Mindfulness-based strategies are drawn from ancient Buddhist practices and have found acceptance as one of the major behavioral medicine techniques of today (Hilton et al, 2016; Khazan, 2013). Throughout this blog the term mindfulness will refer broadly to a mental state of paying total attention to the present moment, with a non-judgmental awareness of inner and outer experiences (Baer, Smith, & Allen, 2004; Kabat-Zinn, 1994). This approach is the common core for many stress management approaches (Peper, Harvey, & Lin, 2019).
Transcendental meditation (TM), a form of concentrative meditation involving repetition of a sacred word or phrase known as a mantra, was a popular meditation technique introduced in the United States from India and participants reported improvement of mental and physical health (Wallace, 1970; Paul-Labrador et al, 2006; Rainforth et al, 2007; Hawkins, 2003). To make TM more acceptable for the western audience, Herbert Benson, MD, adapted and simplified the TM process and then labelled a core element, the ‘relaxation response’ (Benson, Beary, & Carol, 1974; Benson & Clipper, 1992). Instead of giving people a secret mantra and part of a spiritual tradition, he recommend using the word “one” as the mantra. Since that time numerous studies have demonstrated that when patients practice the relaxation response, many clinical symptoms were reduced.
In 1979, Jon Kabat-Zinn introduced a manual for a standardized Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts Medical Center (Kabat-Zinn, 1994; Kabat-Zin, 2003). The eight-week program combined mindfulness as a form of insight meditation with mindful yogic movement exercises designed to focus awareness on body sensations, thoughts, feelings, and behaviors. Mindfulness based programs have become a predominant approach used in behavioral medicine.
Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) combine mindfulness meditation training with cognitive therapy and is a useful approach to reduce a variety of mental and physical conditions such as stress, anxiety, depression, addiction, disordered eating, chronic pain, sleep disturbances, and high blood pressure (Andersen et al., 2013; Carlson, Speca, Patel, & Goodey, 2003; Fjorback, Arendt, Ørnbøl, Fink, & Walach, 2011; Greeson, & Eisenlohr-Moul, 2014; Hoffman et al., 2012; Marchand, 2012; Baer, 2015; Demarzo et al, 2015; Khoury et al, 2013; Khoury et al, 2015; Teasdale, Segal, & Williams, 1995; Kabat-Zinn, 1994; Kabat-Zin, 2003; Zimmermann, Burrell, , & Jordan, 2018). Although in most cases, MBSR is helpful, in some cases meditation can evoke negative physical and/or psychological outcomes and inhibit prosocial behavior (Kreplin et al, 2018; Lindahl et al, 2017). Based on this encouraging research, many people are learning to meditate on their own using meditation apps. However, there are many questions that can arise for people new to meditation – such as what is meditation, how do I do it, what are the challenges, and how is it helpful? Some people also develop misconceptions about what meditation is and can become discouraged.
Watch the outstanding presentation by Professor Jennifer Daubenmier presented for the Holistic Health Lecture Series, in which she discusses meditation myths and pragmatic tips for practice.
Andersen, S. R., Würtzen, H., Steding-Jessen, M., Christensen, J., Andersen, K. K., Flyger, H., … & Dalton, S. O. (2013). Effect of mindfulness-based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients. Acta Oncologica, 52(2), 336-344. https://doi.org/10.3109/0284186X.2012.745948
Baer, R., Smith, G., & Allen, K. (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191–206. https://doi.org/10.1177/1073191104268029
Benson, H., Beary, J. F., & Carol, M. P. (1974).The Relaxation Response. Psychiatry, 37(1), 37-46. https://www.tandfonline.com/loi/upsy20
Benson, H. & Clipper, M.Z. (1992). The Relaxation Response. Wings Books.
Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness‐based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65(4), 571-581. https://doi.org/10.1097/01.psy.0000074003.35911.41
Demarzo, M. M., Montero-Marin, J., Cuijpers, P., Zabaleta-del-Olmo, E., Mahtani, K. R., Vellinga, A., Vicens, C., López-del-Hoyo, Y., & García-Campayo, J. (2015). The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review. Annals of family medicine, 13(6), 573–582. https://doi.org/10.1370/afm.1863
Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy–A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102-119. https://doi.org/10.1111/j.1600-0447.2011.01704.x
Greeson, J., & Eisenlohr-Moul, T. (2014). Mindfulness-based stress reduction for chronic pain. In R. A. Baer (Ed.), Mindfulness-Based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications, 269-292. San Diego, CA: Academic Press. https://www.academia.edu/8092878/Mindfulness_Based_Stress_Reduction_for_Chronic_Pain
Hawkins, M. A. (2003). Effectiveness of the Transcendental Meditation program in criminal rehabilitation and substance abuse recovery, Journal of Offender Rehabilitation, 36(1-4), 47-65. https://doi.org/10.1300/J076v36n01_03
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., …Maglione, M. A. (2016). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199-213. https://doi.org/10.1007/s12160-016-9844-2
Hoffman, C. J., Ersser, S. J., Hopkinson, J. B., Nicholls, P. G., Harrington, J. E., & Thomas, P. W. (2012). Effectiveness of mindfulness-based stress reduction in mood, breast-and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: A randomized, controlled trial. Journal of Clinical Oncology, 30(12), 1335-1342. https://doi.org/10.1200/JCO.2010.34.0331
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences, 8, 73–107. https://www.proquest.com/openview/fef538e3ed2210c1201ef2a946faed43/1?pq-origsite=gscholar&cbl=29080
Khazan, I. Z. (2013). The clinical handbook of biofeedback: A step-by-step guide for training and practice with mindfulness. John Wiley & Sons.
