Healing from vulvodynia
Posted: May 4, 2023 Filed under: behavior, biofeedback, Breathing/respiration, emotions, healing, health, Pain/discomfort, relaxation, self-healing, Uncategorized | Tags: muscle tension, pelvic floor pain, therapeutic relationship, triggers for illness, vulvodynia Leave a commentPamela Jertberg and Erik Peper
Adapted from: Jertberg, P. & Peper, E. (2023). The healing of vulvodynia from the client’s perspective. Biofeedback, 51 (1), 18–21. https://doi.org/10.5298/1081-5937-51.01.02
This introspective report describes how a young woman who experienced a year-long struggle with vulvodynia, or vulvar vestibulitis, regained her health through biofeedback training and continues to be symptom-free 7 years after the intervention. This perspective may offer insight into factors that promote health and healing and provide an approach to reduce symptoms and promote health. The methodology of this case was described previously by Peper et al. (2015).
The Client’s Experience
I have been a healthy young woman my whole life. Growing up in a loving, dedicated family, I always ate home-cooked meals, went to bed at a reasonable time, and got plenty of exercise by playing with my family members and friends. I never once thought that at age 23 I might be at risk of undergoing vulvar surgery. There are many factors that contributed to the genesis of my vulvar pain, and many other factors that worsened this pain. Traditional medicine did not help me, and I did not find relief until I met my biofeedback practitioner, who taught me biofeedback. Through the many strategies I learned, such as visualization, diaphragmatic breathing techniques, diet tips, and skills to reframe my thoughts, I finally began to feel relief and hope. Practicing all these elements every day helped me overcome my physical pain and enjoy a normal life once again. Today, I do not have any vulvar discomfort. I am so grateful to my biofeedback practitioner for the many skills he taught me. I can enjoy my daily activities once again without experiencing pain. I have been given a second chance at loving life, and now I have learned the techniques that will help me sustain a more balanced path for the rest of my life. Seven years later, I am healthy and have no symptoms.
Triggers for Illness
Not Having a Positive Relationship with the Doctor
The first factor that aggravated my pain was having a doctor with whom I did not have a good relationship. Although the vulvar specialist I was referred to had treated hundreds of women with vulvar vestibulitis, his methods were very traditional: medicine, low oxalate diet, ointments, and surgery. Whenever I left his office, I would cry and feel like surgery was the only option. Vaginal surgery at 23 was one of the scariest and most unexpected thoughts my brain had ever considered. The doctor never thought of the impact that his words and treatment would have on my mental state.
Depression
Being depressed also triggered more pain. Whenever I would have feelings of hopelessness and create irrational beliefs in my mind (“I will never get better,” “I will never have sex again,” “I am not a woman anymore”), my physical pain would increase. Having depression only triggered more depression and pain, and this became a vicious cycle. The depression deeply affected my relationships with my boyfriend, friends, and family and my performance in my college classes.
Being Sedentary
Being sedentary and not exercising also increased my pain. At first, I believed that the mere act of sitting down hurt me due to the direct pressure on the area, but after a few months I came to realize that it was inactivity itself that triggered pain. Whenever I would sit for too long writing a paper or I would stay home all day because of my depression, my pain would increase, perhaps because I was inhibiting circulation. Still, when I am inactive most of the day, I feel lethargic and bloated. When I exercise, the pain goes away 100%. Exercise is almost magical.
Stress
Stress is the worst trigger for pain. Throughout my life, I always strived to be perfect in every way, meaning I was stressed about the way I looked, performed in school, drove, etc. Through the sessions with my biofeedback practitioner, I learned that my body was in a state of perpetual stress and tightness, which induced pain in certain areas. My body’s way of releasing such tension was to send pain signals to my vulvar area, perhaps because of a yeast infection a couple of months back. Still, if I become very stressed, I will feel pain or tightness in certain parts of my body, but now I have strategies for performing proper stress-relieving techniques.
Processed Foods
Junk food affects me instantly. When I eat processed foods for a week straight, I feel groggy, bloated, lethargic, and in pain. Processed sugar, white flour, and salt are a few of the foods that make the pain increase. I used to love sugar, so I would enjoy the occasional milkshake and cheeseburger and feel mostly okay. However, in times of stress it became crucial for me to learn to refrain from any junk food, because it would worsen my vulvar pain and increase my overall stress levels.
Menstruation
Menstruation is unavoidable, and unfortunately it would always worsen my vulvar pain. Right about the time of my period, my sensitivity and pain would massively increase. Sometimes as my pain would increase incredibly, I would question myself: “What am I doing wrong?” Then, I would remember: “Oh yes, I am getting my period in a few days.” The whole area became very sensitive and would get irritated easily. It became imperative to listen to my body and nurture myself especially around that time of the month.
Triggers for Healing
A Good Doctor
Just as I learned which factors triggered the pain, I also learned how to reduce it. The most important factor that helped me find true relief was meeting a good health professional (which could be a healer, nurse, or professor). The first time I met my biofeedback practitioner and told him about my issues, he really listened, gave me positive feedback, and even made jokes with me. To this day we still have a friendship, which has really aided me in getting better. In contrast to the vulvar specialist, I would leave the biofeedback practitioner’s office feeling powerful, able to defeat vulvodynia, and truly happy. Just having this support from a professional (or a friend, boyfriend, or relative) can make all the difference in the world. I don’t know where I would be right now if I hadn’t worked with him.
Positive Thoughts and Beliefs
Along with having a good support group, having positive thoughts and believing in a positive result helped me greatly. When I actually set my mind to feel “happy” and to believe that I was getting better, I began to really heal. After months of being depressed and feeling incomplete, when I began to practice mantras such as “I am healing,” “I am healthy,” and “I am happy,” my pain began to go away, and I was able to reclaim my life.
Journaling
One of the ways in which “happiness” became easier to achieve was to journal every day. I would write everything: from my secrets to what I ate, my pain levels, my goals for the day, and my symptoms. Writing down everything and knowing that no one would ever read it but me gave me relief, and my journal became my confidante. I still journal every day, and if I forget to write, the next day I will write twice as much. Now that writing has become a habit and a hobby, it is hard to imagine my life without that level of introspection.
Meditation
Although I would do yoga often, I would never sit and meditate. I began to use Dr. Peper’s guided meditations and Dr. Kabat-Zinn’s CD (Kabat-Zinn, 2006; Peper et al., 2002). The combination of these meditation techniques, whether on different days or on the same day, helped me focus on my breathing and relax my muscles and mind. Today, I meditate at least 20 min each day, and I feel that it helps me see life through a more willing and patient perspective. In addition, through meditation and deep breathing I have learned to control my pain levels, concentration, and awareness.
Imagery and Visualization
Imagery is a powerful tool that allowed me to heal faster. My biofeedback practitioner instructed me to visualize how I wanted to feel and look. In addition, he suggested that I draw and color how I was feeling at any given moment, my imagined healing process, and how I would look and feel after the healing process had traveled throughout my body (Peper et al., 2022). It is still amazing to me how much imagery helped me. Even visualizing here and there throughout the day helped. Now I envision how I want to feel as a healthy woman, I take a deep breath, and as a I breathe out I let my imagined healing process go through my body into all my tight areas along with the exhalation.
Biofeedback
Biofeedback is the single strategy that helped me the most. During my first session with my biofeedback practitioner, he pointed out that my muscles were always contracted and stressed and that I was not breathing diaphragmatically. As I learned how to take deep belly breaths, I began to feel the tight areas in my body loosen up. I started to practice controlled breathing 20 min every day. Through biofeedback, my body and muscles became more relaxed, promoting circulation and ultimately reducing the vulvar pain.
Regular Exercise and Yoga
Exercising daily decreased my pain and improved the quality of my life greatly. When I first started experiencing significant vulvar pain, I stopped exercising because I felt that movement would aggravate the pain. To my surprise, the opposite was true. Being sedentary increased the feelings of discomfort, whereas exercising released the tension. The exercise I found most helpful was yoga because it is meditation in movement. I became so focused on my breathing and the poses that my brain did not have time to think about anything else. After attending every yoga class, I felt like I could take on anything. Swimming, Pilates, and gentle cardiovascular exercises have also helped me greatly in reducing stress and feeling great.
Sex
Although sex was impossible for almost a year due to the pain, it became possible and even enjoyable after implementing other relaxation strategies. When I first reintroduced sex back into my life, my partner at the time and I would go gently and stop if it hurt my vulvar area at all. Today, sex again is joyful. Being able to engage in intercourse has boosted my self-esteem and helped me feel sexy again, which empowers me to keep practicing the relaxation techniques.
Listening to the Mind-Body Connection
The mind-body connection is present in all of us, but I am fortunate to have a very strong connection. My thoughts influence my body almost instantly, which is why when I would get depressed my pain would increase, and when I would see my biofeedback practitioner or believe in a good outcome, my pain would decrease. Being aware of this connection is crucial because it can help me or hurt me greatly. After a few months of practicing the relaxation strategies, I saw a different gynecologist and one dermatologist. Both professionals said that there was nothing wrong with my vulvar area—that maybe I just felt some irritation due to the medicines I had previously taken and my current stress. They said that there was no way I needed surgery. When I heard these opinions, I began to feel instantly better—thus proving that my thoughts (and even others’ thoughts) affect my body in significant ways.
Although today I am 100% better, I still experience pain and tightness in my body when I experience the “illness factors” I mentioned above. I still have to remember that feeling healthy and good is a process, not a result, and that even if I feel better one day that does not mean I can stop all my new healthy habits. To completely cure vulvodynia, I needed to change my life habits, perspective, and attitude toward the illness and life. I needed to make significant changes, and now my biggest challenge is to stick to those changes. Biofeedback, imagery, meditation, good food, and exercise are not just treatments that I begin and end on a certain day, but rather they have become essential components of my life forever.
My life with vulvodynia was ultimately a journey of introspection, decision making, and life-changing habits. I struggled with vulvar pain for over a year, and during that year I experienced severe symptoms, depression, and the loss of several friendships and relationships. I felt old, hopeless, useless, and powerless. When I began to incorporate biofeedback, relaxation techniques, journaling, visualization, a proper diet, and regular exercise, life took a turn for the better. Not only did my vulvar pain begin to decrease, but the quality of my overall life improved and I regained the self-confidence I had lost. I became happy, hopeful, and proactive. Even though I practiced the relaxation strategies every day, the pain did not go away in a day or even a month. It took me several months of diligent practice to truly heal my vulvar pain. Even today, such practices have carried on to all areas of my life, and now there is not a day when I do not meditate, even for 5 min.
As paradoxical as it may seem, vulvodynia was a blessing in disguise. I believe that vulvodynia was my body’s way of signaling to me that many areas of my life were in perpetual stress: my pelvic floor, my thoracic breathing, my romantic relationship at the time, etc. When I learned to let go and truly embrace my life, I began to feel relief. I became less irritable and more patient and understanding, with both my body and the outside world. The best advice I can give a woman with vulvar symptoms or any person with otherwise inexplicable chronic pain is to apply the strategies that work for you and stick to them every day—even on the days when you want to go astray. When I started to focus on what my body needed to be nurtured and to live my life and do the things I truly wanted to do, I became free. Today, I live in a way that allows me to find peace, serenity, pride, and fun. I live exactly the way I want to, and I find the time to follow my passions. Vulvodynia, or any kind of chronic pain, does not define who we are. We define who we are.
Conclusion
This introspective account of the client’s personal experience with biofeedback suggests that healing is multidimensional. We suggest that practitioners use a holistic approach, which can provide hope and relief to clients who suffer from vulvodynia or other disorders that are often misunderstood and underreported.
Useful blogs
References
Kabat-Zinn, J. (2006). Coming to our senses: Healing ourselves and the world through mindfulness. Hachette Books
Peper, E., Cosby, J. & Almendras, M. (2022). Healing chronic back pain. NeuroRegulation, 9(3), 164–172. https://doi.org/10.15540/nr.9.3.164
Peper, E., Gibney, K.H, & Holt, C.F. (2002. Make health happen: Training yourself to create wellness. Kendall/Hunt.
Peper, E. Martinex, Aranda, P. & Moss, D. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback, 43(2), 103–109. https://doi.org/10.5298/1081-5937-43.2.04
Hope for menstrual cramps (dysmenorrhea) with breathing
Posted: April 22, 2023 Filed under: behavior, biofeedback, Breathing/respiration, healing, health, meditation, Pain/discomfort, posture, relaxation, self-healing, stress management, Uncategorized | Tags: dysmenorrhea, Imagery, menstrual cramps, stroking, visualization 1 CommentAdapted from: Peper, E., Chen, S., Heinz, N., & Harvey, R. (in press). Hope for menstrual cramps (dysmenorrhea) with breathing. Biofeedback.
