Quick Rescue Techniques When Stressed

Posted: February 4, 2024 | Author: erikpeper | Filed under: attention, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, education, emotions, Evolutionary perspective, Exercise/movement, health, mindfulness, Neck and shoulder discomfort, posture, relaxation, stress management, Uncategorized | Tags: alarm reaction, anxiety, box breathing, Breathing, conditioning, defense reaction, health, huming, Parasympathetic response, rumination, safety, sniff inhale, somatic practices, stress, sympathetic arousal, tactical breathing, Toning, yoga | 9 Comments

Erik Peper, PhD, Yuval Oded, PhD, and Richard Harvey, PhD

Adapted from Peper, E., Oded, Y, & Harvey, R. (2024). Quick somatic rescue techniques when stressed. Biofeedback, 52(1), 18–26. https://doi.org/10.5298/982312

“If a problem is fixable, if a situation is such that you can do something about it, then there is no need to worry. If it’s not fixable, then there is no help in worrying. There is no benefit in worrying whatsoever.” ― Dalai Lama XIV

To implement the Dalai Lama’s quote is challenging. When caught up in an argument, being angry, extremely frustrated, or totally stressed, it is easy to ruminate, worry. It is much more challenging to remember to stay calm. When remembering the message of the Dalai Lama’s quote, it may be possible to shift perspective about the situation although a mindful attitude may not stop ruminating thoughts. The body typically continues to reacti to the torrents of thoughts that may occur when rehashing rage over injustices, fear over physical or psychological threats, or profound grief and sadness over the loss of a family member. Some people become even more agitated and less rational as illustrated in the following examples.

I had an argument with my ex and I am still pissed off. Each time I think of him or anticipate seeing them, my whole body tightened. I cannot stomach seeing him and I already see the anger in his face and voice. My thoughts kept rehashing the conflict and I am getting more and more upset.

A car cut right in front of me to squeeze into my lane. I had to slam on my brakes. What an idiot! My heart rate was racing and I wanted to punch the driver.

When threatened, we respond quickly in our thoughts and body with a defense reaction that may negatively affect those around us as well as ourselves. What can we do to interrupt negative stress reactions?

Background

Many approaches exist that allow us to become calmer and less reactive. General categories include techniques of cognitive reappraisal (seeing the situation from the other person’s point of view and labeling your own feelings and emotions) and stress management techniques. Practices that are beneficial include mindfulness meditation, benign humor (versus gallows humor), listening to music, taking a time out while implementing a variety of self-soothing practices, or incorporating slow breathing (e.g., heart rate variability and/or box breathing) throughout the day.

No technique fits all as we respond differently to our stressful life circumstances. For example, some people during stress react with a “tend and befriend stress response” (Cohen & Lansing, 2021; Taylor et al., 2000). This response appears to be mostly mediated by the hormone oxytocin acting in ways that sooth or calm the nervous system as an analgesic. These neurophysiological mechanisms of the soothing with the calming analgesic effects of oxytocin have been characterized in detail by Xin, et al. (2017).

The most common response is a fight/flight/freeze stress response that is mediated by excitatory hormones such as adrenalin and inhibitory neurotransmitters such as gamma amino butyric acid (GABA). There is a long history of fight/flight/freeze stress response research, which is beyond the scope of this blog with major theories and terms such as interior milleau (Bernard, 1872); homeostasis and fight/flight (Cannon, 1929); general adaptation syndrome (Selye, 1951); polyvagal theory (Porges, 1995); and, allostatic load (McEwen, 1998). A simplified way to start a discussion about stress reactions begins with the fight/flight stress response. When stressed our defense reactions are triggered. Our sympathetic nervous system becomes activated our mind and body stereotypically responds as illustrated in Figure 1.

Figure 1. An intense confrontation tends to evoke a stress response (reproduced from Peper et al., 2020).

The flight/fight response triggers a cascade of stress hormones or neurotransmitters (e.g., hypothalamus-pituitary-adrenal cascade) and produces body changes such as the heart pounding, quicker breathing, an increase in muscle tension and sweating. Our body mobilizes itself to protect itself from danger. Our focus is on immediate survival and not what will occur in the future (Porges, 2021; Sapolsky, 2004). It is as if we are facing an angry lion—a life-threatening situation—and we feel threatened and unsafe.

Rather than sitting still, a quick effective strategy is to interrupt this fight/flight response process by completing the alarm reaction such as by moving our muscles (e.g., simulating a fight or flight behavior) before continuing with slower breathing or other self-soothing strategies. Many people have experienced their body tension is reduced and they feel calmer when they do vigorous exercise after being upset, frustrated or angry. Similarly, athletes often have reported that they experience reduced frequency and/or intensity of negative thoughts after an exhausting workout (Thayer, 2003; Liao et al., 2015; Basso & Suzuki, 2017).

Becoming aware of the escalating cascades of physical, behavioral and psychological responses to a stressor is the first step in interrupting the escalating process. After becoming aware, reduce the body’s arousal and change the though patterns using any of the techniques described in this blog. The self-regulation skills presented in this blog are ideally over-learned and automated so that these skills can be rapidly implemented to shift from being stressed to being calm. Examples of skills that can shift from sympathetic neervous system overarousal to parasympathetic nervous system calm include techniques of autogenic traing (Schulz & Luthe, 1959), the quieting reflex developed by Charles Stroebel in 1985 or more recently rescue breathing developed by Richard Gevirtz (Stroebel, 1985; Gevirtz, 2014; Peper, Gibney & Holt, 2002; Peper & Gibney, 2003).

Concepts underlying the rescue techniques

Psychophysiological principle: “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” (Green et al. 1970, p. 3).
Posture evokes memories and feelings associated with the position. When the body posture is erect and tall while looking slightly up. It is easier to evoke empowering, positive thoughts and feelings. When looking down it is easier to evoke hopeless, helpless and powerless thoughts and feelings (Peper et al., 2017).
Healing occurs more easily when relaxed and feeling safe. Feeling safe and nurtured enhances the parasympathetic state and reduces the sympathetic state. Use memory recall to evoke those experiences when you felt safe (Peper, 2021).
Interrupting thoughts is easier with somatic movement than by redirecting attention and thinking of something else without somatic movement.
Focus on what you want to do not want to do. Attempting to stop thinking or ruminating about something tends to keeps it present (e.g., do not think of pink elephants. What color is the elephant? When you answer, “not pink,” you are still thinking pink). A general concept is to direct your attention (or have others guide you) to something else (Hilt & Pollak, 2012; Oded, 2018; Seo, 2023).
Skill mastery takes practice and role rehearsal (Lally et al., 2010; Peper & Wilson, 2021).
Use classical conditioning concepts to facilitate shifting states. Practice the skills and associate them with an aroma, memory, sounds or touch cues. Then when you the situation occurs, use these classical conditioned cues to facilitate the regeneration response (Peper & Wilson, 2021).

Rescue techniques

Coping When Highly Stressed and Agitated

Complete the alarm/defense reaction with physical activity (Be careful when you do these physical exercises if you have back, hip, knee, or ankle problems).
- Acknowledge you have reacted and have chosen to interrupt your automatic response.
- Check whether the situation is actually a threat. If yes, then do anything to get out of immediate danger (yell, scream, fight, run away, or dial 911).
- If there is no actual physical threat, then leave the situation and perform vigorous physical activity to complete your alarm reaction, such as going for a run or walking quickly up and down stairs. As you do the exercise, push yourself so that the muscles in your thighs are aching, which focusses your attention on the sensations in your thighs. In our experience, an intensive run for 20 minutes quiets the brain while it often takes 40 minutes when walking somewhat quickly.
- After recovering from the exhaustive exercise, explore new options to resolve the conflict.
Complete the alarm/defense reaction and evoke calmness with the S.O.S™ technique (Oded, 2023)
- Acknowledge you have reacted and have chosen to interrupt your automatic response.
- Squat against a wall (similar to the wall-sit many skiers practice). While tensing your arms and fists as shown in Figure 2, gaze upward because it is more difficult to engage in negative thinking while looking upwards. If you continue to ruminate, then scan the room for object of a certain color or feature to shift visual attention and be totally present on the visual object.
- Do this set of movements for 7 to 10 seconds or until you start shaking. Than stand up and relax hands and legs. While standing, bounce up and down loosely for 10 to 15 seconds as you become aware of the vibratory sensations in your arms and shoulders, as shown in Figure 3.

Figure 2.Defense position wall-sit to tighten muscles in the protective defense posture (Oded, 2023). Figure 3. Bouncing up and down to loosen muscles ((Oded, 2023).

Acknowledge you have reacted and have chosen to interrupt your automatic response. Swing your arms back and forth for 20 seconds. Allow the arms to swing freely as illustrated in Figure 4.

Figure 4. Swinging the arms to loosen the body and spine (Oded, 2023).

Rest and ground. Lie on the floor and put your calves and feet on a chair seat so that the psoas muscle can relax, as illustrated in Figure 5. Allow yourself to be totally supported by the floor and chair. Be sure there is a small pillow under your head and put your hand on your abdomen so that you can focus on abdominal breathing.

Figure 5. Lying down to allow the psoas muscle to relax and feel grounded (Oded, 2023).

While lying down, imagine a safe place or memory and make it as real as possible. It is often helpful to listen to a guided imagery or music. The experience can be enhanced if cues are present that are associated with the safe place, such as pictures, sounds, or smells. Continue to breathe effortlessly at about six breaths per minute. If your attention wanders, bring it back to the memory or to the breathing. Allow yourself to rest for 10 minutes.

In most cases, thoughts stop and the body’s parasympathetic activity becomes dominant as the person feels safe and calm. Usually, the hands warm and the blood volume pulse amplitude increases as an indicator of feeling safe, as shown in Figure 6.

Figure 6. Blood volume pulse increases as the person is relaxing, feels safe and calm.

Coping When You Can’t Get Away (adapted from Peper, Harvey & Faass, 2020)

In many cases, it is difficult or embarrassing to remove yourself from the situation when you are stressed out such as at work, in a business meeting or social gathering.

Become aware that you have reacted.
Excuse yourself for a moment and go to a private space, such as a restroom. Going to the bathroom is one of the only acceptable social behaviors to leave a meeting for a short time.
In the bathroom stall, do the 5-minute Nyingma exercise, which was taught by Tarthang Tulku Rinpoche in the tradition of Tibetan Buddhism, as a strategy for thought stopping (see Figure 7). Stand on your toes with your heels touching each other. Lift your heels off the floor while bending your knees. Place your hands at your sides and look upward. Breathe slowly and deeply (e.g., belly breathing at six breaths a minute) and imagine the air circulating through your legs and arms. Do this slow breathing and visualization next to a wall so you can steady yourself if necessary to keep balance. Stay in this position for 5 minutes or longer. Do not straighten your legs—keep squatting despite the discomfort. In a very short time, your attention is captured by the burning sensation in your thighs. Continue. After 5 minutes, stop and shake your arms and legs.

Figure 7. Stressor squat Nyingma exercise (reproduced from Peper et al., 2020).

Follow this practice with slow abdominal breathing to enhance the parasympathetic response. Be sure that the abdomen expands as the inhalation occurs. Breathe in and out through the nose at about six breaths per minute.
Once you feel centered and peaceful, return to the room.
After this exercise, your racing thoughts most likely will have stopped and you will be able to continue your day with greater calm.

What to do When Ruminating, Agitated, Anxious or Depressed
(adapted from Peper, Harvey, & Hamiel, 2019).

Shift your position by sitting or standing erect in a power position with the back of the head reaching upward to the ceiling while slightly gazing upward. Then sniff quickly through nose, hold and again sniff quickly then very slowly exhale. Be sure as you exhale your abdomen constricts. Then sniff again as your abdomen gets bigger, hold, and sniff one more time letting the abdomen get even bigger. Then, very slow, exhale through the nose to the internal count of six (adapted from Balban et al., 2023). When you sniff or gasp, your racing thoughts will stop (Peper et al., 2016).
Continue with box breathing (sometimes described as tactical breathing or battle breathing) by exhaling slowly through your nose for 4 seconds, holding your breath for 4 seconds, inhaling slowly for 4 seconds through your nose, holding your breath for 4 seconds and then repeating this cycle of breathing for a few minutes (Röttger et al., 2021; Balban et al., 2023). Focusing your attention on performing the box breathing makes it almost impossible to think of anything else. After a few minutes, follow this with slow effortless diaphragmatic breathing at about six breaths per minute. While exhaling slowly through your nose, look up and when you inhale imagine the air coming from above you. Then as you exhale, imagine and feel the air flowing down and through your arms and legs and out the hands and feet.
While gazing upward, elicit a positive memory or a time when you felt safe, powerful, strong and/or grounded. Make the positive memory as real as possible.
Implement cognitive strategies such as reframing the issue, sending goodwill to the person, seeing the problem from the other person’s point of view, and ask is this problem worth dying over (Peper, Harvey, & Hamiel, 2019).