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763-771. https://doi.org/10.1016/j.cpr.2013.05.005
Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519-528. https://doi.org/10.1016/j.jpsychores.2015.03.009
Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, R. K, & Britton, W. B. (2017) The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoSONE, 12(5): e0176239. https://doi.org/10.1371/journal.pone.0176239
Marchand, W. R. (2012). Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. Journal of Psychiatric Practice, 18(4), 233-252. https://doi.org/10.1097/01.pra.0000416014.53215.86
Paul-Labrador, M., Polk, D., Dwyer, J.H. et al. (2006). Effects of a randomized controlled trial of Transcendental Meditation on components of the metabolic syndrome in subjects with coronary heart disease. Archive of Internal Medicine, 166(11), 1218-1224. https://doi.org/10.1001/archinte.166.11.1218
Peper, E., Harvey, R., & Lin, I-M. (2019). Mindfulness training has themes common to other technique. Biofeedback. 47(3), 50-57. https://doi.org/10.5298/1081-5937-47.3.02
Rainforth, M.V., Schneider, R.H., Nidich, S.I., Gaylord-King, C., Salerno, J.W., & Anderson, J.W. (2007). Stress reduction programs in patients with elevated blood pressure: A systematic review and meta-analysis. Current Hypertension Reports, 9(6), 520–528. https://doi.org/10.1007/s11906-007-0094-3
Teasdale, J. D., Segal, Z., & Williams, J. M. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 25–39. https://doi.org/10.1016/0005-7967(94)e0011-7
Wallace, K.W. (1970). Physiological Effects of Transcendental Meditation. Science, 167 (3926), 1751-1754. https://doi.org/10.1126/science.167.3926.1
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).
The Alexander Technique was developed in the late 19th 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.
See also the following posts:
Alexander, F.M. (2001). The Use of the Self. London: Orion Publishing. https://www.amazon.com/Use-Self-F-M-Alexander/dp/0752843915
Alexander technique. (2022). National Health Service. Retrieved 19 April, 2022/. https://www.nhs.uk/conditions/alexander-technique/
Deyo, R.A. & Weinstein, J.N. (2001). Low back pain. N Engl J Med., 344(5),363-70. https://doi.org/10.1056/NEJM200102013440508
Hamel, K.A., Ross, C., Schultz, B., O’Neill, M., & Anderson, D.I. (2016). Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. J Body Mov Ther. 20(4), 751-760. https://doi.org/10.1016/j.jbmt.2016.04.009
Klein, S. D., Bayard, C., & Wolf, U. (2014). The Alexander Technique and musicians: a systematic review of controlled trials. BMC complementary and alternative medicine, 14, 414. https://doi.org/10.1186/1472-6882-14-414
Little, P. Lewith, W G., Webley, F., Evans, M., …(2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ, 337:a884. https://doi.org/10.1136/bmj.a884
MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., et al. (2015). Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med, 163(9), 653-62. https://doi.org/10.7326/M15-0667
Preece, S.J., Jones, R.K., Brown, C.A. et al. (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 17, 372. https://doi.org/10.1186/s12891-016-1209-2
Stallibrass, C., Sissons, P., & Chalmers. C. (2002). Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa
Svanbergsson, G., Ingvarsson, T., & Arnardóttir RH. (2017). [MRI for diagnosis of low back pain: Usability, association with symptoms and influence on treatment]. Laeknabladid, 103(1):17-22. Icelandic. https://doi.org/10.17992/lbl.2017.01.116
Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med., 344, 1343–1350. https://doi.org/10.1056/NEJM200105033441801
Uusitupa, Mm, Khan, T.A., Viguiliouk, E., Kahleova, H., Rivellese, A.A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper. J.L. (2019). Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients, 11(11)2611. https://doi.org/10.3390/nu11112611
Most people breathe 22,000 breaths per day. We tend to breathe more rapidly when stressed, anxious or in pain. While a slower diaphragmatic breathing supports recovery and regeneration. We usually become aware of our dysfunctional breathing when there are problems such as nasal congestion, allergies, asthma, emphysema, or breathlessness during exertion. Optimal breathing is much more than the absence of symptoms and is influenced by posture. Dysfunctional posture and breathing are cofactors in illness. We often do not realize that posture and breathing affect our thoughts and emotions and that our thoughts and emotions affect our posture and breathing. Watch the video, A breath of fresh air: Breathing and posture to optimize health, that was recorded for the 2022 Virtual Ergonomics Summit.