“I have always had extremely painful periods. They would get so painful that I would have to call in sick and take some time off from school. I have been to many doctors and medical professionals, and they told me there is nothing I could do. I am currently on birth control, and I still get some relief from the menstrual pain, but it would mess up my moods. I tried to do the diaphragmatic breathing so that I would be able to continue my life as a normal woman. And to my surprise it worked. I was simply blown away with how well it works. I have almost no menstrual pain, and I wouldn’t bloat so much after the diaphragmatic breathing.” -22 year old student
Each semester numerous students report that their cramps and dysmenorrhea symptoms decrease or disappear during the semester when they implement the relaxation and breathing practices that are taught in the semester long Holistic Health class. Given that so many young women suffer from dysmenorrhea, many young women could benefit by using this integrated approach as the first self-care intervention before relying on pain reducing medications or hormones to reduce pain or inhibit menstruation. Another 28-year-old student reported:
“Historically, my menstrual cramps have always required ibuprofen to avoid becoming distracting. After this class, I started using diaphragmatic breath after pain started for some relief. True benefit came when I started breathing at the first sign of discomfort. I have not had to use any pain medication since incorporating diaphragmatic breath work.”
This report describes students practicing self-regulation and effortless breathing to reduce stress symptoms, explores possible mechanisms of action, and suggests a protocol for reducing symptoms of menstrual cramps. Watch the short video how diaphragmatic breathing eliminated recurrent severe dysmenorrhea (pain and discomfort associated with menstruation).
Background: What is dysmenorrhea?
Dysmenorrhea is one of the most common conditions experienced by women during menstruation and affects more than half of all women who menstruate (Armour et al., 2019). Most commonly dysmenorrhea is defined by painful cramps in the lower abdomen often accompanied by pelvic pain that starts either a couple days before or at the start of menses. Symptoms also increase with stress (Wang et al., 2003) with pain symptoms usually decreasing in severity as women get older and, after pregnancy.
Economic cost of dysmenorrhea
Dysmenorrhea can significantly interfere with a women’s ability to be productive in their occupation and/or their education. It is “one of the leading causes of absenteeism from school or work, translating to a loss of 600 million hours per year, with an annual loss of $2 billion in the United States” (Itani et al, 2022). For students, dysmenorrhea has a substantial detrimental influence on academic achievement in high school and college (Thakur & Pathania, 2022). Despite the frequent occurrence and negative impact in women’s lives, many young women struggle without seeking or having access to medical advice or, without exploring non-pharmacological self-care approaches (Itani et al, 2022).
Treatment
The most common pharmacological treatments for dysmenorrhea are nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Aspirin, and Naproxen Sodium) along with hormonal contraceptives. NSAIDs act by preventing the action of cyclooxygenase which prevents the production of prostaglandins. Itani et al (2022) suggested that prostaglandin production mechanisms may be responsible for the disorder. Hormonal contraceptives also prevent the production of prostaglandins by suppressing ovulation and endometrial proliferation.
The pharmacological approach is predominantly based upon the model that increased discomfort appears to be due to an increase in intrauterine secretion of prostaglandins F2α and E2 that may be responsible for the pain that defines this condition (Itani et al, 2022). Pharmaceuticals which influence the presence of prostaglandins do not cure the cause but mainly treat the symptoms.
Treatment with medications has drawbacks. For example, NSAIDs are associated with adverse gastrointestinal and neurological effects and also are not effective in preventing pain in everyone (Vonkeman & van de Laar, 2010). Hormonal contraceptives also have the possibility of adverse side effects (ASPH, 2023). Acetaminophen is another commonly used treatment; however, it is less effective than other NSAID treatments.
Self-regulation strategies to reduce stress and influence dysmenorrhea
Common non-pharmacological treatments include topical heat application and exercise. Both non-medication approaches can be effective in reducing the severity of pain. According to Itani et al. (2022), the success of integrative holistic health treatments can be attributed to “several mechanisms, including increasing pelvic blood supply, inhibiting uterine contractions, stimulating the release of endorphins and serotonin, and altering the ability to receive and perceive pain signals.”
Although less commonly used, self-regulation strategies can significantly reduce stress levels associated menstrual discomfort as well as reduce symptoms. More importantly, they do not have adverse side effects, but the effectiveness of the intervention varies depending on the individual.
- Autogenic Training (AT), is a hundred year old treatment approach developed by the German psychiatrist Johannes Heinrich Schultz that involves three 15 minute daily practice of sessions, resulted in a 40 to 70 percent decrease of symptoms in patient suffering from primary and secondary dysmenorrhea (Luthe & Schultz, 1969). In a well- controlled PhD dissertation, Heczey (1978) compared autogenic training taught individually, autogenic training taught in a group, autogenic training plus vaginal temperature training and a no treatment control in a randomized controlled study. All treatment groups except the control group reported a decrease in symptoms and the most success was with the combined autogenic training and vaginal temperature training in which the subjects’ vaginal temperature increased by .27 F degrees.
- Progressive muscle relaxation developed by Edmund Jacobson in the 1920s and imagery are effective treatments for dysmenorrhea (Aldinda et al., 2022; Chesney & Tasto, 1975; Çelik, 2021; Jacobson, 1938; Proctor et al., 2007).
- Rhythmic abdominal massage as compared to non-treatment reduces dysmenorrhea symptoms (Suryantini, 2022; Vagedes et al., 2019):
- Biofeedback strategies such as frontalis electromyography feedback (EMG) and peripheral temperature training (Hart, Mathisen, & Prater, 1981); trapezius EMG training (Balick et al, 1982); lower abdominal EMG feedback training and relaxation (Bennink, Hulst, & Benthem, 1982); and integrated temperature feedback and autogenic training (Dietvorts & Osborne, 1978) all successfully reduced the symptoms of dysmenorrhea.
- Breathing relaxation for 5 to 30 minutes resulted in a decrease in pain or the pain totally disappeared in adolescents (Hidayatunnafiah et al., 2022). While slow deep breathing in combination with abdominal massage is more effective than applying hot compresses (Ariani et al., 2020). Slow pranayama (Nadi Shodhan) breathing the quality of life and pain scores improved as compared to fast pranayama (Kapalbhati) breathing and improved quality of life and reduces absenteeism and stress levels (Ganesh et al. 2015). When students are taught slow diaphragmatic breathing, many report a reduction in symptoms compared to the controls (Bier et al., 2005).
Observations from Integrated stress management program
This study reports on changes in dysmenorrhea symptoms by students enrolled in a University Holistic Health class that included homework assignment for practicing stress awareness, dynamic relaxation, and breathing with imagery.
Respondents: 32 college women, average age 24.0 years (S.D. 4.5 years)
Procedure: Students were enrolled in a three-unit class in which they were assigned daily home practices which changed each week as described in the book, Make Health Happen (Peper, Gibney & Holt, 2002). The first five weeks consisted of the following sequence: Week 1 focused on monitoring one’s reactions to stressor; week 2 consisted of daily practice for 30 minutes of a modified progressive relaxation and becoming aware of bracing and reducing the bracing during the day; Week 3 consisted of practicing slow diaphragmatic breathing for 30 minutes a day and during the day becoming aware of either breath holding or shallow chest breath and then use that awareness as cue to shift to lower slower diaphragmatic breathing; week 4 focused on evoking a memory of wholeness and relaxing; and week 5 focused on learning peripheral hand warming.
During the class, students observed lectures about stress and holistic health and met in small groups to discuss their self-regulation experiences. During the class discussion, some women discussed postures and practices that were beneficial when experiencing menstrual discomfort, such as breathing slowly while lying on their back, focusing on slow abdominal awareness in which their abdomen expanded during inhalation and contracted during exhalation. While exhaling they focused on imagining a flow of air initially going through their arms and then through their abdomen, down their legs and out their feet. This kinesthetic feeling was enhanced by first massaging down the arm while exhaling and then massaging down their abdomen and down their thighs when exhaling. In most cases, the women also experienced that their hands and feet warmed. In addition, they were asked to shift to slower diaphragmatic breathing whenever they observed themselves gasping, shallow breathing or holding their breath. After five weeks, the students filled out a short assessment questionnaire in which they rated the change in dysmenorrhea symptoms since the beginning of the class.
Results.
About two-thirds of all respondents reported a decrease in overall discomfort symptoms. In addition to any ‘treatment as usual’ (TAU) strategies already being used (e.g. medications or other treatments such as NSAIDs or birth control pills), 91% (20 out 22 women) who reported experiencing dysmenorrhea reported a decrease in symptoms when they practiced the self-regulation and diaphragmatic breathing techniques as shown in Figure 1.
Figure 1. Self-report in dysmenorrhea symptoms after 5 weeks.
Discussion
Many students reported that their symptoms were significantly reduced and they could be more productive. Generally, the more they practiced the relaxation and breathing self-regulation skills, the more they experienced a decrease in symptoms. The limitation of this report is that it is an observational study; however, the findings are similar to those reported by earlier self-care and biofeedback approaches. This suggests that women should be taught the following simple self-regulation strategies as the first intervention to prevent and when they experience dysmenorrhea symptoms.
Why would breathing reduce dysmenorrhea?
Many women respond by ‘curling up’ a natural protective defense response when they experience symptoms. This protective posture increases abdominal and pelvic muscle tension, inhibits lymph and blood flow circulation, increases shallow breathing rate, and decreases heart rate variability. Intentionally relaxing the abdomen with slow lower breathing when lying down with the legs extended is often the first step in reducing discomfort.
By focusing on diaphragmatic breathing with relaxing imagery, it is possible to restore abdominal expansion during inhalation and slight constriction during exhalation. This dynamic breathing while lying supine would enhance abdominal blood and lymph circulation as well as muscle relaxation (Peper et al., 2016). While practicing, participants were asked to wear looser clothing that did not constrict the waist to allow their abdomen to expand during inhalation; since, waist constriction by clothing (designer jean syndrome) interferes with abdominal expansion. Allowing the abdomen to fully extend also increased acceptance of self, that it was okay to let the abdomen expand instead of holding it in protectively. The symptoms were reduced most likley by a combination of the following factors.
- Abdominal movement is facilitated during the breathing cycle. This means reducing the factors that prevent the abdomen expanding during inhalation or constricting during exhalation (Peper et al., 2016).
- Eliminate‘Designer jean syndrome’ (the modern girdle). Increase the expansion of your abdomen by loosening the waist belt, tight pants or slimming underwear (MacHose & Peper, 1991).
- Accept yourself as you are. Allow your stomach to expand without pulling it in.
- Free up learned disuse: Allow the abdomen to expand and constrict instead of inhibiting movement to avoid pain that occurred following a prior abdominal injury/surgery (e.g., hernia surgery, appendectomy, or cesarean operation), abdominal pain (e.g., irritable bowel syndrome, recurrent abdominal pain, ulcers, or acid reflux), pelvic floor pain (e.g., pelvic floor pain, pelvic girdle pain, vulvodynia, or sexual abuse).
- The ‘defense response’ is reduced. Many students described that they often would curl up in a protective defense posture when experiencing menstrual cramps. This protective defense posture would maintain pelvic floor muscle contractions and inhibit blood and lymph flow in the abdomen, increase shallow rapid thoracic breathing and decrease pCO2 which would increase vasoconstriction and muscle constriction (Peper et al., 2015; Peper et al., 2016). By having the participant lie relaxed in a supine position with their legs extended while practicing slow abdominal breathing, the pelvic floor and abdominal wall muscles can relax and thereby increase abdominal blood and lymph circulation and parasympathetic activity. The posture of lying down implies feeling safe which is a state that facilitates healing.
- The pain/fear cycle is interrupted. The dysmenorrhea symptoms may trigger more symptoms because the person anticipates and reacts to the discomfort. The breathing and especially the kinesthetic imagery where the attention goes from the abdomen and area of discomfort to down the legs and out the feet acts as a distraction technique (not focusing on the discomfort).
- Support sympathetic-parasympathetic balance. The slow breathing and kinesthetic imagery usually increases heart rate variability and hand and feet temperature and supports sympathetic parasympathetic balance.
- Interrupt the classical conditioned response of the defense reaction. For some young girls, the first menstruation occurred unexpectedly. All of a sudden, they bled from down below without any understanding of what is going on which could be traumatic. For some this could be a defense reaction and a single trial condition response (somatic cues of the beginning of menstruation triggers the defense reaction). Thus, when the girl later experiences the initial sensations of menstruation, the automatic conditioned response causes her to tense and curl up which would amplify the discomfort. Informal interviews with women suggests that those who experienced their first menstruation experience as shameful, unexpected, or traumatic (“I thought I was dying”) thereafter framed their menstruation negatively. They also tended to report significantly more symptoms than those women who reported experiencing their first menstruation positively as a conformation that they have now entered womanhood.
How to integrate self-care to reduce dysmenorrhea
Be sure to consult your healthcare provider to rule out treatable underlying conditions before implementing learning effortless diaphragmatic breathing.
- Allow the abdomen to expand during inhalation and become smaller during exhalation. This often means, loosen belt and waist constriction, acceptance of allowing the stomach to be larger and reversing learned disuse and protective response caused by stress.
- Master diaphragmatic breathing (see: Peper & Tibbetts, 1994 and the blogs listed at the end of the article).
- Practice slow effortless diaphragmatic breathing lying down with warm water bottle on stomach in a place that feels safe.