What to Do When Thoughts Keep Interrupting

Practice humming or toning. When you are humming or toning, your focus is on making the sound and the thoughts tend to stop. Generally, breathing will slow down to about six breaths per minute (Peper, Pollack et al., 2019). Explore the following:

Box breathing (Röttger et al., 2021; Balban et al., 2023)
Humming also known as bee breath (Bhramari Pranayama) (Abishek et al., 2019; Yoga, 2023) – Allow the tongue to rest against the upper palate, sit tall and erect so that the back of the head is reaching upward to the ceiling, and inhale through your nose as the abdomen expands. Then begin humming while the air flows out through your nose, feel the vibration in the nose, face and throat. Let humming last for about 7 seconds and then allow the air to blow in through the nose and then hum again. Continue for about 5 minutes.
Toning – Inhale through your nose and then vocalize a single sound such as Om. As you vocalize the lower sound, feel the vibration in your throat, chest and even going down to the abdomen. Let each toning exhalation last for about 6 to 7 seconds and then inhale through your nose. Continue for about 5 minutes (Peper, al., 2019).

Many people report that after practice these skills, they become aware that they are reacting and are able to reduce their automatic reaction. As a result, they experience a significant decrease in their stress levels, fewer symptoms such as neck and holder tension and high blood pressure, and they feel an increase in tranquility and the ability to communicate effectively.

Practicing these skills does not resolve the conflicts; they allow you to stop reacting automatically. This process allows you a time out and may give you the ability to be calmer, which allows you to think more clearly. When calmer, problem solving is usually more successful. As phrased in a popular meme, “You cannot see your reflection in boiling water. Similarly, you cannot see the truth in a state of anger. When the waters calm, clarity comes” (author unknown).

Boiling water (photo modified from: https://www.facebook.com/photo/?fbid=388991500314839&set=a.377199901493999)

Below are additional resources that describe the practices. Please share these resources with friends, family and co-workers.

Stressor squat instructions

Are you out of control and reacting in anger? The role of food and exercise

Toning instructions

Healing from paralysis-Music (toning) to activate health

Diaphragmatic breathing instructions

A breath of fresh air: Breathing and posture to optimize health

Healing irritable bowel syndrome with diaphragmatic breathing*

Breathing: Informative YouTube videos and blogs

Reduce stress with posture and breathing

Reduce stress, anxiety and negative thoughts with posture, breathing and reframing

Conditioning

Relive memory to create healing imagery

Improve learning with peak performance techniques

References

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Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 10089. https://doi.org/10.1016/j.xcrm.2022.100895

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Gevirtz, R. (2014). HRV Training and its Importance – Richard Gevirtz, Ph.D., Pioneer in HRV Research & Training. Thought Technology. Accessed December 29, 2023. https://www.youtube.com/watch?v=9nwFUKuJSE0

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Peper, E., Harvey, R., & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. North Atlantic Books. https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X

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Reduce the risk for colds and flu and superb science podcasts

Posted: January 24, 2024 | Author: erikpeper | Filed under: attention, behavior, education, Evolutionary perspective, Exercise/movement, healing, health, Nutrition/diet, self-healing, stress management, Uncategorized, vision | Tags: colds, darkness, flu, influenza, light | 2 Comments

What can we do to reduce the risk of catching a cold or the flu? It is very challenging to make sense out of all the recommendations found on internet and the many different media site such as X(Twitter), Facebook, Instagram, or TikTok. The following podcasts are great sources that examine different topics that can affect health. They are in-depth presentations with superb scientific reasoning.

Huberman Lab podcasts discusses science and science based tools for everyday life. https://www.hubermanlab.com/podcast. Select your episode and they are great to listen to on your cellphone.

THE PODCAST episode, How to prevent and treat cold and flu, is outstanding. Skip the long sponsor introductdion and start listening at the 6 minute point. In this podcast, Professor Andrew Huberman describes behavior, nutrition and supplementation-based tools supported by peer-reviewed research to enhance immune system function and better combat colds and flu. I also dispel common myths about how the cold and flu are transmitted and when you and those around you are contagious. I explain if common preventatives and treatments such as vitamin C, zinc, vitamin D and echinacea work. I also highlight other compounds known to reduce contracting and duration of colds and flu. I discuss how to use exercise and sauna to bolster the immune response. This episode will help listeners understand how to reduce the chances of catching a cold or flu and help people recover more quickly from and prevent the spread of colds and flu.

PODCAST, ScienceVS, is an outstanding podcast series that takes on fads, trends, and opinionated mob to find out what’s fact, what’s not, and what’s somewhere in between. Select your episode and listen.

Link: https://gimletmedia.com/shows/science-vs/episodes#show-tab-picker

PODCAST episode, The Journal club podcast and Youtube, presentation from Huberman Lab is a example of outstanding scientific reasoning. In this presentation, Professor Andrew Huberman and Dr. Peter Attia (author of Outlive: The Science and Art of Longevity) discuss two peer-reviewed scientific papers in-depth. The first discussion explores the role of bright light exposure during the day and dark exposure during the night and its relationship to mental health. The second paper explores a novel class of immunotherapy treatments to combat cancer.

TechStress: Building Healthier Computer Habits

Posted: August 30, 2023 | Author: erikpeper | Filed under: ADHD, behavior, biofeedback, Breathing/respiration, cognitive behavior therapy, computer, digital devices, education, emotions, ergonomics, Evolutionary perspective, Exercise/movement, health, laptops, Neck and shoulder discomfort, Pain/discomfort, posture, screen fatigue, stress management, Uncategorized, vision, zoom fatigue | Tags: cellphone, fatigue, gaming, mobile devices, screens | 5 Comments

August 28, 2023

By Erik Peper, PhD, BCB, Richard Harvey, PhD, and Nancy Faass, MSW, MPH

Adapted by the Well Being Journal, 32(4), 30-35. from the book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics by Erik Peper, Richard Harvey, and Nancy Faass.

Every year, millions of office workers in the United States develop occupational injuries from poor computer habits—from carpal tunnel syndrome and tension headaches to repetitive strain injury, such as “mouse shoulder.” You’d think that an office job would be safer than factory work, but the truth is that many of these conditions are associated with a deskbound workstyle.

Back problems are not simply an issue for workers doing physical labor. Currently, the people at greatest risk of injury are those with a desk job earning over $70,000 annually. Globally, computer-related disorders continue to be on the rise. These conditions can affect people of all ages who spend long hours at a computer and digital devices.

In a large survey of high school students, eighty-five percent experienced tension or pain in their neck, shoulders, back, or wrists after working at the computer. We’re just not designed to sit at a computer all day.

Field of Ergonomics

For the past twenty years, teams of researchers all over the world have been evaluating workplace stress and computer injuries—and how to prevent them. As researchers in the fields of holistic health and ergonomics, we observe how people interact with technology. What makes our work unique is that we assess employees not only by interviewing them and observing behaviors, but also by monitoring physical responses.

Specifically, we measure muscle tension and breathing, in the moment, in real-time, while they work. To record shoulder pain, for example, we place small sensors over different muscles and painlessly measure the muscle tension using an EMG (electromyograph)—a device that is employed by physicians, physical therapists, and researchers. Using this device, we can also keep a record of their responses and compare their reactions over time to determine progress.

What we’ve learned is that people get into trouble if their muscles are held in tension for too long. Working at a computer, especially at a stationary desk, most people maintain low-level chronic tension for much of the day. Shallow, rapid breathing is also typical of fine motor tasks that require concentration, like data entry.

Muscle tension and breathing rate usually increase during data entry or typing without our awareness.

When these patterns are paired with psychological pressure due to office politics or job insecurity, the level of tension and the risk of fatigue, inflammation, pain, or injury increase. In most cases, people are totally unaware of the role that tension plays in injury. Of note, the absolute level of tension does not predict injury—rather, it is the absence of periodic rest breaks throughout the day that seems to correlate with future injuries.

Restbreaks

All of life is the alternation between movement and rest, inhaling and exhaling, sleeping and waking. Performing alternating tasks or different types of activities and movement is one way to interrupt the couch potato syndrome—honoring our evolutionary background.

Our research has confirmed what others have observed: that it’s important to be physically active, at least periodically, throughout the day. Alternating activity and rest recreate the pattern of our ancestors’ daily lives. When we alternate sedentary tasks with physical activity, and follow work with relaxation, we function much more efficiently. In short, move your body more.

Better Computer Habits: Alternate Periods of Rest and Activity

As mentioned earlier, our workstyle puts us out of sync with our genetic heritage. Whether hunting and gathering or building and harvesting, our ancestors alternated periods of inactivity with physical tasks that required walking, running, jumping, climbing, digging, lifting, and carrying, to name a few activities. In contrast, today many of us have a workstyle that is so immobile we may not even leave our desk for lunch.

As health researchers, we have had the chance to study workstyles all over the world. Back pain and strain injuries now affect a large proportion of office workers in the US and in high-tech firms worldwide. The vast majority of these jobs are sedentary, so one focus of the research is on how to achieve a more balanced way of working.

A recent study on exercise looked at blood flow to the brain. Researchers Carter and colleagues found that if people sit for four hours on the job, there’s a significant decrease in blood flow to the brain. However, if every thirty or forty minutes they get up and move around for just two minutes, then brain blood flow remains steady. The more often you interrupt sitting with movement, the better.

It may seem obvious that to stay healthy, it’s important to take breaks and be physically active from time to time throughout the day. Alternating activity and rest recreate the pattern of our ancestors’ daily lives. The goal is to alternate sedentary tasks with physical activity and follow work with relaxation. When we keep this type of balance going, most people find that they have more energy, are more productive, and can be more effective.

Genetics: We’re Hardwired Like Ancient Hunters

Despite a modern appearance, we carry the genes of our forebearers—for better and for worse. (Art courtesy of Peter Sis). Reproduced from Peper, E., Harvey, R., & Faass (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

In the modern workplace, most of us find ourselves working indoors, in small office spaces, often sitting at a computer for hours at a time. In fact, the average Westerner spends more than nine hours per day sitting indoors, yet we’re still genetically programmed to be physically active and spend time outside in the sunlight most of the day, like the nomadic hunters and gatherers of forty thousand years ago.

Undeniably, we inherently conserve energy in order to heal and regenerate. This aspect of our genetic makeup also helps burn fewer calories when food is scarce. Hence the propensity for lack of movement and sedentary lifestyle (sitting disease).

In times of famine, the habit of sitting was essential because it reduced calorie expenditure, so it enabled our ancestors to survive. In a prehistoric world with a limited food supply, less movement meant fewer calories burned. Early humans became active when they needed to search for food or shelter. Today, in a world where food and shelter are abundant for most Westerners, there is no intrinsic drive to initiate movement.

It is also true that we have survived as a species by staying active. Chronic sitting is the opposite of our evolutionary pattern in which our ancestors alternated frequent movement while hunting or gathering food with periods of rest. Whether they were hunters or farmers, movement has always been an integral aspect of daily life. In contrast, working at the computer—maintaining static posture for hours on end—can increase fatigue, muscle tension, back strain, and poor circulation, putting us at risk of injury.

Quit a Sedentary Workstyle

Almost everyone is surprised by how quickly tension can build up in a muscle, and how painful it can become. For example, we tend to hover our hands over the keyboard without providing a chance for them to relax. Similarly, we may tighten some of the big muscles of our body, such as bracing or crossing our legs.

What’s needed is a chance to move a little every few minutes—we can achieve this right where we sit by developing the habit of microbreaks. Without regular movement, our muscles can become stiff and uncomfortable. When we don’t take breaks from static muscle tension, our muscles don’t have a chance to regenerate and circulate oxygen and necessary nutrients.

Build a variety of breaks into your workday:

Vary work tasks
Take microbreaks (brief breaks of less than thirty seconds)
Take one-minute stretch breaks
Fit in a moving break

Varying Work Tasks

You can boost physical activity at work by intentionally leaving your phone on the other side of the desk, situating the printer across the room, or using a sit-stand desk for part of the day. Even a few minutes away from the desk makes a difference, whether you are hand delivering documents, taking the long way to the bathroom, or pacing the room while on a call.

When you alternate the types of tasks and movement you do, using a different set of muscles, this interrupts the contractions of muscle fibers and allows them to relax and regenerate. Try any of these strategies:

Alternate computer work with other activities, such as offering to do a coffee run
Schedule walking meetings with coworkers
Vary keyboarding and hand movements

Ultimately, vary your activities and movements as much as possible. By changing your posture and making sure you move, you’ll find that your circulation and your energy improve, and you’ll experience fewer aches and pains. In a short time, it usually becomes second nature to vary your activities throughout the day.

Experience It: “Mouse Shoulder” Test

You can test this simple mousing exercise at the computer or as a simulation. If you’re at the computer, sit erect with your hand on the mouse next to the keyboard. To simulate the exercise, sit with erect posture as if you were in front of your computer and hold a small object you can use to imitate mousing.

With the mouse (or a sham mouse), simulate drawing the letters of your name and your street address, right to left. Be sure each letter is very small (less than half an inch in height). After drawing each letter, click the mouse.

As part of the exercise, draw the letters and numbers as quickly as possible for ten to fifteen seconds. What did you observe? In almost all cases, you may note that you tightened your mousing shoulder and your neck, stiffened your trunk, and held your breath. All this occurred without awareness while performing the task. Over time, this type of muscle tension can contribute to discomfort, soreness, pain, or eventual injury.

Microbreaks

If you’ve developed an injury—or have chronic aches and pains—you’ll probably find split-second microbreaks invaluable. A microbreak means taking brief periods of time that last just a few seconds to relax the tension in your wrists, shoulders, and neck.

For example, when typing, simply letting your wrists drop to your lap for a few seconds will allow the circulation to return fully to help regenerate the muscles. The goal is to develop a habit that is part of your routine and becomes automatic, like driving a car. To make the habit of microbreaks practical, think about how you can build the breaks into your workstyle. That could mean a brief pause after you’ve completed a task, entered a column of data, or before starting typing out an assignment.

