Forty percent of adults and eighty percent of teenagers report experiencing significant visual symptoms (eyestrain, blurry vision, dry eyes, headaches, and exhaustion) during and immediately after viewing electronic displays. These ‘technology-associated overuse’ symptoms are often labeled as digital eyestrain or computer vision syndrome (Rosenfield, 2016; Randolph & Cohn, 2017). Even our distant vision may be affected— after working in front of a screen for hours, the world looks blurry. At the same time, we may experience an increase in neck, shoulders and back discomfort. These symptoms increase as we spend more hours looking at computer screens, laptops, tablets, e-readers, gaming consoles, and cellphones for work, taking online classes, watching streaming videos for entertainment, and keeping connected with friends and family (Borhany et al, 2018; Turgut, 2018; Jensen et al, 2002).
Eye, head, neck, shoulder and back discomfort are partly the result of sitting too long in the same position and attending to the screen without taking short physical and vision breaks, moving our bodies and looking at far objects every 20 minutes or so. The obvious question is, “Why do we stare at and are captured by, the screen?” Two answers are typical: (1) we like the content of what is on the screen; and, (2) we feel compelled to watch the rapidly changing visual scenes.
From an evolutionary perspective, our sense of vision (and hearing) evolved to identify predators who were hunting us, or to search for prey so we could have a nice meal. Attending to fast moving visual changes is linked to our survival. We are unaware that our adaptive behaviors of attending to a visual or auditory signals activate the same physiological response patterns that were once successful for humans to survive–evading predictors, identifying food, and discriminating between friend or foe. The large and small screen (and speakers) with their attention grabbing content and notifications have become an evolutionary trap that may lead to a reduction in health and fitness (Peper, Harvey & Faass, 2020).
Near vision stress
To be able to see the screen, the eyes need to converge and accommodate. To converge, the extraocular muscles of the eyes tighten; to focus (accomodation), the ciliary muscle around the lens tighten to increase the curvature of the lens. This muscle tension is held constant as long as we look at the screen. Overuse of these muscles results is near vision stress that contributes to computer vision syndrome, development of myopia in younger people, and other technology-associated overuse syndromes (Sherwin et al, 2012; Enthoven et al, 2020).
Continually overworking the visual muscles related to convergences increases tension and contributes to eyestrain. While looking at the screen, the eye muscles seldom have the chance to relax. To function effectively, muscles need to relax /regenerate after momentary tightening. For the eye muscles to relax, they need to look at the far distance– preferably objects green in color. As stated earlier, the process of distant vision occurs by relaxing the extraocular muscles to allow the eyes to diverge along with relaxing the ciliary muscle to allow the lens to flatten. In our digital age, where screen of all sizes are ubiquitous, distant vision is often limited to the nearby walls behind a screen or desk which results in keeping the focus on nearby objects and maintaining muscular tension in the eyes.
As we evolved, we continuously alternated between between looking at the far distance and nearby areas for food sources as well as signals indicating danger. If we did not look close and far, we would not know if a predator was ready to attack us. Today we tend to be captured by the screens. Arguably, all media content is designed to capture our attention such as data entry tasks required for employment, streaming videos for entertainment, reading and answering emails, playing e-games, responding to text notifications, looking at Instagram and Snapchat photos and Tiktok videos, scanning Tweets and using social media accounts such as Facebook. We are unaware of the symptoms of visual stress until we experience symptoms. To illustrate the physiological process that covertly occurs during convergence and accommodation, do the following exercise.
Sit comfortably and lift your right knee a few inches up so that the foot is an inch above the floor. Keep holding it in this position for a minute…. Now let go and relax your leg.
A minute might have seemed like a very long time and you may have started to feel some discomfort in the muscles of your hip. Most likely, you observed that when you held your knee up, you most likely held your breath and tightened your neck and back. Moreover, to do this for more than a few minutes would be very challenging.
Lift your knee up again and notice the automatic patterns that are happening in your body.
For muscles to regenerate they need momentary relaxation which allows blood flow and lymph flow to occur. By alternately tensing and relaxing muscles, they can work more easily for longer periods of time without experiencing fatigue and discomfort (e.g., we can hike for hours but can only lift our knee for a few minutes).
Solutions to relax the eyes and reduce eye strain
- Reestablish the healthy evolutionary pattern of alternately looking at far and near distances to reduce eyestrain, such as:
- Look out through a window at a distant tree for a moment after reading an email or clicking link.
- Look up and at the far distance each time you have finished reading a page or turn the page over.
- Rest and regenerate your eyes with palming. While sitting upright, place a pillow or other supports under our elbows so that your hands can cover your closed eyes without tensing the neck and shoulders.
- Cup the hands so that there is no pressure on your eyeballs, allow the base of the hands to touch the cheeks while the fingers are interlaced and resting your forehead.
- Close your eyes, imagine seeing black. Breathe slowly and diaphragmatically while feeling the warmth of the palm soothing the eyes. Feel your shoulders, head and eyes relaxing. Palm for 5 minutes while breathing at about six breaths per minute through your nose. Then stretch and go back to work.
Palming is one of the many practices that improves vision. For a comprehensive perspective and pragmatic exercises to reduce eye strain, maintain and improve vision, see the superb book by Meir Schneider, PhD., L.M.T., Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement.
Increased sympathetic arousal
Seeing the changing stimuli on the screen evokes visual attention and increases sympathetic arousal. In addition, many people automatically hold their breath when they see novel visual or hear auditory signals; since, they trigger a defense or orienting response. At the same time, without awareness, we may tighten our neck and shoulder muscles as we bring our nose literally to the screen. As we attend and concentrate to see what is on the screen, our blinking rate decreases significantly. From an evolutionary perspective, an unexpected movement in the periphery could be a snake, a predator, a friend or foe and the body responds by getting ready: freeze, fight or flight. We still react the same survival responses. Some of the physiological reactions that occur include:
- Breath holding or shallow breathing. These often occur the moment we receive a text notification, begin concentrating and respond to the messages, or start typing or mousing. Without awareness, we activate the freeze, flight and fight response. By breath holding or shallow breathing, we reduce or limit our body movements, effectively becoming a non-moving object that is more difficult to see by many animal predators. In addition, during breath holding, hearing become more acute because breathing noises are effectively reduced or eliminated.
- Inhibition of blinking. When we blink it is another movement signal that in earlier times could give away our position. In addition, the moment we blink we become temporarily blind and cannot see what the predator could be doing next.
- Increased neck, shoulder and back tension. The body is getting ready for a defensive fight or avoidance flight.
Experience some of these automatic physiological responses described above by doing the following two exercises.
Eye movement neck connection: While sitting up and looking at the screen, place your fingers on the back of the neck on either side of the cervical spine just below the junction where the spine meets the skull.
Feel the muscles of neck along the spine where they are attaching to the skull. Now quickly look to the extreme right and then to the extreme left with your eyes. Repeat looking back and forth with the eyes two or three times.
What did you observe? Most likely, when you looked to the extreme right, you could feel the right neck muscles slightly tightening and when you looked the extreme left, the left neck muscles slightly tightening. In addition, you may have held your breath when you looked back and forth.
Focus and neck connection: While sitting up and looking at the screen, place your fingers on the back of the neck as you did before. Now focus intently on the smallest size print or graphic details on the screen. Really focus and concentrate on it and look at all the details.