- Include kinesthetic imagery as you breathe at about 6 breaths per minute (e.g. slowly inhale for 4 or 5 seconds and then exhale for 5 or 6 seconds, exhaling slightly longer than inhaling). Imaging that when you exhale you can sense healing energy flow through your abdomen, down the legs and out the feet.
- If possible, integrate actual touch with the exhalation can provide added benefit. Have a partner first stroke or massage down the arms from the shoulder to your fingertips as you exhale and, then on during next exhalation stroke gently from your abdomen down your legs and feet. Stroke in rhythm the exhalation.
- Exhale slowly and shift to slow and soft diaphragmatic breathing each time you become aware of neck and shoulder tension, breath holding, shallow breathing, or anticipating stressful situations. At the same time imagine /sense when exhaling a streaming going through the abdomen and out the feet when exhaling. Do this many times during the day.
- Practice and apply general stress reduction skills into daily life since stress can increase symptoms. Anticipate when stressful event could occur and implement stress reducing strategies.
- Be respectful of the biological changes that are part of the menstrual cycle. In some cases adjust your pace and slow down a bit during the week of the menstrual cycle; since, the body needs time to rest and regenerate. Be sure to get adequate amount of rest, hydration, and nutrition to optimize health.
- Use self-healing imagery and language to transform negative association with menstruation to positive associations (e.g., “curse” to confirmation “I am healthy”).
Conclusion
There are many ways to alleviate dysmenorrhea. Women can find ways to anticipate and empower themselves by practicing stress reduction, wearing more comfortable clothing, using heat compression, practicing daily diaphragmatic breathing techniques, visualizing relaxed muscles, and positive perception towards menstrual cycles to reduce the symptoms of dysmenorrhea. These self-regulation methods should be taught as a first level intervention to all young women starting in middle and junior high school so that they are better prepared for the changes that occur as they age.
“I have been practicing the breathing techniques for two weeks prior and I also noticed my muscles, in general, are more relaxed. Of course, I also avoided the skinny jeans that I like to wear and it definitely helped.
I have experienced a 90% improvement from my normal discomfort. I was still tired – and needed more rest and sleep but haven’t experienced any “terrible” physical discomfort. Still occasionally had some sharp pains or bloating but minor discomfort, unlike some days when I am bedridden and unable to move for half a day. – and this was a very positive experience for me “ — Singing Chen (Chen, 2023)
Useful blogs to learn diaphragmatic breathing
References
Aldinda, T. W., Sumarni, S., Mulyantoro, D. K., & Azam, M. (2022). Progressive muscle relaxation application (PURE App) for dysmenorrhea. Medisains Jurnal IlmiahLlmiah LLmu-LLmu Keshatan, 20(2), 52-57. https://doi.org/10.30595/medisains.v20i2.14351
Ariani, D., Hartiningsih, S.S., Sabarudin, U. Dane, S. (2020). The effectiveness of combination effleurage massage and slow deep breathing technique to decrease menstrual pain in university students. Journal of Research in Medical and Dental Science, 8(3), 79-84. https://www.jrmds.in/articles/the-effectiveness-of-combination-effleurage-massage-and-slow-deep-breathing-technique-to-decrease-menstrual-pain-in-university-stu-53607.html
Armour, M., Parry, K., Manohar, N., Holmes, K., Ferfolja, T., Curry, C., MacMillan, F., & Smith, C. A. (2019). The prevalence and academic impact of dysmenorrhea in 21,573 young women: a systematic review and meta-analysis. Journal of women’s health, 28(8), 1161-1171.https://doi.org/10.1089/jwh.2018.7615
ASPH. (2023). Estrogen and Progestin (Oral Contraceptives). MedlinePlus. Assessed March 3, 2023. https://medlineplus.gov/druginfo/meds/a601050.html
Balick, L., Elfner, L., May. J., Moore, J.D. (1982). Biofeedback treatment of dysmenorrhea. Biofeedback Self Regul, 7(4), 499-520. https://doi.org/10.1007/BF00998890
Bennink, C.D., Hulst, L.L. & Benthem, J.A. (1982). The effects of EMG biofeedback and relaxation training on primary dysmenorrhea. J Behav Med, 5(3), 329-341.https://doi.org/10.1007/BF00846160
Bier, M., Kazarian, D. & Peper, E. (2005). Reducing PMS through biofeedback and breathing. Poster presentation at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract published in: Applied Psychophysiology and Biofeedback. 30 (4), 411-412.
Çelik, A.S. & Apay, S.E. (2021). Effect of progressive relaxation exercises on primary dysmenorrhea in Turkish students: A randomized prospective controlled trial. Complement Ther Clin Pract, Feb 42,101280. https://doi.org/10.1016/j.ctcp.2020.101280
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Hidayatunnafiah, F., Mualifah, L., Moebari, M., & Iswantiningsih, E. (2022). The Effect of Relaxation Techniques in Reducing Dysmenorrhea in Adolescents. The International Virtual Conference on Nursing. in The International Virtual Conference on Nursing, KnE Life Sciences, 473–480. https://doi.org/10.18502/kls.v7i2.10344
Itani, R., Soubra, L., Karout, S., Rahme, D., Karout, L., & Khojah, H.M.J. (2022). Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med, 43(2), 101-108. https://doi.org/10.4082/kjfm.21.0103
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Compassion supports healing: Case report how a “bad eye” became an “amazing eye”*
Posted: April 11, 2023 Filed under: behavior, cognitive behavior therapy, healing, health, mindfulness, Pain/discomfort, self-healing, stress management, Uncategorized, vision | Tags: compassion, self-image 1 CommentErik Peper, PhD and Dana Yirmiyahu
“I completely changed my perception of having a bad eye, to having an amazing eye. After two months, my eye is totally normal and healthy”
When experiencing chronic discomfort or reduced function, we commonly describe that part of our body that causes problems as broken or bad. Sometimes we even wish that it did not exist. In other cases, especially if there is pain or disfigurement, the person may attempt to dissociate from that body part. The language the person uses creates a graphic imagery that may impact the healing process; since, language can also be seen as a self-hypnotic suggestion.
The negative labeling, plus being disgusted or frustrated with that part of the body that is the cause of discomfort, often increases stress, tension and sympathetic activity. This reduces our self-healing potential. In many cases, the language is both the description and the prognosis-a self-fulfilling prophecy. If the description is negative and judgmental, it may interfere with the healing/treatment process. The negative language may activate the nocebo process that inhibits regeneration. On the other hand, positive affirming language may implicitly activate the placebo process that enhances healing.
By reframing the experience as positive and appreciating what the problem area of the body had done for you in the past as well as incorporating a healing compassionate process, healing is supported. Our limiting beliefs limit our possibilities. See the TED talk, A broken body isn’t a broken person, by Janine Shepherd (2014) who, after a horrendous accident and being paralyzed, became an acrobatic pilot instructor. Another example of a remarkable recovery is that of Madhu Anziani. After falling from a second floor window, he was a quadriplegic and used Reiki, toning, self-compassion and hope to improve his health. He reframed the problem as an opportunity for growth. He can now walk, talk and play the most remarkable music (Anziani and Peper, 2021).
When a person can focus on what they can do instead of focusing on what they cannot do or on their suffering, pain may be reduced. For example, Jill Cosby describes undergoing two surgeries to replace her shattered L3 with a metal “cage” and fused this cage to the L4 and L2 vertebrae with bars. She used imagery to eliminate the pains in her back and stopped her pain medications (Peper et al., 2022). The healing process is similar to how children develop, growth, and learn–a process that is promoted through playfulness and support with an openness to possibilities.
Healing only goes forwards in time
After an injury, most people want to be the same as they were before the injury, and they keep comparing themselves to how they were. The person can never be what they were in the past, butthey can be different and even better.. Time flows only in a forward direction, and the person already has been changed by the experience. Instead, the person explores ways to accept where they are, appreciate how much the problem area has done for them in the past, and continue to work to improve. This is a dynamic process in which the person appreciates the very small positive changes that are occurring without setting limits on how much change can occur.
A useful tool while working with clients is to explore ways by which they can genuinely transform their negative beliefs and self-talk about the problem to appreciation and growth. This process is illustrated in the following report about the rapid healing of a 15-year problem with an eye that had become smaller following severe corneal abrasion.
Case report
On January 18th, 2023, I attended a workshop/ lecture by Professor Erik Peper.
During the break, I spoke to him and expressed my concern regarding my right eye. 15 years ago, the cornea of my eye was accidently scratched by my 3-year-old daughter. The eye suffered a trauma and was treated at the hospital. In addition, I had a patch over my eye for 3 weeks and suffered extrusion pain during the first 2 weeks. A scar remained on my eye, and doctors were not able to say if it would be permanent or whether the eye would heal itself eventually. An invasive operation was also suggested, which I refused. The trauma affected my eyesight for a few months, but after a year, the scar was gone and physically no permanent damage has remained.
Although it was certainly determined that my eye had healed completely, it didn’t feel that way at all. I always considered it ‘my bad eye’ and suffered irritation and pain every time I experienced tiredness, anxiety, or any other emotional discomfort. My eye was the first and only organ to reflect pain/itchiness/irritation. Over time, my eye ‘shrank’ as well. It became visibly smaller and it felt tense at all times.
For 15 years, that was my reality! I coped with it and haven’t thought of it much, until January 18, when I attended the workshop.
Professor Peper asked me to the front of the stage when we returned from break and conducted an exercise with me, where I used my imagination and words to comfort my eye and embrace it rather than call it ‘the defective/bad eye’. He pointed out that if you only describe your children as bad or evil, how can you expect them to grow? Then, he explored with me a few exercises such as evoking self-healing imagery. The self-healing imagery did not totally resonate; however, I felt I just needed to hug my eye. I thanked my eye for its being and stroked it gently in my mind. On stage and during the rest of the lecture I felt a sense of comfort. I felt if the muscles around my eye had finally loosened–a feeling I haven’t experienced for years. I continued to follow the instructions I got at the workshop for a couple of days, but unfortunately, I did not persist, and the negative sensations returned.
On a follow-up zoom meeting 10 days after the lecture with Prof. Peper, I received additional tools to practice ‘eye physiotherapy’ as well as mindfulness regarding the eye. This practice consisted of closing my eyes and covering the non-problem eye and then as I exhaled gently and softly opening my eyes, opening them more and more while looking all around. I completely changed my perception of having a bad eye, to having ‘an amazing eye’. At first talking to it didn’t come naturally to me but as I persisted it became easier and easier. I did it in the car, before going to sleep and when waking up in the morning. In addition, I practiced the exercises I got over zoom, where I covered my left eye (the undamaged one) and had my right eye look up and down to both sides.
It has been about three months since this zoom meeting and I am awed by the results. My eye has opened more, and no longer feels shrunk and small, I rarely feel negative sensations in it and when I do, I immediately know how to handle it.
I can say that attending this workshop has definitely been a life-changing event for my amazing right eye and for me.
Why did the healing occur?
The “bad eye” symptoms were most likely caused by “learned disuse”; namely, the chronic eye tension was the result of the protective response to reduce the discomfort after the injury to the cornea (Uswatte & Taub, 2005). After the injury and medical treatment, she would have unknowingly tensed her muscles around the eye to protect it. This process occurs automatically without conscious awareness. This protective response became her “new normal” and once her eye had healed, the bracing continued. The bracing pattern was amplified by the ongoing self-labeling of having a “bad eye.” By accepting the eye as it was, giving it compassionate caring and support, and following up with simple eye movement exercises to allow the eye to rediscover and experience the complete range of motion, the symptoms disappeared.
What can we take home from this case example?
Listen to the language a client uses to describe their problem. Does the language implicitly limit recovery, growth and hope (e.g., I will always have the problem)? Does the language inhibit caring and compassion for the problem area (e.g., I’m frustrated, angry, disgusted)? If that is the case, explore ways to reframe the language and emotional tone. A useful strategy is to incorporate self-healing imagery: the person first inspects the problem area, next imagines how it would look when it is healthy, and finally creates self-healing imagery that transforms what was observed to become well and whole. Then, each moment the client’s attention is drawn to the problem, he or she evokes the self-healing imagery (Peper, Gibney, & Holt, 2002). In many cases, combining this imagery with slower breathing to reduce stress promotes healing.
References
Anziani, M. & Peper, E. (2021). Healing from paralysis-Music (toning) to activate health. the peper perspective-ideas on illness, health and well-being from Erik Peper. Accessed March 22, 2023. https://peperperspective.com/2021/11/22/healing-from-paralysis-music-toning-to-activate-health/
Mullins, A. (2009). The opportunity of adversity. TEDMED. Accessed March 22, 2023. https://www.ted.com/talks/aimee_mullins_the_opportunity_of_adversity?language=en
Peper, E. Cosby, J. & Amendras, M. (2022). Healing chronic back pain. NeuroRegulation, 9(3), 165-172. https://doi.org/10.15540/nr.9.3.164
Peper, E., Gibney, H. K. & Holt, C. (2002). Make Health Happen. Dubuque, Iowa: Kendall-Hunt. pp. 193-236. https://he.kendallhunt.com/make-health-happen
Shepherd, J. (2014). A broken body isn’t a broken person. TEDxKC. Accessed March 20, 2023 https://www.ted.com/talks/janine_shepherd_a_broken_body_isn_t_a_broken_person?language=en
Uswatte, G. & Taub, E. (2005). Implications of the Learned Nonuse Formulation for Measuring Rehabilitation Outcomes: Lessons From Constraint-Induced Movement Therapy. Rehabilitation Psychology, 50(1), 34-42. https://doi.org/10.1037/0090-5550.50.1.34
*I thank Cathy Holt, MPH, for her supportive feedback.