The purpose of this blog is to describe how a university class that incorporated structured self-experience practices reduced self-reported anxiety symptoms. 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
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.
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
- 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.
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.
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
Adams. K.L., Saunders KE, Keown-Stoneman CDG, et al. (2021). Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study. BMJ Open 2021; 11:e047393. https://doi.org/10.1136/bmjopen-2020-047393
Barr, E. A., Peper, E. & Swatzyna, R.J. (2019). Slouched Posture, Sleep Deprivation, and Mood Disorders: Interconnection and Modulation by Theta Brain Waves. Neuroregulation, 6(4), 181–189 https://doi.org/10.15540/nr.6.41.181
Bhattacharya, R., Shen, C. & Sambamoorthi, U. (2014). Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry 14, 10 (2014). https://doi.org/10.1186/1471-244X-14-10
Bier, M., Peper, E., & Burke, A. (2005). Integrated stress management with ‘Make Health Happen: Measuring the impact through a 5-month follow-up. Poster presentation at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract published in: Applied Psychophysiology and Biofeedback, 30(4), 400. https://biofeedbackhealth.files.wordpress.com/2013/12/2005-aapb-make-health-happen-bier-peper-burke-gibney3-12-05-rev.pdf
Bierman, E.J.M., Comijs, H.C. , Jonker, C. & Beekman, A.T.F. (2005). Effects of Anxiety Versus Depression on Cognition in Later Life. The American Journal of Geriatric Psychiatry,13(8), 686-693, https://doi.org/10.1097/00019442-200508000-00007.
Brad, J., Bushman, C., DeWall, N., Pond, R.S., &. Hanus, M.D. (2014).. Low glucose relates to greater aggression in married couples. PNAS, April 14, 2014. https://doi.org/10.1073/pnas.1400619111
Chirikov, I., Soria, K. M, Horgos, B., & Jones-White, D. (2020). Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic. UC Berkeley: Center for Studies in Higher Education. Retrieved from https://escholarship.org/uc/item/80k5d5hw
Coakley, K.E., Le, H., Silva, S.R. et al. Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic. Nutr J 20, 45 (2021). https://doi.org/10.1186/s12937-021-00701-9
Crane,E.H. (2013).Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. 2013 Feb 22. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384680/
Du Pasquier, D., Fellrath, J.M., & Sauty, A. (2020). Hyperventilation syndrome and dysfunctional breathing: update. Revue Medicale Suisse, 16(698), 1243-1249. https://europepmc.org/article/med/32558453
Gilbert C. Clinical Applications of Breathing Regulation: Beyond Anxiety Management. Behavior Modification. 2003;27(5):692-709. https://doi.org/10.1177/0145445503256322
Kaczkurkin, A.N. & Foa, E.B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 17(3):337-46. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
Kang, H. J., Bae, K. Y., Kim, S. W., Shin, H. Y., Shin, I. S., Yoon, J. S., & Kim, J. M. (2017). Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population. Psychiatry investigation, 14(3), 240–248. https://doi.org/10.4306/pi.2017.14.3.240
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Pain is so different for each person. It can range from mildly distracting to totally debilitating. It can be the result from a medical procedure (post- surgical pain), a traumatic injury, disease, trauma or unknown causes. It is challenging to know what to do to reduce suffering and improve health and functioning. Should I take narcotics, have surgery, see a pain psychologist, have acupuncture, receive physical therapy, use biofeedback, change my diet, or get a massage? Should I exercise or rest? Should I follow my doctor’s recommendations?
Before you do anything, first listen to this podcast by pain psychologist, Rachel Zoffness, PhD. In this podcast she will explain what pain is; how it works; and how thoughts, emotions, and sensations are always interconnected. You will also learn the fundamentals of treating chronic pain and helping patients living with it. As one of my close friends stated, “I only wished I could have listened to this before, it would have saved years of suffering.” The podcast is Ologies with Alie Ward and the episode is Dolorology. The link for the episode is:
Rachel Zoffness, PhD, a pain psychologist, Visiting Professor at Stanford, and Assistant Clinical Professor at the UCSF School of Medicine. She serves on the Board of Directors of the U.S. Association for the Study of Pain, and the Society of Pediatric Pain Medicine. She is the author of The Pain Management Workbook and The Chronic Pain and Illness Workbook for Teens. She is a 2021 Mayday Fellow and consults on the development of integrative pain programs around the world.