What did you observe? Most likely, when you focused on the text, you brought your head slightly forward and closer to the screen, felt your neck muscles tighten, and possibly held your breath or started to breathe shallowly.
As you concentrated, the automatic increase in arousal, along with the neck and shoulder tension and reduced blinking contributes to developing discomfort. This can become more pronounced after looking at screens to detailed figures, numerical data, characters and small images for hours (Peper, Harvey & Tylova, 2006; Peper & Harvey, 2008; Waderich et al, 2013).
Staying alert, scanning and reacting to the images on a computer screen or notifications from text messages, can become exhausting. in the past, we scanned the landscape, looking for information that will help us survive (predators, food sources, friend or foe) however today, we react to the changing visual stimuli on the screen. The computer display and notifications have become evolutionary traps since they evoke these previously adaptive response patterns that allowed us to survive.
The response patterns occur mostly without awareness until we experience discomfort. Fortunately, we can become aware of our body’s reactions with physiological monitoring which makes the invisible visible as shown in the figure below (Peper, Harvey & Faass, 2020).
Representative physiological patterns that occur when working at a computer, laptop, tablet or cellphone are unnecessary neck and shoulder tension, shallow rapid breathing, and an increase in heart rate during data entry. Even when the person is resting their hands on the keyboard, forearm muscle tension, breathing and heart rate increased.
Moreover, muscle tension in the neck and shoulder region also increased, even when those muscles were not needed for data entry task. Unfortunately, this unnecessary tension and shallow breathing contributes to exhaustion and discomfort (Peper, Harvey & Faass, 2020).
With biofeedback training, the person can learn to become aware and control these dysfunctional patterns and prevent discomfort (Peper & Gibney, 2006; Peper et, 2003). However, without access to biofeedback monitoring, assume that you respond similarly while working. Thus, to prevent discomfort and improve health and performance, implement the following.
- Practice breathing lower and slower to reduce sympathetic activation. Every few minutes remember to breathe slowly in and out through the nose. See the following blogs for more detailed instructions:
- Blink many times. Blink each time you click on a link, after typing a paragraph or after entering a few numbers.
- Get up, move, stretch and wiggle.
- Every few minutes do a small movement such as rotating your shoulders, dropping your hands to your lap.
- Every twenty minutes get up, stretch and walk around to reduce the chronic muscle tension.
- Install the free Stretch Break software on your computer or laptop to remind you to stretch… and then shows you how. Download free version from: https://stretchbreak.com/.
- Use small portable muscle biofeedback devices to learn awareness of the covert muscle tension and how to work without unnecessary muscle tension. For detailed training procedures see the free downloadable book by Erik Peper and Katherine Gibney, Muscle Biofeedback at the Computer- A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training.
Finally, for a comprehensive overview based on an evolutionary perspective that explains why TechStress develops, why digital addiction occurs. and what can be done to prevent discomfort and improve health and performance, see our new book by Erik Peper, Richard Harvey and Nancy Faass, Tech Stress-How Technology is Hijack our Lives, Strategies for Coping and Pragmatic Ergonomics.
Enthoven, C. A., Tideman, W.L., Roel of Polling, R.J.,Yang-Huang, J., Raat, H., & Klaver, C.C.W. (2020). The impact of computer use on myopia development in childhood: The Generation R study. Preventtive Medicine, 132, 105988.
Peper, E. & Gibney, K. (2006). Muscle Biofeedback at the Computer- A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. The Biofeedback Federation of Europe. Download free PDF version of the book: http://bfe.org/helping-clients-who-are-working-from-home/
Peper, E., Wilson, V.S., Gibney, K.H., Huber, K., Harvey, R. & Shumay. (2003). The Integration of Electromyography (sEMG) at the Workstation: Assessment, Treatment and Prevention of Repetitive Strain Injury (RSI). Applied Psychophysiology and Biofeedback, 28 (2), 167-182.
Sherwin, J.C., Reacher, M.H., Keogh, R. H., Khawaja, A. P., Mackey, D.A.,& Foster, P. J. (2012). The association between time spent outdoors and myopia in children and adolescents. Ophthalmology,119(10), 2141-2151.
Waderich, K., Peper, E., Harvey, R., & Sara Sutter. (2013). The psychophysiology of contemporary information technologies-Tablets and smart phones can be a pain in the neck. Presented at the 44st Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Portland, OR.
This post has been adapted from Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy. NeuroRegulation, 6(3), 153-169. doi:10.15540/nr.6.3.1533-1
When locked into a position, options appear less available. By unlocking our body, we allow our brain to unlock and become open to new options.
Changing positions may dissolve the rigidity associated with a fixed position. When we step away from the conflict, take a walk, look up at the treetops, roof lines and clouds, or do something different, we loosen up and new ideas may occur. We may then be able see the conflict from a different point of view that allows resolution.
When stressed, anxious or depressed, it is challenging to change. The negative feelings, thoughts and worries continue to undermine the practice of reframing the experience more positively. Our recent study found that a simple technique, that integrates posture with breathing and reframing, rapidly reduces anxiety, stress, and negative self-talk (Peper, Harvey, Hamiel, 2019).
Thoughts and emotions affect posture and posture affects thoughts and emotions. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies respond to the negative thoughts and emotions by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are much more at risk to:
- Feel helpless (Riskind & Gotay, 1982).
- Feel powerless (Westfeld & Beresford, 1982; Cuddy, 2012).
- Recall and being more captured by negative memories (Peper, Lin, Harvey, & Perez, 2017; Tsai, Peper, & Lin, 2016),
- Experience cognitive difficulty (Peper, Harvey, Mason, & Lin, 2018).
When we are upright and look up, we are more likely to:
- Have more energy (Peper & Lin, 2012).
- Feel stronger (Peper, Booiman, Lin, & Harvey, 2016).
- Find it easier to do cognitive activity (Peper, Harvey, Mason, & Lin, 2018).
- Feel more confident and empowered (Cuddy, 2012).
- Recall more positive autobiographical memories (Michalak, Mischnat,& Teismann, 2014).
Experience how posture affects memory and the feelings (adapted from Alan Alda, 2018)
Stand up and do the following:
- Think of a memory/event when you felt defeated, hurt or powerless and put your body in the posture that you associate with this feeling. Make it as real as possible . Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Think of a memory/event when you felt empowered, positive and happy put your body in the posture that you associate with those feelings. Make it as real as possible. Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Adapt the defeated posture and now recall the positive empowering memory while staying in the defeated posture. Observe what you experience.
- Adapt the empowering posture and now recall the defeated hopeless memory while staying in the empowered posture. Observe what you experience.
Almost all people report that when they adapt the body posture congruent with the emotion that it was much easier to access the memory and feel the emotion. On the other hand when they adapt the body posture that was the opposite to the emotions, then it was almost impossible to experience the emotions. For many people, when they adapted the empowering posture, they could not access the defeated hopeless memory. If they did access that memory, they were more likely be an observer and not be involved or emotionally captured by the negative memory.
Comparison of Posture with breathing and reframing to Reframing
The study investigated whether changing internal dialogue (reframing) or combining posture change and breathing with changing internal dialogue would reduce stress and negative self-talk more effectively.
The participants were 145 college students (90 women and 55 men) average age 25.0 who participated as part of a curricular practice in four different classes.
After the students completed an anonymous informational questionnaire (history of depression, anxiety, blanking out on exams, worrying, slouching), the classes were divided into two groups. They were then asked to do the following:
- Think of a stressful conflict or problem and make it as real as possible for one minute. Then let go of the stressful memory and do one of the two following practices.