Breathing: Informative YouTube videos and blogs
Posted: March 20, 2023 Filed under: behavior, Breathing/respiration, health, mindfulness, Pain/discomfort, relaxation, self-healing | Tags: anxiety, box breathing, carbon dioxide, exhaling, hickups 2 Comments
Breathing is a voluntary and involuntary process and affects our body, emotions, mind and performance. The focus of breathing is to bring oxygen into the body and eliminate carbon dioxide. This is the basic physiological process that underlies the concepts described in the videos; however, it does not included the concept as breathing as a pump to optimize abdominal venous and lymph circulation. The pumping action may reduce abdominal discomfort such as irritable bowel disease, acid reflux and pelvic floor discomfort. Effortless whole body breathing also supports pelvic floor muscle tone balance and spinal column dynamics. Effortless diaphragmatic breathing can only occur if the abdomen is able to expand and constrict in 360 degrees and not constricted by tight clothing around the waist (designer’s jean syndrome), self-image (holding the abdomen in to look slimmer), or learned disuse of abdominal movement (breathing shallowly and in the chest to avoid movement at the incisionsafter abdominal surgery).
The outstanding videos discuss the psychophysiology, mechanics, chemistry of respiration as well as useful practices practices to enhance health..
- How to Breathe Correctly for Optimal Health, Mood, Learning & Performance | Huberman Lab Podcast (Skip the advertisements embedded in this video)
- Dr. Jack Feldman: Breathing for Mental & Physical Health & Performance | Huberman Lab Podcast #54 (Skip the advertisements embedded in this video)
The videos provide additional approaches to improve breathing and health
- 5 Ways to Improve your Breathing with James Nestor
- Patrick McKeown-Why we breathe: How to improve your sleep, concentration, focus & performance
The blogs that explores how diaphragmatic breathing may reduce symptoms of irritable bowel syndrome, acid reflux, and pelvic floor pain.
- Healing irritable bowel syndrome with diaphragmatic breathing
- Breathing to reduce acid reflux and dysmenorrhea
- Enjoy sex: Breath away the pain
- Resolving pelvic floor pain-a casae report
Below are the descriptions of the youtube videos.
How to Breathe Correctly for Optimal Health, Mood, Learning & Performance | Huberman Lab Podcast
In this episode, I explain the biology of breathing (respiration), how it delivers oxygen and carbon dioxide to the cells and tissues of the body and how is best to breathe—nose versus mouth, fast versus slow, deliberately versus reflexively, etc., depending on your health and performance needs. I discuss the positive benefits of breathing properly for mood, to reduce psychological and physiological stress, to halt sleep apnea, and improve facial aesthetics and immune system function. I also compare what is known about the effects and effectiveness of different breathing techniques, including physiological sighs, box breathing and cyclic hyperventilation, “Wim Hof Method,” Prānāyāma yogic breathing and more. I also describe how to breath to optimize learning, memory and reaction time and I explain breathing at high altitudes, why “overbreathing” is bad, and how to breathe specifically to relieve cramps and hiccups. Breathwork practices are zero-cost and require minimal time yet provide a unique and powerful avenue to improve overall quality of life that is grounded in clear physiology. Anyone interesting in improving their mental and physical health or performance in any endeavor ought to benefit from the information and tools in this episode.
Dr. Jack Feldman: Breathing for Mental & Physical Health & Performance | Huberman Lab Podcast #54
This episode my guest is Dr. Jack Feldman, Distinguished Professor of Neurobiology at University of California, Los Angeles and a pioneering world expert in the science of respiration (breathing). We discuss how and why humans breathe the way we do, the function of the diaphragm and how it serves to increase oxygenation of the brain and body. We discuss how breathing influences mental state, fear, memory, reaction time, and more. And we discuss specific breathing protocols such as box-breathing, cyclic hyperventilation (similar to Wim Hof breathing), nasal versus mouth breathing, unilateral breathing, and how these each effect the brain and body. We discuss physiological sighs, peptides expressed by specific neurons controlling breathing, and magnesium compounds that can improve cognitive ability and how they work. This conversation serves as a sort of “Master Class” on the science of breathing and breathing related tools for health and performance.
5 Ways To Improve Your Breathing with James Nestor
James Nestor believes we’re all breathing wrong. Here he breaks down 5 ways to transform your breathing, from increasing your lung capacity to stopping breathing through your mouth. There is nothing more essential to our health and wellbeing than breathing: take air in, let it out, repeat 25,000 times a day. Yet, as a species, humans have lost the ability to breathe correctly, with grave consequences. In Breath, journalist James Nestor travels the world to discover the hidden science behind ancient breathing practices to figure out what went wrong and how to fix it. Modern research is showing us that making even slight adjustments to the way we inhale and exhale can: – jump-start athletic performance – rejuvenate internal organs – halt snoring, allergies, asthma and autoimmune disease, and even straighten scoliotic spines None of this should be possible, and yet it is. Drawing on thousands of years of ancient wisdom and cutting-edge studies in pulmonology, psychology, biochemistry and human physiology, Breath turns the conventional wisdom of what we thought we knew about our most basic biological function on its head. You will never breathe the same again.
Patrick McKeown – Why We Breathe: How to Improve Your Sleep, Concentration, Focus & Performance
Watch Oxygen Advantage founder and world-renowned breathing expert Patrick McKeown speak to an influential group of health professionals at the recent Health Optimisation Summit in London. Patrick was presenting his very well-received topic: ‘Why We Breathe: How to Improve Your Sleep, Concentration, Focus & Performance’. The aim of the event was to “unite the health, wellness and science disciplines”, and in doing so, it brought together thousands of industry professionals and members of the public. Patrick would like to take this opportunity to thank the organisers of The Health Optimisation Summit for an excellent event and for giving him the opportunity to speak among such luminaries of the health and wellbeing world and on a subject about which he is very passionate.
Breathing is more than gas exchange
Effortless diaphragmatic breathing is optimized when the abdomen is able to expand and constrict in 360 degrees like and not constricted by tight clothing (designer’s jean syndrome induced by the constriction of the waist), self-image (holding the abdomen in to look slimmer), or learned disuse of abdominal movement (breathing shallowly and in the chest to avoid movement at the incisions site after abdominal surgery).
Thoughts Have the Power to Create or Eliminate Body Tension
Posted: January 31, 2023 Filed under: Breathing/respiration, CBT, cognitive behavior therapy, computer, emotions, ergonomics, healing, health, Neck and shoulder discomfort, Pain/discomfort, posture, stress management, Uncategorized | Tags: Alexander Technique, mind-body connection 3 CommentsBy Tami Bulmash republished from: Medium-Body Wisdom
Photo by Jonathan Borba on Unsplash
The mind and body have long been regarded and treated as separate entities, yet this distinction does little to promote holistic health. Understanding the direct relationship between thoughts and body tension can illustrate how the mind and body either work dysfunctionally through separation, or optimally as a unit.
Mental and physical aren’t separate entities
Stress and pain existed long before the coronavirus, though it was highlighted during this isolating era. In the height of the pandemic nearly eight in 10 American adults cited COVID-19 as a significant stressor. Though it may no longer be front page news, the aftermath of COVID still lingers. Its toll on mental health continues to impact children and adults alike. The shift to remote work was appealing at first, but later created a more pervasive sedentary lifestyle. Now the concern has shifted to an emerging pandemic of back pain.
Yet, there is nothing novel about body tension brought forth by stressful thinking. In 2014, the American Institute of Stress reported 77 percent of people regularly experience physical symptoms caused by stress. Moreover, the findings of a 2018 Gallup poll suggest 55 percent of Americans report feeling stressed for a large part of their day. This is compounded by the American Academy of Orthopaedic Surgeons finding one in two Americans have a musculoskeletal condition. Discerning between mental and physical stress is becoming increasingly obscure.
While the mind and body have long been regarded and treated as separate entities, this distinction does little to promote holistic health. Understanding the direct relationship between thoughts and tension can illustrate how the mind and body either work dysfunctionally through separation, or optimally as a unit. What’s more, viewing the body as a whole being — in thought and activity — can promote better habits which eliminate tension.
The link between stress and pain
Dividing the self into parts is common practice in the Western world. Expressions such as “I’m mentally exhausted” vs. “I’m physically exhausted” provoke differing self-reflections. However, the psycho-physical relationship is evident in the tension stimulated by either thought. For example, sitting in front of a computer necessitates both thought and action. Viewing content on a screen lends itself to a reaction from behind the screen. This response can be minimal and inconsequential, or it can be subtle, yet critical.
Repeatedly engaging in certain thinking habits like, “I have to get this done and fast” are often reflected in forms of body tension such as stiff fingers at the keyboard, a clenched jaw after a meeting, or tense neck at the end of the day. These unconscious responses are common and have a pervasive effect.
The prevalence of technology has led to a plethora of occupational ailments, now referred to as technology diseases. These include carpal tunnel syndrome, mouse shoulder, and cervical pain syndrome and occur because of excessive work at the computer — especially keyboard and mouse usage. According to the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, by Drs. Erik Peper, Richard Harvey and Nancy Faass, 45 million people suffer from tension headaches, carpal tunnel, and back injuries linked to computer use and more than 30 percent of North Americans who work at a computer develop a muscle strain injury every year.
Pushing through mental tasks is reflected in the physical
Dr. Peper, a biofeedback expert and Professor of Holistic Health at San Francisco State University, gives an illustration of the mind-body connection in relation to pain. His example requires the use of a computer mouse while trying to complete difficult mental tasks. He asks me to hold the mouse in my dominant hand and draw with it the last letter of an address. Then continue to go backward with each letter of the street name, making sure the letter height is only one-half of an inch. He tells me to perform the task as quickly as possible. As I’m drawing the address backwards trying to recall the letters and their order, Dr. Peper commands, “Do it quicker, quicker, quicker! Don’t make a mistake! Quicker, quicker, quicker!”
These commands reflect the endless to-do lists that pile up throughout the day and the stress associated with their efficacy and timely completion. While enacting this task, Dr. Peper asks me, “Are you tightening your shoulders? Are you tightening your trunk? Are you raising your shoulders possibly holding all this tension? If you are like most people who do this task, you did all of that and you were totally unaware. We are usually really unaware of our body posture.”
I have spent the past 20 years practicing the Alexander Technique, a method used to improve postural health. At its core the technique is about observation and utilizing psycho-physical awareness to stop repeating harmful habits. Dr. Peper’s words resonate because becoming aware of unconscious responses isn’t easy. Most people are completely unaware of the relationship between mind-body habits and how they contribute to stress-related pain.
Posture affects mood and energy levels
Posture is often thought of as a pose — most notably being associated with “sitting up straight”. Yet the health implications of good posture extend far beyond any held position. The agility and movement which are evident in good posture exemplify the mind-body connection.
It is well-known that feeling depressed has been linked to having less subjective energy. The American Psychiatric Association listed a variety of symptoms connected to depression including feeling sad or having a depressed mood, loss of interest in activities once enjoyed, and loss of energy or increased fatigue. While the treatment of depression hasn’t traditionally considered the role of posture in informing mood, researchers have started exploring this relationship.
A study by Dr. Peper and Dr. I-Mei Lin examined the subjective energy levels of university students and their corresponding expression of depression. Participants who walked in a slouched position reported lower energy levels and higher self-rated depression scores. In contrast, when those participants walked in a pattern of opposite arm and leg skipping, they experienced an increase in energy, allowing a positive mindset to ensue.
As mentioned in the study, the mind-body relationship is a two-way street: mind to body and body to mind. If thoughts are manifested in the way one holds their body, the inverse would also be true. Namely, changing the way one carries their body would also influence their thinking and subsequent mood. If stopping certain habits — such as walking in a slumped posture — could have a positive impact on mood and well-being, perhaps it’s worth exploring the mind-body relationship even further.
Supporting the mind-body connection
One of the best ways to improve the mind-body connection is through awareness. The more present you are in your activities, the more unified the relation becomes. Give yourself a couple of minutes to connect your thoughts with what you are doing at the moment.
Begin With Grounding
If you are sitting down, imagine coloring in the space of your whole body with an imaginary marker. Begin with your feet planted on the floor. Start to outline the footprints of your feet and then color in the bottom and top of each foot. Take your time. Fill in all the space. See if you discover new parts of your feet — like the spaces between your toes. Continue up through your ankles and toward your calves. Pay attention to the entire limb (front and back). Work your way upward through the knee and then the upper leg. See if you can find your sit bones along the way to the torso. Explore new joints — such as the hip joint.
