiences as described above.
RESULTS: SUBJECTIVE FINDINGS
Toning was much more successful in reducing mind wandering and intrusive thoughts than mindfulness. Toning also significantly increased awareness of body vibration as compared to mindfulness as shown in Figure 1.
Figure 1. Differences between mindfulness and toning practice.
There was no significant difference between toning and mindfulness in the increased self-report of peacefulness, warmth, relaxation, and decreased self-report of anxiety and depression as shown in Figure 2.
Figure 2. No significant difference between toning and mindfulness practice in relaxation or stress reports.
RESULTS: PHYSIOLOGICAL FINDINGS
Respiration rate was significantly lower during toning (4.6 br/min) as compared to mindfulness practice (11.6 br/min); heart rate standard deviation (SDNN) was much higher during toning condition (11.6) (SDNN 103.7 ms) than mindfulness (6.4) (SDNN 61.9 ms). Two representative physiological recording are shown in Figure 3.
Figure 3. Representative recordings of breathing and heart rate during mindfulness and toning practice. During toning the respiration rate (chest and abdomen) was much slower than during mindfulness and baseline conditions. Also, during toning heart rate variability was much larger than during mindfulness or baseline conditions.
Toning practice is a useful strategy to reduce mind wandering as well as inhibit intrusive thoughts and increase heart rate variability (HRV). Most likely toning uses the same neurological pathways as self-talk and thus inhibits the negative and hopeless thoughts. Toning is a useful meditation alternative because it instructs people to make a sound that vibrates in their body and thus they attend to the sound and not to their thoughts.
Physiologically, toning immediately changed the respiration rate to less than 6 breaths per minute and increases heart rate variability. This increase in heart rate variability occurs without awareness or striving. We recommend that toning is integrated as a strategy to complement bio-neurofeedback protocols. It may be a useful approach to enhance biofeedback-assisted HRV training since toning increases HRV without trying and it may be used as an alternative to mindfulness, or used in tandem for maximum effectiveness.
TAKE HOME MESSAGE
1) When people report feeling worried and anxious and have difficulty interrupting ruminations that they first practice toning before beginning mindfulness meditation or bio-neurofeedback training.
2) When training participants to increase heart rate variability, toning could be a powerful technique to increase HRV without striving
TONING DEMONSTRATION AND INSTRUCTION BY SOUND HEALER MADHU ANZIANI
For the published article see: Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133.
Kopelman-Rubin, D., Omer, H., & Dar, R. (2017). Brief therapy for excessive worry: Treatment model, feasibility, and acceptability of a new treatment. Journal of Psychotherapy Integration, 29(3), 291-306.
van der Zwan, J. E., de Vente, W., Huizink, A. C., Bogels, S. M., & de Bruin, E. I. (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: A randomized controlled trial. Applied Psychophysiology and Biofeedback, 40(4), 257-268. https://doi.org/10.1007/s10484-015-9293-x