- Practice A: Reframe the experience positively for 20 seconds.
- Practice B: Sit upright, look up, take a breath and reframe the experience positively for 20 seconds.
- After doing practice A or practice B, rate the extent to which your negative thoughts and anxiety/tension were reduced, from 0 (not at all) to 10 (totally).
- Now repeat this exercise except switch and do the other practice. (Namely, if you did A now you do B; if you did B now you do A).
Overwhelmingly students reported that sitting erect, breathing and reframing positively was much more effective than only reframing as shown in Figure 1 and 2.
Figure 1. Percentage of students rating posture, breath and reframing practice (PBRP) as more effective than reframing practice (RP) in reducing negative thoughts, anxiety and stress. Figure 2. Self-rating of reduction of negative thoughts and anxiety/tension
Stop reading. Do the practice yourself. It is only through experience that you know whether posture with breathing and reframing is a more beneficial than simply reframing the language.
Implications for education, counseling, psychotherapy.
Our findings have implications for education, counseling and psychotherapy because students and clients usually sit in a slouched position in classrooms and therapeutic settings. By shifting the body position to an erect upright position, taking a breath and then reframing, people are much more successful in reducing their negative thoughts and anxiety/stress. They report feeling much more optimistic and better able to cope with felt stress as shown by representative comments in table 1.
|Reframing||Posture, breath and reframing|
|After changing my internal language, I still strongly felt the same thoughts.||I instantly felt better about my situation after adjusting my posture.|
|I felt a slight boost in positivity and optimism. The negative feelings (anxiety) from the negative thoughts also diminished slightly.||The effects were much stronger and it was not isolated mentally. I felt more relief in my body as well.|
|Even after changing my language, I still felt more anxious.||Before changing my posture and breathing, I felt tense and worried. After I felt more relaxed.|
|I began to lift my mood up; however, it didn’t really improve my mood. I still felt a bit bad afterwards and the thoughts still stayed.||I began to look from the floor and up towards the board. I felt more open, understanding and loving. I did not allow myself to get let down.|
|During the practice, it helped calm me down a bit, but it wasn’t enough to make me feel satisfied or content, it felt temporary.||My body felt relaxed overall, which then made me feel a lot better about the situation.|
|Difficult time changing language.||My posture and breathing helped, making it easier to change my language.|
|I felt anger and stayed in my position. My body stayed tensed and I kept thinking about the situation.||I felt anger but once I sat up straight and thought about breathing, my body felt relaxed.|
|Felt like a tug of war with my thoughts. I was able to think more positively but it took a lot more brain power to do so.||Relaxed, extended spine, clarity, blank state of mind.|
Table 1. Some representative comments of practicing reframing or posture, breath and reframing.
The results of our study in the classroom setting are not surprising. Many us know to take three breaths before answering questions, pause and reflect before responding, take time to cool down before replying in anger, or wait till the next day before you hit return on your impulsive email response.
Currently, counseling, psychotherapy, psychiatry and education tend not to incorporate body posture as a potential therapeutic or educational intervention for teaching participants to control their mood or reduce feelings of powerlessness. Instead, clients and students often sit slightly collapsed in a chair during therapy or in class. On the other hand, if individuals were encouraged to adopt an upright posture especially in the face of stressful circumstances it would help them maintain their self-esteem, reduce negative mood, and use fewer sadness words as compared to the individual in a slumped and seated posture (Nair, Sagar, Sollers, Consedine, & Broadbent, 2015).
THE VALUE OF SELF-EXPERIENCE
What makes this study valuable is that participants compare for themselves the effects of the two different interventions techniques to reduce anxiety, stress and negative thoughts. Thus, the participants have an opportunity to discover which strategy is more effective instead of being told what to do. The demonstration is even more impressive when done in groups because nearly all participants will report that changing posture with breathing and reframing is more beneficial.
This simple and quick technique can be integrated in counseling and psychotherapy by teaching clients this behavioral technique to reduce stress. In Cognitive Behavioral Therapy (CBT), sitting upright can help the individual replace a thought with a more reasonable one. In third wave CBT, it can help bypass the negative content of the original language and create a metacognitive change, such as, “I will not let this thought control me.”
It can also help in Acceptance and Commitment Therapy (ACT) since changing one’s body posture may facilitate the process of “acceptance” (Hayes, Pistorello, & Levin, 2012). Adopting an upright sitting position and taking a breath is like saying “I am here, I am present, I am not escaping or avoiding.” This change in body position represents movement from inside to outside, movement from accepting the unpleasant emotion related to the negative thoughts toward a “commitment” to moving ahead, contrary to the automatic tendency to follow the negative thought. The positive reframing during body position or posture change is not an attempt to color reality in pretty colors, but rather a change of awareness, perspective, and focus that helps the individual identify and see some new options for moving ahead toward commitment according to one’s values. This intentional change in direction is central in ACT and also in positive psychology (Stichter, 2018).
CONCLUSION AND RECOMMENDATIONS
We suggest that therapists, educators, clients and students get up out of their chairs and incorporate body movements when they feels overwhelmed and stuck. Finally, this study points out that mind and body are affected by each other. It provides another example of the psychophysiological principle enunciated by Elmer Green (1999, p 368):
“Every change in the physiological state is accompanied by an appropriate change in the mental-emotional state, conscious or unconscious; and conversely, every change in the mental-emotional state, conscious or unconscious is accompanied by an appropriate change in the physiological state.”
The findings of this study echo the ancient spiritual wisdom that is is central to the teaching of the Zen Master, Thich Nhat Hanh. He recommends that his students recite the following at any time:
Breathing in I calm my body,
Breathing out I smile,
Dwelling in the present moment,
I know it is a wonderful moment.
“I am doing very well, and I am very healthy. The vulvodynia symptoms have never come back. Also,my stomach (gastrointestinal discomfort) has gotten much, much better. I don’t really have random pain anymore, now I just have to be watchful and careful of my diet and my exercise, which are all great things!” —A five-year follow-up report from a 28-year-old woman who had previously suffered from severe vulvodynia (pelvic floor pain).
Numerous clients and students have reported that implementing self-healing strategies–common sense suggestions often known as “grandmother’s therapy”—significantly improves their health and find that their symptoms decreased or disappeared (Peper et al, 2014). These educational self-healing approaches are based upon a holistic perspective aimed to reduce physical, emotional and lifestyle patterns that interfere with healing and to increase those life patterns that support healing. This may mean learning diaphragmatic breathing, doing work that give you meaning and energy, alternating between excitation and regeneration, and living a life congruent with our evolutionary past.
If you experience discomfort/symptoms and worry about your health/well-being, do the following:
- See your health professional for diagnosis and treatment suggestions.
- Ask what are the benefits and risks of treatment.
- Ask what would happen if you if you first implemented self-healing strategies before beginning the recommended and sometimes invasive treatment?
- Investigate how you could be affecting your self-healing potential such as:
- Lack of sleep
- Too much sugar, processed foods, coffee, alcohol, etc.
- Lack of exercise
- Limited social support
- Ongoing anger, resentment, frustration, and worry
- Lack of hope and purpose
- Implement self-healing strategies and lifestyle changes to support your healing response. In many cases, you may experience positive changes within three weeks. Obviously, if you feel worse, stop and reassess. Keep a log and monitor what you do so that you can record changes.