It is the time of year when we once again make New Year resolutions, “I plan to exercise every day,” “I will stop drinking,” “I will eat less processed foods and more fruits and vegetables.” We use our will power and positive thoughts to begin these new activities; however, our will power often fades out and we quickly fall of the wagon. The reason vary such as, I had planned to jog today; however it is raining, I was planning to eat more vegies; however, I had dinner with a friend and ate a juicy hamburger, I had planned to meditate; however, I needed to help my son. So many other things took priority and the motivation disappeared..
Yet it is possible to be successful with starting and then maintaining new health promoting habits. The key is to increase the friction for the behaviors that you want to reduce and decrease the friction for behaviors that you want to increase. Friction is the extra work you need to do in order to do the task. For example, to eat fewer cookies, increase the friction by not having them in the house (you now have to go to the store to buy them) or by placing them somewhere where it takes greater effort to get them such as the top shelf for which that you need a small ladder to reach them. The extra effort (increased friction) brings awareness to the automatic behavior. At that point, you can interrupt your unconscious eating pattern and choose to do something else. On the other hand, to increase eating fruits, decrease the friction by having the fruit right in front of you on the table so that you can take one without thinking.
The key is to interrupt the habit chain of behavior you want to reduce and automate the habit chains of behaviors you want to increase. The more you do a behavior and the more pleasurable it is, the more likely will the new behaviore become an automatic habit. To learn how to change friction and how to be successful in creating new habits, listen to Shankar Vedantam Hidden Brain’s Podcast, Creatures of Habit.
Madhu Anziani and Erik Peper
In April 2009, Madhu Anziani, just one month prior to graduation from San Francisco State University with a degree in Jazz/World music performance, fell two stories and broke C5 and C7 vertebras. He became a quadriplegic (tretraplegia) and could not breathe, talk, move his arms and legs and was incontinent. He also could not remember anything about the accident because of retrograde amnesia. Even though he was paralyzed and the medical staff suggested that he focussed on how to live well as a quadriplegic, he transcended his paralysis and the prognosis and is now a well-known vocal looping arts and ceremonial song leader/composer.
His recovery against all odds provides hope that growth and healing is possible when the mind and spirit focus on possibilities and not on limitations. Alongside physical thereapy he utilized energy healing and toning/sound vibrations to recover mobility. Toning, the vocalization of an elonggated monotonous vowel sound susteained for a number of minutes tends to vibrate specific areas in the body where the chakras are located (Crowe & Scovel, 1996; Goldman, 2017). Toning compared to mindfulness meditation reduces intrusive thoughts and mind wandering. It also increases body vibration sensations and heart rate variability much more than mindfulness practice (Peper et al, 2019). The body vibrations induced by toning and music could be one of the mechanisms by which recovery can occur at an accelerated rate as it allows the person’s passive awareness and sustained attention to feel the paralyzed body and yet be relaxed in the present without judgement.
Watch Madhu’s inspirational presentation as part of the Holistic Health Lecture Series by the Institute for Holistic Health Studies, San Francisco State University. In this presentation, he describes the process of recovery and guides the viewer through toning practices to evoke quieting of mind, bliss within the heart, and a healing state of being.
For an additional discussion and guided practice in toning, see the blog, Toning quiets the mind and increases HRV more quickly than mindfulness practice.
Madu Anziani is a sound healer who endured being a tetraplegic (paralysis affecting all four
limbs) and used sound and energy healing to recover mobility. He is a SFSU graduate and most
well-known as a vocal looping artist and ceremonial song leader/composer.
As we emerge from the COVID pandemic and look forward to the New Year, we can bring joy and happiness though through simple acts of kindness.
I just received an email from the Rick Hansen Foundation that inspired me to share its recommendations. In 1957 at the age of 15, Rick Hansen injured his spinal cord and was paralyzed from the waist down. He is an inspiration for all of us. In these crazy times of sheltering in place, experiencing social isolation, anxiety, depression, racial bias, and also happiness and joy, he recommends the following TED talks to increase resilience, overcome racial bias, and achieve self-acceptance. Enjoy watching the talks as they suggest strategies to deal with adversity and offer hope for the New Year.
3 Secrets of resilient people by Dr. Lucy Hone, Co-director of the New Zealand Institute of Wellbeing & Resilience and adjunct fellow at the University of Canterbury in Christchurch, New Zealand.
How racial bias works-and how to disrupt it by Stanford University social psychologist, Jennifer L. Eberhardt
To overcome challenges, stop comparing yourself to other by wheelchair athlete Dean Furnes