For frequent microbreaks, you don’t even need to get up—just drop your hands in your lap or shake them out, move your shoulders, and then resume work. Any type of shaking or wiggling movement is good for your circulation and kind of fun.

In general, a microbreak may be defined as lasting one to thirty seconds. A minibreak may last roughly thirty seconds to a few minutes, and longer large-movement breaks are usually greater than a few minutes. Popular microbreaks:

Take a few deep breaths
Pause to take a sip of water
Rest your hands in your lap
Stretch
Let your arms drop to your sides
Shake out your hands (wrists and fingers)
Perform a quick shoulder or neck roll

Often, we don’t realize how much tension we’ve been carrying until we become more mindful of it. We can raise our awareness of excess tension—this is a learned skill—and train ourselves to let go of excess muscle tension. As we increase our awareness, we’re able to develop a new, more dynamic workstyle that better fits our goals and schedule.

One-Minute Stretch Breaks

We all benefit from a brief break, even with the best of posture (left). One approach is to totally release your muscles (middle). That release can be paired with a series of brief stretches (right). Reproduced from Peper, E., Harvey, R., & Faass (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

The typical mini-stretch break lasts from thirty seconds to a few minutes, and ideally you want to take them several times per hour. Similar to microbreaks, mini-stretch breaks are especially important for people with an injury or those at risk of injury. Taking breaks is vital, especially if you have symptoms related to computer stress or whenever you’re working long hours at a sedentary job. To take a stretch break:

Begin with a big stretch, for example, by reaching high over your head then drop your hands in your lap or to your sides.

Look away from the monitor, staring at near and far objects, and blink several times. Straighten your back and stretch your entire backbone by lifting your head and neck gently, as if there were an invisible string attached to the crown of your head.

Stretch your mind and body. Sitting with your back straight and both feet flat on the floor, close your eyes and listen to the sounds around you, including the fan on the computer, footsteps in the hallway, or the sounds in the street.

Breathe in and out over ten seconds (breathe in for four or five seconds and breathe out for five or six seconds), making the exhale slightly longer than the inhale. Feel your jaw, mouth, and tongue muscles relax. Feel the back and bottom of the chair as your body breathes all around you. Envision someone in your mind’s eye who is kind and reassuring, who makes you feel safe and loved, and who can bring a smile to your face inwardly or outwardly.

Do a wiggling movement. When you take a one-minute break, wiggling exercises are fast and easy, and especially good for muscle tension or wrist pain. Wiggle all over—it feels good, and it’s also a great way to improve circulation.

Building Exercise and Movement into Every Day

Studies show that you get more benefit from exercising ten to twenty minutes, three times a day, than from exercising for thirty to sixty minutes once a day. The implication is that doing physical activities for even a few minutes can make a big difference.

Dunstan and colleagues have found that standing up three times an hour and then walking for just two minutes reduced blood sugar and insulin spikes by twenty-five percent.Fit in a Moving Break

Fit in a Moving Break

Once we become conscious of muscle tension, we may be able to reverse it simply by stepping away from the desk for a few minutes, and also by taking brief breaks more often. Explore ways to walk in the morning, during lunch break, or right after work. Ideally, you also want to get up and move around for about five minutes every hour.

Ultimately, research makes it clear that intermittent movement, such as brief, frequent stretching throughout the day or using the stairs rather than elevator, is more beneficial than cramming in a couple of hours at the gym on the weekend. This explains why small changes can have a big impact—it’s simply a matter of reminding yourself that it’s worth the effort.

Workstation Tips

Your ability to see the display and read the screen is key to reducing neck and eye strain. Here are a few strategic factors to remember:

Monitor height: Adjust the height of your monitor so the top is at eyebrow level, so you can look straight ahead at the screen.

Keyboard height: The keyboard height should be set so that your upper arms hang straight down while your elbows are bent at a 90-degree angle (like the letter L) with your forearms and wrists held horizontally.

Typeface and font size: For email, word processing, or web content, consider using a sans serif typeface. Fonts that have fewer curved lines and flourishes (serifs) tend to be more readable on screen.

Checking your vision: Many adults benefit from computer glasses to see the screen more clearly. Generally, we do not recommend reading glasses, bifocals, trifocals, and progressive lenses as they tend to allow clear vision at only one focal length. To see through the near-distance correction of the lens requires you to tilt your head back. Although progressive lenses allow you to see both close up and at a distance, the segment of the lens for each focal length is usually too narrow for working at the computer.

Wearing progressive lenses requires you to hold your head in a fixed position to be in focus. Yet you may be totally unaware that you are adapting your eye and head movements to sustain your focus. When that is the case, most people find that special computer glasses are a good solution.

Consider computer glasses if you must either bring your nose to the screen to read the text, wear reading glasses and find that their focal length is inappropriate for the monitor distance, wear bi- or trifocal glasses, or are older than forty.

Computer glasses correct for the appropriate focal distance to the computer. Typically, monitor distance is about twenty-three to twenty-eight inches, whereas reading glasses correct for a focal length of about fifteen inches. To determine your individual, specific focal length, ask a coworker to measure the distance from the monitor to your eyes. Provide this personal focal distance at the eye exam with your optometrist or ophthalmologist and request that your computer glasses be optimized for that distance.

Remembering to blink: As we focus on the screen, our blinking rate is significantly reduced. Develop the habit of blinking periodically: at the end of a paragraph, for example, or when sending an email.

Resting your eyes: Throughout the day, pause and focus on the far distance to relax your eyes. When looking at the screen, your eyes converge, which can cause eyestrain. Each time you look away and refocus, that allows your eyes to relax. It’s especially soothing to look at green objects such as a tree that can be seen through a window.

Minimizing glare: If the room is lit with artificial light, there may be glare from your light source if the light is right in front of you or right behind you, causing reflection on your screen. Reflection problems are minimized when light sources are at a 90-degree angle to the monitor (with the light coming from the side). The worst situations occur when the light source is either behind or in front of you.

An easy test is to turn off your monitor and look for reflections on the screen. Everything that you see on the monitor when it’s turned off is there when you’re working at the monitor. If there are bright reflections, they will interfere with your vision. Once you’ve identified the source of the glare, change the location of the reflected objects or light sources, or change the location of the monitor.

Contrast: Adjust the light contrast in the room so that it is neither too bright nor too dark. If the room is dark, turn on the lights. If it is too bright, close the blinds or turn off the lights. It is exhausting for your eyes to have to adapt from bright outdoor light to the lighting of your computer screen. You want the light intensity of the screen to be somewhat similar to that in the room where you’re working. You also do not want to look from your screen to a window lit by intense sunlight.

Don’t look down at phone: According to Kenneth Hansraj, MD, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine, pressure on the spine increases from about ten pounds when you are holding your head erect, to sixty pounds of pressure when you are looking down. Bending forward to look at your phone, your head moves out of the line of gravity and is no longer balanced above your neck and spine. As the angle of the face-forward position increases, this intensifies strain on the neck muscles, nerves, and bones (the vertebrae).

The more you bend your neck, the greater the stress since the muscles must stretch farther and work harder to hold your head up against gravity. This same collapsed head-forward position when you are seated and using the phone repeats the neck and shoulder strain. Muscle strain, tension headaches, or neck pain can result from awkward posture with texting, craning over a tablet (sometimes referred to as the iPad neck), or spending long hours on a laptop.

A face-forward position puts as much as sixty pounds of pressure on the neck muscles and spine.

Repetitive strain of neck vertebrae (the cervical spine), in combination with poor posture, can trigger a neuromuscular syndrome sometimes diagnosed as thoracic outlet syndrome. According to researchers Sharan and colleagues, this syndrome can also result in chronic neck pain, depression, and anxiety.

When you notice negative changes in your mood or energy, or tension in your neck and shoulders, use that as a cue to arch your back and look upward. Think of a positive memory, take a mindful breath, wiggle, or shake out your shoulders if you’d like, and return to the task at hand.

Strengthen your core: If you find it difficult to maintain good posture, you may need to strengthen your core muscles. Fitness and sports that are beneficial for core strength include walking, sprinting, yoga, plank, swimming, and rowing. The most effective way to strengthen your core is through activities that you enjoy.

Final Thoughts

If these ideas resonate with you, consider lifestyle as the first step. We need to build dynamic physical activity into our lives, as well as the lives of our children. Being outside is usually an uplift, so choose to move your body in natural settings whenever possible, whatever form that takes. Being outside is the factor that adds an energetic dimension. Finally, share what you learn, and help others learn and grow from your experiences.

If you spend time in front of a computeror using a mobile device, read the book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. It provides practical, easy-to-use solutions for combating the stress and pain many of us experience due to technology use and overuse. The book offers extremely helpful tips for ergonomic use of technology, it
goes way beyond that, offering simple suggestions for improving muscle health that seem obvious once you read them, but would not have thought of yourself: “Why didn’t I think of that?” You will learn about the connection between posture and mood, reasons for and importance of movement breaks, specific movements you can easily perform at your desk, as well as healthier ways to utilize technology in your everyday life.

See the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics by Erik Peper, Richard Harvey and Nancy Faass. Available from: https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X/

Additional resources

Resolve Eyestrain and Screen Fatigue

Reversing Pandemic-Related Increases in Back Pain

Addicted to your phone? How to separate from your phone for a healthy lifestyle[1]

Cartoon ergonomics for working at the computer and laptop

Digital fatigue and what to do

Evolutionary traps: How screens, digital notifications and gaming software exploits fundamental survival mechanisms

Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythm

Posted: July 4, 2023 | Author: erikpeper | Filed under: ADHD, behavior, computer, digital devices, education, emotions, Evolutionary perspective, health, laptops, screen fatigue, Uncategorized | Tags: anxiety, autism, bonding, circadian rhythms, depression, nature, still face experiment | 10 Comments

Adapted from: Peper, E. Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythms. NeuroRegulation,10(2), 134-138. https://doi.org/10.15540/nr.10.2.134

Over the past two decades, there has been a significant increase in the prevalence of autism, Attention-Deficit/hyperactivity disorder (ADHD), anxiety, depression, and pediatric suicidal behavior. Autism rates have risen from 1 in 150 children in 2000 to 1 in 36 children in 2020 (CDC, 2023), while ADHD rates have increased from 6% in 1997 to approximately 10% in 2018 (CDC, 2022). The rates of anxiety among 18-25 year-olds have also increased from 7.97% in 2008 to 14.66% in 2018 (Goodwin et al., 2020), and depression rates for U.S. teens ages 12-17 have increased from 8% in 2007 to 13% in 2017 (Geiger & Davis, 2019; Walrave et al., 2022). Pediatric suicide attempts have also increased by 163% from 2009 to 2019 (Arakelyan et al., 2023), and during the COVID-19 pandemic, these rates have increased by more than 25% (WHO, 2022; Santomauro et al., 2021). In addition, the prevalence of these disorders has tripled for US adults during the pandemic compared to before (Ettman et al., 2020).

The rapid increase of these disorders is not solely due to improved diagnostic methods, genetic factors or the COVID-19 pandemic. The pandemic amplified pre-existing increasing trends. More likely, individuals who were at risk had their disorders triggered or amplified by harmful environmental and behavioral factors. Conceptually, Genetics loads the gun; epigenetics, behavior, and environment pull the trigger.

While behavioral strategies such as neurofeedback, Cognitive Behavior Therapy, biofeedback, meditation techniques, and pharmaceuticals can treat or ameliorate these disorders, the focus needs to be on risk reduction. In some ways, treatment can be likened to closing the barn doors after the horses have bolted.

Evolutionary perspective to reduce risk factors

Nassim Taleb (2012) in his book, Antifragile: Things That Gain from Disorder (Incerto), provides an evolutionary perspective and offers simple rules of health by reducing risk factors:

Assume that anything that was not part of our evolutionary past is probably harmful.
Remove the unnatural/unfamiliar (e.g. smoking/ e-cigarettes, sugar, digital media).
We do not need evidence of harm to claim that a drug or an unnatural procedure is dangerous. If evidence of harm does not exist, it does not mean harm does not exist.
Only resort to medical techniques when the health payoff is very large (to save a life), exceeds its potential harm, such as incontrovertibly needed surgery or life-saving medicine (penicillin).
Avoid the iatrogenics and negative side effects of prescribed medication.

Writer and scholar Taleb’s suggestions are reminiscent of the perspective described by the educator Joseph C. Pearce (1993) in his book, Evolution’s End. Pearce argued that modern lifestyles have negatively affected the secure attachment and bonding between caregivers and infants. The lack of nurturing and responsive caregiving in early childhood may lead to long-term emotional and psychological problems. He points out that we have radically adapted behaviors that differ from those that evolved over thousands of generations and that allowed us to thrive and survive. In the last 100 years, babies have often been separated from their mothers at birth or early infancy by being put in a nursery or separate room, limited or no breastfeeding with the use of formula, exposure to television for entertainment, lack of exploratory play outdoors, and the absence of constant caretakers in high-stress and unsafe environments.

As Pearce pointed out, “If you want true learning, learning that involves the higher frontal lobes – the intellectual, creative brain – then again, the emotional environment must be positive and supportive. This is because at the first sign of anxiety the brain shifts its functions from the high, prefrontal lobes to the old defenses of the reptilian brain… These young people need audio-vocal communication, nurturing, play, body movement, eye contact, sweet sounds and close heart contact on a physical level” (Mercogliano & Debus, 1999).