This self-healing process has often been labeled or dismissed as the “placebo effect;” however, the placebo effect is the body’s natural self-healing response (Peper & Harvey, 2017). It is impressive that many people report feeling better when they take charge and become active participants in their own healing process. A process that empowers and supports hope and healing. When participants change their life patterns, they often feel better. Their health worries and concerns become reminders/cues to initiate positive action such as:
- Practicing self-healing techniques throughout the day (e.g., diaphragmatic breathing, self-healing imagery, meditation, and relaxation)
- Eating organic foods and eliminating processed foods
- Incorporating daily exercise and movement activities
- Accepting what is and resolving resentment, anger and fear
- Taking time to regenerate
- Resolving stress
- Focusing on what you like to do
- Be loving to yourself and others
For suggestions of what to do, explore some of the following blogs that describe self-healing practices that participants implemented to improve or eliminate their symptoms.
Hot flashes and premenstrual symptoms https://peperperspective.com/2015/02/18/reduce-hot-flashes-and-premenstrual-symptoms-with-breathing/
Internet addiction https://peperperspective.com/2018/02/10/digital-addiction/
Irritable bowel syndrome (IBS) https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/
Math and test anxiety https://peperperspective.com/2018/07/03/do-better-in-math-dont-slouch-be-tall/
Trichotillomania (hair pulling) https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/
Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.
Is your neck stiff, uncomfortable and painful?
When driving is it more difficult to turn your head?
Neck and shoulder pain affect more than 30% of people (Fejer et al, 2006; Cohen, 2015). This blog explores some strategies to reduce or prevent neck stiffness and discomfort and suggests practices to reduce discomfort and increase flexibility if you already are uncomfortable.
Shifts in posture may optimize neck flexibility
In our modern world, we frequently engage in a forward head position while looking at electronic devices or typing on computers. Prolonged smart phone usage has the potential to negatively impact posture and breathing functions (Jung et al., 2016) since we tilt our head down to look at the screen. Holding the head in a forward position, as displayed in Figure 1, can result in muscle tension in the spine, neck, and shoulders.
Fig 1. Forward head and neck posture in comparison to a neutral spine. Source: https://losethebackpain.com/conditions/forward-head-posture/
Whenever you bring your head forward to look at the screen or tilt it down to look at your cellphone, your neck and shoulder muscles tighten and your breathing pattern become more shallowly. The more the head is forward, the more difficulty is it to rotate your head as is describe in the blog, Head position, it matters! (Harvey et al, 2018). Over time, the head forward position may lead to symptoms such as headaches and backpain. On the other hand, when we shift to an aligned upright position throughout the day, we create an opportunity to relieve this tension as shown in Figure 2.
Figure 2. EMG and respiration recording from a subject sitting with a forward head position and a neutral, aligned head position. The neck and shoulder muscle tension was recorded from the right trapezius and left scalene muscles (Mason et all, unpublished). .
The muscle tension recorded from scalene and trapezius muscles (neck and shoulder) in Figure 2 shows that as the head goes forward or tilts down, the muscle tension significantly increases. In most cases participants are totally unware that their neck tightens. It is only after looking at the screen or focus our eyes until the whole day that we notice discomfort in the late afternoon.
Experience this covert muscle tension pattern in the following video, Sensing neck muscle tension-The eye, head, and neck connection.
Interrupt constant muscle tension
One possible reason why we develop the stiffness and discomfort is that we hold the muscles contracted for long time in static positions. If the muscle can relax frequently, it would significantly reduce the probability of developing discomfort. Experience this concept of interrupting tension practice by practicing the following:
- Sit on a chair and lift your right foot up one inch up from the floor. Keep holding it up? For some people, as soon as five seconds, they will experience tightening and the onset of discomfort and pain in the upper thigh and hip.
How long could you hold your foot slight up from the floor? Obviously, it depends on your motivation, but most people after one minute want to put the foot down as the discomfort become more intense. Put the foot down and relax. Notice the change is sensation and for some it takes a while for the discomfort to fade out.
- The reason for the discomfort is that the function of muscle is to move a joint and then relax. If tightening and relaxation occurs frequently, then there is no problem
- Repeat the same practice except lift the foot, relax and drop it down and repeat and repeat. Many people can easily do this for hours when walking.
What to do to prevent neck and shoulder stiffness.
Interrupt static muscle neck tension by moving your head neck and shoulder frequently while looking at the screen or performing tasks. Explore some of the following:
- Look away from the screen, take a breath and as you exhale, wiggle your head light heartedly as if there is a pencil at reaching from the top of your head to the ceiling and you are drawing random patterns on the ceiling. Keep breathing make the lines in all directions.
- Push the chair back from the desk, roll your right shoulder forward, up and back let it drop down and relax. Then roll you left shoulder forward up and back and drop down and relax. Again, be sure to keep breathing.
- Stand up and skip in place with your hands reaching to the ceiling so that when your right foot goes up you reach upward with your left hand toward the ceiling while looking at your left hand. Then, as your left foot goes up your reach upward to the ceiling with your right hand and look at your right hand. Smile as you are skipping in place.
- Install a break reminder program on your computer such as Stretch Break to remind you to stretch and move.
- Learn how to sit and stand aligned and how to use your body functionally such as with the Gokhale Method or the Alexander Technique (Gokhale, 2013; Peper et al, in press, Vineyard, 2007).
- Learn awareness and control neck and shoulder muscle tension with muscle biofeedback. For practitioners certified in biofeedback BCB, see https://certify.bcia.org/4dcgi/resctr/search.html
- Become aware of your collapsed and slouching wearing a posture feedback device such as UpRight Go on your upper back. This device provides vibratory feedback every time you slouch and reminds you to interrupt slouching and be upright and alighned.
Arrange your computer screen and keyboard so that the screen is at eye level instead of having to reach forward or look down. Similarly, hold your cell phone so that it is at eye level as shown in Figure 3 and 4.
Figure 3. Slouching forward to see the laptop screen can be avoided by using an external keyboard, mouse and desktop riser. Reproduced by permission from www.backshop.nl
Figure 4. Avoid the collapsed while looking down at a cell phone by resting the arms on a backpack or purse and keeping the spine and head alighned. Photo of upright position reproduced with permission from Imogen Ragone, https://imogenragone.com/
If you are squinting, bringing your nose to the screen, or if the letters are too small or blurry, have your eyes checked to see if you need computer glasses. Generally do not use bifocals or progressive glasses as they force you to tilt your head up or down to see the material at a specific focal length. Other options included changing the display size on screen by making the text and symbols larger may allow you see the screen without bending forward. Just as your muscle of your neck, your eyes need many vision breaks. Look away from the screen out of the window at a distant tree or for a moment close your eyes and breathe.
What to do if you have stiffness and discomfort
My neck was stiff and it hurt the moment I tried to look to the sides. I was totally surprised that I rapidly increased my flexibility and reduced the discomfort when I implemented the following two practices.
Begin by implementing the previous described preventative strategies. Most important is to interrupt static positions and do many small movement breaks. Get up and wiggle a lot. Look at the blog, Freeing the neck and shoulder, for additional practices.
Then, practice the following exercises numerous times during the day to release neck and shoulder tension and discomfort. While doing these practices exhale gently when you are stretching. If the discomfort increases, stop and see your health professional.
