Suggestions for mastering and generalizing breathing skills
Posted: October 30, 2024 Filed under: attention, behavior, biofeedback, Breathing/respiration, CBT, cellphone, cognitive behavior therapy, emotions, ergonomics, healing, health, mindfulness, Neck and shoulder discomfort, Pain/discomfort, posture, relaxation, self-healing, stress management, Uncategorized | Tags: abdominal beathing, anxiety, diaphragmatic braething, health, hyperventilation, meditation, mental-health, mindfulness, mouth breathing, Toning 3 CommentsAdapted from: Peper, E., Oded, Y., Harvey, R., Hughes, P., Ingram, H., & Martinez, E. (2024). Breathing for health: Mastering and generalizing breathing skills. Townsend Letter-Innovative Health Perspectives. November 15, 2024. https://townsendletter.com/suggestions-for-mastering-and-generalizing-breathing-skills/
Breathing techniques are commonly employed with complimentary treatments, biofeedback, neurofeedback or adjunctive therapeutic strategies to reduce stress and symptoms associated with excessive sympathetic arousal such as anxiety, high blood pressure, insomnia, or gastrointestinal discomfort. Even though it seems so simple, some participants experience difficulty in mastering effortless breathing and/or transferring slow breathing skills into daily life. The purpose of this article is to describe: 1) factors that may interfere with learning slow diaphragmatic breathing (also called cadence or paced breathing, HRV or resonant frequency breathing along with other names), 2) challenges that may occur when learning diaphragmatic breathing, and 3) strategies to generalize the effortless breathing into daily life.
Background
A simple two-item to-do list could be: ‘Breathe in, breathe out.’ Simple things are not always easy to master. Mastering and implementing effortless ‘diaphragmatic’ or ‘abdominal belly’ breathing may be simple, yet not easy. Breathing is a dynamic process that involves the diaphragm, abdominal, pelvic floor and intercostal muscles that can include synchronizing the functions of the heart and lungs and may result in cardio-respiratory synchrony or coupling, as well as ‘heart-rate variability breathing training (Codrons et al., 2014; Dick et al., 2014; Elstad et al., 2018; Maric et al., 2020; Matic et al., 2020). Improving heart-rate variability is a useful approach to reduce symptoms of stress and promotes health and reduce anxiety, asthma, blood pressure, insomnia, gastrointestinal discomfort and many other symptoms associated with excessive sympathetic activity (Lehrer & Gevirtz, 2014; Xiao et al., 2017; Jerath et al., 2019; Chung et al., 2021; Magnon et al., 2021; Peper et al., 2022).
Breathing can be effortful and In some cases people have dysfunctional breathing patterns such as breath holding, rapid breathing (hyperventilation), shallow breathing and lack of abdominal movement. This usually occurs without awareness and may contribute to illness onset and maintenance. When participants learn and implement effortless breathing, symptoms often are reduced. For example, when college students are asked to practice effortless diaphragmatic breathing twenty-minutes a day for one week, as well as transform during the day dysfunction breathing patterns into diaphragmatic breathing, they report a reduction in shallow breathing, breath holding,, and a decrease of symptoms as shown in Fig 1 (Peper et al, 2022).
Figure 1. Percent of people who reported that their initial symptoms improved after practicing slow diaphragmatic breathing for twenty minutes per day over the course of a week (reproduced from: Peper et al, 2022).
Most students became aware of their dysfunctional breathing and substituted slow, diaphragmatic breathing whenever they realized they were under stress; however, some students had difficulty mastering ‘effortless’ (e.g., automated, non-volitional) slow, diaphragmatic breathing that allowed abdominal expansion during inhalation.
Among those had more difficulty, they tended to have almost no abdominal movement (expansion during inhalation and abdominal constriction during exhalation). They tended to breathe shallowly as well as quickly in their chest using the accessory muscles of breathing (sternocleidomastoid, pectoralis major and minor, serratus anterior, latissimus dorsi, and serratus posterior superior).
The lack of abdominal movement during breathing reduced the movement of lymph as well as venous blood return in the abdomen; since; the movement of the diaphragm (the expansion and constriction of the abdomen) acts a pump. Breathing predominantly in the chest may increase the risk of anxiety, neck, back and shoulder pain as well as increase abdominal discomfort, acid reflux, irritable bowel, dysmenorrhea and pelvic floor pain (Banushi et al., 2023; Salah et al., 2023; Peper & Cohen, 2017; Peper et al., 2017; Peper et al., 2020, Peper et al., 2023). Learning slow, diaphragmatic or effortless breathing at about six breaths per minute (resonant frequency ) is also an ‘active ingredient’ in heartrate variability (HRV) training (Steffen et al., 2017; Shaffer & Meehan, 2020).
1. Factors that interfere with slow, diaphragmatic breathing
Difficulty allowing the skeletal and visceral muscles in the abdomen to expand or constrict in ‘three-dimensions’ (e.g., all around you in 360 degrees) during inhalation or exhalation. Whereas internal factors under volitional control and will mediate breathing practices, external factors can restrict and moderate the movement of the muscles. For example:
Clothing restrictions (designer jeans syndrome). The clothing is too tight around the abdomen; thereby, the abdomen cannot expand (MacHose & Peper, 1991; Peper et al., 2016). An extreme example were the corsets worn in the late 19th century that was correlated with numerous illnesses.
Suggested solutions and recommendations: Explain the physiology of breathing and how breathing occurs by the diaphragmatic movement. Discuss how babies and dogs breathe when they are relaxed; namely, the predominant movement is in the abdomen while the chest is relaxed. This would also be true when a person is sitting or standing tall. Discuss what happens when the person is eating and feels full and how they feel better when they loosen their waist constriction. When their belt is loosened or the waist button of their pants is undone, they usually feel better.
Experiential practice. If the person is wearing a belt, have the person purposely tighten their belt so that the circumference of the stomach is made much smaller. If the person is not wearing a belt, have them circle their waist with their hands and compress it so that the abdomen can not expand. Have them compare breathing with the constricted waist versus when the belt is loosened and then describe what they experienced.
Most participants will feel it is easier to breathe and much more comfortable when the abdomen is not constricted.
Previous abdominal injury. When a person has had abdominal surgery (e.g., Cesarean section, appendectomy, hernia repair, or episiotomy), they unknowingly may have learned to avoid pain by not moving (relaxing or tensing) the abdomen muscles (Peper et al., 2015; Peper et al., 2016). Each time the abdomen expands or constricts, it would have pulled on the injured area or stitches that would have cause pain. The body immediately learns to limit movement in the affected area to avoid pain. The reduction in abdominal movement becomes the new normal ‘feeling’ of abdominal muscle inactivity and is integrated in all daily activities. This is a process known as ‘learned disuse’ (Taub et al., 2006). In some cases, learned disuse may be combined with fear that abdominal movement may cause harm or injury such as after having a kidney transplant. The reduction in abdominal movement induces shallow thoracic breathing which could increase the risk of anxiety and would reduce abdominal venous and lymph circulation that my interfere with the healing.
Suggested solutions and recommendations. Discuss the concept of learned disuse and have participant practice abdominal movement and lower and slower breathing.
Experiential practices: Practicing abdominal movements
Sit straight up and purposely exhale while pulling the abdomen in and upward and inhale while expanding the abdomen. Even with these instructions, some people may continue to breathe in their chest. To limit chest movement, have the person interlock their hands and bring them up to the ceiling while going back as far as possible. This would lock the shoulders and allows the abdomen to elongate and thereby increase the diaphragmatic movement by allowing the abdomen to expand. If people initially have held their abdomen chronically tight then the initial expansion of abdomen by relaxing those muscle occurs with staccato movement. When the person becomes more skilled relaxing the abdominal muscles during inhalation the movement becomes smoother.
Make a “psssssst” sound while exhaling. Sit tall and erect and slightly pull in and up the abdominal wall and feel the anus tightening (pulling the pelvic floor up) while making the sound. Then allow inhalation to occur by relaxing the stomach and feeling the anus go down.
Use your hands as feedback. Sit up straight, placing one hand on the chest and another on the abdomen. While breathing feel the expansion of the abdomen and the contraction of the abdomen during exhalation. Use a mirror to monitor the chest-muscle movement to ensure there is limited rising and falling in this area.
Observe the effect of collapsed sitting. When sitting with the lower back curled, there is limited movement in the lower abdomen (between the pubic region and the umbilicus/belly button) and the breathing movement is shallower without any lower pelvic involvement (Kang et al., 2016). This is a common position of people who are working at their computer or looking at their cellphone.
Experiential practice: looking at your cellphone
Sit in a collapsed position and look down at your cellphone. Look at the screen and text as quickly as possible.
Compare this to sitting up and then lift the cell phone at eye level while looking straight ahead at the cellphone. Look at the screen and text as quickly as possible.
Observe how the position effected your breathing and peripheral awareness. Most likely, your experience is similar those reported by students. Close to 85%% of students who complete this activity reported that their breathing was shallower sitting slouched versus erect and about 85% of the students reported that their peripheral awareness and vision improved when sitting erect (Peper et al., 2024).
Suggested solutions and recommendations. Be aware how posture affect breathing. While sitting, place a rolled-up towel against the lower back so that the person sits more erect which would allow the abdomen to expand when inhaling.
Self-image, self-esteem, and confidence. Participants may hold their abdomen in because they want to look slim (sometimes labeled as the “hourglass syndrome” associate expanding the abdomen as unattractive (PTI, 2023). A flat abdomen is culturally reinforced by social media and fashion models and encouraged in some activities such as ballet. On the other hand, some people purposely puff up their chest to increase size and dominance (Cohen & Leung, 2009).
Suggested solutions and recommendations. Discuss the benefits of diaphragmatic breathing including its ability to reduce anxiety in social settings that may enhance confidence. Similar to an earlier suggestion, have the person explore clothing with a looser waist that still supports feelings of attractiveness and power.
Feeling anxious, fearful or threatened. The normal physiological stress reaction is a slight gasp with the tightening of the abdomen muscles for protection when a stressor occurs (Gilbert, 1998; Ekerholt & Bergland., 2008). The stressor can be an actual physical event, social situation or thoughts and emotions. Shallow breathing is a natural self-protective response. This pattern is often maintained until one feels ‘safe’ enough to relax, which for many can have a duration of the entire day or until finding the relative safety of sleep.
Suggested solutions and recommendations. Discuss how the physiological stress reaction is a normal response pattern that the person most likely learned in early childhood for self-protection. This pattern is often observed in clients who are emotionally sensitive and/or react excessively to a variety of stimuli. Note that some people have learned not to show their reactivity on their face or in the overt behaviors, yet they continue to breathe shallowly as a telltale sign of ‘distress.’ People who breath shallowly may experience this response as burdensome. Discuss with them how to reframe their sensitivity as a gift; namely, they are more aware of other people’s reactions and emotions. They just need to learn how not to respond automatically. Encourage awareness of their breath-holding and shallow breathing. Follow this by teaching them to replace the dysfunctional breathing with slow, diaphragmatic breathing at 6-breaths-per-minute. A possible training sequence is the following:
- Teach slow, diaphragmatic breathing
- Practice evoking a stressor and the moment the client senses the stress response, shallow breaths or holds their breath have them shift to slow, diaphragmatic breathing.