To optimize health, eliminate or reduce those factors that have significantly changed or were not part of our evolutionary past. The proposed recommendations are based upon Talib’s perspective that anything that was not part of our evolutionary past is probably harmful; thus, it is wise to remove the unnatural/unfamiliar and adopt the precautionary principle, which states that if evidence of harm does not exist, it does not mean harm does not exist (Kriebel et al., 2010).

This article is the first of a three-part series. Part 1 focuses on increasing reciprocal communication between infant and caretaker, reducing screen time, and re-establishing circadian rhythms; Part 2 focuses on reducing exposure to neurotoxins, eliminating processed foods, and supporting the human biome; and Part 3 focuses on respiration and movement.

Part 1- Increase bonding, reduce screen time, and re-establish circadian rhythms

Increase bonding between infant and caretaker

Infants develop emotional communication through reciprocal interactions with their caregivers, during which the caregiver responds to the infant’s expressions. When this does not occur, it can be highly stressful and detrimental to the infant’s development. Unfortunately, more and more babies are emotionally and socially isolated while their caregivers are focussed on, and captured by, the content on their digital screens. Moreover, infants and toddlers are entertained (babysat) by cellphones and tablets instead of dynamically interacting with their caretakers. Screens do not respond to the child’s expressions; the screen content is programmed to capture the infant’s attention through rapid scene changes. Without reciprocal interaction, babies often become stressed, as shown by the research of developmental psychologist Professor Edward Tronick, who conducted the “Still Face” experiment (Tronick & Beeghly, 2011; Weinberg et al, 2008).

The “Still Face” experiment illustrated what happens when caregivers are not responding to infants’ communication. The caregivers were asked to remain still and unresponsive to their babies, resulting in the infants becoming increasingly distressed and disengaged from their surroundings. Not only does this apply to infants but also to children, teenagers and older individuals. Watch the short Still Face experiment, which illustrates what happens when the caretaker is not responding to the infant’s communication.

Recommendation. Do not use cellphone and digital media while being with an infant in the first two years of life. It is important for caregivers to limit their cellphone use and prioritize reciprocal interactions with their infants for healthy emotional and psychological development.

Reduce screen time (television, social media, streaming videos, gaming)^{^[1]}

From an evolutionary perspective, screen time is an entirely novel experience. Television, computers, and cellphones are modern technologies that have significantly impacted infants’ and young people’s development. To grow, infants, toddlers, and children require opportunities to explore the environment through movement, touch, and play with others, which is not possible with screens. Research has shown that excessive screen time can negatively affect children’s motor development, attention span, socialization skills, and contribute to obesity and other health problems (Hinkley et al., 2014; Carson et al., 2016; Mark, 2023).

When four-year-olds watch fast-paced videos, they exhibit reduced executive functions and impulse control, which may be a precursor for ADHD, compared to children who engage in activities such as drawing (Lillard & Peterson, 2011; Mark, 2023).

Furthermore, excessive screen time and time spent on social media are causal in increasing depression in young adults-–as was discovered when Facebook became available at selected universities. Researchers compared the mental health of students at similar universities where Facebook was or was not available and observed how the students’ mental health changed when Facebook became available (Braghieri et al., 2022). Their research showed that “College-wide access to Facebook led to an increase in severe depression by 7% and anxiety disorders by 20%. In total, the negative effect of Facebook on mental health appeared to be roughly 20% the magnitude of what is experienced by those who lose their job” (Walsh, 2022).

Exposure to digital media has also significantly reduced our attention span from 150 seconds in 2004 to an average of 44 seconds in 2021. The shortening of attention span may contribute to the rise of ADHD and anxiety (Mark, 2022, p. 96).

Recommendations: Reduce time spent on social media, gaming, mindlessly following one link after the other, or watching episode after episode of streaming videos. Instead, set time limits for screen use, turn off notifications, and prioritize in-person interactions with friends, family and colleagues while engaging in collaborative activities. Encourage children to participate in physical and social activities and to explore nature.

To achieve this, follow the guidelines from the American Academy of Pediatrics’ recommendation on screen time (Council on Communications and Media, 2016), which suggest these limits on screen time for children of different age groups:

Children under 18 months of age should avoid all screen time, except for video chatting with family and friends.
Children aged 18-24 months should have limited screen time, and only when watched together with a caretaker.
Children aged 2 to 5 years should have no more than one hour of screen time per day with parental supervision.
For adolescents, screen and social media time should be limited to no more than an hour a day.

In our experience, when college students reduce their time spent on social media, streaming videos, and texting, they report that it is challenging; however, they then report an increase in well-being and performance over time (Peper et al., 2021). It may require more effort to provide children with actual experiential learning and entertainment than allowing them to use screens, but it is worthwhile. Having children perform activities and play outdoors–in a green nature environment–appears to reduce ADHD symptoms (Louv, 2008; Kuo & Taylor, 2004).

Reestablish circadian (daily) rhythms

Our natural biological and activity rhythms were regulated by natural light until the 19th century. It is hard to imagine not having light at night to read, to work on the computer, or to answer email. However, light not only illuminates, but also affects our physiology by regulating our biological rhythms. Exposure to light at night can interfere with the production of melatonin, which is essential for sleep. Insufficient sleep affects 30% of toddlers, preschoolers, and school-age children, as well as the majority of adolescents. The more media is consumed at bedtime, the more bedtime is delayed and total sleep time is reduced (Hale et al., 2018). Reduced sleep is a contributing factor to increased ADHD symptoms of inattention, hyperactivity and impulsivity (Cassoff et al., 2012).

Recommendations: Support the circadian rhythms. Avoid screen time one hour before bedtime. This will reduce exposure to blue light and reduce sympathetic arousal triggered by the content on the screen or reactions to social media and emails. Sleep in total darkness, and establish a regular bedtime and waking time to avoid “social jetlag,” which can negatively affect health and performance (Caliandro et al., 2021). Implement sleep hygiene strategies such as developing a bedtime ritual to improve sleep quality (Stager et al., 2023; Suni, 2023). Thus, go to bed and wake up at the same time each day, including weekends. Avoid large meals, caffeine, and alcohol before bedtime. Consistency is key to success.

Conclusion

To optimize health, eliminate or reduce those factors that have significantly changed or were not part of our evolutionary past, and explore strategies that support behaviors that have allowed the human being to thrive and survive. Improve clinical outcomes and optimize health by enhancing reciprocal communication interactions, reducing screen time and re-establishing the circadian rhythm.

References

Arakelyan, M., Freyleue, S., Avula, D., McLaren, J.L., O’Malley, A.J., & Leyenaar, J.K. (2023). Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019. JAMA, 329(12), 1000–1011. https://doi.org/10.1001/jama.2023.1992

Braghieri, L., Levy, R., & Makarin, A. (2022). Social Media and Mental Health (July 28, 2022). Available at SSRN: https://ssrn.com/abstract=3919760 or http://dx.doi.org/10.2139/ssrn.3919760

Caliandro, R., Streng, A.A., van Kerkhof, L.W.M., van der Horst, G.T.J., & Chaves, I. (2021). Social Jetlag and Related Risks for Human Health: A Timely Review. Nutrients, 13(12), 4543. https://doi.org/10.3390/nu13124543

Carson, V., Tremblay, M.S., Chaput, J.P., & Chastin, S.F. (2016). Associations between sleep duration, sedentary time, physical activity, and health indicators among Canadian children and youth using compositional analyses. Appl Physiol Nutr Metab, 41(6 Suppl 3), S294-302. https://doi.org/10.1139/apnm-2016-0026

Cassoff, J., Wiebe, S.T., & Gruber, R. (2012). Sleep patterns and the risk for ADHD: a review. Nat Sci Sleep, 4, 73-80. https://doi.org/10.2147/NSS.S31269

CDC. (2022). Attention-Deficit/hyperactivity disorder (ADHD): ADHD through the years. Centers for Disease Control and Prevention. Assessed March 27, 2023. https://www.cdc.gov/ncbddd/adhd/timeline.html

CDC. (2023). Data & Statistics on Autism Spectrum Disorder. CDC Centers for Disease Control and Prevention. Assessed March 25, 2023. https://www.cdc.gov/ncbddd/autism/data.html

Council on Communications and Media. (2016). Media and young minds. Pediatrics, 138(5), e20162591. https://doi.org/10.1542/peds.2016-2591

Ettman, C.K., Abdalla, S.M., Cohen, G.H., Sampson, L., Vivier, P.M.,& Galea, S. (2020), Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open, 3(9):e2019686. https://doi.org/10.1001/jamanetworkopen.2020.19686

Geiger, A.W. & Davis, L. (2019). A growing number of American teenagers-particularly girls-are facing depression. Pew Research Center. Accessed March 28, 2023.

https://www.pewresearch.org/fact-tank/2019/07/12/a-growing-number-of-american-teenagers-particularly-girls-are-facing-depression/

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[1] The critique of social media does not imply that there are no benefits. If used judiciously, it is a powerful tool to connect with family and friends or access information.

Biofeedback, posture and breath: Tools for health

Posted: December 1, 2022 | Author: erikpeper | Filed under: ADHD, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, computer, digital devices, education, emotions, ergonomics, Evolutionary perspective, Exercise/movement, healing, health, laptops, mindfulness, Neck and shoulder discomfort, Pain/discomfort, posture, relaxation, screen fatigue, self-healing, stress management, Uncategorized, vision, zoom fatigue | 3 Comments

Two recent presentations that that provide concepts and pragmatic skills to improve health and well being.

How changing your breathing and posture can change your life.

In-depth podcast in which Dr. Abby Metcalf, producer of Relationships made easy, interviews Dr. Erik Peper. He discusses how changing your posture and how you breathe may result in major improvement with issues such as anxiety, depression, ADHD, chronic pain, and even insomnia! In the presentation he explain how this works and shares practical tools to make the changes you want in your life.

How to cope with TechStress

A wide ranging discussing between Dr. Russel Jaffe and Dr Erik that explores the power of biofeedback, self-healing strategies and how to cope with tech-stress.

These concepts are also explored in the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. You may find this book useful as we spend so much time working online. The book describes the impacts personal technology on our physical and emotional well-being. More importantly, “Tech Stress” provides all of the basic tools to be able not only to survive in this new world but also thrive in it.

Additiona resources:

Gonzalez, D. (2022). Ways to improve your posture at home.

Resolving a chronic headache with posture feedback and breathing

Healing chronic back pain

Posted: July 31, 2022 | Author: erikpeper | Filed under: behavior, Breathing/respiration, CBT, cognitive behavior therapy, education, healing, health, meditation, relaxation, self-healing, stress management, surgery | Tags: back pain, Imagery, self-care, visualization | 4 Comments

Erik Peper, PhD, BCB, Jillian Cosby, and Monica Almendras

Adapted from Peper, E. Cosby, J. & Amendras, M. (2022).Healing chronic back pain. NeuroRegulation, 9(3), 165-172. https://doi.org/10.15540/nr.9.3.164

In at the beginning of 2021, I broke my L3 vertebra during a motor cycle accident and underwent two surgeries in which surgeons replaced my shattered L3 with a metal “cage” (looks like a spring) and fused this cage to the L4 and L2 vertebrae with bars. I also broke both sides of my jaw and fractured my left shoulder. I felt so overwhelmed and totally discouraged by the ongoing pain. A year later, after doing the self-healing project as part of the university class assignment, I feel so much better all the time, stopped taking all prescription pain medications and eliminated the sharp pains in my back. This project has taught me that I have the skill set needed to be whole and healthy. –J.C., 28-year-old college student

Chronic pain is defined as a pain that persist or recurs for more than 3 months (Treede et al., 2019). It is exhausting and often associated with reduced quality of life and increased medical costs (Yong, Mullins, & Bhattacharyya, 2022). Pain and depression co-exacerbate physical and psychological symptoms and can lead to hopelessness (IsHak, 2018; Von Korff & Simon, 1996). To go to bed with pain and anticipate that pain is waiting for you as you wake up is often debilitating. One in five American adults experience chronic pain most frequently in back, hip, knee or foot (Yong, Mullins, & Bhattacharyya, 2022). Patients are often prescribed analgesic medications (“pain killers”) to reduce pain. Although, the analgesic medications can be effective in the short term to reduce pain, the efficacy is marginal for relieving chronic pain (Eriksen et al., 2006; Tan, & Jensen, 2007). Recent research by Parisien and colleagues (2022) reported that anti-inflammatory drugs were associated with increased risk of persistent pain. This suggest that anti-inflammatory treatments might have negative effects on pain duration. In addition, the long-term medication use is a major contributor to opioid epidemic and increased pain sensitivity (NIH– NIDA, 2022; Higgins, Smith, & Matthews, 2019; Koop, 2020). Pain can often be successfully treated with a multidisciplinary approach that incorporates non-pharmacologic approaches. These include exercise, acceptance and commitment therapy, as well as hypnosis (Warraich, 2022). This paper reports how self-healing strategies as taught as part of an undergraduate university class can be an effective approach to reduce the experience of chronic pain and improve health.

Each semester, about 100 to 150 junior and senior college students at San Francisco State University enroll in a holistic health class that focused on ‘whole-person’ Holistic Health curriculum. The class includes an assessment of complementary medicine and holistic health. It is based upon the premise that mind/emotions affect body and body affect mind/emotions that Green, Green & Walters (1970) called the psychophysiological principle.

“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 didactic components of the class includes the psychobiology of stress, the role of posture, psychophysiology of respiration, lifestyle and other health factors, reframing internal language, guided and self-healing imagery. Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney, & Holt, 2002).