Cohen, S.P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90 (2), 284-299. https://doi.org/10.1016/j.mayocp.2014.09.008
Fejer, R., Kyvik, K.Ohm, & Hartvigesen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834-848. https://doi.org/10.1007/s00586-004-0864-4
Gokhale, E. (2013). 8 Steps to a Pain-Free Back. Pendo Press.
Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Mason, L., Peper, E., Harvey, R., & Hernandez, W. (unpublished). Healing headaches. Does success sustain over time?
Peper, E., Krüger, B., Gokhale, E., & Harvey, R. (in press). Comparing Muscle Activity and Spine Shape in Various Sitting Styles. Biofeedback.
Vineyar, M. (2007). How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery. Boston: Da Capo Lifelong Books.
The blog has been adapted from our published article, Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Why is it so difficult to turn your head to see what is behind you?
How come so many people feel pressure in the back of the head or have headaches after working on the computer?
Your mother may have been right when she said, “Sit up straight! Don’t slouch!” Sitting slouched and collapsed is the new norm as digital devices force us to slouch or tilt our head downward. Sometimes we scrunch our neck to look at the laptop screen or cellphone. This collapsed position also contributes to an increased in musculoskeletal dysfunction (Nahar & Sayed, 2018). The more you use a screen for digital tasks, the more you tend to have head-forward posture, especially when the screens are small (Kang, Park, Lee, Kim, Yoon, & Jung, 2012). In addition, the less time children play outside and the more time young children watch the screen, the more likely will they become near sighted and need to have their vision corrected (Sherwin et al, 2012). In addition, the collapsed head forward position unintentionally decreases subjective energy level and may amplify defeated, helpless, hopeless thoughts and memories (Bader, 2015; Peper & Lin, 2012; Tsai, Peper, & Lin, 2016; Peper et al, 2017).
Explore the following two exercises to experience how the head forward position immediately limits head rotation and how neck scrunching can rapidly induce back of the head pressure and headaches.
Exercise 1. Effect of head forward position on neck rotation
Sit at the edge of the chair and bring your head forward, then rotate your head to the right and to the left and observe how far you can rotate. Then sit erect with the crown of the head reaching towards the ceiling and again rotate your head from right to left and observe how far you can rotate as shown in Figure 1.
Figure 1. Head-erect versus head-forward position.
What did you experience?
Most likely your experience is similar to the 87 students (Mean Age = 23.6 years) who participated in this classroom activity designed to bring awareness of the effect of head and neck position on symptoms of muscle tension. 92.0% of the students reported that is was much easier to rotate their head and could rotate further during the head-erect position as compared to the head-forward position (see Figure 2).
Figure 2. Self-report of ease of head rotation.
What does this mean?
Almost all participants were surprised that the head forward position restricted head rotation as well as reduced peripheral awareness (Fernandez-de-Las-Penas et al., 2006). The collapsed head forward may directly affect personal safety; since, it reduces peripheral awareness while walking, biking or driving a car. In addition, when the head is forward, the cervical vertebrae are in a more curved position compared to the erect head with the normal cervical curve (Kang et al., 2012). This means that in the head-forward position, the pressure on the vertebrae and the intervertebral disc is elevated compared to the preferred position with a stretched neck. This increases the risk of damage to the vertebrae and intervertebral disc (Kang et al, 2012). It also means that the muscles that hold the head in the forward position have to work much harder.
Be aware that of factors that contribute to a head-forward position.
- Sitting in a car seat in which the headrest pushes the head forward. Solutions: Tilt the headrest back or put pillow in your back from your shoulders to your pelvis to move your body slightly forward.
- If you wear a bun or ponytail, the headrest (car, airplane seat, or chair) will often push your head forward. This causes a change of the head to a more forward position and it becomes a habit without the person even knowing it. Solution: Place a pillow in your back to move your body forward or loosen the bun or ponytail.
- Difficulty reading the text on the digital screen. The person automatically cranes their head forward to read the text. Solutions: Have your eyes checked and, if necessary, wear computer-reading glasses; alternatively, increase the font size and reduce glare.
- Working on a laptop and looking down on the screen. Solutions: Detachable keyboard and laptop on a stand to raise screen to eye level as shown in Figure 3.
Figure 3. Trying to read the laptop screen, which causes the head to go forward as compared to raising the screen and using an external keyboard. Reproduced by permission from www.backshop.nl
- Being tired or exhausted encourages the body to collapse and slouch and increases the muscle tension in the upper cervical region. You can explore the effect of tiredness that causes slouching and head-forward position during the day by observing the following if you drive a car.
In the morning, adjust your rear mirror and side mirrors. Then at the end of the day when you sit in the car, you may note that you may need to readjust your inside rear mirror. No, the mirror didn’t change of position during the day by itself—you slouched unknowingly. Solutions: Take many breaks during the day to regenerate, install stretch break reminders, or wear an UpRight Go posture feedback device to remind you when you begin to slouch (Peper, Lin & Harvey, 2017).
Exercise 2: Effect of neck scrunching on symptom development
Sit comfortably and your nose forward and slightly. While the head is forward tighten your neck as if your squeezing the back of the head downward into the shoulders and hold this contracted neck position for 20 seconds. Let go and relax.
What did you experience?
Most likely your experience was similar to 98.4% of the 125 college students who reported a rapid increase in discomfort after neck scrunching as shown in Figure 4.
Figure 4. Symptoms induced by 30 seconds of neck scrunching.
During scrunching there was a significant increase in the cervical and trapezius sEMG activity recorded from 12 volunteers as shown in Figure 5.Figure 5. Change in cervical and trapezius sEMG during head forward and neck scrunching.
What does this mean?
Nearly all participants were surprised that 30 seconds of neck scrunching would rapidly increase induce discomfort and cause symptoms. This experience provided motivation to identify situations that evoked neck scrunching and avoid those situations or change the ergonomics that induced the neck scrunching. If you experience headaches or neck discomfort, scrunching could be a contributing factor.
Factors that contribute to neck scrunching and discomfort.
- Bringing your head forward to see the text or graphics more clearly. There may be multiple causes such as blurred vision, tiny text font size, small screen and ergonomic factors. Possible solutions. Have your eyes checked and if appropriate wear computer-reading glasses. Increase the text font size or use a large digital screen. Reduce glare and place the screen at the appropriate height so that the top of the screen is no higher than your eyebrows.
- Immobility and working in static position for too long a time period. Possible solutions. Interrupt your static position with movements every few minutes such as stretching, standing, and wiggling.
These two experiential practices are “symptom prescription practices” that may help you become aware that head position contributes to symptoms development. For example, if you suffer from headaches or neck and backaches from computer work, check your posture and make sure your head is aligned on top of your neck–as if held by an invisible thread from the ceiling and take many movement breaks.The awareness may help you to identify situations that cause these dysfunctional body patterns that could cause symptoms. By inhibiting these head and neck patterns, you may be able to reduce or avoid discomfort. Just as a picture is worth a thousand words, self-experience through feeling and seeing is believing.
Bader, E. E. (2015). The Psychology and Neurobiology of Mediation. Cardozo J. Conflict Resolution, 17, 363.
Fernandez-de-Las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Forward head posture and neck mobility in chronic tension-type headache: A blinded, controlled study. Cephalalgia, 26(3), 314-319.
Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98-104.