Lengthen Your Body Through Thought
Continue up while circling the front and back of the torso. Extend the awareness of your thoughts through your shoulders. Allow for an exploration of the arms — noting the joints such as the elbows, wrists and fingers. Pay attention to their length and mobility. Come back up through the arms. Extend up through the shoulders again, this time noting the passage through the chest and neck. Observe the length and space within your entire being. Journey up to the head and travel around its circumference. Imagine filling your head space with air. Picture the wholeness of your head from top to bottom and side to side.
This two-minute mind-body meditation allows you to feel the full extent of the space your body takes up. It is a way to awaken the senses and include them in conscious thinking. This helps generate awareness in how to engage the mind-body relationship optimally. The next time you try it, use a visual aid like an anatomy diagram of the whole body. This can also introduce new parts and spaces of the body you may not have thought of before. However, don’t rely on the diagram each time, as it can pull away your attention from the mind-body meditation. Instead, use it as a reference or guide every once in a while.
Learn from other cultures
In Western cultures, it is common practice to divvy up musculoskeletal ailments into an array of categories such as tension headaches, tension neck syndrome, or mechanical back syndrome. For instance, in countries like the U.S., it is normal to seek a specialist for each area of concern — like a neurologist for a migraine, an orthopedist for neck strain, or chiropractors for back pain. In contrast, Eastern lifestyles have historically taken a more holistic approach to treating (and healing) their patients.
An article by Dr. Cecilia Chan, Professor of Social Sciences at the University of Hong Kong, explains how the Eastern philosophies of Buddhism, Taoism and traditional Chinese medicine adopt a holistic approach to the healing of an individual. Rather than diagnose and treat with medication, Chan and her colleagues explore health through the harmony and balance of the body-mind-spirit as a whole.
Because basic biology clearly delineates how the human head is attached to the body, it seems fitting that the entire being be regarded as a unit. By recognizing the relationship between thought stressors and their manifestation in the physical body, awareness is elevated. This, in turn, can prevent mindlessly engaging in harmful patterns that lead to stress and pain. Combating tension is possible through the realization of how thoughts — whether they are emotional or task oriented — directly impact the body as a whole.
This excerpt from Taro Gold’s book, Open Your Mind, Open Your Life: A Book of Eastern Wisdom, cites Mahatma Gandhi’s famous quote which beautifully elucidates the mind-body connection:
Keep your thoughts positive, because your thoughts become your words.
Keep your words positive, because your words become your behavior.
Keep your behavior positive, because your behavior becomes your habits.
Keep your habits positive, because your habits become your values.
Keep your values positive, because your values become your destiny.
Referring to the mind and body as separate entities perpetuates a disconnect in the being as a whole. This is why distinguishing the mental from the physical further exacerbates the notion that the two don’t work together as an indivisible unit. Understanding the relationship between stress and tension begins through the awareness of habits.
There are recurrent thinking habits like “I’ve got to get this done now” and their unconscious counterparts that become visible through posture. The unknown habits are the ones which accrue over time and often appear seemingly out of nowhere — in the form of tension or pain. Modern culture is quick to treat symptoms, such as those related to excessive technology use. However, a holistic approach to addressing the underlying issue would examine how stress and pain work hand in hand. Once the thoughts change, so will the tension.
Biofeedback, posture and breath: Tools for health
Posted: December 1, 2022 Filed under: ADHD, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, computer, digital devices, education, emotions, ergonomics, Evolutionary perspective, Exercise/movement, healing, health, laptops, mindfulness, Neck and shoulder discomfort, Pain/discomfort, posture, relaxation, screen fatigue, self-healing, stress management, Uncategorized, vision, zoom fatigue 2 CommentsTwo recent presentations that that provide concepts and pragmatic skills to improve health and well being.
How changing your breathing and posture can change your life.
In-depth podcast in which Dr. Abby Metcalf, producer of Relationships made easy, interviews Dr. Erik Peper. He discusses how changing your posture and how you breathe may result in major improvement with issues such as anxiety, depression, ADHD, chronic pain, and even insomnia! In the presentation he explain how this works and shares practical tools to make the changes you want in your life.
How to cope with TechStress
A wide ranging discussing between Dr. Russel Jaffe and Dr Erik that explores the power of biofeedback, self-healing strategies and how to cope with tech-stress.
These concepts are also explored in the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. You may find this book useful as we spend so much time working online. The book describes the impacts personal technology on our physical and emotional well-being. More importantly, “Tech Stress” provides all of the basic tools to be able not only to survive in this new world but also thrive in it.
Additiona resources:
Gonzalez, D. (2022). Ways to improve your posture at home.
Reversing Pandemic-Related Increases in Back Pain
Posted: August 30, 2022 Filed under: behavior, Breathing/respiration, digital devices, ergonomics, Exercise/movement, health, laptops, Neck and shoulder discomfort, Pain/discomfort, posture, relaxation, self-healing, stress management, Uncategorized | Tags: back pain 1 Comment
By: Chris Graf
Reproduced by permission from: https://www.paintreatmentdirectory.com/posts/reversing-pandemic-related-increases-in-back-pain
Back pain increased significantly during the pandemic
Google searches for the words “back pain” reached an all-time high in January 2022. In a Harris Poll in September 2021, 56% of respondents said they had chronic pain, up from about 30% before the pandemic. There are probably multiple reasons for the uptick in pain in general and back pain in particular related to COVID, including added stress and ongoing symptoms of long COVID. Poor posture while working at home is another likely contributor.
Back pain and Ergonomics
According to Dr. Erik Peper, co-author of Tech Stress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, It is likely that poor ergonomics in the home office are partially to blame for the apparent rise in back pain. “With COVID, ergonomics have become a disaster—especially with people who use laptops.” Peper, an internationally known expert in biofeedback and Professor of Holistic Health Studies at San Francisco State University, said that it is “almost impossible” to sit correctly when using a laptop. “In order for the hands to be at the correct level for the keyboard, the head must be tilted down. The more the head tilts forward, the most stress that is placed on the cervical spine,” he said, noting that the arms will no longer be in the proper position if the laptop is placed on a stand to raise it to eye level.
For laptop users, Peper recommends using either an external monitor or external keyboard. When using an external keyboard, a laptop stand can be used to elevate the screen to the proper eye level. University of California at Berkeley recommends other tips for ergonomic laptop positioning.
When using both laptops and desktops, attention should be focused on proper sitting posture. Ergonomic chairs are only part of the equation when it comes to achieving proper posture.
“A good chair only gives you the opportunity to sit correctly,” Peper said. The goal is to achieve anterior pelvic tilt by having the seat pan slightly lower in the front that in the back. He recommends using a seat insert or cushion to achieve proper positioning (see figure 1).
Figure 1. A small pillow or rolled up towel can be placed behind the back at kidney level in order to keep the spine slightly arched (see figure 2).
Figure 2. Sitting Disease: Cause of Back Pain and Much More
According to Peper, people who spend extended periods of time at their computers are at risk of developing sitting disease—a condition of increased sedentary behavior associated with adverse health effects. A study that appeared in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases and conditions including chronic back and musculoskeletal pain. According to the study, “Being seated alters the activation patterns of multiple weight-bearing muscles and, therefore, excessive desk use is associated with adverse back curvature, back pain and upper extremity problems such as carpel tunnel syndrome.”
To Avoid Back Pain, Don’t Slouch!
Sitting for prolonged periods of time can cause back, neck, arm, and leg pain, but slouching is even worse and can damage spinal structures. “Most people slouch at computer, and when you slouch, our spine becomes more like the letter C, our abdomen is compressed, the diaphragm goes up which causes us to shallow breathe in our upper chest,” Peper said. “That impacts our back and digestion and many other things.”
According to Peper, slouching can also impact our mood. “Slouching is the posture associated with depression and low energy. That posture collapse may evoke negative and hopeless emotions. If I sit up and look up, I have less of that. I can have more positive and uplifting thinking.”
Peper recommends a simple device to help people improve their posture. Called an Upright Go, it attaches to the neck and provides vibrational feedback when slouching occurs. “Every time it starts buzzing, it’s a reminder to stop slouching and to get up, wiggle, and move,” he said. “We have published some studies on it, but I have no investment in the company.”
Peper’s 4 Basic Tips for Avoiding Back Pain and Other Sitting Diseases:
#1 Get Up and Move
“Rule one is to take many breaks—wiggle and move,” he said. “People are unaware that they slightly raise their shoulders and their arm goes slightly forward—in their mousing especially. By the end of the day, they feel stiffness in their shoulders or back. So, you need to take many wiggly breaks. Get up from your chair every 15 minutes.”
Use Stretch Break or one of the other apps that remind people to get up out of their chairs and stretch.
Walk around while on the phone and wear a headset to improve posture while on the phone.
For back pain, skip in place or lift the right arm at the same time as the left knee followed by the left arm and right knee–exercises that cause a diagonal stretch along the back.
#2 Just Breathe
- “Learn to practice lower breathing,” Peper said. “When you sit, you are forced to breath higher in your chest. You want to practice slow diaphragmatic breathing. Breathe deeply and slowly to restore a natural rhythm. Take three deep breaths, inhaling for five seconds, then exhale very slowly for six seconds.” For more instructions on slower diaphragmatic breathing visit Peper’s blog on the subject.
#3 Take Visual Breaks:
- Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes,” he said. By looking into the distance, near-focus muscle tension in the eyes is disrupted.
- If you have children, make sure they are taking frequent visual breaks from their screens. According to Peper, there has been a 20 percent increase in myopia (nearsightedness) in young children as a result of COVID-related distance learning. “The eyes are being formed and shaped during childhood, and if you only focus on the screen, that changes the muscle structure of our eyes over time leading to more myopia.”
#4 Pay Attention to Ergonomics
- “If you are working on a desktop, the top of screen should be at eyebrow level,” Peper said. “Your feet should be on the ground, and the angle of the knees should be about 110 degrees. You should feel support in mid back and low back and be able to sit, lean back, and be comfortable.”
- Peper recommends adjustable sit/stand desks and regularly alternating between sitting and standing.
For more specific guidance on ergonomics for prolonged sitting, UCLA School of Medicine offers detailed guidelines. And don’t forget to check out Dr. Peper’s book on ergonomics as well as his blog, The Peper Perspective, where you can use the search feature to help you find exactly what you are looking for.
But in the meantime, Dr. Peper said, “It’s time for you to get up and wiggle!”
Find a Provider Who Can Help with Back Pain
Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.
Healing chronic back pain
Posted: July 31, 2022 Filed under: behavior, Breathing/respiration, CBT, cognitive behavior therapy, education, healing, health, meditation, relaxation, self-healing, stress management, surgery | Tags: back pain, Imagery, self-care, visualization 1 CommentErik Peper, PhD, BCB, Jillian Cosby, and Monica Almendras
Adapted from Peper, E. Cosby, J. & Amendras, M. (2022).Healing chronic back pain. NeuroRegulation, 9(3), 165-172. https://doi.org/10.15540/nr.9.3.164
In at the beginning of 2021, I broke my L3 vertebra during a motor cycle accident and underwent two surgeries in which surgeons replaced my shattered L3 with a metal “cage” (looks like a spring) and fused this cage to the L4 and L2 vertebrae with bars. I also broke both sides of my jaw and fractured my left shoulder. I felt so overwhelmed and totally discouraged by the ongoing pain. A year later, after doing the self-healing project as part of the university class assignment, I feel so much better all the time, stopped taking all prescription pain medications and eliminated the sharp pains in my back. This project has taught me that I have the skill set needed to be whole and healthy. –J.C., 28-year-old college student
Chronic pain is defined as a pain that persist or recurs for more than 3 months (Treede et al., 2019). It is exhausting and often associated with reduced quality of life and increased medical costs (Yong, Mullins, & Bhattacharyya, 2022). Pain and depression co-exacerbate physical and psychological symptoms and can lead to hopelessness (IsHak, 2018; Von Korff & Simon, 1996). To go to bed with pain and anticipate that pain is waiting for you as you wake up is often debilitating. One in five American adults experience chronic pain most frequently in back, hip, knee or foot (Yong, Mullins, & Bhattacharyya, 2022). Patients are often prescribed analgesic medications (“pain killers”) to reduce pain. Although, the analgesic medications can be effective in the short term to reduce pain, the efficacy is marginal for relieving chronic pain (Eriksen et al., 2006; Tan, & Jensen, 2007). Recent research by Parisien and colleagues (2022) reported that anti-inflammatory drugs were associated with increased risk of persistent pain. This suggest that anti-inflammatory treatments might have negative effects on pain duration. In addition, the long-term medication use is a major contributor to opioid epidemic and increased pain sensitivity (NIH– NIDA, 2022; Higgins, Smith, & Matthews, 2019; Koop, 2020). Pain can often be successfully treated with a multidisciplinary approach that incorporates non-pharmacologic approaches. These include exercise, acceptance and commitment therapy, as well as hypnosis (Warraich, 2022). This paper reports how self-healing strategies as taught as part of an undergraduate university class can be an effective approach to reduce the experience of chronic pain and improve health.