The self-practices during the last six weeks of the class focus on identifying, developing and implementing a self-healing project to optimize their personal health. The self-healing project can range from simple life style changes to reducing chronic pain. Each student identifies their project such as increasing physical activity, eating a healthy diet and reducing sugar and junk food, stopping vaping/smoking, reducing anxiety or depression, stopping hair pulling, reducing headaches, decreasing ezema, or back pain, etc. At the end of the semester, 80% or more of the students report significant reduction in symptoms (Peper, Sato-Perry, & Gibney, 2003; Peper, Lin, Harvey, Gilbert, Gubbala, Ratkovich, & Fletcher, 2014; Peper, Miceli, & Harvey, 2016; Peper, Harvey, Cuellar, & Membrila, 2022). During the last five semesters, 13 percent of the students focused reducing pain (e.g., migraines, neck and shoulder pain, upper or lower back pain, knee pain, wrist pain, and abdominal pain). The students successfully improved their symptoms an average of 8.8 on a scale from 0 (No benefit) to 10 (total benefit/improvement). The success for improving their symptoms correlates 0.63 with their commitment and persistence to the project (Peper, Amendras, Heinz, & Harvey, in prep).

The purposes of this paper is to describe a case example how a student with severe back pain reduced her symptoms and eliminated medication by implementing an integrated self-healing process as part of a class assignment and offer recommendations how this could be useful for others.

Participant: A 28-year-old female student (J.C.) who on January 28, 2021 broke her L3 vertebra in a motor cycle accident. She underwent two surgeries in which surgeons replaced her shattered L3 with a metal “cage” (which she describes as looking like a spring) and fused this cage to the L2 and L4 vertebrae with bars. She also broke both sides of her jaw and fractured her left shoulder. More than a year later, at the beginning of the self-healing project, she continue to take 5-10 mgs of Baclofen and 300 mgs of Gabapentin three times a day to reduce pain.

Goal of the self-healing project: To decrease the sharp pain/discomfort in her lower back that resulted from the motor cycle accident and, although not explicitly listed, to decrease the pain medications.

Self-healing process

During the last six weeks of the 2022 Spring semester, the student implemented her self-healing practices for her personal project which consisted of the following steps.

1. Create a self-healing plan that included exploring the advantage and disadvantage of her illness.

2. Develop a step-by-step plan with specific goals to relief her tension and pain in her lower back. This practice allowed her to quantify her problem and the solutions. Like so many people with chronic pain, she focused on the problem and feelings (physical and emotional) associated with the pain. As a result, she often feel hopeless and worried that it would not change.

3. Observe and evaluate when pain sensations changed. She recognized that she automatically anticipated and focused on the pain and anxiety whenever she needed to bend down into a squat. She realized that she had been anticipating pain even before she began to squat. This showed that she needed to focus on healing the movement of this area of her body.

Through her detailed observations, she realized that her previous general rating of back pain could be separated into muscle tightness/stiffness and pain. With this realization, she changed the way she was recording her pain level. She changed it from “pain level” into into two categories: tightness and sharp pains.

4. Ask questions of her unconscious through a guided practice of accessing an inner guide through imagery (For detailed instructions, see Peper, Gibney, & Holt, 2002, pages 197-206). In this self-guided imagery the person relaxes and imagines being in a special healing place where you felt calm, safe and secure. Then as you relaxed, you become aware of another being (wise one or guide) approaching you (the being can be a person, animal, light, spirit, etc.). The being is wise and knows you well. In your mind, you ask this being or guide questions such as, “What do I need to do to assist in my own healing?” Then you wait and listen for an answer. The answer may take many forms such as in words, a pictures, a sense of knowing, or it may come later in dreams or in other forms. When students are assigned this practice for a week, almost all report experiencing some form of guide and many find the answers meaningful for their self-healing project.

Through this imagery of the inner guide script, she connected with her higher self and the wise one told her to “Wait.” This connecting with the wise one was key in accepting that the project was not as daunting as she initially thought. She realized that pain was not going to be forever in her future. She also interpreted that as reminder to have patience with herself. Change takes practice, time and practice such as she previously experienced while correcting her posture to manage her emotions and edit her negative thoughts into positive ones (Peper, Harvey, Cuellar, & Membrila, 2022). Whenever she would have pain or feel discouraged because of external circumstances, she would remind herself of three things:

A. I need to have patience with myself.

B. I have all the healing tools inside me and I am learning to use them.

C. If I do not make time for my wellness, I’ll be forced to make time for my illness.

5. Practice self-healing imagery as described by Peper, Gibney, & Holt (2002) and adapted from the work by Dr. Martin Rossman (Rossman, 2000). Imagery can be the communication channel between the conscious/voluntary and the unconscious/autonomic/involuntary nervous system (Bressler, 2005; Hadjibalassi et al, 2018; Rossman, 2019). It appears to act as the template and post-hypnotic suggestion to implement behavior change and may offer insight and ways to mobilize the self-healing potential (Battino, 2020). Imagery is dynamic and changeable.

The process of self-healing imagery consists of three parts.

Inspection the problem and drawing a graphic illustration of the problem as it is experienced at that moment of time.
Drawing of how that area/problem would look when being completely well/whole or disappeared.
Creation of a self-healing process by which the problem would become transformed into health (Peper, Gibney & Holt, 2002, pp. 217-236). The process focused on what the person could do for themselves; namely, each time they became aware of, anticipated, or felt the problem, they would focus on the self-healing process. It provideshope; since, the person now focuses on the healing of the problem and becoming well.

The drawings of inspection of the pain and problem she experienced at that moment of time are shown in Figure 1.

Figure 1. Illustration of the problem of the pain. Thorns dug deep, muscles tight, and frozen vertebrates grinding.

The resolution of the problem and being well/whole are illustrated in Figure 2.

Figure 2. Resolution of the problem in which her muscles are warm, full of blood, free of thorns, relaxed and flexible and being whole happy and healthy in which her spine is warm, her muscles are warm, her back is flexible and full of movement.

Although she utilized the first image of the muscles warm, full of blood, free of thorns and the muscles relaxed and flexible, her second image of her fully being healed was inspired through a religious statue of Yemaya that she had in her room (Yemaya is a major water spirit from the Yoruba religion Santeria and Orisha of the seas and protector of women). Each time she saw the statue, she thought of the image of herself fully healed and embodying the spirit Orisha. Therefore, this image remained important to her all the time.

Her healing imagery process by which she transforms the image of inspecting of the problem to being totally well are illustrated in Figure 3.

Figure 3. The healing process: The sun’s warm fingers thaw my muscles, lubricate my vertebra, thorns fall out, and blood returns.

For five weeks as she implemented her self-healing project by creating a self-healing plan, asking questions of her unconscious, drawing her self-healing imagery. She also incorporated previously learned skills from the first part of the semester such diaphragmatic breathing, hand warming, shifting slouching to upright posture, and changing language. Initially she paired hand warming with the self-healing imagery and she could feel an increase in body warmth each time she practiced the imagery. She practiced the self-healing imagery as an in-depth daily practice and throughout the day when she became aware of her back as described in one of her log entries.

I repeated the same steps as the day prior today. I did my practice in the early morning but focused on the details of the slowed down movements of the sun’s hands. I saw them as they stretched out to my back, passed through my skin, wrapped around my muscles, and began to warm them. I focused on this image and tried to see, in realistic detail, my muscles with a little ice still on them, feeling hard through and through, the sun’s glowing yellow-orange fingers wrapped around my muscles. I imaged the thorns still in my muscles, though far fewer than when I started, and then I imaged the yellow-orange glow start to seep out from the sun’s palms and fingers and spread over my muscles. I imaged the tendons developing as the muscle tissue thawed and relaxed, the red of the muscle brightened, the ice on and within my muscles started to melt, and the condensation formed as it ran down into collected droplets at the bottom of my muscles. I imaged the thorns lose their grip and fall out, one at a time, in tandem with the droplets falling. I continued this process and imaged my muscles expanding with warmth and relaxation as they stayed engulfed in the warmth of the sun.

At the end of my practice, I did a small stretch session. I felt extremely refreshed and ready for yet another extremely busy day between internship, graduation, and school. I would say I felt warm and relaxed all the way into the afternoon, about 6 hours after my practice. This was by far the most detailed and impactful imagery practice I have had.

The self-healing imagery practice provided me with the ability to conceptualize more than my problem as it showed me the tools to (and the importance of) conceptualizing my solution, both the tool and end result.

Results

Pain and tightness decreased and she stopped her medication by the third week as shown in Figure 4.

Figure 4. Self-rating of sharp pains and tightness during the self-healing project.

At the 14-week follow-up, she has continued to improve, experiences minimal discomfort, and no longer takes medication. As she stated, I was so incredibly shocked how early on [in the project] I was able to stop taking pain medications that I had already taken every day for over a year.

Discussion

This individual case example provides hope that health can be improved when shifting the focus from pain and discomfort to focusing on actively participating in the self-healing process. As she wrote, The lesson was self- empowerment in regard to my health. I brought comfort to my back. There is metal in my back for the rest of my life and this is something I have accepted. I used to look at that as a horrible thing to have to handle forever. I now look at it as a beautiful contraption that has allowed me to walk across a graduation stage despite having literally shattered a vertebra. I am reintegrating these traumatized parts of my body back into a whole health state of mind and body. Doctors did not do this, surgeries did not, PT didn’t and neither did pain medications. MY body and MY mind did it. I did this.

Besides the self-healing imagery and acting upon the information she received from the asking questions from the unconscious there were many other factors contributed to her healing. These included the semester long self-practices and mastery of different stress management techniques, learning how stress impacts health and what can the person can do to self-regulate, as well as being introduced to the many case examples and research studies that suggested healing could be possible even in cases where it seemed impossible.

The other foundational components that was part of the class teachings included attending the weekly classes session and completing the assign homework practices. These covered discussion about placebo/nocebo, possibilities and examples of self-healing with visualization, the role of nutrition, psychophysiology of stress and factors are associated with healthy aging across cultures. The asynchronous assignments investigated factors that promoted or inhibited health and the role of hope. The discussions pointed out that not everyone may return to health; however, they can always be whole. For example, if a person loses a limb, the limb will not regrow. The healing process includes acceptance and creating new goals to achieve and live a meaningful life.

The possibility that students could benefit by implementing the different skills and concepts taught in the class were illustrated by sharing previous students’ successes in reversing disorders such as hair pulling, anxiety, psoriasis, and pain. In addition, students were assigned to watch and comment on videos of people who had overcome serious illness. These included Janine Shepherd’s 2012 TED talk, A broken body isn’t a broken person, and Dr. Terry Wahl’s 2011 TEDxIowaCity talk, Minding your mitochondria. Janine Shepard shared how she recovered from a very serious accident in which she became paralyzed to becoming an aecrobatic pilot instructor while Dr. Terry Wahl shares how she he used diet to cure her MS and get out of her wheelchair (Shepherd, 2012; Wahl, 2011). Other assignments included watching Madhu Anziani’s presentation, Healing from paralysis-Music (toning) to activate health, in which he discussed his recovery from being a quadriplegic to becoming an inspirational musician (Anziani, & Peper, 2021). The students as read and commented on student case examples of reversing acid reflux, irritable bowel and chronic headaches (Peper, Mason, & Huey, 2017a; Peper, Mason, & Huey, 2017b; Peper, 2018; Peper et al., 2020; Peper, Covell, & Matzembacker, 2021; Peper, 2022).

Although self-healing imagery appears to be the major component that facilitated the healing, it cannot be separated from the many other concepts and practices that may have contributed. For example, the previous practices of learning slow diaphragmatic breathing and hand warming may have allowed the imagery to become a real kinesthetic experience. In addition, by seeing how other students overcame chronic disorders, the class provided a framework to mobilize one’s health.

Lessons extracted from this case example that others may be able use to mobilize health.