Lee, M. Y., Lee, H. Y., & Yong, M. S. (2014). Characteristics of cervical position sense in subjects with forward head posture. Journal of physical therapy science, 26(11), 1741-1743. https://doi.org/10.1589/jpts.26.1741
Nahar, S., & Sayed, A. (2018). Prevalence of musculoskeletal dysfunction in computer science students and analysis of workstation characteristics-an explorative study. International Journal of Advanced Research in Computer Science, 9(2), 21-27. https://doi.org/10.26483/ijarcs.v9i2.5570
Peper, E., & Lin, I. M. (2012). Increase or decrease depression: How body postures influence your energy level. Biofeedback, 40(3), 125-130
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback.45 (2), 36-41.
Peper, E., Lin, I-M, & Harvey, R. (2017). Posture and mood: Implications and applications to therapy. Biofeedback.35(2), 42-48.
Sherwin, J.C., Reacher, M.H., Keogh, R.H., Khawaja, A.P, Mackey, D.A., & Foster, P.J. (2012). The Association between Time Spent Outdoors and Myopia in Children and Adolescents: A Systematic Review and Meta-analysis. Ophthalmology, 119(10), 2141-2151. https://doi.org/10.1016/j.ophtha.2012.04.020
Tsai, H. Y., Peper, E., & Lin, I. M. (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27.
*This blog was adapted from our published article, The blog has been adapted from our research article, Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
“I couldn’t belief it. I thought that I was strong and yet, I could not resist the downward pressure when I recalled a hopeless and helpless memory. Yet a minute later, I could easily resist the downward pressure on my arm when I thought of a positive and empower memory. I now understand how thoughts affect me.”
Thoughts/emotions affect body and body affects thoughts and emotions is the basis of the psychophysiological principle formulated by the biofeedback pioneers Elmer and Alice Green. The language we use, the thoughts we contemplate, the worries and ruminations that preoccupy us may impact our health.
Changing thoughts is the basis of cognitive behavior therapy and practitioners often teach clients to become aware of their negative thoughts and transform the internal language from hopeless, helpless, or powerless to empowered and positive. Think and visualize what you want and not what you do not want. For example, state, “I have studied and I will perform as best as I can” or “I choose to be a non-smoker instead of stating, “I hope I do not fail the exam” or “I want to stop smoking.” The more you imagine what you what in graphic detail, the more likely will it occur.
Most people rationally accept that thoughts may affect their body; however, it is abstract and not a felt experience. Also, some people have less awareness of the mind-body connection unless it causes discomfort. Our attention tends to be captured by visual and auditory stimuli that constantly bombard us so that we are d less aware of the subtle somatic changes.
This guided practice explores what happens when you recall helpless, hopeless, powerless or defeated memories as compared to recalling empowering positive memories. It allows a person to experience–instead of believing—how thoughts impact the body. 98% of participants felt significantly weaker after recalling the helpless, hopeless, powerless or defeated memories. Once the participants have experienced the effect, they realize how thoughts effect their body.
The loss of strength is metaphor of what may happen to our immune system and health. Do you want to be stronger or weaker? The challenge in transforming thoughts is that they occur automatically and we often doubt that we can change them. The key is to become aware of the onset of the thought and transform the thought. Thoughts are habit patterns and the more you practice a habit, the more it becomes automatic. Enjoy the experiential exercise, Mind-body/Bodymind-connection: Muscle testing.
*I thank Paul Godina, Jung Lee and Lena Stampfli for participating in the videos.
The practice was adapted from, Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic.
“When I saw the exam questions, I blanked out and slouched in defeat. Then I shifted to an erect/tall position and took a diaphragmatic breath. All of a sudden I remembered the answer.” College student
Anticipating that math is difficult, experiencing test anxiety, blanking out on exams, or being scared when asked to give class presentation are common experiences of many students. Their thoughts include, “I am not good enough,” “What will the other students think,” “I am embarrassed and can’t remember what to say,” or “I only thought of the correct answer after it was all over.” Many students report some test anxiety: 32% report severe test anxiety, fear of math and blanking out on exams while less than 10 percent report minimal test anxiety, fear of math and blanking out on exams.
When students anticipate that they will perform poorly on an exam or class presentation, they tend to sit in a slouched or collapsed position, coincident with feelings of powerlessness, hopelessness and defeat. This posture not only communicates to others that they are powerless and defeated, it also decreases their self-esteem, mood and cognitive performance. In previous research, Tsai et al (2016) and Peper et al (2017) observed that when participants sat in a slouched posture, they could access hopeless, helpless, powerless and defeated memories much more easily than when they sat in the upright/erect position. In the upright position it was much easier to access positive and empowering memories. For numerous participants they also experienced being captured and flooded by emotions associated with defeat and hopelessness when they slouched. These feelings and memories associated with a slouched posture may affect how we feel and perform. Nair et al (2015) found that adopting an upright seated posture in the face of stress can maintain self-esteem, reduce negative mood, and increase positive mood as compared to a slumped posture. Furthermore, sitting upright increases rate of speech and reduces self-focus.” Posture may also affect our hormone levels. Harvard Social Psychologist Amy Cuddy has reported that sitting in a slouched posture (powerless position) decreased testosterone (the hormone associated dominance and assertiveness) and increased cortisol (the hormone associated with stress) and performance on a stressor test (Cuddy, 2012; Carney et al, 2010).
This blog points out how posture significantly impacts math performance especially for students who have test anxiety, are fearful of math, and blank out on exams and is adapted from our published research article, Peper, E., Harvey, R., Mason, L., & Lin, I-M. (2018). Do better in math: How your body posture may change stereotype threat response. NeuroRegulation, 5(2), 67-74
In our study 125 university students participated. Half the students sat in an erect position while the other half sat in a slouched position and were asked to mentally subtract 7 serially from 964 for 30 seconds. They then reversed the positions before repeating the math subtraction task beginning at 834. They rated the math task difficulty on a scale from 0 (none) to 10 (extreme).
Figure 1. Sitting in a collapsed position and upright position (photo from: http://news.sfsu.edu/news-story/good-posture-important-physical-and-mental-health)
The students rated the mental math significantly more difficult while sitting slouched than while sitting erect as shown in Figure 2.
Figure 2. The subjective rating of difficulty in performing the serial 7 math subtraction when sitting in a collapsed or upright position.
For the students with the lowest 30% test anxiety, math difficulty and blanking out scores, there was no significant difference between slouched and erect positions in mental math performance. More importantly, students with the highest 30% test anxiety, math difficulty and blanking out scores rated the math task significantly more difficult and some could not do it at all and blanked out in the slouched position as compared to the erect position as shown in Figure 3.
Figure 3. Effect of posture on math performance for students with test anxiety, math difficulty and blanking out.
The students with the highest test anxiety, math difficulty and blanking out scores also reported significantly more somatic symptoms as compared with those with the lowest scores as shown in Figure 4.
Figure 4. Self-reported symptoms associated with the highest and lowest 30% of summed test anxiety, math difficulty and blanking out.
Posture affects mental math and inhibit abstract thinking. By incorporating posture changes clinicians and teachers may help students improve performance. The slouched position was associated with increased difficulty in performing a math subtraction task for 15 seconds, especially for students reporting higher test anxiety, math difficulty and blanking out on exams. In contrast, slouched position had no significant effect on students who reported that they were not stressed about performance. For participants who report higher test anxiety, math difficulty and blanking out they also reported significant increase in breathing difficulty, neck and shoulder tension, headaches, depression and anxiety. Most likely, the students attribute physiological reactions such as increased heart rate and breathing changes negatively, which amplifies their negative self-perception and exacerbates their anxiety symptoms which then may inhibit their cognitive ability to perform on math tasks.