Each semester, about 100 to 150 junior and senior college students at San Francisco State University enroll in a holistic health class that focused on ‘whole-person’ Holistic Health curriculum. The class includes an assessment of complementary medicine and holistic health. It is based upon the premise that mind/emotions affect body and body affect mind/emotions that Green, Green & Walters (1970) called the psychophysiological principle.
“Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state.”
The didactic components of the class includes the psychobiology of stress, the role of posture, psychophysiology of respiration, lifestyle and other health factors, reframing internal language, guided and self-healing imagery. Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney, & Holt, 2002).
The self-practices during the last six weeks of the class focus on identifying, developing and implementing a self-healing project to optimize their personal health. The self-healing project can range from simple life style changes to reducing chronic pain. Each student identifies their project such as increasing physical activity, eating a healthy diet and reducing sugar and junk food, stopping vaping/smoking, reducing anxiety or depression, stopping hair pulling, reducing headaches, decreasing ezema, or back pain, etc. At the end of the semester, 80% or more of the students report significant reduction in symptoms (Peper, Sato-Perry, & Gibney, 2003; Peper, Lin, Harvey, Gilbert, Gubbala, Ratkovich, & Fletcher, 2014; Peper, Miceli, & Harvey, 2016; Peper, Harvey, Cuellar, & Membrila, 2022). During the last five semesters, 13 percent of the students focused reducing pain (e.g., migraines, neck and shoulder pain, upper or lower back pain, knee pain, wrist pain, and abdominal pain). The students successfully improved their symptoms an average of 8.8 on a scale from 0 (No benefit) to 10 (total benefit/improvement). The success for improving their symptoms correlates 0.63 with their commitment and persistence to the project (Peper, Amendras, Heinz, & Harvey, in prep).
The purposes of this paper is to describe a case example how a student with severe back pain reduced her symptoms and eliminated medication by implementing an integrated self-healing process as part of a class assignment and offer recommendations how this could be useful for others.
Participant: A 28-year-old female student (J.C.) who on January 28, 2021 broke her L3 vertebra in a motor cycle accident. She underwent two surgeries in which surgeons replaced her shattered L3 with a metal “cage” (which she describes as looking like a spring) and fused this cage to the L2 and L4 vertebrae with bars. She also broke both sides of her jaw and fractured her left shoulder. More than a year later, at the beginning of the self-healing project, she continue to take 5-10 mgs of Baclofen and 300 mgs of Gabapentin three times a day to reduce pain.
Goal of the self-healing project: To decrease the sharp pain/discomfort in her lower back that resulted from the motor cycle accident and, although not explicitly listed, to decrease the pain medications.
Self-healing process
During the last six weeks of the 2022 Spring semester, the student implemented her self-healing practices for her personal project which consisted of the following steps.
1. Create a self-healing plan that included exploring the advantage and disadvantage of her illness.
2. Develop a step-by-step plan with specific goals to relief her tension and pain in her lower back. This practice allowed her to quantify her problem and the solutions. Like so many people with chronic pain, she focused on the problem and feelings (physical and emotional) associated with the pain. As a result, she often feel hopeless and worried that it would not change.
3. Observe and evaluate when pain sensations changed. She recognized that she automatically anticipated and focused on the pain and anxiety whenever she needed to bend down into a squat. She realized that she had been anticipating pain even before she began to squat. This showed that she needed to focus on healing the movement of this area of her body.
Through her detailed observations, she realized that her previous general rating of back pain could be separated into muscle tightness/stiffness and pain. With this realization, she changed the way she was recording her pain level. She changed it from “pain level” into into two categories: tightness and sharp pains.
4. Ask questions of her unconscious through a guided practice of accessing an inner guide through imagery (For detailed instructions, see Peper, Gibney, & Holt, 2002, pages 197-206). In this self-guided imagery the person relaxes and imagines being in a special healing place where you felt calm, safe and secure. Then as you relaxed, you become aware of another being (wise one or guide) approaching you (the being can be a person, animal, light, spirit, etc.). The being is wise and knows you well. In your mind, you ask this being or guide questions such as, “What do I need to do to assist in my own healing?” Then you wait and listen for an answer. The answer may take many forms such as in words, a pictures, a sense of knowing, or it may come later in dreams or in other forms. When students are assigned this practice for a week, almost all report experiencing some form of guide and many find the answers meaningful for their self-healing project.
Through this imagery of the inner guide script, she connected with her higher self and the wise one told her to “Wait.” This connecting with the wise one was key in accepting that the project was not as daunting as she initially thought. She realized that pain was not going to be forever in her future. She also interpreted that as reminder to have patience with herself. Change takes practice, time and practice such as she previously experienced while correcting her posture to manage her emotions and edit her negative thoughts into positive ones (Peper, Harvey, Cuellar, & Membrila, 2022). Whenever she would have pain or feel discouraged because of external circumstances, she would remind herself of three things:
A. I need to have patience with myself.
B. I have all the healing tools inside me and I am learning to use them.
C. If I do not make time for my wellness, I’ll be forced to make time for my illness.
5. Practice self-healing imagery as described by Peper, Gibney, & Holt (2002) and adapted from the work by Dr. Martin Rossman (Rossman, 2000). Imagery can be the communication channel between the conscious/voluntary and the unconscious/autonomic/involuntary nervous system (Bressler, 2005; Hadjibalassi et al, 2018; Rossman, 2019). It appears to act as the template and post-hypnotic suggestion to implement behavior change and may offer insight and ways to mobilize the self-healing potential (Battino, 2020). Imagery is dynamic and changeable.
The process of self-healing imagery consists of three parts.
- Inspection the problem and drawing a graphic illustration of the problem as it is experienced at that moment of time.
- Drawing of how that area/problem would look when being completely well/whole or disappeared.
- Creation of a self-healing process by which the problem would become transformed into health (Peper, Gibney & Holt, 2002, pp. 217-236). The process focused on what the person could do for themselves; namely, each time they became aware of, anticipated, or felt the problem, they would focus on the self-healing process. It provideshope; since, the person now focuses on the healing of the problem and becoming well.
The drawings of inspection of the pain and problem she experienced at that moment of time are shown in Figure 1.
Figure 1. Illustration of the problem of the pain. Thorns dug deep, muscles tight, and frozen vertebrates grinding.
The resolution of the problem and being well/whole are illustrated in Figure 2.
Figure 2. Resolution of the problem in which her muscles are warm, full of blood, free of thorns, relaxed and flexible and being whole happy and healthy in which her spine is warm, her muscles are warm, her back is flexible and full of movement.
Although she utilized the first image of the muscles warm, full of blood, free of thorns and the muscles relaxed and flexible, her second image of her fully being healed was inspired through a religious statue of Yemaya that she had in her room (Yemaya is a major water spirit from the Yoruba religion Santeria and Orisha of the seas and protector of women). Each time she saw the statue, she thought of the image of herself fully healed and embodying the spirit Orisha. Therefore, this image remained important to her all the time.
Her healing imagery process by which she transforms the image of inspecting of the problem to being totally well are illustrated in Figure 3.
Figure 3. The healing process: The sun’s warm fingers thaw my muscles, lubricate my vertebra, thorns fall out, and blood returns.
For five weeks as she implemented her self-healing project by creating a self-healing plan, asking questions of her unconscious, drawing her self-healing imagery. She also incorporated previously learned skills from the first part of the semester such diaphragmatic breathing, hand warming, shifting slouching to upright posture, and changing language. Initially she paired hand warming with the self-healing imagery and she could feel an increase in body warmth each time she practiced the imagery. She practiced the self-healing imagery as an in-depth daily practice and throughout the day when she became aware of her back as described in one of her log entries.
I repeated the same steps as the day prior today. I did my practice in the early morning but focused on the details of the slowed down movements of the sun’s hands. I saw them as they stretched out to my back, passed through my skin, wrapped around my muscles, and began to warm them. I focused on this image and tried to see, in realistic detail, my muscles with a little ice still on them, feeling hard through and through, the sun’s glowing yellow-orange fingers wrapped around my muscles. I imaged the thorns still in my muscles, though far fewer than when I started, and then I imaged the yellow-orange glow start to seep out from the sun’s palms and fingers and spread over my muscles. I imaged the tendons developing as the muscle tissue thawed and relaxed, the red of the muscle brightened, the ice on and within my muscles started to melt, and the condensation formed as it ran down into collected droplets at the bottom of my muscles. I imaged the thorns lose their grip and fall out, one at a time, in tandem with the droplets falling. I continued this process and imaged my muscles expanding with warmth and relaxation as they stayed engulfed in the warmth of the sun.
At the end of my practice, I did a small stretch session. I felt extremely refreshed and ready for yet another extremely busy day between internship, graduation, and school. I would say I felt warm and relaxed all the way into the afternoon, about 6 hours after my practice. This was by far the most detailed and impactful imagery practice I have had.
The self-healing imagery practice provided me with the ability to conceptualize more than my problem as it showed me the tools to (and the importance of) conceptualizing my solution, both the tool and end result.
Results
Pain and tightness decreased and she stopped her medication by the third week as shown in Figure 4.
Figure 4. Self-rating of sharp pains and tightness during the self-healing project.
At the 14-week follow-up, she has continued to improve, experiences minimal discomfort, and no longer takes medication. As she stated, I was so incredibly shocked how early on [in the project] I was able to stop taking pain medications that I had already taken every day for over a year.
Discussion
This individual case example provides hope that health can be improved when shifting the focus from pain and discomfort to focusing on actively participating in the self-healing process. As she wrote, The lesson was self- empowerment in regard to my health. I brought comfort to my back. There is metal in my back for the rest of my life and this is something I have accepted. I used to look at that as a horrible thing to have to handle forever. I now look at it as a beautiful contraption that has allowed me to walk across a graduation stage despite having literally shattered a vertebra. I am reintegrating these traumatized parts of my body back into a whole health state of mind and body. Doctors did not do this, surgeries did not, PT didn’t and neither did pain medications. MY body and MY mind did it. I did this.
Besides the self-healing imagery and acting upon the information she received from the asking questions from the unconscious there were many other factors contributed to her healing. These included the semester long self-practices and mastery of different stress management techniques, learning how stress impacts health and what can the person can do to self-regulate, as well as being introduced to the many case examples and research studies that suggested healing could be possible even in cases where it seemed impossible.
The other foundational components that was part of the class teachings included attending the weekly classes session and completing the assign homework practices. These covered discussion about placebo/nocebo, possibilities and examples of self-healing with visualization, the role of nutrition, psychophysiology of stress and factors are associated with healthy aging across cultures. The asynchronous assignments investigated factors that promoted or inhibited health and the role of hope. The discussions pointed out that not everyone may return to health; however, they can always be whole. For example, if a person loses a limb, the limb will not regrow. The healing process includes acceptance and creating new goals to achieve and live a meaningful life.
The possibility that students could benefit by implementing the different skills and concepts taught in the class were illustrated by sharing previous students’ successes in reversing disorders such as hair pulling, anxiety, psoriasis, and pain. In addition, students were assigned to watch and comment on videos of people who had overcome serious illness. These included Janine Shepherd’s 2012 TED talk, A broken body isn’t a broken person, and Dr. Terry Wahl’s 2011 TEDxIowaCity talk, Minding your mitochondria. Janine Shepard shared how she recovered from a very serious accident in which she became paralyzed to becoming an aecrobatic pilot instructor while Dr. Terry Wahl shares how she he used diet to cure her MS and get out of her wheelchair (Shepherd, 2012; Wahl, 2011). Other assignments included watching Madhu Anziani’s presentation, Healing from paralysis-Music (toning) to activate health, in which he discussed his recovery from being a quadriplegic to becoming an inspirational musician (Anziani, & Peper, 2021). The students as read and commented on student case examples of reversing acid reflux, irritable bowel and chronic headaches (Peper, Mason, & Huey, 2017a; Peper, Mason, & Huey, 2017b; Peper, 2018; Peper et al., 2020; Peper, Covell, & Matzembacker, 2021; Peper, 2022).
Although self-healing imagery appears to be the major component that facilitated the healing, it cannot be separated from the many other concepts and practices that may have contributed. For example, the previous practices of learning slow diaphragmatic breathing and hand warming may have allowed the imagery to become a real kinesthetic experience. In addition, by seeing how other students overcame chronic disorders, the class provided a framework to mobilize one’s health.
Lessons extracted from this case example that others may be able use to mobilize health.
- Take action to shifts from being hopeless and powerless to becoming empowered and active agent in the healing process.
- Change personal beliefs through experiential practices and storytelling that provides a framework that healing and improvement are possible.
- Teach the person self-regulation skills such as slower breathing, muscle relaxation, cognitive internal language changes, hand warming by which the person experiences changes.
- Provide believable role models who shared their struggle in overcoming traumatic injury, watch inspirational talks, and share previous clients or students’ self-reports who had previously improved.
- Transform the problem from global description into behavioral specific parts. For example, being depressed is a global statement and too big to work on. Breaking the global concept into specific behaviors such as, my energy is too low to do exercise or I have negative thoughts, would provide specific interventions to work on such as, increasing exercise or changing thoughts. In JC’s case, she changed the general rating of pain into ratings of muscle tightness and sharp pains. This provided the bases for strategies to relax and warm her muscles.