Take action to shifts from being hopeless and powerless to becoming empowered and active agent in the healing process.
Change personal beliefs through experiential practices and storytelling that provides a framework that healing and improvement are possible.
- Teach the person self-regulation skills such as slower breathing, muscle relaxation, cognitive internal language changes, hand warming by which the person experiences changes.
- Provide believable role models who shared their struggle in overcoming traumatic injury, watch inspirational talks, and share previous clients or students’ self-reports who had previously improved.
Transform the problem from global description into behavioral specific parts. For example, being depressed is a global statement and too big to work on. Breaking the global concept into specific behaviors such as, my energy is too low to do exercise or I have negative thoughts, would provide specific interventions to work on such as, increasing exercise or changing thoughts. In JC’s case, she changed the general rating of pain into ratings of muscle tightness and sharp pains. This provided the bases for strategies to relax and warm her muscles.
Focus on what you can do at that moment versus focusing on the past, what happened, who caused it, or blaming yourself and others. Explore and ask what you now can do now to support your healing process and reframe the problem as a new opportunity for growth and development.
Practice, practice, and practice with a childlike exploratory attitude. Focus on the small positive benefits that occur as a result of the practices. It is not mindless practice; it is practice while being present and being gentle with yourself. Do not discard very small changes. The benefits accrue as you practice more and more, just many people have experienced when learning to play a musical instrument or mastering a sport. Even though many participants think that practicing 15 minutes a day is enough, it usually takes much more time. Reflect on how a baby learns to walk or climb. The toddler practices day-long and takes naps to regenerate and grow. When the toddler is not yet successful in walking or climbing, it does not give up or interpret it as failure or blaming himself that he cannot do it, it just means more practice.
Have external reminders to evoke the self-healing practices. In JC’s case, the small statue of Yemaya in her room was the reminder. It reminded her to thinks of the image of herself fully healed each time she saw it.
Guide yourself through the wise one imagery, ask yourself a question and listen and act on the intuitional answers.
Develop a self-healing imagery process that transforms the dysfunction to health or wholeness. Often the person only perceives the limitations and focusses on describing the problem. Instead, acknowledge, accept what was and is, and focus on developing a process to promote healing. What many people do not realize that if they think/imagine how their injury/illness was caused, it may reactivate and recreate the initial trauma. This can be illustrated through imagery. When we think or imagine something, it changes our physiology. For example, when one imagines eating a lemon, many people will salivate. The image affects physiology. Thus, focus on processes that support healing.
While practicing the imagery, experience it as if it is real and feel it happening inside yourself. Many people initially find this challenging as they see it outside themselves. One way to increase the “felt sense” is to incorporate more body involvement such as acting out the imagery with hand and body movements.
When having a relapse, remind yourself to keep going. Every morning is the beginning of a new day, do each practices anew. In addition, reflect of something that was challenging in the past but that you successfully overcame. Focus on that success. As JC wrote, I was also successful in that I gave myself slack and reminded myself that relapses will happen and what matters more is the steps I take to move forward.
Make your healing a priority that means doing it often during the day. Allow the self-healing imagery and process to run in the back of the head all the time just as a worry can be present in the background. So often people practice for a few minutes (which is great and better than not practicing at all); however, at other times during the day they are captured by their worry, negative thoughts or focus on the limitations of the disorder. When a person focuses on the limitations, it may interrupt the self-healing process. The analogy we often use is that the healing process is similar to healing from a small cut in the skin. Initially a scab forms and eventually the scab falls off and the skin is healed. On the other hand, if you keep moving the skin or pick on the scab, healing is much slower. By focusing on the limitations and past visualization of the injury, self-healing is reduced. This is similar to removing the scab before the skin has healed. As JC stated, “If you don’t make time for your wellness, you’ll be forced to make time for your illness” was 100% a motivating factor in my success.
Explore resources for providers and people living with pain. See Dr. Rachel Zoffness website which provides a trove of high quality articles, books, videos, apps, and podcasts. https://www.zoffness.com/resources

In summary, we do not know the limits of self-healing; however, this case example illustrates that by implementing self-healing strategies health and recovery occurred. As JC wrote:

To have broken a vertebra in my back and experience all the injuries that came with the accident when I already did not have the strongest mind-body connection was incredibly intense and really heartbreaking and discouraging in my life. And, that made things difficult because I was not able to 100% focus on my healing because I felt so overwhelmed by the feeling of discouragement that I felt. Experiencing this self-healing project, seeing the imagery that helped me not just feel so much better all the time but be able to stop taking all prescription pain medications and eliminate the sharp pains in my back has taught me that I have the skill set needed to be whole and healthy.

Watch the interview will Jillian Cosby inwhich she describes her self-healing process.

References

Anziani, M. & Peper, E. (2021). Healing from paralysis-Music (toning) to activate health. The peperperspective. https://peperperspective.com/2021/11/22/healing-from-paralysis-music-toning-to-activate-health/

Battino, R. (2020). Using Guided Imagery and Hypnosis in Brief Therapy and Palliative Care. New York: Routledge.

Bresler, D. (2005).Physiological Consequences of Guided Imagery. Pract Pain Manag, 5(6). https://www.practicalpainmanagement.com/treatments/complementary/biobehavioral/physiological-consequences-guided-imagery

Eriksen, J., Sjøgren, P., Bruera, E., et al. (2006). Critical issues on opioids in chronic non-cancer pain: An epidemiologic study. Pain, 125,172–179. https://doi.org/10.1016/j.pain.2006.06.009

Green, E. E., Green, A. M., & Walters, E. D. (1970). Voluntary control of internal states: Psychological and physiological. The Journal of Transpersonal Psychology, 2(1), 1. https://atpweb.org/jtparchive/trps-02-70-01-001.pdf

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Peper, E., Almedras, M., Heinz, N. & Harvey, R. (in prep). How attending a Holistic Health class reduced symptoms.

Peper, E. Cosby, J. & Amendras, M. Healing chronic back pain. NeuroRegulation, 9I(3), 165-172. https://doi.org/10.15540/nr.9.3.164

Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194

Peper, E., Gibney, K.H. & Holt. C. (2002). Make Health Happen: Training Yourself to Create Wellness. Dubuque, IA: Kendall-Hunt.ISBN: 978-0787293314 https://he.kendallhunt.com/make-health-happen

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Freedom of movement with the Alexander Technique

Posted: April 26, 2022 | Author: erikpeper | Filed under: behavior, computer, digital devices, education, emotions, ergonomics, Exercise/movement, healing, health, Pain/discomfort, posture, screen fatigue, self-healing, stress management, Uncategorized | Tags: Alexander Technique, back pain, neck and shoulder pain, somatics | 3 Comments

Erik Peper and Elyse Shafarman

After taking Alexander Technique lessons I felt lighter and stood taller and I have learned how to direct myself differently. I am much more aware of my body, so that while I am working at the computer, I notice when I am slouching and contracting. Even better, I know what to do so that I have no pain at the end of the day. It’s as though I’ve learned to allow my body to move freely.

The Alexander Technique is one of the somatic techniques that optimize health and performance (Murphy, 1993). Many people report that after taking Alexander lessons, many organic and functional disorders disappear. Others report that their music or dance performances improve. The Alexander Technique has been shown to improve back pain, neck pain, knee pain walking gait, and balance (Alexander technique, 2022; Hamel, et al, 2016; MacPherson et al., 2015; Preece, et al., 2016). Benefits are not just physical. Studying the technique decreases performance anxiety in musicians and reduces depression associated with Parkinson’s disease (Klein, et al, 2014; Stallibrass et al., 2002).

Background

The Alexander Technique was developed in the late 19^th century by the Australian actor, Frederick Matthias Alexander (Alexander, 2001). It is an educational method that teaches students to align, relax and free themselves from limiting tension habits (Alexander, 2001; Alexander technique, 2022). F.M Alexander developed this technique to resolve his own problem of becoming hoarse and losing his voice when speaking on stage.

Initially he went to doctors for treatment but nothing worked except rest. After resting, his voice was great again; however, it quickly became hoarse when speaking. He recognized that it must be how he was using himself while speaking that caused the hoarseness. He understood that “use” was not just a physical pattern, but a mental and emotional way of being. “Use” included beliefs, expectations and feelings. After working on himself, he developed the educational process known as the Alexander Technique that helps people improve the way they move, breathe and react to the situations of life.

The benefits of this approach has been documented in a large randomized controlled trial of one-on-one Alexander Technique lessons which showed that it significantly reduced chronic low back pain and the benefits persisted a year after treatment (Little, et al, 2008). Back pain as well as shoulder and neck pain often is often related to stress and how we misuse ourselves. When experiencing discomfort, we quickly tend to blame our physical structure and assume that the back pain is due to identifiable structural pathology identified by X-ray or MRI assessments. However, similar structural pathologies are often present in people who do not experience pain and the MRI findings correlate poorly with the experience of discomfort (Deyo & Weinstein, 2001; Svanbergsson et al., 2017). More likely, the causes and solutions involve how we use ourselves (e.g., how we stand, move, or respond to stress). A functional approach may include teaching awareness of the triggers that precede neck and back tension, skills to prevent the tensing of those muscles not needed for task performance, resolving psychosocial stress and improving the ergonomic factors that contribute to working in a stressed position (Peper, Harvey & Faass, 2020). Conceptually, how we are use ourselves (thoughts, emotions, and body) affects and transforms our physical structure and then our physical structure constrains how we use ourselves.

Watch the video with Alexander Teacher, Elyse Shafarman, who describes the Alexander Technique and guides you through practices that you can use immediately to optimize your health while sitting and moving.

Reduce anxiety

Posted: March 23, 2022 | Author: erikpeper | Filed under: behavior, Breathing/respiration, CBT, cognitive behavior therapy, digital devices, education, emotions, health, mindfulness, posture, relaxation, self-healing, stress management | Tags: anxiety, concentration, insomnia, menstrual cramps, pain | 3 Comments

The purpose of this blog is to describe how a university class that incorporated structured self-experience practices reduced self-reported anxiety symptoms (Peper, Harvey, Cuellar, & Membrila, 2022). This approach is different from a clinical treatment approach as it focused on empowerment and mastery learning (Peper, Miceli, & Harvey, 2016).

As a result of my practice, I felt my anxiety and my menstrual cramps decrease. — College senior

When I changed back to slower diaphragmatic breathin, I was more aware of my negative emotions and I was able to reduce the stress and anxiety I was feeling with the deep diaphragmatic breathing.– College junior

Background

More than half of college students now report anxiety (Coakley et al., 2021). In our recent survey during the first day of the spring semester class, 59% of the students reported feeling tired, dreading their day, being distracted, lacking mental clarity and had difficulty concentrating.

Before the COVID pandemic nearly one-third of students had or developed moderate or severe anxiety or depression while being at college (Adams et al., 2021. The pandemic accelerated a trend of increasing anxiety that was already occurring. “The prevalence of major depressive disorder among graduate and professional students is two times higher in 2020 compared to 2019 and the prevalence of generalized anxiety disorder is 1.5 times higher than in 2019” As reported by Chirikov et al (2020) from the UC Berkeley SERU Consortium Reports.

This increase in anxiety has both short and long term performance and health consequences. Severe anxiety reduces cognitive functioning and is a risk factor for early dementia (Bierman et al., 2005; Richmond-Rakerd et al, 2022). It also increases the risk for asthma, arthritis, back/neck problems, chronic headache, diabetes, heart disease, hypertension, pain, obesity and ulcer (Bhattacharya et al., 2014; Kang et al, 2017).

The most commonly used treatment for anxiety are pharmaceutical and cognitive behavior therapy (CBT) (Kaczkurkin & Foa, 2015). The anti-anxiety drugs are usually benzodiazepines (e.g., alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium) and lorazepam (Ativan). Although these drugs they may reduce anxiety, they have numerous side effects such as drowsiness, irritability, dizziness, memory and attention problems, and physical dependence (Shri, 2012; Crane, 2013).

Cognitive behavior therapy techniques based upon the assumption that anxiety is primarily a disorder in thinking which then causes the symptoms and behaviors associated with anxiety. Thus, the primary treatment intervention focuses on changing thoughts.

Given the significant increase in anxiety and the potential long term negative health risks, there is need to provide educational strategies to empower students to prevent and reduce their anxiety. A holistic approach is one that assumes that body and mind are one and that soma/body, emotions and thoughts interchangeably affect the development of anxiety. Initially in our research, Peper, Lin, Harvey & Perez (2017) reported that it was easier to access hopeless, helpless, powerless and defeated memories in a slouched position than an upright position and it was easier to access empowering positive memories in an upright position than a slouched position. Our research on transforming hopeless, helpless, depressive thought to empowering thoughts, Peper, Harvey & Hamiel (2019) found that it was much more effective if the person first shifts to an upright posture, then begins slow diaphragmatic breathing and finally reframes their negative to empowering/positive thoughts. Participants were able to reframe stressful memories much more easily when in an upright posture compared to a slouched posture and reported a significant reduction in negative thoughts, anxiety (they also reported a significant decrease in negative thoughts, anxiety and tension as compared to those attempting to just change their thoughts).

The strategies to reduce anxiety focus on breathing and posture change. At the same time there are many other factors that may contribute the onset or maintenance of anxiety such as social isolation, economic insecurity, etc. In addition, low glucose levels can increase irritability and may lower the threshold of experiencing anxiety or impulsive behavior (Barr, Peper, & Swatzyna, 2019; Brad et al, 2014). This is often labeled as being “hangry” (MacCormack & Lindquist, 2019). Thus, by changing a high glycemic diet to a low glycemic diet may reduce the somatic discomfort (which can be interpreted as anxiety) triggered by low glucose levels. In addition, people are also sitting more and more in front of screens. In this position, they tend to breathe quicker and more shallowly in their chest.

Shallow rapid breathing tends to reduce pCO2 and contributes to subclinical hyperventilation which could be experienced as anxiety (Lum, 1981; Wilhelm et al., 2001; Du Pasquier et al, 2020). Experimentally, the feeling of anxiety can rapidly be evoked by instructing a person to sequentially exhale about 70 % of the inhaled air continuously for 30 seconds. After 30 seconds, most participants reported a significant increase in anxiety (Peper & MacHose, 1993). Thus, the combination of sitting, shallow breathing and increased stress from the pandemic are all cofactors that may contribute to the self-reported increase in anxiety.

To reduce anxiety and discomfort, McGrady and Moss (2013) suggested that self-regulation and stress management approaches be offered as the initial treatment/teaching strategy in health care instead of medication. One of the useful approaches to reduce sympathetic arousal and optimize health is breathing awareness and retraining (Gilbert, 2003).

Stress management as part of a university holistic health class

Every semester since 1976, up to 180 undergraduates have enrolled in a three-unit Holistic Health class on stress management and self-healing (Klein & Peper, 2013). Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney & Holt, 2002).