The slouched position combined with the somatic symptoms activate are part of the a “defense reaction.” The slouch posture evokes a classically conditioned response to protect oneself under conditions of perceived physical threat. The activation of this defense pattern is associated with reduced levels of abstract thinking and frontal cortical deactivation as observed in this study. This biological defense response is triggered when the person expects the situation to be ‘dangerous’ and include conditions of social-evaluative threat. By changing posture to an erect/upright posture appears to inhibit the defense reaction; thus, the person may perform better on cognitive tasks.
Head-upright/erect postures may make it easier to access ‘positive and empowering’ thoughts and memories, thereby helping students, especially those who are anxious or fearful of math and blank-out during exams, Anxious students who also slouch may benefit from training with a posture feedback devices such as the UpRight Go™. We recommend that students use posture feedback to become aware of the situations that are associated with slouching, such as ergonomic factors (looking down at the screen), being tired, or having depressive thoughts or feeling of powerless and defeat.
The moment students experience the feedback that they are slouching, they become aware and have the option to shift to an upright posture and perform interventions to counter the factors that caused the slouching. These interventions included ergonomic changes of their computer or laptop, transforming self-critical thoughts to empowering thoughts, or taking a break or performing movements. When students practice these interventions for four weeks, they report an increase of confidence, decrease in stress levels and an improvement in health and performance (Colombo et al, 2017; Harvey et al, in press). Equally important is to teach the participants self-regulation strategies such as slower breathing, heart rate variability training, and muscle relaxation to reduce symptoms. The training needs to be generalized and practiced at home, school or work.
We recommend that students guide themselves through the posture positions as described in this research while performing mental math to experience how posture impacts performance. This experiential practice may increase motivation to be tall since the participant can now have a choice based upon self-experience.
Take home message echoes what your mother said, “Don’t slouch. Sit up tall!”
- If you feel secure and safe, posture has little to no effect on performance–you can be collapsed or slouched.
- If you are anxious and fearful, sitting tall/erect may improve your performance.
- If you want to become aware when you slouch, posture feedback from a wearable posture feedback device such as an UpRight Go can provide vibration feedback each time you slouch. The feedback can be the reminder to sit tall and change your thoughts.
- If you automatically slouch while working at the computer or sitting in chair, change your furniture so that you sit in an upright position while studying or watching digital devices.
- If you experience significant somatic symptoms (e.g., headaches, breathing difficulty, neck and shoulder tension, or depression and anxiety) learn self-regulation skills such as slower diaphragmatic breathing and heartrate variability training in conjunction with transforming negative self-talk to positive self-talk to improve performance.
Changing posture may also impact other areas of one’s life besides improving math performance as illustrated by the report from a mother of ten-year old boy.
”At the moment I am trying to be aware of the situation in front of me rather that reacting to it. For example, yesterday my son who is 10 had a bad mood and I did not know what had happened, and he at first refused to tell me. Because I was aware of the posture information I could help him open up by making him change his posture without knowing. He became more open and told me what had happened earlier and I could help him move forward.”
Colombo, S., Joy, M., Mason, L., Peper, E., Harvey, R., & Booiman, A.C. (2017). Posture Change Feedback Training and its Effect on Health. Poster presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Chicago, IL March, 2017. Abstract published in Applied Psychophysiology and Biofeedback.42(2), 147.
Harvey, R., Mason, L., Joy, M., & Peper, E. (in press). Effect of Posture Feedback Training on Health, Applied Psychophysiology and Biofeedback.
This blog has been reprinted from: Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback, 45 (2), 36-41.
When I sat collapsed looking down, negative memories flooded me and I found it difficult to shift and think of positive memories. While sitting erect, I found it easier to think of positive memories. -Student participant
The link between posture and mood is embedded in idiomatic phrases such as walking tall, standing proud, and an upstanding citizen, versus collapsed, defeated, or in a slump–Language suggests that posture and mood/emotions are connected. Slumped posture is commonly observed in depression (Canales et al., 2010; Michalak et al., 2009) and adapting an upright posture increases positive affect, reduces fatigue, and increases energy in people with mild to moderate depression (Wilkes et al., 2017; Peper & Lin, 2012).
This blog describes in detail our research study that demonstrated how posture affects memory recall (Peper et al, 2017). Our findings may explain why depression is increasing the more people use cell phones. More importantly, learning posture awareness and siting more upright at home and in the office may be an effective somatic self-healing strategy to increase positive affect and decrease depression.
Most psychotherapies tend to focus on the mind component of the body-mind relationship. On the other hand, exercise and posture focus on the body component of the mind/emotion/body relationship. Physical activity in general has been demonstrated to improve mood and exercise has been successfully used to treat depression with lower recidivism rates than pharmaceuticals such as sertraline (Zoloft) (Babyak et al., 2000). Although the role of exercise as a treatment strategy for depression has been accepted, the role of posture is not commonly included in cognitive behavior therapy (CBT) or biofeedback or neurofeedback therapy.
The link between posture, emotions and cognition to counter symptoms of depression and low energy have been suggested by Wilkes et al. (2017) and Peper and Lin (2012), . Peper and Lin (2012) demonstrated that if people tried skipping rather than walking in a slouched posture, subjective energy after the exercise was significantly higher. Among the participants who had reported the highest level of depression during the last two years, there was a significant decrease of subjective energy when they walked in slouched position as compared to those who reported a low level of depression. Earlier, Wilson and Peper (2004) demonstrated that in a collapsed posture, students more easily accessed hopeless, powerless, defeated and other negative memories as compared to memories accessed in an upright position. More recently, Tsai, Peper, and Lin (2016) showed that when participants sat in a collapsed position, evoking positive thoughts required more “brain activation” (i.e. greater mental effort) compared to that required when walking in an upright position.
Even hormone levels also appear to change in a collapsed posture (Carney, Cuddy, & Yap, 2010). For example, two minutes of standing in a collapsed position significantly decreased testosterone and increased cortisol as compared to a ‘power posture,’ which significantly increased testosterone and decreased cortisol while standing. As Professor Amy Cuddy pointed out in herTechnology, Entertainment and Design (TED) talk, “By changing posture, you not only present yourself differently to the world around you, you actually change your hormones” (Cuddy, 2012). Although there appears to be controversy about the results of this study, the overall findings match mammalian behavior of dominance and submission. From my perspective, the concepts underlying Cuddy’s TED talk are correct and are reconfirmed in our research on the effect of posture. For more detail about the controversy, see the article by Susan Dominusin in the New York Times, “When the revolution came for Amy Cuddy,”, and Amy Cuddy’s response (Dominus, 2017;Singal and Dahl, 2016).
The purpose of our study is to expand on our observations with more than 3,000 students and workshop participants. We observed that body posture and position affects recall of emotional memory. Moreover, a history of self-described depression appears to affect the recall of either positive or negative memories.
Subjects: 216 college students (65 males; 142 females; 9 undeclared), average age: 24.6 years (SD = 7.6) participated in a regularly planned classroom demonstration regarding the relationship between posture and mood. As an evaluation of a classroom activity, this report of findings was exempted from Institutional Review Board oversight.