- If the person slouches in response to stress, the moment they become aware of slouching, have then sit erect, look up and then breathe diaphragmatically. (Peper et al., 2019)
Experiential practice: Transform stressful thoughts by looking up, breathing, and changing thoughts.
Evoke a stressor and then attempt to reframe the experience (cognitive behavior therapy or CBT approach).
Compare this to evoking a stressor, then shift to an upright position while looking up, take a few slow, diaphragmatic breaths, and reframe the experience.
In almost all cases, when the client shifts position, looks up and then reframes, the stress reaction is significantly reduced and it is much easier to reframe the experiences positively compared to when only attempting to reframe the experience (Peper et al., 2019).
Diaphragmatic breathing feels abnormal. How you breathe habitually is what feels normal unless there is overt illness such as asthma or emphysema. Any new pattern usually feels abnormal. When the person shifts their breathing pattern, such as in a transition from habitual shallow chest breathing to slower diaphragmatic abdominal breathing, it feels strange and wrong.
Suggested solutions and recommendations. Discuss the concept that habitual patterns are normal (e.g., a person who typically slouches when standing straight may experience that they are going to fall backwards). Emphasize the importance of making a shift in posture and leaning into the discomfort of the new experience. Often after practicing slow diaphragmatic breathing, the person may report feeling much more relaxed (e.g., sensing heaviness and warmth) with their fingers increasing in temperature.
2. Challenges that may occur when learning diaphragmatic breathing
Ideally, breathing is an effortless diaphragmatic process as described by the phrase, “it breathes me” (Luthe & Schultz, 1970; Luthe, 1979); however, some participants struggle to achieve this type of breathing. The following are common challenges and possible solutions:
Distraction and internal dialogue. Many people struggle with thoughts jumping from one area to another. Some people refer to this mental state as “monkey mind.”
Suggested solutions and recommendations. Validate that distraction and internal dialogue are normal and require continual managing and practice to overcome. Experimental Practice: Have the person train focus during diaphragmatic breathing techniques by focusing on 1 item in the room. Remind them that when thoughts arise, note them briefly instead of engaging with them and then refocus on the item. Start with increments of time and increase with practice.
Effect of gravity on breathing. In the vertical position, exhalation occurs when the abdomen constricts (slight tightening of the transverse and oblique abdominal muscles and the pelvic floor) pushes the diaphragm up, allowing the air to go out. It needs to push against gravity.
In the vertical position, inhalation occurs when the abdominal muscles and pelvic floor muscles relax and the abdomen widens in all directions (360 degrees) which causes the diaphragm to descend as it is being pulled down by gravity. This process allows effortless inhalation. The experience is the opposite when lying supine on one’s back. While lying down, gravity pulls on the abdomen that cause the diaphragm to go upward allowing the air to flow out during exhalation. Inhalation takes work because as the diaphragm descends it has to push the abdominal content upward against gravity.
Experiential practice: Erect versus supine
- Vertical position. Begin by exhaling completely by pulling the abdomen in and up while staying erect and not pressing/contracting the chest downward. At the end of exhalation, allow the abdomen to relax (pop out) and feel how the air is sucked in without trying to inhale
- Horizontal position. Begin by lying down, with the face pointing up. Inhale by expanding your abdomen and pushing your abdomen upward against gravity. Then let exhalation occur while totally relaxing as gravity pushes the abdomen downward, which pushes the diaphragm upward into the chest allowing the air to flow out. Optionally, place a small bag of rice/beans (e.g., approximately one to five pound or. One-half to two kilograms) on your lower abdomen while lying down. When you inhale, push the weight upward and away from you by allowing the stomach, but not the chest, to expand. Allow exhalation to occur as the weight pushes your abdomen down and upward into your chest. The weight is useful as it allows the mind to focus more easily on the task of feeling the movement of the abdomen.
Over breathing/hyperventilation. Even breathing at about six breaths per minute can cause hyperventilation can occur. Hyperventilation occurs when a person is breathing in excess of the metabolic needs of the body and thereby eliminating more carbon dioxide. The result is respiratory alkalosis and an elevated blood pH as the dissolved carbon dioxide (pCO2) in the blood is reduced (Folgering, 1999).
The most common symptoms of over breathing are colder sweaty hands and light-headedness. If this starts to occur, focus on decreasing the airflow during exhalation by exhaling through pursed lips making the sound, “Pssssssst.” While making this sound, make the sound softer with less airflow. Alternatively, have them imagine a holding a dandelion flower a few inches from their lips and blow so softly the seeds do not blow away. The blowing away of the seed is the feedback that you are blowing to hard as shown in Figure 2.
Figure 2. Dandelion seeds as feedback when the person is blowing with too much effort. Alternatively, we recommend that the client imagine smelling the scent/fragrance of a flower that usually causes nose inhalation and then exhale gently through pursed lips ast if the air flows over a candle and, the flame does not move back and forth.
Mouth breathing. Mouth breathing contributes to disturbed sleep, snoring, sleep apnea, dry mouth upon waking, fatigue, allergies, ear infections, attention deficit disorders, crowded miss-aligned teeth, and poorer quality of life (Kahn & Ehrlich, 2018). Even the risk of ear infections in children is 2.4 time higher for mouth breathers than nasal breathers (van Bon et al, 1989) and nine and ten year old children who mouth breath have significantly poorer quality of life and have higher use of medications (Leal et al, 2016).
Breathing through the nose is associated with deeper and slower breathing rate than mouth breathing. Nose breathing reduces airway irritation since the nose filters, humidifies, warms/cools the inhaled air as well as reduces the air turbulence in the upper airways. The epithelial cells of the nasal cavities produce nitric oxide that are carried into the lungs when inhaling during nasal breathing (Lundberg & Weitzberg, 1999). The nitric oxide contributes to healthy respiratory function by promoting vasodilation, aiding in airway clearance, exerting antimicrobial effects, and regulating inflammation (McKeown, 2019; Allen, 2024). Note that alternate nostril breathing, such as breathing in one nostril for 5-seconds and out of the other for 5-seconds is another technique which some people find beneficial.
Slower breathing approaches also facilitates sympathetic parasympathetic balance and reduces airway irritation. If the person breathes habitually through their mouth, refer them to health care provider to explore factors that may contribute to mouth breathing such as enlarged tonsils and adenoids or deviated septum. In addition, explore environmental factors that could contribute nasal inflammation such as allergies or foods such as dairy (Al-Raby, 2016).
Performance anxiety. Many participants are concerned about their performance. The direct instructions such as “follow the graphic” causes the person to try hard to breathe with too much effort. Explore some of the following indirect strategies to interrupt ongoing cognitive judgements and self-talk.
- Toning or humming (Peper et al., 2019a). While exhaling, have the person hum a sound with their mouth closed. Let the sound go for about 6 seconds, relax, inhale and hum again. Toning is very similar except you verbalize a tone such as “Oammm.” (For detailed instructions on toning, see: Anziani & Peper (2021)).
- Stroking down arms and legs during exhalation. Have a partner gently stroke down your arms from your shoulder past your fingertips as you are exhaling. The downward stroking is in rhythm with the exhalation. As the arm is being stroked, attend to the sensations going down the arms. Be sure that the toucher exhales at the same time and the stroking down the arm takes about six seconds. After being stroked for a few times, have the person imagine that each time they exhale they feel a flow down through their arms and out their fingers.
- Repeat the same process while stroking down the legs from the side of their hips to their toes.
- Finally, have the person imagine/feel the sensation streaming down their legs with each exhalation.
- Many participants will report that they sense a steaming going down their arms, that they hands warm up, and their thought have stopped.
- Integrated body movement with breathing especially flexion and contraction (Meehan & Shaffer, 2023). Integrate the normal response of flexion that induces exhalation and extension evokes inhalation. Be careful that the flexion movement does not encourage participants to compress their chest during exhalation, which tends to encourage chest breathing. Have the person focus on their head staying tall and erect. Have the person sit straight up with their feet slight apart and their hands palm down on their lap. Allow inhaling to initiate as the person simultaneously arches their lower back expanding the stomach, separating the knees and turning the hands palm up. Initiate exhalation while simultaneously bringing the knees together, turning the palms face down on the thighs and rolling the pelvic back slightly rounding the lower back. Do the movements smoothly while keeping the legs and shoulders relaxed.
Flooded by emotions. Although very rare, at times when the person allows the abdomen to relax, they may experience by the emotions from a past trauma as the habitual bracing patterns are relaxed.
Suggested solutions and recommendations. Validate these emotions for the person. Explain that this is a normal process that may occur if past trauma has occurred. Clients who have had past trauma often experience hypervigilance, which may interfere with the relaxation response that occurs during more optimal states of breathing. Transitioning to a more optimal rest state may be uncomfortable for a person who has experienced trauma because it reduces hypervigilance. This can feel uncomfortable as hypervigilance in these cases serves a protective role, even if it is an illusory feeling of protection from future harm. Since persistent hypervigilance can interfere with the relaxation response, the benefits of allowing a relaxation response to occur through slower breathing should be highlighted. Grounding techniques as described by Peper et al (2024a) can be useful to become centered.
3. Strategies to generalize the effortless breathing into daily life.
Generalizing the skill occurs after having mastered diaphragmatic breathing in different positions (sitting, standing, lying down, and while performing tasks). It is important to remember that our breathing patterns are conditioned with our behavior. Become aware how breathing affects cognitions and emotions and how emotions and cognitions affects breathing. The following are some strategies that may facilitate learning and generalizing the slower breathing skills.
Observing how our behavior affects our breathing: Anything that may evoke the alarm or defense reaction tends to cause the person gasp and/or hold their breath. For example, when a person is sitting peacefully, make an unexpected noise behind their back or movement in their periphery of vision. In most cases they will gasp or hold their breath. Usually, they are unaware of this process unless they are asked what happened to their breathing. The major reason for the breath holding is that the stimuli triggers an alarm/defense reaction and when we hold our breath our hearing is more acute (we can hear approaching danger earlier). The problem is that we give this response when there is no actual, immediate or present threat.
Experiential practice. Sit comfortably. Now as quickly as possible without rotating the head, look with your eyes to the extreme right and then left and back and forth as if trying to identify danger at the periphery. Do this for a few eye movements. Almost everyone holds their breath when doing this exercise. For generalizing the skill, ask the person to observe during the day situations in which they hold their breath, ask them if it was necessary and encourage them to start diaphragmatic breathing.