82% of students self-reported that they were ‘mostly successful’ in achieving their self-healing goals. Students have consistently reported achieving positive benefits such as increasing physical fitness, changing diets, reducing depression, anxiety, and pain, eliminating eczema, and even reducing substance abuse (Peper et al., 2003; Bier et al., 2005; Peper et al., 2014).

This assessment reports how students’ anxiety decreased after five weeks of daily practice. The students filled out an anonymous survey in which they rated the change in their discomfort after practicing effortless diaphragmatic breathing. More than 70% of the students reported a decrease in anxiety. In addition, they reported decreases in symptoms of stress, neck and shoulder pain as shown in Figure 1.

Figure 1. Self-report of decrease in symptoms after practice diaphragmatic breathing for a week.

In comparing the self-reported responses of the students in the holistic health class to those of the control group (N=12), the students in the holistic health class reported a significant decrease in symptoms since the beginning of the semester as compared to the control group as shown in Figure 2.

Figure 2. Change in self-reported symptoms after 6 weeks of practice the integrated holistic health skills as compared to the control group who did not practice these skills.

Changes in symptoms Most students also reported an increase in mental clarity and concentration that improved their study habits. As one student noted: Now that I breathe properly, I have less mental fog and feel less overwhelmed and more relaxed. My shoulders don’t feel tense, and my muscles are not as achy at the end of the day.

The teaching components for the first five weeks included a focus on the psychobiology of stress, the role of posture, and psychophysiology of respiration. The class included didactic presentations and daily self-practice

Lecture content

Diadactic presentation on the physiology of stress and how posture impacts health.
Self-observation of stress reactions; energy drain/energy gain and learning dynamic relaxation.
Short experiential practices so that the student can experience how slouched posture allows easier access to helpless, hopeless, powerless and defeated memories.
Short experiential breathing practices to show how breathing holding occurs and how 70% exhalation within 30 seconds increases anxiety.
Didactic presentation on the physiology of breathing and how a constricted waist tends to have the person breathe high in their chest (the cause of neurasthemia) and how the fight/flight response triggers chest breathing, breath holding and/or shallow breathing.
Explanation and practice of diaphragmatic breathing.

Daily self-practice

Students were assigned weekly daily self-practices which included both skill mastery by practicing for 20 minutes as well and implementing the skill during their daily life. They then recorded their experiences after the practice. At the end of the week, they reviewed their own log of week and summarized their observations (benefits, difficulties) and then met in small groups to discuss their experiences and extract common themes. These daily practices consisted of:

Awareness of stress. Monitoring how they reacted to daily stressor
Practicing dynamic relaxation. Students practiced for 20 minutes a modified progressive relaxation exercise and observed and inhibit bracing pattern
Changing energy drain and energy gains. Students observed what events reduced or increased their subjective energy and implemented changes in their behavior to decrease events that reduced their energy and increased behaviors that increase their enery
Creating a memory of wholeness practice
Practicing effortless breathing. Students practiced slowly diaphragmatic abdominal breathing for 20 minutes per day and each time they become aware of dysfunctional breathing (breath holding, shallow chest breathing, gasping) during the day, they would shift to slower diaphragmatic breathing.

Discussion

Almost all students were surprised how beneficial these practices were to reduce their anxiety and symptoms. Generally, the more the students would interrupt their personal stress responses during the day by shifting to diaphragmatic breathing the more did they experience success. We hypothesize that some of the following factors contributed to the students’ improvement.

Learning through self-mastery as an education approach versus clinical treatment.
Generalizing the skills into daily life and activities. Practicing the skills during the day in which the cue of a stress reaction triggered the person to breathe slowly. The breathing would reduce the sympathetic activation.
Interrupting escalating sympathetic arousal. Responding with an intervention reduced the sense of being overwhelmed and unable to cope by the participant by taking charge and performing an active task.
Redirecting attention and thoughts away from the anxiety triggers to a positive task.
Increasing heart rate variability. Through slow breathing heart rate variability increased which enhanced sympathetic parasympathetic balance.
Reducing subclinical hyperventilation by breathing slower and thereby increasing pC02.
Increasing social support by meeting in small groups. The class discussion group normalized the anxiety experiences.
Providing hope. The class lectures, assigned readings and videos provide hope; since, it included reports how other students had reversed their chronic disorders such as irritable bowel disease, acid reflux, psoriasis with behavioral interventions.

Although the study lacked a control group and is only based upon self-report, it offers an economical non-pharmaceutical approach to reduce anxiety. These stress management strategies may not resolve anxiety for everyone. Nevertheless, we recommend that schools implement this approach as the first education intervention to improve health in which students are taught about stress management, learn and practice relaxation and diaphragmatic breathing and then practice these skills during the day whenever they experience stress or dysfunctional breathing.

I noticed that breathing helped tremendously with my anxiety. I was able to feel okay without having that dreadful feeling stay in my chest and I felt it escape in my exhales. I also felt that I was able to breathe deeper and relax better altogether. It was therapeutic, I felt more present, aware, and energized.

See the following blogs for detailed breathing instructions

Healing irritable bowel syndrome with diaphragmatic breathing*

Breathing reduces acid reflux and dysmenorrhea discomfort

Resolving a chronic headache with posture feedback and breathing

Enjoy sex: Breathe away the pain*

Do nose breathing FIRST in the age of COVID-19

References

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Wilhelm, F.H., Gevirtz, R., & Roth, W.T. (2001). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and treatment. Behav Modif, 25(4), 513-45. https://doi.org/10.1177/0145445501254003

Addicted to your phone? How to separate from your phone for a healthy lifestyle[1]

Posted: September 21, 2021 | Author: erikpeper | Filed under: behavior, computer, digital devices, education, ergonomics, Evolutionary perspective, Exercise/movement, health, Neck and shoulder discomfort, posture, vision, zoom fatigue | 6 Comments

Erik Peper, PhD[2] and Monica Almendras

Our evolutionary traps with technology

Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—and reclaiming health, happiness, and sanity in a plugged-in world. We have the ability to control everything from our mobile phones without needing to get up from our seat. Work, social life and online learning all involve the mobile phone or some type of smart devices.

A convenient little device that is supposed to simplify our lives has actually trapped us into a vicious cycle of relying on it for every single thing we must do. We spend most of our day being exposed to digital displays on our smartphones, computers, gaming consoles, and other digital devices, immersing ourselves in the content we are viewing. From work related emails or tasks, to spending our free time looking at the screen for texting, playing games, and updating social media sites on a play-by-play of what we are eating, wearing, and doing. We click on one hyperlink after the other and create a vicious cycle trapped for hours until we realize we need to move. We are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day. 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 and college students interact with media for over 40 hours per week, or around 6 hours per day. That is a lot of hours spent on staring at the screen, which it is almost impossible not to be distracted by the digital screen. In time, 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. The powerful audiovisual formats override our desires to do something different, that some of us become enslaved to streaming videos, playing virtual games, or texting. We then tell ourselves that the task that needs to be done, will be finished later. That later becomes never by the end of the day, since the ongoing visual and auditory notifications from our apps interrupt and/or capture our attention. This difficulty to turn away from visual or auditory stimuli roots in our survival instincts.

Each time visual or auditory stimuli occur, we automatically check it out and see if it is a friend or foe, safety or danger. It is such an automatic response that we are unaware are reacting. The good news is that we all have experienced this compelling effect. Even when we are waiting for a response and the notifications has not arrived, 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 notification is long. As one student said, “Don’t worry, they’ll respond. It’s only been 30 seconds”. Anticipating responses from the media can interrupt what we are otherwise doing. Rather than finishing our work or task, we continuously 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.

Unfortunately, some forms of social media interactions also lead to a form of social isolation, loneliness–sometimes called 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 that include not only media, but junk food as well.

In my class survey of 99 college students, 85% reported experiencing anxiety, 48% neck and should tension, and 41% abdominal discomfort.

We are not saying to avoid the beneficial parts of the digital age. Instead, it should be used in moderation and to be aware of 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. Parental control and societal policies may be needed to mitigate the damage and enhance the benefits of the digital age.

Zoom Fatigue- How to reduce it and configure your brain for better learning

Zoom became the preferred platform for academic teaching and learning for synchronous education during the pandemic. Thus, students and faculty have been sitting and looking at the screen for hours end. While looking at the screen, the viewers were often distracted by events in their environment, notifications from their mobile phones, social media triggers, and emails; which promoted multitasking (Solis, 2019). These digital distractions cause people to respond to twice as many devices with half of our attention- a process labeled semi-tasking’ -meaning getting twice as much done and half as well.

We now check our phones an average of 96 times a day – that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019). Those who do media multitasking such as texting while doing a task perform significantly worse on memory tasks than those who are not multitasking (Madore et al., 2020). Multitasking is negatively correlated with school performance (Giunchiglia et al, 2018). The best way to reduce multitasking is to turn off all notifications (e.g., email, texts, and social media) and let people know that you will look at the notifications and then respond in a predetermined time, so that you will not be interrupted while working or studying.

When students from San Francisco State University in the United States chose to implement a behavior change to monitor mobile phone and media use and reduce the addictive behavior during a five-week self-healing project, many reported a significant improvement of health and performance. For example one student reported that when she reduced her mobile phone use, her stress level equally decreased as shown in Fig 1 (Peper et al, 2021).

Figure 1. Example of student changing mobile phone use and corresponding decrease in subjective stress level. Reproduced by permission from Peper et al. (2021).

During this class project, many students observed that the continuous responding to notifications and social media affected their health and productivity. As one student reported,

The discovery of the time I wasted giving into distractions was increasing my anxiety, increasing my depression and making me feel completely inadequate. In the five-week period, I cut my cell phone usage by over half, from 32.5 hours to exactly 15 hours and used some of the time to do an early morning run in the park. Rediscovering this time makes me feel like my possibilities are endless. I can go to work full time, take online night courses reaching towards my goal of a higher degree, plus complete all my homework, take care of the house and chores, cook all my meals, and add reading a book for fun! –22-year-old College Student

Numerous students reported that it was much easier to be distracted and multitask, check social media accounts or respond to emails and texts than during face-to-face classroom sessions as illustrated by two student comments from San Francisco State University.

“Now that we are forced to stay at home, it’s hard to find time by myself, for myself, time to study, and or time to get away. It’s easy to get distracted and go a bit stir-crazy.”

“I find that online learning is more difficult for me because it’s harder for me to stay concentrated all day just looking at the screen.”

Students often reported that they had more difficulty remembering the material presented during synchronous presentations. Most likely, the passivity while watching Zoom presentations affected the encoding and consolidation of new material into retrievable long-term memory. The presented material was rapidly forgotten when the next screen image or advertisement appeared and competed with the course instructor for the student’s attention. We hypothesize that the many hours of watching TV and streaming videos have conditioned people to sit and take in information passively, while discouraging them to respond or initiate action (Mander, 1978; Mărchidan, 2019).

To reduce the deleterious impact of media use, China has placed time limits on cellphone use, gaming, and social media use for children. On February 2021 Chinese children were banned from taking their mobile phones into school, on August 2021 Children under 18 were banned from playing video games during the week and their play was restricted to just one hour on Fridays, weekends and holidays, and beginning on September 20, 2021 children under 14 who have been authenticated using their real name can access Douyin, the Chinese version of Tik Tok, for maximum of 40 minutes a day between the hours of 6:00 and 22:00.

Ways to avoid Zoom

Say goodnight to your phone

It is common for people to use their mobile phone before going to bed, and then end up having difficult falling asleep. The screen emits blue light that sends a signal to your brain that says it is daytime instead of night. This causes your body to suppress the production of the melatonin hormone, which tells your body that it is time to sleep. Reading or watching content also contributes, since it stimulates your mind and emotions and thereby promote wakefulness (Bravo, 2020). Implement sleep hygiene and stop using your phone or watching screens 30-minutes before going to bed for a better night’s sleep.

Maintaining a healthy vision

We increase near visual stress and the risk of developing myopia when we predominantly look at nearby surfaces. We do not realize that eyes muscles can only relax when looking at the far distance. For young children, the constant near vision remodels the shape of eye and the child will likely develop near sightedness. The solutions are remarkably simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).

Interrupt sitting disease

We sit for the majority of the day while looking at screens that is a significant risk factor for diabetes, cardiovascular disease, depression and anxiety (Matthews et al., 2012; Smith et al., 2020). Interrupt sitting by getting up every 30 minutes and do a few stretches. You will tend to feel less sleepy, less discomfort and more productive. As one of our participants reported that when he got up, moved and exercised every 30 minutes at the end of the day he felt less tired. As he stated, “There is life after five”, which meant he had energy to do other activities after working at the computer the whole day. While working time flies and it is challenging to get up every 30 minutes. Thus, install a free app on your computer that reminds you to get up and move such as StretchBreak (www.stretchbreak.com).

Use slouching as a cue to change

Posture affects thoughts and emotions as well as, vice versa. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies tend to respond by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are 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 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). When you are captured by helpless defeated thoughts and slouch, use the thought or posture as the trigger to take change. The moment you are aware of the thoughts or slouched posture, sit up straight, look up, take a slow large diaphragmatic breath and only then think about reframing the problem positively (Peper, Harvey, Hamiel, 2019).

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).

The challenge is that we are usually unaware we have begun to slouch. A very useful solution is to use a posture feedback device to remind us, such as the UpRight Go (https://www.uprightpose.com/). This simple device and app signals you when you slouch. The device attaches to your neck and connects with blue tooth to your cellphone. After calibrating, it provides vibrational feedback on your neck each time you slouch. When participants use the vibration feedback to become aware of what is going on and interrupt their slouch by stretching and sitting up, they report a significant decrease in symptoms and an increase in productivity. As one student reported: “Having immediate feedback on my posture helped me to be more aware of my body and helped me to link my posture to my emotions. Before using the tracker, doing this was very difficult for me. It not only helped my posture but my awareness of my mental state as well.”