- Focus on what you can do at that moment versus focusing on the past, what happened, who caused it, or blaming yourself and others. Explore and ask what you now can do now to support your healing process and reframe the problem as a new opportunity for growth and development.
- Practice, practice, and practice with a childlike exploratory attitude. Focus on the small positive benefits that occur as a result of the practices. It is not mindless practice; it is practice while being present and being gentle with yourself. Do not discard very small changes. The benefits accrue as you practice more and more, just many people have experienced when learning to play a musical instrument or mastering a sport. Even though many participants think that practicing 15 minutes a day is enough, it usually takes much more time. Reflect on how a baby learns to walk or climb. The toddler practices day-long and takes naps to regenerate and grow. When the toddler is not yet successful in walking or climbing, it does not give up or interpret it as failure or blaming himself that he cannot do it, it just means more practice.
- Have external reminders to evoke the self-healing practices. In JC’s case, the small statue of Yemaya in her room was the reminder. It reminded her to thinks of the image of herself fully healed each time she saw it.
- Guide yourself through the wise one imagery, ask yourself a question and listen and act on the intuitional answers.
- Develop a self-healing imagery process that transforms the dysfunction to health or wholeness. Often the person only perceives the limitations and focusses on describing the problem. Instead, acknowledge, accept what was and is, and focus on developing a process to promote healing. What many people do not realize that if they think/imagine how their injury/illness was caused, it may reactivate and recreate the initial trauma. This can be illustrated through imagery. When we think or imagine something, it changes our physiology. For example, when one imagines eating a lemon, many people will salivate. The image affects physiology. Thus, focus on processes that support healing.
- While practicing the imagery, experience it as if it is real and feel it happening inside yourself. Many people initially find this challenging as they see it outside themselves. One way to increase the “felt sense” is to incorporate more body involvement such as acting out the imagery with hand and body movements.
- When having a relapse, remind yourself to keep going. Every morning is the beginning of a new day, do each practices anew. In addition, reflect of something that was challenging in the past but that you successfully overcame. Focus on that success. As JC wrote, I was also successful in that I gave myself slack and reminded myself that relapses will happen and what matters more is the steps I take to move forward.
- Make your healing a priority that means doing it often during the day. Allow the self-healing imagery and process to run in the back of the head all the time just as a worry can be present in the background. So often people practice for a few minutes (which is great and better than not practicing at all); however, at other times during the day they are captured by their worry, negative thoughts or focus on the limitations of the disorder. When a person focuses on the limitations, it may interrupt the self-healing process. The analogy we often use is that the healing process is similar to healing from a small cut in the skin. Initially a scab forms and eventually the scab falls off and the skin is healed. On the other hand, if you keep moving the skin or pick on the scab, healing is much slower. By focusing on the limitations and past visualization of the injury, self-healing is reduced. This is similar to removing the scab before the skin has healed. As JC stated, “If you don’t make time for your wellness, you’ll be forced to make time for your illness” was 100% a motivating factor in my success.
- Explore resources for providers and people living with pain. See Dr. Rachel Zoffness website which provides a trove of high quality articles, books, videos, apps, and podcasts. https://www.zoffness.com/resources
In summary, we do not know the limits of self-healing; however, this case example illustrates that by implementing self-healing strategies health and recovery occurred. As JC wrote:
To have broken a vertebra in my back and experience all the injuries that came with the accident when I already did not have the strongest mind-body connection was incredibly intense and really heartbreaking and discouraging in my life. And, that made things difficult because I was not able to 100% focus on my healing because I felt so overwhelmed by the feeling of discouragement that I felt. Experiencing this self-healing project, seeing the imagery that helped me not just feel so much better all the time but be able to stop taking all prescription pain medications and eliminate the sharp pains in my back has taught me that I have the skill set needed to be whole and healthy.
Watch the interview will Jillian Cosby inwhich she describes her self-healing process.
References
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Peper, E. (2018). Breathing reduces acid reflux and dysmenorrhea discomfort. the peperperspective. https://peperperspective.com/2018/10/04/breathing-reduces-acid-reflux-and-dysmenorrhea-discomfort/
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Peper, E., Gibney, K.H. & Holt. C. (2002). Make Health Happen: Training Yourself to Create Wellness. Dubuque, IA: Kendall-Hunt.ISBN: 978-0787293314 https://he.kendallhunt.com/make-health-happen
Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91 https://www.neuroregulation.org/article/view/22815/14575
Peper, E., Lin, I-M., Harvey, r., Gilbert, M. Gubbala, P, Ratkovich, A., & Fletcher, L. (2014). Transforming Chained Behaviors: Case Studies of Overcoming Smoking, Eczema, and Hair Pulling (Trichotillomania), Biofeedback, 42 (4), 154–160. https://doi.org/10.5298/1081-5937-42.4.06
Peper, E., Mason, L, & Huey, C. (2017a). Healing irritable bowel syndrome with diaphragmatic breathing. the peperperspective. https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/
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Peper, E., Miceli, B., & Harvey, R. (2016). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137. https://doi.org/10.5298/1081-5937-44.3.03
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Hope for insomnia, depression, anxiety, ADHD, exhaustion, and nasal congestion -Breathe light, slow and deep
Posted: July 9, 2022 Filed under: ADHD, behavior, Breathing/respiration, emotions, Exercise/movement, health, Pain/discomfort, relaxation, Uncategorized | Tags: allergies, anxiety, asthma, depression, hyperventilation, insomnia, nasal congestion, nose breathing Leave a commentAnxiety, depression, insomnia, exhaustion, ADHD, allergies, poor performance have all increased (Barendse et al., 2021; London & Landes, 2021; Peper et al, 2022a; Peper et al, 2022b; Vasileiadou et al, 2021). One of the unrecognized contributing factor is dysfunctional mouth breathing (McKeown, 2022). Improve health by learning to breathe in and out through the nose during the day and night. Listen to the inspiring presentation by Patrick McKeown, author of the superb book, The breathing cure-Develop new habits for a healthier, happier & long life (McKeown, 2022). In this presentation, he describes the science behind these disorders, the rationale for breathing light, slow and deep and offers simple breathing exercises to reduce symptoms and improve performance.
References
Barendse, M., Flannery, J., Cavanagh, C., Aristizabal, M., Becker, S. P., Berger, E., … & Pfeifer, J. (2021). Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: A collaborative of 12 samples from 3 countries. https://doi.org/10.31234/osf.io/hn7us
London, A.S. & Landes, S.D. (2021). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect. Journal of attention disorders, 25(6), 771-782. https://doi.org/10.1177/1087054719855689
McKeown, P. (2022). The breathing cure-Develop new habits for a healthier, happier & long life. West Palm Beach, FL: Humanix Books.
Peper, E. (2022). Reduce anxiety. the peperperspective. https://peperperspective.com/2022/03/23/reduce-anxiety/
Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022b). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91
Vasileiadou, S., Ekerljung, L., Bjerg, A., & Goksor, E. (2021). Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking. PLoS ONE, 16(6): e0253322. https://doi.org/10.1371/journal.pone.0253322
Hope for abdominal discomfort
Posted: June 21, 2022 Filed under: behavior, biofeedback, Breathing/respiration, emotions, Evolutionary perspective, healing, health, Pain/discomfort | Tags: functional abdominal pain, heart rate variability, HRV, IBS, irritable bowel syndrome, neurasthenia, Rap, recurrent abdominal pain, respiration 3 CommentsAdapted from: Peper, E. & Harvey, R. (2022). Nausea and GI discomfort: A biofeedback assessment model to create a rational for training. Biofeedback, 50(1), 24–32. https://doi.org/10.5298/1081-5937-50.1.05
Abdominal discomfort and pain such as functional abdominal pain, acid reflux or irritable bowel affects many people. Teaching slower biofeedback-assisted HRV breathing with biofeedback is a useful strategy by which the person may be able to reduce symptoms. This essay provides detailed instruction for a first session assessment for clients who have abdominal discomfort (functional abdominal pain). Descriptions include how the physiological recording can be used to understand a possible etiology of the illness, to create a biological/evolutionary based explanation that is readily understood by the client, and finally to offer self-regulation suggestions to improve health.
Background of abdominal discomfort (irritable bowel syndrome, acid reflux, functional abdominal pain, recurrent abdominal pain)
Irritable bowel syndrome (IBS) affects 7% to 21% of the general population in Western cultures with a global prevalence estimated at around 11% (Fairbrass, Costantino, Gracie, & Ford, 2020). The chronic symptoms (i.e., lasting more than 30 days) usually include abdominal cramping, discomfort or pain, bloating, loose or frequent stools and constipation, which can significantly reduce the quality of life (Chey et al., 2015). A precursor of IBS in children is called recurrent abdominal pain (RAP), which affects 0.3% to 19% of school children (Chitkara et al., 2005). Both IBS and RAP appear to be functional illnesses, as no organic causes have been identified to explain the symptoms. IBS and RAP are contrasted to various types of diseases such as Crohn’s disease, inflammatory bowel disease or ulcerative colitis.
Multiple factors may contribute to IBS, such as genetics, food allergies, previous treatment with antibiotics, infections, psychological status and stress. More recently, dietary factors contributing to changes in the intestinal and colonic microbiome resulting in small intestine bacterial overgrowth have been suggested as another risk factor (Dupont, 2014). Generally, standard medical treatments (reassurance, dietary manipulation and of pharmacological therapy) are often ineffective in reducing IBS symptoms (Chey et al., 2015). On the other hand, complementary and alternative approaches such as biofeedback-assisted relaxation techniques (Davidoff & Whitehead, 1996; Goldenberg et al., 2019; Stern et al. 2014), autogenic training (Luthe & Schultz, 1969) and cognitive therapy are more effective than traditional medical treatment (Vlieger et al., 2008).
Biofeedback-assisted relaxation training typically moderates IBS or RAP symptoms by restoring balance in the nervous system (sympathetic/parasympathetic autonomic balance), such as through heart rate variability (HRV) breathing training. For example, Sowder et al. (2010) as well as Sun et al. (2016) demonstrated that functional abdominal pain can be reduced with HRV feedback training. In most cases, increased vagal tone was achieved by breathing at about six breaths per minute. While Taneja et al. (2004) reported that yogic breathing decreased diarrhea-predominant irritable bowel syndrome symptoms significantly more than conventional treatment in a randomized control study.Sympathetic/parasympathetic balance can be enhanced by increasing HRV, which occurs when a person breathes at their resonant frequency, which is usually 5–7 breaths per minute. For most people, the HRV training means breathing at much slower rate. A benefit of slow abdominal breathing appears to be a self-control strategy that can reduce symptoms of IBS, RAP and similar functional abdominal pain symptoms.
Mastery of effortless diaphragmatic breathing can be affected by injury, surgery or similar insults to the abdominal area (Peper et al., 2015). In addition, dysregulation of diaphragm, which is enervated by the phrenic nerve and the vagus nerve, along with dysregulation of other abdominal muscles appears to be associated with irritable bowel syndrome (Bordoni & Morabito, 2018). It is likely that slower biofeedback-assisted HRV breathing training restores abdominal muscles and diaphragmatic movement, theoretically by tonic and phasic regulation of the phrenic and vagal nerve activity (cf. Marchenko et al., 2015; Streeter et al., 2012). The theory, simply stated, is that HRV breathing training at an individual’s resonant frequency produces increases in regulatory neurotransmitters, particularly gamma amino butyric acid (GABA). Many of our students who complain of abdominal discomfort report reductions of symptoms following HRV breathing training.
Consistently for more than 40 years, we have taught undergraduate students a semester-long integrated stress management program that includes modified progressive relaxation, slow diaphragmatic breathing and changing internal language as outlined in the book, Make Health Happen, by Peper, Gibney & Holt (2002). At the end of each semester, numerous students report that their anxiety, gastrointestinal distress and other symptoms related to self-described IBS or RAP have decreased or disappeared (Peper et al., 2014; Peper, Miceli, & Harvey, 2016; Peper, Mason, Huey, 2017; Peper et al., 2020). Abdominal discomfort is prevalent experience of distress by college students. In our recent survey of 99 undergraduate students, 41% self-reported abdominal discomfort (25% irritable bowel or acid reflux), 86% self-reported anxiety, 70% neck and shoulder tension and 48% headaches. After practicing slower breathing (i.e., typically directing them to breath abdominally at a rate of about six breaths a minute) and focus on slower exhalation and allowing the air to flow in without effort as the abdominal wall expands, as a homework assignment for a week, many reported that their symptoms significantly decreased (Peper, Harvey, Cuellar, & Membrila, in press).
Case example illustrating how to use the physiological recording to guide the client discussion and provide motivation
A 16-year-old high school junior suffered from abdomen discomfort for years. The symptoms mainly consisted of frequent constipation, and when it occurred, great discomfort from nausea. After having been diagnosed and undergoing all the necessary tests by the gastroenterologist, there was no identifiable cause of the chief complaints. Biofeedback was suggested as an alternative to medications for symptom reduction. During the biofeedback assessment and training session, the client discussed what she would like to learn from the session. It was challenging for her to respond to those questions. Not being able to report what the client would like from a training session is also a very common experience when working with students. A useful strategy is to describe experiences of other students that the clients could relate to, and imply that their abdominal discomfort is somewhat commonplace in other students.