Observing how breathing affects our thoughts and emotions. Breathing patterns are intrinsically linked to our emotions and thoughts as illustrated in the many language phrases such as sigh of relief, full of hot air, waiting with bated breath. At the same time, our breathing patterns also affect our thoughts. For instance, when we breathe shallowly and more rapidly, we can induce feelings of fear or anxiety. If we gasp, we can experience thought stopping.
Experiential practices: Incomplete exhalation: Observe what happens when you exhale less than you inhale. Begin by exhaling only 70% of the air you inhaled, then inhale and exhale again only 70% of the air you just inhaled continue this for 30 seconds. Many people will experience the onset of anxiety symptoms, lightheadedness, dizziness, neck and shoulder tension, etc. (Peper & MacHose, 1993). If you experience symptoms during this exercise and you have experienced these symptoms in the past, it is likely that unknowingly breathing in a dysfunctional pattern could have evoked them. Therefore, practicing effortless breathing may interrupt and reduce the symptoms. Do this practice while observing the person carefully and immediately interrupt and distract the person if they start feeling dizzy, too anxious, or trigger the beginning of a panic attack or PTSD symptoms.
Experiential practice: Gasp or sniff-hold sniff. Observe what happens when you are performing a cognitive task and you rapidly gasp or do sniff-hold-sniff again before exhaling. Begin by sequentially subtracting mentally, the number 7 from 146 (e.g., 146, 139, 132….). Do this as rapidly as possible and do not make a mistake. While doing the subtracting, take a rapid gasp (such as one is triggered by surprise or fear), alternatively, take a quick sniff through your nose, hold your breath and take another sniff on top of the first one, then exhale. Whereas subtrating numbers is a skill most adults can perform, the ‘time pressure’ along with the direction to avoid mistakes may be the ‘immediate’ source of strain. Whether it was the time pressure, the direction to avoid mistakes or the direction to gasp, observe what happened to your thinking process. In almost all cases, your higher-order thoughts (doing the sequential subtraction under time pressure while gasping) have disappeared, replaced by the immediate thoughts of ‘performance anxiety.’
If you blank out on exams or experience anxiety, gasping and breath holding may be one of the factors that increases symptoms and affects your performance. If you are aware that you are holding your breath or gasped, use that as the cue to shift to slow diaphragmatic breathing and you may find that your performance improves. Therefore, observe when and where you were blanking out, gasping and/or holding your breathing then substitute slow, effortless diaphragmatic breathing.
How to develop awareness and interrupting of dysfunctional breathing response. Most participants are unaware of their somatic responses until symptoms occur. Being aware of the initiation of a somatic response may assist you in identifying triggers and interrupting the developing process. A significant component of the training is symptom prescription rehearsal.
Symptom prescription is a practice in which the participant simulates/acts out the psychophysiological pattern associated with their symptoms. They amplify the body pattern until they feel the onset of the actual symptoms. The moment the person feels the beginning of the symptom, they stop the practice and initiate slow breathing and relaxation. After practicing the symptom rehearsal, they are instructed to become aware of the onset of the symptom and then use that signal to trigger the effortless breathing while looking up and shifting the body into an upright sitting position (Peper et al., 2019). Gasping and breath holding are normal responses to unexpected stimuli; however, they may trigger sympathetic activation even when there is no actual danger.
Experiential practice: Developing awareness on neck and shoulder tension:
Sit comfortably and practice effortless breathing for a minute. Take a fearful gasp and observe what happens in your body (e.g., slight neck and upper chest tension, light headedness, slight radiating pain into the eye, etc.). Shift back to effortless breathing until all symptoms /sensations have disappeared.
- Now gasp with less effort and observe the first sensations, use the awareness of first sensations to trigger the effortless breathing and continue to breathe until symptoms have disappeared
- Continue this practice. Reduce the gasping effort each time.
- After having developed the initial somatic sensation then during the day observe what triggers this response and immediately shift to slower diaphragmatic breathing. After you have shifted to effortless breathing, reflect on the trigger. Was it necessary to react? If yes, explore strategies to resolve the issue.
The same process can be done to assist with desensitization to painful memories or stressful events. Each time the person becomes aware of their somatic reaction to an evoked memory or stressful event, they shift to effortless diaphragmatic breathing. If they find that it is difficult to interrupt the emotional memories and it triggers more and more negative thoughts and associations, use the sniff-hold-sniff technique and follow that with box-breathing or any of the other quick somatic rescue techniques (Peper et al., 2024a). Box-breathing in this context could include a brief breath-holding. A typical box-breathing technique is to breath in for a count of four, hold for a count of four, breath out for a count of four, then breath in again for a count of four, continuing the figurative 4-4-4-4 count of breathing.
Practice slower diaphragmatic breathing during the day. Implement effortless diaphragmatic breathing through regeneration and interrupting the stress response.
- Support regeneration. Each day set aside 10 to 20 minutes to practice slow effortless diaphragmatic breathing at about 6-breaths-per-minute. In the beginning 10 to 20 minutes may be too long, thus in some cases have the person practice a few times a day for two minutes and slowly build up to 10 or more minutes. The practice is not just a mechanical process of breathing it includes mindfulness training. Namely, as you are breathing each time you exhale imagine a flow doing down your arms and legs and as you inhale an energy coming into you. Whenever your attention drifts bring it back to the breathing.
- Integrate breathing with daily activities. Practice slower breather before eating, after putting the seat belt on in the car, or whenever a notification pops up on the cell phone.
- Set reminders and alarms on your phone to check how you are feeling and breathing. Leave notes on nearby furniture such as a nightstand, on the shower door, and/or on the kitchen table as reminders to be mindful of your breath. If stressed or breathing shallowly, take a moment to breathe slowly.
- Interrupt the stress response. During the day when you are aware that you shallow breathe, are holding your breath, feel anxious, experience neck and shoulder tightness, or worry and use that as a cue to shift position by sitting or standing more erect, looking upward and take a few slow diaphragmatic breaths.
- Use cue condition to facilitate this process. Each time you begin the practice smell a specific aroma or do some behavioral movement and then do the breathing. After a while the aroma or behavioral movement will become the classically conditioned cue to trigger the effortless breathing.
- Use role rehearsal and conditioning to generalize the skill. Generalizing the skills often takes more time than what may be expected. In a culture where instant relief is expected— implied message associated with medication— self-mastery techniques are different and challenging as they take time to master the skill and implement them during daily life. The process of mastery is similar to learning to play a musical instrument or sports. Learning to play the violin requires practice as well as practice with failures along the way until one is ready for more challenging musical pieces, recitals, or performances.
A useful strategy to implement the learning is role rehearsal in the office, at home at work, and in real life. It is usually much easier to practice these skills in a safe space such as your own room or, with a therapist compared to with other people or, at work. To generalize the skill most efficiently, it can be helpful to practice in a safe environment while imagining being in the actual stressful location This process is illustrated by the strategy to reduce social anxiety and menstrual cramps.
Social anxiety when seeing my supervisor. Master effortless breathing in a safe environment. Role rehearsal in imagery. If you observed that you held your breath when your supervisor is around, begin with imagery when your supervisor is not present. Sit, comfortably. Let go of muscle tension and breathe effortlessly, evoking a scenario where your supervisor is walking by and continue to breathe slowly as you imagine the scene. Role rehearsal in action. Ask another person to role-play your supervisor. Sit, comfortably. Let go of muscle tension and breathe effortlessly. Have this person walk into the room in a similar way that your supervisor would. Imagine that person is your supervisor while practicing your effortless breathing. Repeat until the effortless breathing is more automatic. Practice many times in real life. Whenever the rehearsed situation occurs, implement slower paced breathing.
Menstrual cramps that causes most women to curl up and breathe shallowly when experiencing menstrual cramps (Peper et al., 2023). Master effortless breathing in a safe environment. Practice breathing lying down. While lying down, breathe diaphragmatically by having a three-to-five-pound weight such as a bag of rice or hot water pad on your abdomen. If you have a partner, have the person stroke your legs from the abdomen to your toes while you exhale. Role rehearse experiencing pain and then practice lower diaphragmatic breathing. Namely, tighten your abdomen as if you have discomfort, then focus on relaxing the buttocks and sensing the air flowing down your legs and out your feet as you exhale. Practice in real life. A few days before you expected menstruation, practice slow diaphragmatic breathing several times for at least 5-10 minutes during the day. When your menstruation starts practice the slower and lower breathing while imagining the air flowing down the abdomen, through the legs and out the feet.
Summary/Conclusion
Breathing is the mind-body bridge. It usually occurs without awareness and breathing changes affect our thought, emotions and body. Mastering and implementing slower breathing during the day takes time and practice. By observing when breathing patterns change, participants may identify internal and external factors that affect breathing which provides an opportunity to implement effortless diaphragmatic breathing to optimize health as well as resolve some of the triggers. As one 20-year-old, female student reported,
The biggest benefit from learning diaphragmatic breathing was that it gave me the feeling of safety in many moments. My anxiety tended to make me feel unsafe in many situations but homing in and mastering diaphragmatic breathing helped tremendously. I shifted from constant chest breathing to acknowledging it and in turn, reminding myself to breathe with my diaphragm.
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Grandmother Therapy: A Common-Sense Approach to Health and Wellness
Posted: July 24, 2024 Filed under: ADHD, attention, behavior, education, Evolutionary perspective, Exercise/movement, Nutrition/diet, Pain/discomfort, relaxation, self-healing | Tags: anxiety, depression, epilepsy, exhaustion, grandmother therapy, health, insomnia, life style change, mental-health, therapy 1 CommentErik Peper, PhD and Angelika Sadar, MA
In today’s fast-paced world, college students and young adults often struggle with various health issues. From anxiety and depression to ADHD and epilepsy, these challenges can significantly impact their daily lives. But what if the solution to many of these problems lies in something as simple as “Grandmother Therapy”?
What is Grandmother Therapy? Grandmother Therapy is all about going back to basics and establishing healthy lifestyle habits. It’s the common-sense approach that our grandmothers might have suggested: regular sleep patterns, balanced nutrition, increased social connections, and regular physical activity.
The Problem: Many college students:
- Skip breakfast before their first class
- Rely on fast food and sugary stimulants
- Have irregular sleep schedules
- Spend excessive time on gaming and social media
The Medical Approach: Often, the quick solution is medication:
- Depression? Take antidepressants.
- Insomnia? Use sleeping pills.
- Anxiety? Try anti-anxiety medication.
- ADHD? Prescribe Ritalin or similar drugs.
While these treatments may help manage symptoms, they often overlook the underlying lifestyle factors contributing to these issues.