[1] Adapted from the bookby Erik Peper, Richard Harvey and Nancy Faass,TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, North Atlantic Press. https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X/

[2] Correspondence should be addressed to:

Erik Peper, Ph.D., Institute for Holistic Healing Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 COVID-19 mailing address: 2236 Derby Street, Berkeley, CA 94705 Email: epeper@sfsu.edu web: www.biofeedbackhealth.org blog: www.peperperspective.com

Improve learning with peak performance techniques

Posted: August 12, 2021 | Author: erikpeper | Filed under: ADHD, behavior, digital devices, education, educationj, screen fatigue, stress management, zoom fatigue | Tags: cueing, learning, optimum performance, peak performance, state dependent learning | 3 Comments

Erik Peper, PhD and Vietta Wilson, PhD

Adapted from: Peper, E. & Wilson, V. (2021). Optimize the learning state: techniques and habits. Biofeedback, 9(2), 46-49. https://doi.org/10.5298/1081-5937-49-2-04

Long after the COVID-19 pandemic is over, online learning will continue to increase as better methodologies and strategies are developed to implement and integrate it into our lives. This post provides suggestions on how to enhance the learner’s ability to engage while online with the use of pre-performance routines or habits.

Facilitating online learning requires coordination of the teacher, technology, student, environment and the topic. Teachers can enhance engagement (Shoepe et al., 2020) online through different types of prompts: intellectual (associated with instructor interaction, academic challenge, active learning), organizational (associated with enriching academic experiences by directing students, selecting topics and summarizing or redirecting), and social (associated with supportive campus environments by encouraging social interaction, using informal language and affirming student comments).

The student can enhance the satisfaction and quality of the online experience by having a good self-regulated learning style. Learning is impacted by motivation (beliefs about themselves or the task, perceived value, etc.), and metacognition (ability to plan, set goals, monitor and regulate their behavior and evaluate their performance) (Greene & Azevedo, 2010; Mega et al., 2014). While critical for learning, it does not provide information on how students can maintain their optimized performance long term, which is increasingly necessary during the pandemic but will possibly be the model of education and therapy of the future.

Habit can enhance performance across a life span.

Habit is a behavioral tendency tied to a specific context, such as learning to brush one’s teeth while young and continuing through life (Fiorella, 2020). Habits are related to self-control processes that are associated with higher achievement (Hagger, 2019). Sport performance extensively values habit, typically called pre-performance routine, in creating an ongoing optimized state of performance (Lautenbach et al., 2015; Lidor & Mayan, 2005; Mesagno et al., 2015). Habits or pre-performance routines are formed by repeating a behavior tied to a specific context and with continued repetition, wherein the mental association between the context and the response are strengthened. This shifts from conscious awareness to subconscious behavior that is then cued by the environment. The majority of one’s daily actions and behaviors are the results of these habits.

Failure to create a self-regulated learning habit impedes long-term success of students. It does take significant time and reinforcement to create the automaticity of a real-life habit. Lally et al. (2010) tracked real world activities (physical activity, eating, drinking water) and found habit formation varied from 18-254 days with a mean of 66 days. There was wide variability in the creation of the habit and some individuals never reached the stage of automaticity. Interestingly, those who performed the behavior with greater consistency were more likely to develop a habit.

The COVID pandemic resulted in many people working at home, which interrupted many of the covert habit patterns by which they automatically performed their tasks. A number of students reported that everything is the same and that they are more easily distracted from doing the tasks. As one student reported:

After a while, it all seems the same. Sitting and looking at the screen while working, taking classes, entertaining, streaming videos and socializing. The longer I sit and watch screens, the more I tend to feel drained and passive, and the more challenging it is to be present, productive and pay attention.

By having rituals and habits trigger behavior, it is easier to initiate and perform tasks. Students can use the strategies developed for peak performance in sports to optimize their performances so that they can achieve their personal best (Wilson & Peper, 2011; Peper et al., 2021). These strategies include environmental cueing and personal cueing.

Environmental cueing

By taking charge of your environment and creating a unique environment for each task, it is possible to optimize performance specific for each task. After a while, we do not have to think to configure ourselves for the task. It is no different than the sequence before going to sleep: you brush your teeth and if you forget, it feels funny and you probably will get up to brush your teeth.

Previously, many people, without awareness, would configure and reinforce themselves for work by specific tasks such as commuting to go work, being at a specific worksite to perform the work, wearing specific clothing, etc. (Peper et al., 2021). Now there are few or no specific cues tied to working; it tends to be all the same and it is no wonder that people feel less energized and focused.

Many people forget that learning and recall are state-dependent to where the information was acquired. The Zoom environment where we work or attend class is the same environment where we socialize, game, watch videos, message, surf the net and participate in social media. For most, there has been no habit developed for the new reality of in-home learning. To do this, the environment must be set up so the habit state (focused, engaged) is consistently paired with environmental, emotional, social and kinesthetic cues. The environment needs to be reproducible in many locations, situations, and mental states as possible. As illustrated by one student’s report.

To cue myself to get ready for learning, I make my cappuccino play the same short piece of music, wear the same sweater, place my inspiring poster behind my screen, turn off all software notifications and place the cell phone out of visual range.

A similar concept is used in the treatment of insomnia by making the bedroom the only room to be associated with sleep or intimacy (Irish et al., 2017; Suni, 2021). All other activities, arguing with your partner, eating, watching television, checking email, texting, or social media are done at other locations. Given enough time, the cues in the bedroom become the conditioned triggers for sleep and pleasure.

Create different environments that are unique to each category of Zoom involvement (studying, working, socializing, entertaining).

Pre COVID, we usually wore different clothing for different events (work versus party) or visited different environments for different tasks (religious locations for worship; a bar, coffee shop, or restaurant for social gathering). The specific tasks in a specified location had conscious and subconscious cues that included people, lighting, odors, sound or even drinks and food. These stimuli become the classically conditioned cues to evoke the appropriate response associated with the task, just as Pavlov conditioned dogs to salivate when the bell sound was paired with the presentation of meat. Taking charge of the conditioning process at home may help many people to focus on their task as so many people now use their bedroom, kitchen or living room for Zoom work that is not always associated with learning or work. The following are suggestions to create working/learning environments.

Wear task-specific clothing just as you would have done going to work or school. When you plan to study or work, put on your work shirt. In time, the moment you put on the work shirt, you are cueing yourself to focus on studying/working. When finishing with working/studying, change your clothing.
If possible, maintain a specific location for learning/working. When attending classes or working, sit at your desk with the computer on top of the desk. For games or communication tasks, move to another location.
If you can’t change locations, arrange task-specific backgrounds for each category of Zoom tasks. Place a different background such as a poster or wall hanging behind the computer screen—one for studying/working, and another for entertainment. When finished with the specific Zoom event, take down the poster and change the background.
Keep the sound appropriate to the workstation area. Try to duplicate what is your best learning/working sound scape.

Personal Cueing

Learning to become aware of and in control of one’s personal self is equally or more important than setting up the environment with cues that foster attention and learning. Practicing getting the body/mind into the learning state can become a habit that will be available in many different learning situations across one’s lifespan.

Perform a specific ritual or pre-performance routine before beginning your task to create the learning/performing state. The ritual is a choreographed sequence of actions that gets you ready to perform. For example, some people like to relax before learning and find playing a specific song or doing some stretching before the session is helpful. Others sit at the desk, turn off all notifications, take a deep breath then look up and state to themselves: “I am now looking forward to working/studying and learning,” “focus” (whatever it may be). For some, their energy level is low and doing quick arm and hand movements, slapping their thighs or face, or small fast jumps may bring them to a more optimal state. For many people smell and taste are the most powerful conditioners, and coffee improves their attention level. Test out an assortment of activities that get your body and mind at the performance level. Practice and modify as necessary.

Just as in sport, the most reliable method is to set up oneself for the learning/performance state, because a person has less control over the environment. For example, when I observed the Romanian rhythmic gymnasts team members practice their routine during the warmup before the international competition, they would act as if it was the actual competition. They stood at the mat preparing their body/mind state, then they would bow to the imaginary judge, wait for a signal to begin, and then perform their routine. On the other hand, most of the American rhythmic gymnasts would just do their practice routine. For the Romanian athletes, the competition was the same as their rehearsal practice. No wonder, the Romanian athletes were much more consistent in their performance. Additionally, ritual helps buffer against uncertainty and anxiety (Hobson et al., 2017).

Develop awareness of the body-mind state associated with optimum performance. This can be done by creating a ritual and an environment that evoke the optimum mental and emotional state for learning. As you configure yourself and your environment, explore how you physically feel when you are most focused and engaged. Identify what your posture, muscle tension, and body position feel like during these times, and identify what you are paying attention to. If your attention wanders, observe how you bring your attention back to the task. Does it help focus you to write summary notes or doodle? Do you flag important statements in your head and then visibly nod your head when you understand the concept? Or do you repeat an important cue word? Find what you do when you are optimally functioning. Then try to reproduce that same state that can be triggered by a key word that tells you what to focus on (e.g., listen to teacher, look at slide, etc.).

In summary, by becoming aware of and controlling one’s environment and personal states that are associated with productive learning, and then practicing them until they become a routine or habit, one can maximize all learning opportunities. This blog presented a few tips, techniques and cues that may help one to maximize attention and increase performance and learning while online.

I noticed when I took the time to prepare and ready myself to be focused and be present during the class, I no longer had to actively work to resist distractions; I was focused in the moment and not worried about emails, other assignments, what to make for dinner, etc…

References

Findlay-Thompson, S. and Mombourquette, P. (2014). Evaluation of a Flipped Classroom in an Undergraduate Business Course. Business Education & Accreditation, v. 6 (1), 63-71.https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2331035

Fiorella, L. (2020). The science of habit and its implications for student learning and ell-being. Educational Psychology Review, 32,603–625. https://doi.org/10.1007/s10648-020-09525-1

Greene, J. A., & Azevedo, R. (2010). The measurement of learners’ self-regulated cognitive and metacognitive processes while using computer-based learning environments. Educational Psychologist, 45(4), 203–209. https://doi.org/10.1080/00461520.2010.515935

Hagger, M. S. (2019). Habit and physical activity: Theoretical advances, practical implications, and agenda. Psychology of Sport and Exercise, 42, 118–129. https://doi.org/10.1016/j.psychsport.2018.12.007

Hobson, N. M., Bonk, D., & Inzlicht, M. (2017). Rituals decrease the neural response to performance failure. PeerJ, 5, e3363. https://doi.org/10.7717/peerj.3363

Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001

Lautenbach, F., Laborder, S. I., Lobinger, B. H., Mesagno, C. Achtzehn, S., & Arimond, F. (2015). Non automated pre-performance routine in tennis: An intervention study. Journal of Applied Sport Psychology, 27(2), 123-131. https://doi.org/10.1080/10413200.2014.957364

Lidor, R. & Mayan, Z. (2005). Can beginning learners benefit, from pre-performance routines when serving in volleyball? The Sport Psychologist 19(4), 243–263. https://doi.org/10.1123/tsp.19.4.343

Mega, C., Ronconi, L., & De Beni, R. (2014). What makes a good student? How emotions, self-regulated learning, and motivation contribute to academic achievement. Journal of Educational Psychology, 106(1), 121–131. https://doi.org/10.1037/a0033546

Mesagno, C., Hill, D. M., & Larkin, P. (2015). Examining the accuracy and in game performance effects between pre- and post-performance routines: A mixed methods study. Psychology of Sort and Exercise, 19, 85–94. https://doi.org/10.1016/j.psychsport.2015.03.005

Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 7(1).

Shoepe, T. C., McManus, J. F., August, S. E., Mattos, N. L., Vollucci, T. C. & Sparks, P. R. (2020). Instructor prompts and student engagement in synchronous online nutrition classes. American Journal of Distance Education, 34, 194–210. https://doi.org/10.1080/08923647.2020.1726166

Suni, E. (2021). Sleep Hygiene. https://www.sleepfoundation.org/sleep-hygiene.

Wilson, V. E. & Peper, E. (2011). Athletes are different: factors that differentiate biofeedback/neurofeedback for sport versus clinical practice. Biofeedback, 39(1), 27–30. https://doi.org/10.5298/1081-5937-39.1.01

the peper perspective

ideas on illness, health and well-being from Erik Peper

Quick Rescue Techniques When Stressed

Reduce the risk for colds and flu and superb science podcasts

TechStress: Building Healthier Computer Habits

Field of Ergonomics

Restbreaks

Better Computer Habits: Alternate Periods of Rest and Activity

Genetics: We’re Hardwired Like Ancient Hunters

Quit a Sedentary Workstyle

Varying Work Tasks

Experience It: “Mouse Shoulder” Test

Microbreaks

One-Minute Stretch Breaks

Building Exercise and Movement into Every Day

Fit in a Moving Break

Workstation Tips

Final Thoughts

Additional resources

Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythm

Biofeedback, posture and breath: Tools for health

Healing chronic back pain

Freedom of movement with the Alexander Technique

Reduce anxiety

Addicted to your phone? How to separate from your phone for a healthy lifestyle[1]

Improve learning with peak performance techniques

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