While sitting in a class, students filled out a short, anonymous questionnaire, which asked them to rate their history of depression over the last two years, their level of depression and energy at this moment, and how easy it was for them to change their moods and energy level (on a scale from 1–10). The students also rated the extent they became emotionally absorbed or “captured” by their positive or negative memory recall. Half of the students were asked to rate how they sat in front of their computer, tablet, or mobile device on a scale from 1 (sitting upright) to 10 (completely slouched).
Two different sitting postures were clearly defined for participants: slouched/collapsed and erect/upright as shown in Figure 1. To assume the collapsed position, they were asked to slouch and look down while slightly rounding the back. For the erect position, they were asked to sit upright with a slight arch in their back, while looking upward.
Figure 1. Sitting in a collapsed position and upright position (photo by Jana Asenbrennerova). Reprinted by permission from Gorter and Peper (2011).
After experiencing both postures, half the students sat in the collapsed position while the other half sat in the upright position. While in this position, they were asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible, one after the other, for 30 seconds.
After 30 seconds they were reminded to keep their same position and let go of thinking negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds.
They were then asked to switch positions. Those who were collapsed switched to sitting erect, and those who were erect switched to sitting collapsed. Then they were again asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible one after the other for 30 seconds. After 30 seconds they were reminded to keep their same position and again let go of thinking of negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds, while still retaining the second posture.
They then rated their subjective experience in recalling negative or positive memories and the degree to which they were absorbed or captured by the memories in each position, and in which position it was easier to recall positive or negative experiences.
86% of the participants reported that it was easier to recall/access negative memories in the collapsed position than in the erect position, which was significantly different as determined by one-way ANOVA (F(1,430)=110.193, p < 0.01) and 87% of participants reported that it was easier to recall/access positive images in the erect position than in the collapsed position, which was significantly different as determined by one-way ANOVA (F(1,430)=173.861, p < 0.01) as shown in Figure 2.
Figure 2. Percent of respondents who reported that it was easier to recall positive or negative memories in an upright or slouched posture.
The difficulty or ease of recalling negative or positive memories varied depending on position as shown in Figure 3.
Figure 3. The relative subjective rating in the ease or difficulty of recalling negative and positive memories in collapsed and upright positions.
The participants with a high level of depression over the last two years (top 23% of participants who scored 7 or higher on the scale of 1–10) reported that it was significantly more difficult to change their mood from negative to positive (t(110) = 4.08, p < 0.01) than was reported by those with a low level of depression (lowest 29% of the participants who scored 3 or less on the scale of 1–10). It was significantly easier for more depressed students to recall/evoke negative memories in the collapsed posture (t(109) = 2.55, p = 0.01) and in the upright posture (t(110) = 2.41, p ≦0.05 he) and no significant difference in recalling positive memories in either posture, as shown in Figure 4.
Figure 4. Differences is in memory access for participants with a history of least or most depression.
For all participants, there was a significant correlation (r = 0.4) between subjective energy level and ease with which they could change from negative to positive mood. There were no significance differences for gender in all measures except that males reported a significantly higher energy level than females (M = 5.5, SD = 3.0 and M = 4.7, SD = 3.8, respectively; t(203) = 2.78, p < 0.01).
A subset of students also had rated their posture when sitting in front of a computer or using a digital device (tablet or cell phone) on a scale from 1 (upright) to 10 (completely slouched). The students with the highest levels of depression over the last two years reporting slouching significantly more than those with the lowest level of depression over the last two years (M = 6.4, SD = 3.5 and M = 4.6, SD = 2.6; t(46) = 3.5, p < 0.01).
There were no other order effects except of accessing fewer negative memories in the collapsed posture after accessing positive memories in the erect posture (t(159)=2.7, p < 0.01). Approximately half of the students who also rated being “captured” by their positive or negative memories were significantly more captured by the negative memories in the collapsed posture than in the erect posture (t(197) = 6.8, p < 0.01) and were significantly more captured by positive memories in the erect posture than the collapsed posture (t(197) = 7.6, p < 0.01), as shown in Figure 5.
Figure 5. Subjective rating of being captured by negative and positive memories depending upon position.
Posture significantly influenced access to negative and positive memory recall and confirms the report by Wilson and Peper (2004). The collapsed/slouched position was associated with significantly easier access to negative memories. This is a useful clinical observation because ruminating on negative memories tends to decrease subjective energy and increase depressive feelings (Michi et al., 2015). When working with clients to change their cognition, especially in the treatment of depression, the posture may affect the outcome. Thus, therapists should consider posture retraining as a clinical intervention. This would include teaching clients to change their posture in the office and at home as a strategy to optimize access to positive memories and thereby reduce access or fixation on negative memories. Thus if one is in a negative mood, then slouching could maintain this negative mood while changing body posture to an erect posture, would make it easier to shift moods.
Physiologically, an erect body posture allows participants to breathe more diaphragmatically because the diaphragm has more space for descent. It is easier for participants to learn slower breathing and increased heart rate variability while sitting erect as compared to collapsed, as shown in Figure 6 (Mason et al., 2017).
Figure 6. Effect of posture on respiratory breathing pattern and heart rate variability.
The collapsed position also tends to increase neck and shoulder symptoms This position is often observed in people who work at the computer or are constantly looking at their cell phone—a position sometimes labeled as the i-Neck.
Implication for therapy
In most biofeedback and neurofeedback training sessions, posture is not assessed and clients sit in a comfortable chair, which automatically causes a slouched position. Similarly, at home, most clients sit on an easy chair or couch, which lets them slouch as they watch TV or surf the web. Finally, most people slouch when looking at their cellphone, tablet, or the computer screen (Guan et al., 2016). They usually only become aware of slouching when they experience neck, shoulder, or back discomfort.
Clients and therapists are usually not aware that a slouched posture may decrease the client’s energy level and increase the prevalence of a negative mood. Thus, we recommend that therapists incorporate posture awareness and training to optimize access to positive imagery and increase energy.
Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., … Krishnan, K. R. (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62(5), 633–638.
Canales, J. Z., Cordas, T. A., Fiquer, J. T., Cavalcante, A. F., & Moreno, R. A. (2010). Posture and body image in individuals with major depressive disorder: A controlled study. Revista brasileira de psiquiatria, 32(4), 375–380.
Guan, X., Fan, G., Chen, Z., Zeng, Y., Zhang, H., Hu, A., … He, S. (2016). Gender difference in mobile phone use and the impact of digital device exposure on neck posture. Ergonomics, 59(11), 1453–1461.
Mason, L., Joy, M., Peper, E., & Harvey, R, A. (2017). Posture Matters. Poster presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Chicago, IL March, 2017. Abstract published in Applied Psychophysiology and Biofeedback, 42(2), 148.
Michalak, J., Troje, N. F., Fischer, J., Vollmar, P., Heidenreich, T., & Schulte, D. (2009). Embodiment of sadness and depression: Gait patterns associated with dysphoric mood. Psychosomatic Medicine, 71(5), 580–587.
Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339.
Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 54, 143–149.
We thank Frank Andrasik for his constructive comments.
Breathing affects all aspects of your life. This invited keynote, Breathing and posture: Mind-body interventions to improve health, reduce pain and discomfort, was presented at the Caribbean Active Aging Congress, October 14, Oranjestad, Aruba. www.caacaruba.com
The presentation includes numerous practices that can be rapidly adapted into daily life to improve health and well-being.