The Grandmother Therapy Approach:
- Establish regular sleep patterns
- Adopt healthy eating habits
- Increase social connections
- Incorporate regular physical activity
- Reduce gaming and social media use
Case Study #1: The Power of Sleep
This illustrates the simple intervention of having a bedtime routine. A college student in a holistic health class complained that she was tired most of the time and had difficulty focusing her attention and continuously drifted off in class.
Here is her reported sleep schedule:
- last night I went to bed at 3am and woke up 7;
- the day before, I went to bed at 1pm and woke up at 6,
- two nights before, I went to bed at 4pm and woke up at 10 am.
Holistic treatment approach:
Set a sleep schedule: she was provided with information about the importance of having a regular pattern of sleep and waking. Namely, go to bed at the same time and get up 8 hours later. She agreed to do an experiment for a week to go to bed at 12 and wake up at 8m. To her surprise, she felt so much more energized and could pay attention in class during the week of the experiment.
Case Study #2: Beyond Seizures: A Holistic Approach to Treating Psychogenic Nonepileptic Seizures
This case study highlights the importance of a comprehensive, lifestyle-based approach to treating psychogenic nonepileptic seizures (PNES). It follows a 24-year-old male student initially diagnosed with intractable epilepsy, experiencing over 10 seizures per week that didn’t respond to medication.
Key points:
1. Initial misdiagnosis: Despite normal MRI and EEG results, the client was initially treated for epilepsy.
2. Limited assessment: Traditional medical evaluations focused solely on seizure descriptions and diagnostics, overlooking crucial lifestyle factors.
3. Comprehensive evaluation: A psychophysiological assessment revealed high sympathetic arousal, including rapid breathing, sweaty palms, and muscle tension.
4. Lifestyle factors: The client’s diet consisted of high-glycemic fast foods, excessive caffeine, alcohol, and daily marijuana use. He also had significant student debt and a history of abdominal surgery.
Holistic treatment approach:
– Dietary changes: Switching to unprocessed, low-glycemic foods and increasing vegetable and fruit intake
– Breathing techniques: Learning and practicing slow diaphragmatic breathing
– Stress management: Addressing underlying stressors and practicing relaxation techniques
– Supplements: Adding omega-3 and multivitamins to support brain health
Remarkable results: Within four months, the patient became seizure-free, reduced marijuana use significantly, and decreased medication dosage.
Summary
These cases underscore the potential of integrating lifestyle modifications and stress management techniques in treating attention, anxiety and even psychogenic nonepileptic seizures; offering hope for patients who don’t respond to traditional treatments alone. Before turning to medication or complex treatments, consider the power of Grandmother Therapy. By addressing fundamental lifestyle factors, we can often improve our health and well-being significantly. Remember, sometimes the most effective solutions are the simplest ones.
The Challenges of Simplicity: While Grandmother Therapy may seem straightforward, its simplicity can make it challenging to implement. It requires commitment and a willingness to change long-standing habits.
Implement many Life Style Changes at once: Recommending one change at the time is logical; however, participants will more likely experience rapid benefits and are more motivated to continue when they change multiple lifestyle factors at once.
Call to Action: Are you struggling with health issues? Try implementing some aspects of Grandmother Therapy in your life. Implement changes and see how they impact your overall well-being.
Please let us know your experience with implementing Grandmother Therapy.
See the following blogs for more background information
Playful practices to enhance health with biofeedback
Posted: May 4, 2024 Filed under: attention, behavior, biofeedback, Breathing/respiration, computer, Exercise/movement, health, Neck and shoulder discomfort, Pain/discomfort, self-healing, Uncategorized | Tags: exercise, Feldenkrais, pain, Play, somatics 1 CommentAdapted from: Gibney, K.H. & Peper, E. (2003). Exercise or play? Medicine of fun. Biofeedback, 31(2), 14-17.
Homework assignments are sometimes viewed as chore and one more thing to do. Changing the perception from that of work to fun by encouraging laughter and joy often supports the healing process. This blog focusses on utilizing childhood activities and paradoxical movement to help clients release tension patterns and improve range of motion. A strong emphasis is placed on linking diaphragmatic breathing to movement.
When I went home I showed my granddaughter how to be a tree swaying in the wind, she looked at me and said, “Grandma, I learned that in kindergarten!”
‘Betty’ laughed heartily as she relayed this story. Her delight in being able to sway her arms like the limbs of a tree starkly contrasted with her demeanor only a month prior. Betty was referred for biofeedback training after a series of 9 surgeries – wrists, fingers, elbows and shoulders. She arrived at her first session in tears with acute, chronic pain accompanied by frequent, incapacitating spasms in her shoulders and arms. She was unable to abduct her arms more than a few inches without triggering more painful spasms. Her protective bracing and rapid thoracic breathing probably exacerbated her pain and contributed to a limited range of motion of her arms. Unable to work for over a year, she was coping not only with pain, but also with weight gain, poor self-esteem and depression.
The biofeedback training began with effortless, diaphragmatic breathing which is often the foundation of health (Peper and Gibney, 1994). Each thoracic breath added to Betty’s chronic shoulder pain. Convincing Betty to drop her painful bracing pattern and to allow her arms to hang freely from her shoulders as she breathed diaphragmatically was the first major step in regaining mobility. She discovered in that first session that she could use her breathing to achieve control over muscle spasms when she initiated the movement during the exhalation phase of breathing as shown in Figure 1.
Figure 1. Initiate the physical activity after exhaling has begun and body is relaxing especially if the movement or procedure such as an injection would cause pain. Pause the movement when inhaling and then continue the movement again during the exhalation phase. The simple rule is to initiate the activity slightly after beginning exhaling and when the heart rate started to decrease (reproduced with permission from Gorter & Peper, 2012).
During the first week, she practiced her breathing assiduously at home and had fewer spasms. Betty was able to move better during her physical therapy sessions. Each time she felt the onset of muscle spasms she would stop all activity for a moment and ‘go into my trance’ to prevent a recurrence. For the first time in many months, she was feeling optimistic.
Subsequent sessions built upon the foundation of diaphragmatic breathing: boosting Betty’s confidence, increasing range of motion (ROM), and bringing back some fun in life. Activities included many childhood games: tossing a ball, swaying like a tree in the wind, pretending to conduct an orchestra, bouncing on gym balls, playing “Simon Says” (following the movements of the therapist), and dancing. Laughter and childlike joy became a common occurrence. She looked forward to receiving the sparkly star stickers she was given after successful sessions. With each activity, Betty gained more confidence, gradually increased ROM, and began losing weight. Although she had some days where the pain was strong and spasms threatened, Betty reframed the pain as occurring as a result of healing and expanding her ROM—she was no longer a victim of the pain. In addition, her family was proud of her, she was doing more fun activities, and she felt confident that she would return to work.
Betty’s story is similar to other clients whom we have seen. The challenge presented to therapists is to help the client better cope with pain, increase ROM, regain function and, often the most important, to reclaim a “joie de vivre”. Increasing function includes using the minimum amount of effort necessary for the task, allowing unnecessary muscles to remain relaxed (inhibition of dysponesis[i]), and quickly releasing muscle tension when the muscle is no longer required for the activity (work/rest) (Whatmore & Kohli, 1974; Peper et al, 2010; Sella, 2019). The challenge is to perform the task without concurrent evocation of components of the alarm reaction, which tend to be evoked when “we try to do it perfectly,” or “it has to work,” “If I do not do it correctly,” or “I will be judged.” For example, when people learn how to implement micro-breaks (1–2 second rest periods) at the computer, they often sit quietly believing that they are relaxed; however, they may continue a bracing pattern (Peper et al, 2006). Alternatively, tossing a small ball rather than resting at the keyboard will generally evoke laughter, encourage generalization of skills, and covertly induce more relaxation. In some cases, therapists in their desire to help clientss to get well assign structured exercises as homework that evoke striving for performance and boredom—this striving to perform the structured exercises may inhibit healing. Utilizing tools other than those found in the work setting helps the client achieve a broader perspective of the healing/preventive concepts that are taught.
To optimize success, clients are active participants in their own healing process which means that they learn the skills during the therapeutic session and practice at home and at work. Home practices are assigned to integrate the mastery of news skills into daily life. To help clients achieve increased health through physical activity three different approaches are often used: movement reeducation, youthful play, and pure exercise. How the client performs the activity may be monitored with surface electromyography (SEMG) to identify muscles tightening that are not needed for the task and how the muscle relaxes when not needed for the task performance. This monitoring can be done with a portable biofeedback device or multi-channel system when walking or performing the exercises. Clients can even use a single channel SEMG at home.
When working to improve ROM and physical function, explore the following:
- Maintain diaphragmatic breathing – rhythm or tempo may change but the breath must be generated from the diaphragm with emphasis on full exhalation. Use strain gauge feedback and/or SEMG feedback to monitor and train effortless breathing (Peper et al., 2016). Strain gauge feedback is used to teach a slower and diaphragmatic breathing pattern, while SEMG recorded from the scalene to trapezius is used to teach how to reduce shoulder and ancillary muscle tension during inhalation
- Perform activities or stretching/strengthening exercises so slowly that they don’t trigger or aggravate pain during the exhalation phase of breathing.
- Use the minimum amount of tension necessary for the task and let unnecessary muscles remain relaxed. Use SEMG feedback recorded from muscles not needed for the performance of the task to teach clients awareness of inappropriate muscle tension and to learn relaxation of those muscles.
- Release muscle tension immediately when the task is accomplished. Use SEMG feedback to monitor that the muscles are completely relaxed. If rapid relaxation is not achieved, first teach the person to relax the muscles before repeating the muscle activity.
- Perform the exercises as if you have never performed them and do them with a childlike, beginner’s mind, and exploratory attitude (Kabat-Zinn, 1990).
- Create exercises that are totally new and novel so that the participant has no expectancy of outcome can be surprised by their own experience. This approach is part of many somatic educational and therapeutic approaches such as Feldenkrais or Somatics (Hanna, 2004; Feldenkrais, 2009).
Movement and exercise can be taught as pure physical exercise, movement reeducation or youthful playing. Physical exercise is necessary for strength and endurance and at the same time, improves our mood (Thayer, 1996; Mahindru et al., 2023). However, many exercises are considered a burden and are often taught without a sense of lightness and fun, which results in the client thinking in terms that are powerless and helpless (depressive)—“I have to do them.” Helping your clients to understand that exercise is simply a part of every day life, that it encourages healing and improves health, and that they can “cheat” at it, may help them to reframe their attitudes toward it and accomplish their healing goals.
Pure Physical Exercise—Enjoyment through Strength and Flexibility
The major challenge of structured exercises is that the person is very serious and strives too hard to attain the goal. In the process of striving, the body is often held rigid: Breath is shallow and halted and shoulders are slightly braced. Maintaining a daily chart is an excellent tool to show improvement (e.g., more repetitions, more weight, increased flexibility; since, structured exercises are very helpful for improving ROM and strength. When using pure exercise, remember that injured person may have a sense of urgency – they want to get well quickly and, if work stress was a factor in developing pain, they often rush when they need to meet a deadline.