Discussed during the session was the link between being very sensitive and reactive to other people’s feeling and being concerned about what others think of her. The client nodded her head in agreement. When describing herself, she discussed being very perfectionistic using a scale from being lackadaisical/undemanding to being perfectionistic (i.e., self-oriented perfectionism, self-worth contingencies, concern over mistakes, doubts about actions, self-criticism, socially prescribed perfectionism, other-oriented perfectionism, hypercriticism; see Smith, Saklofske, Stoeber, & Sherry, 2016).
Furthermore, the client sat slouched in the chair. Possibly her slouched posture implied a state of powerlessness instead of empowerment, a state of being ready to react and protect (Carney, Cuddy, & Yap, 2010; Cuddy, 2012; Peper, Lin, & Harvey, 2017).
Working hypotheses. The client was very sensitive and continuously reacted to external and internal signals with sympathetic arousal, while masking her reactions. These ongoing flight/flight responses would decrease intestinal peristalsis and abdominal blood flow, which would result in nausea, constipation and abdominal distress. Namely, the body reacts to the stimuli as signals of danger and blood flow is shunted away from the abdomen into the large muscles to run and fight. To paraphrase Stanford University professor Robert Sapolsky (2004): Why should the body digest food and repair itself, if it is going to be the predator’s lunch? It is only when we are safe that we can digest and regenerate.
The session began by exploring how pressure on the abdomen could potentially affect experiences of nausea and abdominal distress. After explaining how the diaphragm descends and how abdominal content in the stomach can be displaced (spread out) during inhalation, we systematically changed her posture by placing and adjusting a small pillow behind her middle back so that she could sit tall. The tall posture resulted in an open feeling of empowerment not felt during slouching. She observed that breathing was slightly easier and felt there was more space in her abdomen. As she began to feel more comfortable during the training session, we discussed the impact of posture on the body. We also discussed the relationship between thoughts of perfectionism and abdominal discomfort. The discussion also included an exploration of why some people tend to curl-up and slouch in a protective posture (e.g., head down to protect the neck region and big bones of the arms and legs positioned to protect the core organs) when feeling self-consciousness or perfectionistic about body image.
Biofeedback monitoring for assessment
Psychophysiology was recorded with multichannel physiological system (Procomp Infinity System running Biograph Infinity software version 6.7.1, Thought Technology Ltd). Respiration was monitored with strain-gauge sensors placed around the abdomen and thoracic regions (for a discussion on sensor placement see Peper et al., 2016 and Chu et al., 2019). Blood volume pulse was recorded with the sensor placed on the left thumb. The thumb was used because the participant had small and cold fingers (for a discussion about blood volume pulse, see Peper et al, 2007 and Peper, Shafer, & Lin, 2010). Skin conductance was recorded with the sensor wrapped around the left index and middle fingers with the electrodes on the finger pads (for a discussion about skin conductance and normal values, see Khazan, 2019, and Shafer et al, 2016).
After sensors were attached and the signals explained, the client sat comfortably while looking at the screen. Unexpectedly the clinician clapped his hands and made a loud noise. The client reacted with a momentary startle and smile. The physiological response, showed an increase in skin conductance, decrease in pulse amplitude, decrease in abdominal diameter, and increase in heart rate, is shown in Figure 1.
Figure 1. Physiological response to a loud noise (clap) (1) increased skin conductance, (2) decrease in pulse amplitude, (3) decrease in decreased abdominal circumference, and (4) increased heart rate and decreased heart rate variability.
The client was aware that she reacted to the clap; however, she was totally unaware how much her body responded. The computer screen display of her physiological reaction made the invisible visible. It provided the opportunity to discuss how various body reactions related to heart rate, breathing, and skin conductance could contribute to experiences of abdominal discomfort.
She was unaware that skin conductance did not return to baseline levels for more than 20 minutes. An elevated skin conductance level may mean that the body’s reaction to the hand-clap noise triggered a defense reaction and maintained the increased sympathetic activity for more than 20 minutes. Having a sustained flight/fight reaction to external stimuli such as a hand-clap would most likely affect digestive and peristalsis processes, contributing to symptoms found in IBS and RAP. The observations made during biofeedback monitoring led to a discussion of how sympathetic activation affects the gastrointestinal track.
Blood volume pulse amplitude decreased, which indicated a decrease in blood flow through her hands, which would decrease hand temperature and again indicated a systemic sympathetic activation.
Abdominal circumference decreased, which indicated that she tightened her abdominal muscles as a protective response to the hand-clap. She was unaware of the abdominal muscles tightening; however, she stated that she was aware that her breathing had changed. The abdominal muscle, which pulled the abdomen in, took almost two minutes to relax. The sustained muscle constriction around the abdomen increased pressure around the core organs, which may contribute to ongoing abdominal discomfort. A fight-flight reaction includes body bracing (e.g. tightened muscles, head down to protect the neck, big bones of arms and legs curled to protect core organs), and she confirmed that she experienced neck and shoulder tensions.
The discussion of abdominal muscle tension led to another discussion of how holding your stomach in may relate to self-image. For example, tight clothing can contribute to constricted movement around the abdomen. Wearing corsets contributed to psychophysiological symptoms, mainly for women in the late 19th and early 20th centuries, during a time when women who wore very tight corsets were diagnosed with neurasthenia. Simply stated, neurasthenia was characterized as a condition of mental and/or physical fatigue with at least two of the following symptoms: dyspepsia, dizziness, muscular aches or pains, tension headaches, inability to relax, irritability and sleep disturbance.
“Dyspepsia” was the commonly reported symptom of neurasthenia, which included upset stomach, a gnawing or burning stomach pain, heartburn, bloating, and or burping, nausea, and vomiting. The constricted waist region that resulted from wearing a corset in the name of fashion compromises the functions of both digestion and breathing. When the person inhales, the abdomen cannot expand as the diaphragm is flattening and pushing downward. Thus, the person is forced to breathe more shallowly by lifting their ribs; this increases neck and shoulder tension as well as the risk of anxiety, heart palpitation, and fatigue (Cohen & White, 1947; Courtney, 2009).
It also can contribute to abdominal discomfort since the abdomen is being squeezed by the corset and forcing the abdominal organs upward. Even architects of the Victorian era recognized a need for a place to position a chair or chaise lounge, such as at the top of some stairs, because people wearing corsets could faint, pass out or otherwise experience breathlessness through the effort of climbing the stairs with restrictive clothing around their abdomen (Melissa, 2015). Many of these symptoms could be easily reduced by wearing looser clothing and learning slower diaphragmatic breathing. In modern times, a related phenomenon results when people wear items of clothing that are too tight around their waist or abdomen (e.g., tight jeans) in service to fashion trends often labeled as designer jean syndrome (MacHose & Peper, 1991; Stonehewer, 2009). Similarly, when people wear garments that are too tight around their chest or thoracic region (e.g., tight vests) in service to external protection (e.g., athletes, industrial workers, police or soldiers wearing heavy, restrictive gear), then restrictive ventilatory disorders can occur (Harty et al., 1999). Simply stated, when the muscles related to breathing are restricted from moving, respiration is affected.
The client’s heart rate increased and stayed high for more than 30 seconds. The first decrease in heart rate at about 20 seconds after the hand-clap was a long sigh of relief as breathing (i.e., oxygen/carbon dioxide exchange) started again. It took almost 90 seconds before breathing and heart rate returned to normal as reflected by measures of HRV. The computer screen showing increased heart rate was reviewed with the client to explain how her body reacted with a fight-flight response to the hand-clap, as well as how regulating breathing through biofeedback training could lower the heart rate and reduce the sympathetic activation and enhance the parasympathetic activation.
Body responds to cognitive stressful thoughts
After discussion about the psychophysiological response to the hand-clap (a physical external stressor) and how other external stressors (e.g., startling noise) or internal stressors (e.g., perfectionistic ruminations) could trigger a similar response of abdominal muscle tightening, the assessment was repeated by having her relax and then think about a mental stressor, as shown in Figure 2.
Figure 2. Physiological responses to thinking about a past stressor (1) increased skin conductance, (2) decreased pulse amplitude, (3) decreased abdominal circumference, and (4) increased heart rate and decreased HRV.
The physiological response pattern to thinking about a past stressor was similar to the bodily reaction to a loud noise. The skin conductance increased and blood volume pulse amplitude decreased immediately after hearing (e.g., anticipating) the task of evoking/thinking of a past stressor. Most likely, the initial response was triggered by performance anxiety, then 6 seconds later the heart rate increased and breathing changed as she began experiencing the somatic reaction evoked by the recall of a negative stressor. The recordings also showed that her pulse amplitude decreased. The decrease in pulse amplitude suggested that her hands would probably become colder, which was confirmed by her self-report that she often experienced cold hands and feet. She reported being aware of the feeling an emotional reaction, but mainly noticing the change of breathing in her chest, and she was unaware of the abdominal changes. The client was surprised by how her body reacted to emotional thoughts. The recording viewed on the computer screen demonstrated objectively that her thoughts (initial performance anxiety) had a physical effect on her body. Specifically, experiencing the emotions that were evoked by recalling the stressful memory had a direct effect on the body in the same way that a physical external threat leads to a fight-flight response.
Building a psychophysiological model
Using these recorded computer images reflecting physical reactions to the hand clap and emotional thoughts, the discussion focused on how abdominal discomfort could be the result of activating a normal biological survival response. Survival responses would occur hundreds of times throughout a day, especially when worrying. Each thought would evoke the response, and the awareness of body reaction would evoke another reaction. Similar to how awareness of blushing amplifies blushing.
The client shared that she was very sensitive and reactive especially when other people were upset. She reported feeling “cursed” by their sensitivity and reactivity. The linguistic metaphor that could be used to describe her reactions is “she could not stomach what was going on.”
The discussion about physiological reactions provided the client with a model how her disorder (IBS and RAP) could have developed and been maintained over the years. The model matched her subjective experience: when stressed, the discomfort often increased. The discussion shifted to reframing her internal labels. Instead of describing her sensitivity as a curse, the sensitivity was reframed and labeled a gift; namely, she could sense many people’s emotional reactions, to which they would react in a variety of ways. She just needed to learn how to manage this sensitivity. Once she learned to manage it, she would have many advantages in interpersonal relations at home and at work. She would be able to sense what other people are experiencing. By reframing her symptoms as a result of a survival physiological response pattern, it reduces self- blame and offers solutions about how to master and change reactions and thereby have more control in the world.
Training to demonstrate control is possible.
The discussion was followed by teaching her diaphragmatic breathing in sitting and lying down positions. As she had no history of abdominal injuries, similar to many of our students, she rapidly demonstrated slower diaphragmatic breathing as shown in Figures 3 and 4.
Figure 3. The client practiced a few slower diaphragmatic breaths in the sitting and reclining position, which increased heart rate variability, decreased skin conductance and increased blood volume pulse amplitude.
Figure 4. Practicing slower diaphragmatic breathing at about six breaths per minute in a reclining position increased HRV.
With tactile coaching, she demonstrated that she could breathe at about six breaths per minute with the heart rate increasing during inhalation and decreasing during exhalation. She reported feeling more relaxed and that the sensations of nausea had disappeared. Additionally, her hands felt warmer. This recording provided proof that there was hope and that she could do something about her body’s psychophysiological responses.
The discussion focused on how breathing affecting heart rate variability. Namely, if she allowed exhalation to occur without effort, her heart rate decreased (the vagal response of slowing the heart) and thereby increased the parasympathetic activation that would support digestion and gastrointestinal functioning. Often when people practice effortless diaphragmatic breathing, abdominal noises (borborygmus)– the gurgling, rumbling, or squeaking noise from the abdomen–occur and indicate that intestinal activity is being activated, and that food, liquids and digestive juice are moving through the intestines. It is usually a positive indicator that the person is relaxing and sympathetic activity has been reduced.
During the last part of session, we reviewed how posture affects physiology, emotions and cognitions, as well as how posture and breathing would be the first step in beginning to reduce symptoms and enhance health. To provide additional information using video and bibliotherapy/education, we suggested that she watches the embedded videos in the blogs listed at the end of the article.
Recommendations for future sessions and home practice
The recommended strategies for future sessions would focus on teaching the client to master slow diaphragmatic breathing and practicing that for 10–20 minutes per day. The teaching techniques would incorporate imagery to imagine air flowing down their arms and legs as she exhaled. . More importantly, the focus would shift to generalize the skill during the day; namely, whenever she would become aware of feeling stressed or observed herself holding her breath or breathing in her chest, she would use that as the cue to shift to slower abdominal breathing. Had the client continued training, future sessions would focus on mastering slower diaphragmatic breathing. The training would include relaxing the lower abdominal muscles during inhalation, increasing control of HRV, practicing imagining stress and use image to trigger slower breathing, and cognitive reframing practices to interrupt worrying and promote self-acceptance. The final goal is to generalize these skills into daily life as illustrated in the successful cases described in the following blogs
Blogs on posture:
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the peper perspective 