As much as possible make the exercise fun. Help the client understand that he/she can be quick while not rushed. For example, monitor SEMG from an upper trapezius muscle using a portable electromyography. For example, begin by walking slowly. Add a ramp or step to ensure that there is no bracing when climbing (a common occurrence). Walk around the room, down the hall, around the block. Maintain relaxed shoulders, an even swing of the arms, and diaphragmatic breathing. Walk more quickly while emphasizing relaxation with speed rather than rushing. Go faster and faster. Up the stairs. Down the stairs. Walk backward. Skip. Hop. Laugh.
Movement Reeducation – Be ‘Oppositional’ And Do It Differently
Movement reeducation, such as Feldenkrais, Alexander Technique or Hannah Somatics, involves conscious awareness of movement (Alexander, 2001; Hanna, 2004; Murphy, 1993). Many daily patterns of movement become imbedded in our consciousness and, over the years, may include a pain trigger. A common trigger is lifting the shoulders when reaching for the keyboard or mouse, people suffering from thoracic outlet syndrome (TOS) often have such patterns (Peper & Harvey, 2021). A keyboard can often inadvertently cue the client to trigger this dysponetic, and frequently painful, pattern. Have the client do movement reeducation exercises as they are guided through practices in which they have no expectancy and the movements are novel. The focus is on awareness without triggering any fight/flight or startle responses.
Ask the client to explore performing many functional activities with the opposite hand, such as brushing his/her hair or teeth, eating, blowing his/her hair dry, or doing household chores, such as vacuuming. (Explore this for yourself, as well!). Be aware of how much shoulder muscle tension is needed to raise the arms for combing or blow-drying the hair. Explore how little effort is required to hold a fork or knife (you might want to do this in the privacy of your own home!).
Do movements differently such as, practicing alternating hands when leading with the vacuum or when sweeping, changing routes when driving/walking to work or the store, getting out of bed differently. Break up habitual conditioned reflex patterns such as eye, head and hand coordination. For example, slowly rotate your head from left to right and simultaneously shift your eyes in the opposite direction (e.g., turn your head fully to the right while shifting your eyes fully to the left, and then reverse) or before reaching forward, drop your elbows to your sides then, bend your elbows and touch your shoulders with your thumbs then, reach forward. Often, when we change our patterns we increase our flexibility, inhibit bracing and reduce discomfort.
Free Your Neck and Shoulders (adapted from a demonstration by Sharon Keane and developed by Ilana Rubenfeld, 2001)
–Push away from the keyboard and sit at the edge of the chair with your knees bent at right angles and your feet shoulder-width apart and flat on the floor. Do the following movements slowly. Do NOT push yourself if you feel discomfort. Be gentle with yourself.
–Look to the right and gently turn your head and body as far as you can go to the right. When you have gone as far as you can comfortably go, look at the furthest spot on the wall and remember that spot. Gently rotate your head back to center. Close your eyes and relax.
–Reach up with your left hand; pass it over the top of your head and hold on to your right ear. Then, gently bend to the left lowering your elbow towards the floor. Slowly straighten up. Repeat for a few times feeling as if you are a sapling flexing in the breeze. Observe what your body is doing as it bends and comes back up to center. Notice the movements in your ribs, back and neck. Then, drop your arm to your lap and relax. Make sure you continue to breathe diaphragmatically throughout the exercise.
–Reach up with your right hand and pass it over the top of your head and hold on to your left ear. Repeat as above except bending to the right.
–Reach up with your left hand and pass it over the top of your head and hold on to your right ear. Then, look to the left with your eyes and rotate your head to the left as if you are looking behind you. Return to center and repeat the movement a few times. Then, drop your arm to your lap and relax for a few breaths.
–Again, reach over your head with your left hand and hold onto your right ear. Repeat the same rotating motion of your head to the left except that your eyes look to the right. Repeat this a few times then, drop your arm to your lap and relax for a few breaths.
–Reach up with your right hand and pass it over the top of your head and hold on to your left ear. Then, look to the right with your eyes and rotate your head to the right as if you are looking behind you. Return to center and repeat a few times. Then, drop your arm to your lap and relax for a few breaths.
–Again, reach over your head with your right hand and hold onto your left ear. Repeat the same rotating motion of your head to the right except that your eyes look to the left. Repeat this a few times then, drop your arm to your lap and relax for a few breaths.
–Now, look to the right and gently turn your head and body as far as you can go. When you can not go any further, look at that point on the wall. Did you rotate further than at the beginning of the exercise?
–Gently rotate your head back to center, close your eyes, relax and notice the feeling in your neck, shoulders and back.
Youthful Playing – Pavlovian Practice
Evoking positive past memories and actually acting them out may enhance health as is illustrated by the recovery of serious illness of Ivan Pavlov, the discovery of classical conditioning. When Pavlov quietly lay in his hospital bed, many, including his family, thought he was slipping into death. He then ask the nurse to get him a bowl of water with earth in it and the whole night long he gently played with the mud. He recreated the experience when as a child he was playing in mud along a river’s bank. Pavlov knew that evoking the playful joy of childhood would help to encourage mental and physical healing. The mud in hands was the conditioned stimulus to evoke the somatic experience of wellness (Peper, Gibney, & Holt, 2002).
Having clients play can encourage laughter and joie de vivre, which may help in physical healing. Being involved in childhood games and actually playing these games with children removes one from worries and concerns—both past and future—and allows one to be simply in the present. Just being present is associated with playfulness, timelessness, passive attention, creativity and humor. A state in which one’s preconceived mental images and expectancies—the personal, familial, cultural, and healthcare provider’s hypnotic suggestions—are by-passed and for that moment, the present and the future are yet undefined. This is often the opposite of the client’s expectancy; since, remembering the past experiences and the diagnosis creates a fixed mental image that may expect pain and limitation.
Explore some of the following practices as strategies to increase movement and flexibility without effort and to increase joy. Use your creativity and explore your own permutations of the practices. Observe how your mood improves and your energy increases when you play a childhood game instead of an equivalent exercise. For example, instead of dropping your hands to your lap or stretching at the computer terminal during a micro- or meso-break[ii], go over to your coworker and play “pattycake.” This is the game in which you and your partner face each other and then clap your hands and then touch each other’s palms. Do this in all variations of the game.
For increased ROM in the shoulders explore some of the following (remember the basics: diaphragmatic breathing, minimum effort, rapid release) in addition, do the practices to the rhythm of the music that you enjoyed as a young person.
Ball Toss: a hand-sized ball that is easily squeezed is best for this exercise. Monitor respiration patterns, and SEMG forearm extensors and/or flexors, and upper trapezii muscles. Sit quietly in a chair and focus on a relaxed breathing rhythm. Toss the ball in the air with your right hand and catch it with your left hand. As soon as you catch the ball, drop both hands to your lap. Toss the ball back only when you achieve relaxation—both with the empty hand and the hand holding the ball. Watch for over-efforting in the upper trapezii. Begin slowly and increase the pace as you train yourself to quickly release unnecessary muscle tension. Go faster and faster (just about everyone begins to laugh, especially each time they drop the ball).
Ball Squeeze/Toss: Expand upon the above by squeezing the ball prior to tossing. When working with a client, call out different degrees of pressure (e.g., 50%, 10%, 80%, etc.). The same rules apply as with the ball toss.
Ball Hand to Hand: Close your eyes and hand the ball back and forth. Go faster and faster and add ball squeezes prior to passing the ball.
Gym Ball Bounces: Sit on a gym ball and find your balance. Begin bouncing slowly up and down. Reach up and lower your left then, right hand. Abduct your arms forward then, laterally. Turn on the radio and bounce to music.
Simon Says: This can be done standing, sitting in a chair or on a gym ball. When on a gym ball, bounce during the game. Have your client do a mirror image of your movements: reaching up, down, left, right, forward or backward. Touch your head, nose, knees or belly. Have fun and go more quickly.
Back-To-Back Massage: With a partner, stand back-to-back. Lean against each other’s back so that you provide mutual support. Then each rub your back against each other’s back. Enjoy the wiggling movement and stimulation. Be sure to continue to breathe.
Summary: An Attitude of Fun
In summary, it is not what you do; it is also the attitude by which you do it that affects health. From this perspective,when exercises are performed playfully, flexibility, movement and health are enhanced while discomfort is decreased. Inducing laughter promotes healing and disrupts the automatic negative hypnotic suggestion/self-images of what is expected. The clients begins to live in the present moment and thereby decreases the anticipatory bracing and dysponetic activity triggered by striving. By decreasing striving and concern for results, clients may allow themselves to perform the practices with a passive attentive attitude that may facilitate healing. For that moment, the client forgets the painful past and a future expectances that are fraught with promises of continued pain and inactivity. At moment, the pain cycle is interrupted which provides hope for a healthier future.
References
Alexander, F.M. (2001). The Use of the Self. London: Orion Publishing. https://www.amazon.com/Use-Self-F-M-Alexander/dp/0752843915
Feldenkrais, M. (2009). Awareness Through Movement Easy-to-Do Health Exercises to Improve Your Posture, Vision, Imagination, and Personal Awareness. New York: HarperOne. https://www.amazon.com/Awareness-Through-Movement-Easy-Do/dp/0062503227
Gibney, K.H. & Peper, E. (2003). Exercise or play? Medicine of fun. Biofeedback, 31(2), 14-17. https://www.researchgate.net/publication/380317304_EXERCISE_OR_PLAY_MEDICINE_OF_FUN
Gorter, R. & Peper, E. (2012). Fighting Cancer- A Nontoxic Approach to Treatment. Berkeley: North Atlantic Books. https://www.amazon.com/Fighting-Cancer-Nontoxic-Approach-Treatment/dp/1583942483
Hanna, T. (2004). Somatics: Reawakening The Mind’s Control Of Movement, Flexibility, And Health. Da Capo Press. https://www.amazon.com/Somatics-Reawakening-Control-Movement-Flexibility/dp/0738209570
Kabat-Zinn, J. (1990). Full catastrophe living. New York: Delacorte Press.
Mahindru, A., Patil, P., & Agrawal, V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus, I5(1), e33475. https://doi.org/10.7759/cureus.33475
Murphy, M. (1993). The future of the body. New York: Jeremy P. Tarcher/Perigee. https://www.amazon.com/Future-Body-Explorations-Further-Evolution/dp/0874777305
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://www.researchgate.net/publication/300365890_Abdominal_SEMG_Feedback_for_Diaphragmatic_Breathing_A_Methodological_Note
Peper, E., Booiman, A., Tallard, M., & Takebayashi, N. (2010). Surface electromyographic biofeedback to optimize performance in daily life: Improving physical fitness and health at the worksite. Japanese Journal of Biofeedback Research, 37(1), 19-28. https://doi.org/10.20595/jjbf.37.1_19
Peper, E., Gibney, K. & Holt, C. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall-Hunt. https://he.kendallhunt.com/product/make-health-happen-training-yourself-create-wellness
Peper, E. & Harvey, R. (2021). Causes of TechStress and ‘Technology-Associated Overuse’ Syndrome and Solutions for Reducing Screen Fatigue, Neck and Shoulder Pain, and Screen Addiction. Townsend Letter-The examiner of Alternative Medicine, Oct 28, 2021. https://www.townsendletter.com/article/459-techstress-how-technology-is-hurting-us
Peper, E., Harvey, R. & Tylova, H. (2006). Stress protocol for assessing computer related disorders. Biofeedback. 34(2), 57-62. https://www.researchgate.net/publication/242549995_FEATURE_Stress_Protocol_for_Assessing_Computer-Related_Disorders
Peper, E. & Tibbetts, V. (1994). Effortless diaphragmatic breathing. Physical Therapy Products. 6(2), 67-71. Also in: Electromyography: Applications in Physical Therapy. Montreal: Thought Technology Ltd. https://www.bfe.org/protocol/pro10eng.htm
Rubenfeld, I. (2001). The listening hands: Self-healing through Rubenfeld Synergy method of talk and touch. New York: Random House. https://www.amazon.com/Listening-Hand-Self-Healing-Through-Rubenfeld/dp/0553379836
Sella, G. E. (2019). Surface EMG (SEMG): A Synopsis. Biofeedback, 47(2), 36–43. https://doi.org/10.5298/1081-5937-47.1.05
Thayer, R.E. (1996). The origin of everyday moods—Managing energy, tension, and stress. New York: Oxford University Press. https://www.amazon.com/Origin-Everyday-Moods-Managing-Tension/dp/0195118057
Whatmore, G. and Kohli, D. The Physiopathology and Treatment of Functional Disorders. New York: Grune and Stratton, 1974. https://www.amazon.com/physiopathology-treatment-functional-disorders-biofeedback/dp/0808908510
[i] Dysponesis involves misplaced muscle activities or efforts that are usually covert and do not add functionally to the movement. From: Dys” meaning bad, faulty or wrong, and “ponos” meaning effort, work or energy (Whatmore and Kohli, 1974)
[ii] A meso-break is a 10 to 90 second break that consists of a change in work position, movement or a structured activity such as stretching that automatically relaxes those muscles that were previously activated while performing a task.
360-Degree Belly Breathing with Jamie McHugh
Posted: April 26, 2024 Filed under: attention, Breathing/respiration, emotions, healing, health, meditation, mindfulness, Pain/discomfort, relaxation, self-healing | Tags: abdominal braething, belly breathing, daiphragm, effortless breathing, passive attention, self-acceptance, somatic awreness 4 Comments
Breathing is a whole mind-body experience and reflects our physical, cognitive and emotional well-being. By allowing the breath to occur effortlessly, we provide ourselves the opportunity to regenerate. Although there are many directed breathing practices that specifically directs us to inhale or exhale at specific rhythms or depth to achieve certain goals, healthy breathing is whole body experience. Many focus on being paced at a specific rhythm such as 5.5 breath per minute; however, effortless breathing is dynamic and constantly changing. It is contstantly adapting to the body’s needs: sometimes the breath is slightly slower, sometimes slightly faster, sometimes slightly deeper, sometimes slightly more shallower. The breathing process is effortless. This process can be described by the Autogenic training phrase, “It breathes me” (Luthe, 1969; Luthe, 1979; Luthe & de Rivera, 2015). Read the essay by Jamie McHugh, Registered Master Somatic Movement Therapist and then let yourself be guided in this non-striving somatic approach to allow effortless 360 degree belly breathing for regeneration.
The 360 degree belly breathing by Jamie McHugh, MSMT, is a somatic exploration to experience that breathing is not just abdominal breathing by letting the belly expand forward, but a rhythmic 360 degree increase and decrease in abdominal volume without effort. This effortless breathing pattern can often be observed in toddlers when they sit peacefully erect on the floor. This pattern of breathing not only enhances gas exchange, more importantly, it enhances abdominal blood and lymph circulation.
“The usual psychodynamic foundation for the self-experience is that of hunger, not breath. The body is experienced as an alien entity that has to be kept satisfied; the way an anxious mother might experience a new baby. When awareness is shifted from appetite to breath, the anxieties about not being enough are automatically attenuated. It requires a settling down or relaxing into one’s own body. When this fluidity moves to the forefront of awareness…there is a relaxation of the tensed self…and the emergence of a simpler, breath-based self that is capable of surrender to the moment.” – Mark Epstein (2013).
The intention behind 360 Degree Belly Breathing is to access and express the movement of the breath in all three dimensions. This is the basis for all subsequent somatic explorations within the Embodied Mindfulness protocol, a body-based approach to traditional meditation practices I have developed over the past 20 years (McHugh, 2016). Embodied Mindfulness explores the inner landscape of the body with the essential somatic technologies of breath, vocalization, self-contact, stillness and subtle movement. We focus and sustain mental attention while pleasurably cultivating bodily calm and clarity as a daily practice for survival in these turbulent times. Coupled with individual variations and experimentation, this practice becomes a reliable sanctuary from overwhelm, scattered attention, and emotional turmoil.
The Central Diaphragm
The central diaphragm, a dome-shaped muscular sheath that divides the thorax (chest) and the abdomen (belly), is the primary mechanism for breathing. It is the floor for your heart and lungs and the ceiling for your belly. The central diaphragm is a mostly impenetrable divide, with a few openings through it for the aorta, vena cava and the esophagus. Each time you inhale, the diaphragm contracts and flattens out a bit as it presses down towards your pelvis. Each time you exhale, the diaphragm relaxes and floats back up towards your heart. The motion of the diaphragm impacts the barometric pressure in your chest: the downward movement of the diaphragm on the inhale pulls oxygen into your lungs, and the subsequent exhale expels carbon dioxide into the world as the diaphragm releases upwards.
The movement of the diaphragm is twofold: involuntary and voluntary. Involuntary, ordinary breathing is a homebase and a point of return. Breathing just automatically happens – you don’t have to think about it. Breathing is also voluntary; you can choose to change the tempo (quick or slow), the duration (short or long) and quality (smooth or sharp) of this movement to “charge up and chill out” at will. Knowing how to collaborate with your diaphragm, discovering your own rhythm of diaphragmatic action, and undulating between the automatic and the chosen is a foundation for physiological equilibrium and emotional “self-soothing”.
Watch these two brief videos to get a visual image of your diaphragm in motion:
Beginning Sitting Practice
“When your back becomes straight, your mind will become quiet.” – Shunryu Suzuki
What does it mean to have a “straight back”? What are the inner coordinates and outer parameters of this position in space? And what kind of environment is needed to support this uprightness? This simple orientation to sitting can create more comfort, ease and support in your structure, which will stimulate more fluidity in your breathing and your thinking.
As you sit on a chair, consider two points of focus: body and environment. Can I sit upright with ease and comfort on this chair? If not, what changes can I make with my body and how can I adapt the environment of this chair to meet my needs? Since we are all various heights, it is not surprising a one-size-fits-all chair would need adaptation. Don’t be content with your first solution – experiment until you find just the right configuration. Valuing and seeking bodily comfort and ease are simple yet profound acts of self-kindness.
Do you need to move your pelvis forward on the chair or back? If you move your pelvis back, do you get the necessary support from the back of the chair for your pelvic bowl? If the back of the chair is too far away and/or makes you lean back into space, place a small cushion or two between the back of the chair and the base of your spine. With your back supported, are your feet on the floor? If not, place a folded blanket or a cushion under them.
With pelvis and feet in place, take a few full breaths to stabilize your pelvis and let your weight drop down through your sitz bones into the chair. The upper body receives more support from the core muscles of the lower body when your center of gravity drops – you don’t have to work so hard to maintain uprightness. Finally, rock on your sitz bones forward, backward, and side-to-side. Movement awakens bodily feedback so you can feel where center is in this moment. That sense of center will continue to change throughout the duration of the practice period so feel free to periodically adjust your position.
After this initial structural orientation, the next step is attending to the combination of breath and self-contact to fill out our self-perception. Self-contact is like using a magnifying glass – focusing the mind by feeling the substance of the belly’s movement in our hands. Since the diaphragm is a 360-degree phenomenon that generates movement in our sides and our back as well as our front, spreading awareness out not only creates different patterns of muscular activation – it also changes the brain’s map of the body and how we perceive ourselves. This change of orientation over time recalibrates our alignment and how we settle in ourselves, with awareness of our back in equal proportion to our front and sides.
360-Degree Belly Breath
“To stop your mind does not mean to stop the activities of the mind. It means your mind pervades your whole body.” – Shunryu Suzuki
Read text below or be guided by the audio file or YouTube video. http://somaticexpression.com/classes/360DegreeBreathingwithJamieMcHugh.mp3
Sit comfortably and place your hands on the front of your belly. With each inhale, become aware of the forward movement of your belly swelling. Then, with each exhale, notice the release of your belly and the settling back to center. Give this action and each subsequent action at least 5-7 breath cycles. Intersperse this way of breathing with ordinary, effortless breathing by letting the body breathe automatically. Return time and again to ordinary breathing, letting go of the focus and the effort to rest in the aftermath.
Now, slide your hands to the sides of your belly. Notice with each breath cycle how your belly moves laterally out to the sides on the inhale and then settles back to center again on the exhale.
Now, slide your hands to the back of your belly. You may wish to make contact with the back of your hands instead of your palms if it is more comfortable. With each inhale, focus on the movement into the backspace – this will be much smaller than the movement to the front; and with each exhale, the movement settling back to center.
Finally, connect all three directions: your belly radiates out 360 degrees on the horizon with each inhale, simultaneously moving forward, backward, and out to both sides, and then settles inward with each exhale.
Finish with open awareness – scanning your whole inner landscape from feet to head, back to front, and center to extremities, and letting your body breathe itself, as you notice what is alive in you now.
Inhale – Belly Radiates Outwards; Exhale – Belly Settles Inwards
“The belly is an extraordinary diagnostic instrument. It displays the armoring of the heart as a tension in the belly. Trying tightens the belly. Trying stimulates judgment. Hard belly is often judging belly. Observing the relative openness or closedness of the belly gives insight into when and how we are holding (on) to our pain. The deeper our relationship to the belly, the sooner we discover if we are holding in the mind or opening into the heart.” – Steven Levine (1991)
The contact of your hands on your belly helps the mind pay attention to the subtle movement created by the inhale-exhale cycle of the diaphragm. The combination of tactility and interoceptive awareness focusing on the belly shifts attention into our “second brain” (the enteric nervous system) and signals the mind it can rest and soften. More pleasurable sensation is often accompanied by an emergent feeling of safety as you settle into sensing the rhythm of a slower, more even breath, creating a feedback loop between bodily/somatic ease and mental calm. Giving yourself some daily “breathing room” in this way can help you build the calm muscle!
Naturally, there can be hiccups along the way so it is not all unicorns and rainbows! By giving the mind bodily tasks to accomplish, particularly in relationship to deepening and expanding the movement of the breath, we ease the self into a slower, more receptive state of being. Yet, in this receptive state of ease, whatever is in the background of awareness can arise and slip through the “border control”, sometimes taking us by surprise and causing distress. Depending upon the nature of the information, there are layers of action strategies that can be progressively taken to modulate and buffer what arises:
Tether your awareness to the breath rhythm with hands on your belly to stay present as a witness. Next step up: open your eyes softly and look around to orient in your present environment. Further step up: breath flow, hands-on belly, eyes open a wee bit looking around, and adding simple movement, like rocking a bit in all directions or expressing an exhale as a sigh, a yawn or a hum.
Note: If you find your personal resources are insufficient, find a guide to work with one-on-one to discover your own individual path for increasing the “window of capacity”. Above all, be gentle with yourself – take your time – cultivate your garden – and enjoy your breath!
References
Epstein, M. (2013) Thoughts without a Thinker: Psychotherapy from a Buddhist Perspective. New York: Basic Books. https://www.amazon.com/Thoughts-Without-Thinker-Psychotherapy-Perspective/dp/0465050948
Levine, S. (1991). Guided Meditations, Explorations and Healings. New York: Anchor. https://www.amazon.com/Guided-Meditations-Explorations-Healings-Stephen/dp/0385417373
Luthe, W. (1969). Autogenic Therapy Volume 1 Autogenic Methods. New York: Grune and Stratton. https://www.amazon.com/Autogenic-Therapy-1-Methods/dp/B0013457B4/
Luthe, W. (1979). About the Methods of Autogenic Therapy. In: Peper, E., Ancoli, S., Quinn, M. (eds). Mind/Body Integration. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2898-8_12
Luthe, W. & de Rivera, L. (2015). Wolfgang Luthe Introductory workshop: Introduction to the Methods of Autogenic Training, Therapy and Psychotherapy (Autogenic Training & Psychotherapy). CreateSpace Independent Publishing Platform. https://www.amazon.com/WOLFGANG-LUTHE-INTRODUCTORY-WORKSHOP-Psychotherapy/dp/1506008038/
TechStress: Building Healthier Computer Habits
Posted: August 30, 2023 Filed under: ADHD, behavior, biofeedback, Breathing/respiration, cognitive behavior therapy, computer, digital devices, education, emotions, ergonomics, Evolutionary perspective, Exercise/movement, health, laptops, Neck and shoulder discomfort, Pain/discomfort, posture, screen fatigue, stress management, Uncategorized, vision, zoom fatigue | Tags: cellphone, fatigue, gaming, mobile devices, screens 5 CommentsBy Erik Peper, PhD, BCB, Richard Harvey, PhD, and Nancy Faass, MSW, MPH
Adapted by the Well Being Journal, 32(4), 30-35. from the book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics by Erik Peper, Richard Harvey, and Nancy Faass.
Every year, millions of office workers in the United States develop occupational injuries from poor computer habits—from carpal tunnel syndrome and tension headaches to repetitive strain injury, such as “mouse shoulder.” You’d think that an office job would be safer than factory work, but the truth is that many of these conditions are associated with a deskbound workstyle.
Back problems are not simply an issue for workers doing physical labor. Currently, the people at greatest risk of injury are those with a desk job earning over $70,000 annually. Globally, computer-related disorders continue to be on the rise. These conditions can affect people of all ages who spend long hours at a computer and digital devices.
In a large survey of high school students, eighty-five percent experienced tension or pain in their neck, shoulders, back, or wrists after working at the computer. We’re just not designed to sit at a computer all day.
Field of Ergonomics
For the past twenty years, teams of researchers all over the world have been evaluating workplace stress and computer injuries—and how to prevent them. As researchers in the fields of holistic health and ergonomics, we observe how people interact with technology. What makes our work unique is that we assess employees not only by interviewing them and observing behaviors, but also by monitoring physical responses.
Specifically, we measure muscle tension and breathing, in the moment, in real-time, while they work. To record shoulder pain, for example, we place small sensors over different muscles and painlessly measure the muscle tension using an EMG (electromyograph)—a device that is employed by physicians, physical therapists, and researchers. Using this device, we can also keep a record of their responses and compare their reactions over time to determine progress.
What we’ve learned is that people get into trouble if their muscles are held in tension for too long. Working at a computer, especially at a stationary desk, most people maintain low-level chronic tension for much of the day. Shallow, rapid breathing is also typical of fine motor tasks that require concentration, like data entry.
Muscle tension and breathing rate usually increase during data entry or typing without our awareness.
When these patterns are paired with psychological pressure due to office politics or job insecurity, the level of tension and the risk of fatigue, inflammation, pain, or injury increase. In most cases, people are totally unaware of the role that tension plays in injury. Of note, the absolute level of tension does not predict injury—rather, it is the absence of periodic rest breaks throughout the day that seems to correlate with future injuries.
Restbreaks
All of life is the alternation between movement and rest, inhaling and exhaling, sleeping and waking. Performing alternating tasks or different types of activities and movement is one way to interrupt the couch potato syndrome—honoring our evolutionary background.
Our research has confirmed what others have observed: that it’s important to be physically active, at least periodically, throughout the day. Alternating activity and rest recreate the pattern of our ancestors’ daily lives. When we alternate sedentary tasks with physical activity, and follow work with relaxation, we function much more efficiently. In short, move your body more.
Better Computer Habits: Alternate Periods of Rest and Activity
As mentioned earlier, our workstyle puts us out of sync with our genetic heritage. Whether hunting and gathering or building and harvesting, our ancestors alternated periods of inactivity with physical tasks that required walking, running, jumping, climbing, digging, lifting, and carrying, to name a few activities. In contrast, today many of us have a workstyle that is so immobile we may not even leave our desk for lunch.
As health researchers, we have had the chance to study workstyles all over the world. Back pain and strain injuries now affect a large proportion of office workers in the US and in high-tech firms worldwide. The vast majority of these jobs are sedentary, so one focus of the research is on how to achieve a more balanced way of working.
A recent study on exercise looked at blood flow to the brain. Researchers Carter and colleagues found that if people sit for four hours on the job, there’s a significant decrease in blood flow to the brain. However, if every thirty or forty minutes they get up and move around for just two minutes, then brain blood flow remains steady. The more often you interrupt sitting with movement, the better.
It may seem obvious that to stay healthy, it’s important to take breaks and be physically active from time to time throughout the day. Alternating activity and rest recreate the pattern of our ancestors’ daily lives. The goal is to alternate sedentary tasks with physical activity and follow work with relaxation. When we keep this type of balance going, most people find that they have more energy, are more productive, and can be more effective.
Genetics: We’re Hardwired Like Ancient Hunters
Despite a modern appearance, we carry the genes of our forebearers—for better and for worse. (Art courtesy of Peter Sis). Reproduced from Peper, E., Harvey, R., & Faass (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.
In the modern workplace, most of us find ourselves working indoors, in small office spaces, often sitting at a computer for hours at a time. In fact, the average Westerner spends more than nine hours per day sitting indoors, yet we’re still genetically programmed to be physically active and spend time outside in the sunlight most of the day, like the nomadic hunters and gatherers of forty thousand years ago.
Undeniably, we inherently conserve energy in order to heal and regenerate. This aspect of our genetic makeup also helps burn fewer calories when food is scarce. Hence the propensity for lack of movement and sedentary lifestyle (sitting disease).
In times of famine, the habit of sitting was essential because it reduced calorie expenditure, so it enabled our ancestors to survive. In a prehistoric world with a limited food supply, less movement meant fewer calories burned. Early humans became active when they needed to search for food or shelter. Today, in a world where food and shelter are abundant for most Westerners, there is no intrinsic drive to initiate movement.
It is also true that we have survived as a species by staying active. Chronic sitting is the opposite of our evolutionary pattern in which our ancestors alternated frequent movement while hunting or gathering food with periods of rest. Whether they were hunters or farmers, movement has always been an integral aspect of daily life. In contrast, working at the computer—maintaining static posture for hours on end—can increase fatigue, muscle tension, back strain, and poor circulation, putting us at risk of injury.
Quit a Sedentary Workstyle
Almost everyone is surprised by how quickly tension can build up in a muscle, and how painful it can become. For example, we tend to hover our hands over the keyboard without providing a chance for them to relax. Similarly, we may tighten some of the big muscles of our body, such as bracing or crossing our legs.
What’s needed is a chance to move a little every few minutes—we can achieve this right where we sit by developing the habit of microbreaks. Without regular movement, our muscles can become stiff and uncomfortable. When we don’t take breaks from static muscle tension, our muscles don’t have a chance to regenerate and circulate oxygen and necessary nutrients.
Build a variety of breaks into your workday:
- Vary work tasks
- Take microbreaks (brief breaks of less than thirty seconds)
- Take one-minute stretch breaks
- Fit in a moving break
Varying Work Tasks
You can boost physical activity at work by intentionally leaving your phone on the other side of the desk, situating the printer across the room, or using a sit-stand desk for part of the day. Even a few minutes away from the desk makes a difference, whether you are hand delivering documents, taking the long way to the bathroom, or pacing the room while on a call.
When you alternate the types of tasks and movement you do, using a different set of muscles, this interrupts the contractions of muscle fibers and allows them to relax and regenerate. Try any of these strategies:
- Alternate computer work with other activities, such as offering to do a coffee run
- Schedule walking meetings with coworkers
- Vary keyboarding and hand movements
Ultimately, vary your activities and movements as much as possible. By changing your posture and making sure you move, you’ll find that your circulation and your energy improve, and you’ll experience fewer aches and pains. In a short time, it usually becomes second nature to vary your activities throughout the day.
Experience It: “Mouse Shoulder” Test
You can test this simple mousing exercise at the computer or as a simulation. If you’re at the computer, sit erect with your hand on the mouse next to the keyboard. To simulate the exercise, sit with erect posture as if you were in front of your computer and hold a small object you can use to imitate mousing.
With the mouse (or a sham mouse), simulate drawing the letters of your name and your street address, right to left. Be sure each letter is very small (less than half an inch in height). After drawing each letter, click the mouse.
As part of the exercise, draw the letters and numbers as quickly as possible for ten to fifteen seconds. What did you observe? In almost all cases, you may note that you tightened your mousing shoulder and your neck, stiffened your trunk, and held your breath. All this occurred without awareness while performing the task. Over time, this type of muscle tension can contribute to discomfort, soreness, pain, or eventual injury.
Microbreaks
If you’ve developed an injury—or have chronic aches and pains—you’ll probably find split-second microbreaks invaluable. A microbreak means taking brief periods of time that last just a few seconds to relax the tension in your wrists, shoulders, and neck.
For example, when typing, simply letting your wrists drop to your lap for a few seconds will allow the circulation to return fully to help regenerate the muscles. The goal is to develop a habit that is part of your routine and becomes automatic, like driving a car. To make the habit of microbreaks practical, think about how you can build the breaks into your workstyle. That could mean a brief pause after you’ve completed a task, entered a column of data, or before starting typing out an assignment.
For frequent microbreaks, you don’t even need to get up—just drop your hands in your lap or shake them out, move your shoulders, and then resume work. Any type of shaking or wiggling movement is good for your circulation and kind of fun.
In general, a microbreak may be defined as lasting one to thirty seconds. A minibreak may last roughly thirty seconds to a few minutes, and longer large-movement breaks are usually greater than a few minutes. Popular microbreaks:
- Take a few deep breaths
- Pause to take a sip of water
- Rest your hands in your lap
- Stretch
- Let your arms drop to your sides
- Shake out your hands (wrists and fingers)
- Perform a quick shoulder or neck roll
Often, we don’t realize how much tension we’ve been carrying until we become more mindful of it. We can raise our awareness of excess tension—this is a learned skill—and train ourselves to let go of excess muscle tension. As we increase our awareness, we’re able to develop a new, more dynamic workstyle that better fits our goals and schedule.
One-Minute Stretch Breaks
We all benefit from a brief break, even with the best of posture (left). One approach is to totally release your muscles (middle). That release can be paired with a series of brief stretches (right). Reproduced from Peper, E., Harvey, R., & Faass (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.
The typical mini-stretch break lasts from thirty seconds to a few minutes, and ideally you want to take them several times per hour. Similar to microbreaks, mini-stretch breaks are especially important for people with an injury or those at risk of injury. Taking breaks is vital, especially if you have symptoms related to computer stress or whenever you’re working long hours at a sedentary job. To take a stretch break:
Begin with a big stretch, for example, by reaching high over your head then drop your hands in your lap or to your sides.
Look away from the monitor, staring at near and far objects, and blink several times. Straighten your back and stretch your entire backbone by lifting your head and neck gently, as if there were an invisible string attached to the crown of your head.
Stretch your mind and body. Sitting with your back straight and both feet flat on the floor, close your eyes and listen to the sounds around you, including the fan on the computer, footsteps in the hallway, or the sounds in the street.
Breathe in and out over ten seconds (breathe in for four or five seconds and breathe out for five or six seconds), making the exhale slightly longer than the inhale. Feel your jaw, mouth, and tongue muscles relax. Feel the back and bottom of the chair as your body breathes all around you. Envision someone in your mind’s eye who is kind and reassuring, who makes you feel safe and loved, and who can bring a smile to your face inwardly or outwardly.
Do a wiggling movement. When you take a one-minute break, wiggling exercises are fast and easy, and especially good for muscle tension or wrist pain. Wiggle all over—it feels good, and it’s also a great way to improve circulation.
Building Exercise and Movement into Every Day
Studies show that you get more benefit from exercising ten to twenty minutes, three times a day, than from exercising for thirty to sixty minutes once a day. The implication is that doing physical activities for even a few minutes can make a big difference.
Dunstan and colleagues have found that standing up three times an hour and then walking for just two minutes reduced blood sugar and insulin spikes by twenty-five percent.Fit in a Moving Break
Fit in a Moving Break
Once we become conscious of muscle tension, we may be able to reverse it simply by stepping away from the desk for a few minutes, and also by taking brief breaks more often. Explore ways to walk in the morning, during lunch break, or right after work. Ideally, you also want to get up and move around for about five minutes every hour.
Ultimately, research makes it clear that intermittent movement, such as brief, frequent stretching throughout the day or using the stairs rather than elevator, is more beneficial than cramming in a couple of hours at the gym on the weekend. This explains why small changes can have a big impact—it’s simply a matter of reminding yourself that it’s worth the effort.
Workstation Tips
Your ability to see the display and read the screen is key to reducing neck and eye strain. Here are a few strategic factors to remember:
Monitor height: Adjust the height of your monitor so the top is at eyebrow level, so you can look straight ahead at the screen.
Keyboard height: The keyboard height should be set so that your upper arms hang straight down while your elbows are bent at a 90-degree angle (like the letter L) with your forearms and wrists held horizontally.
Typeface and font size: For email, word processing, or web content, consider using a sans serif typeface. Fonts that have fewer curved lines and flourishes (serifs) tend to be more readable on screen.
Checking your vision: Many adults benefit from computer glasses to see the screen more clearly. Generally, we do not recommend reading glasses, bifocals, trifocals, and progressive lenses as they tend to allow clear vision at only one focal length. To see through the near-distance correction of the lens requires you to tilt your head back. Although progressive lenses allow you to see both close up and at a distance, the segment of the lens for each focal length is usually too narrow for working at the computer.
Wearing progressive lenses requires you to hold your head in a fixed position to be in focus. Yet you may be totally unaware that you are adapting your eye and head movements to sustain your focus. When that is the case, most people find that special computer glasses are a good solution.
Consider computer glasses if you must either bring your nose to the screen to read the text, wear reading glasses and find that their focal length is inappropriate for the monitor distance, wear bi- or trifocal glasses, or are older than forty.
Computer glasses correct for the appropriate focal distance to the computer. Typically, monitor distance is about twenty-three to twenty-eight inches, whereas reading glasses correct for a focal length of about fifteen inches. To determine your individual, specific focal length, ask a coworker to measure the distance from the monitor to your eyes. Provide this personal focal distance at the eye exam with your optometrist or ophthalmologist and request that your computer glasses be optimized for that distance.
Remembering to blink: As we focus on the screen, our blinking rate is significantly reduced. Develop the habit of blinking periodically: at the end of a paragraph, for example, or when sending an email.
Resting your eyes: Throughout the day, pause and focus on the far distance to relax your eyes. When looking at the screen, your eyes converge, which can cause eyestrain. Each time you look away and refocus, that allows your eyes to relax. It’s especially soothing to look at green objects such as a tree that can be seen through a window.
Minimizing glare: If the room is lit with artificial light, there may be glare from your light source if the light is right in front of you or right behind you, causing reflection on your screen. Reflection problems are minimized when light sources are at a 90-degree angle to the monitor (with the light coming from the side). The worst situations occur when the light source is either behind or in front of you.
An easy test is to turn off your monitor and look for reflections on the screen. Everything that you see on the monitor when it’s turned off is there when you’re working at the monitor. If there are bright reflections, they will interfere with your vision. Once you’ve identified the source of the glare, change the location of the reflected objects or light sources, or change the location of the monitor.
Contrast: Adjust the light contrast in the room so that it is neither too bright nor too dark. If the room is dark, turn on the lights. If it is too bright, close the blinds or turn off the lights. It is exhausting for your eyes to have to adapt from bright outdoor light to the lighting of your computer screen. You want the light intensity of the screen to be somewhat similar to that in the room where you’re working. You also do not want to look from your screen to a window lit by intense sunlight.
Don’t look down at phone: According to Kenneth Hansraj, MD, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine, pressure on the spine increases from about ten pounds when you are holding your head erect, to sixty pounds of pressure when you are looking down. Bending forward to look at your phone, your head moves out of the line of gravity and is no longer balanced above your neck and spine. As the angle of the face-forward position increases, this intensifies strain on the neck muscles, nerves, and bones (the vertebrae).
The more you bend your neck, the greater the stress since the muscles must stretch farther and work harder to hold your head up against gravity. This same collapsed head-forward position when you are seated and using the phone repeats the neck and shoulder strain. Muscle strain, tension headaches, or neck pain can result from awkward posture with texting, craning over a tablet (sometimes referred to as the iPad neck), or spending long hours on a laptop.
A face-forward position puts as much as sixty pounds of pressure on the neck muscles and spine.
Repetitive strain of neck vertebrae (the cervical spine), in combination with poor posture, can trigger a neuromuscular syndrome sometimes diagnosed as thoracic outlet syndrome. According to researchers Sharan and colleagues, this syndrome can also result in chronic neck pain, depression, and anxiety.
When you notice negative changes in your mood or energy, or tension in your neck and shoulders, use that as a cue to arch your back and look upward. Think of a positive memory, take a mindful breath, wiggle, or shake out your shoulders if you’d like, and return to the task at hand.
Strengthen your core: If you find it difficult to maintain good posture, you may need to strengthen your core muscles. Fitness and sports that are beneficial for core strength include walking, sprinting, yoga, plank, swimming, and rowing. The most effective way to strengthen your core is through activities that you enjoy.
Final Thoughts
If these ideas resonate with you, consider lifestyle as the first step. We need to build dynamic physical activity into our lives, as well as the lives of our children. Being outside is usually an uplift, so choose to move your body in natural settings whenever possible, whatever form that takes. Being outside is the factor that adds an energetic dimension. Finally, share what you learn, and help others learn and grow from your experiences.
If you spend time in front of a computeror using a mobile device, read the book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. It provides practical, easy-to-use solutions for combating the stress and pain many of us experience due to technology use and overuse. The book offers extremely helpful tips for ergonomic use of technology, it
goes way beyond that, offering simple suggestions for improving muscle health that seem obvious once you read them, but would not have thought of yourself: “Why didn’t I think of that?” You will learn about the connection between posture and mood, reasons for and importance of movement breaks, specific movements you can easily perform at your desk, as well as healthier ways to utilize technology in your everyday life.
See the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics by Erik Peper, Richard Harvey and Nancy Faass. Available from: https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X/
Additional resources
Healing a Shoulder/Chest Injury
Posted: August 14, 2023 Filed under: behavior, biofeedback, Breathing/respiration, emotions, Exercise/movement, healing, Neck and shoulder discomfort, Pain/discomfort, relaxation, self-healing, Uncategorized | Tags: electromyograph, guided imagery, shoulder pain Leave a commentAdapted from Peper, E. & Fuhs, M. (2004). Applied psychophysiology for therapeutic use: Healing a shoulder injury, Biofeedback, 32(2), 11-18.
“It has been an occurrence of the third dimension for me! How come my pain — that lasted for more than 10 days and was still so strong that I really had difficulties in breathing, couldn’t laugh without pain nor move my arm not even to fulfil my daily routines such as dressing and eating — disappeared within one single session of 20 minutes? And not only that, I was able to freely rotate my arm as if it had never been injured before.” —23 year old woman
The participant T., aged 23, was a psychology student who participated in an educational workshop for Healthy Computing. She volunteered to be a subject for a surface electromyographic (SEMG) monitoring and feedback demonstration. Ten days prior to this workshop, she had a severe skiing accident. She described the accident as follows:
I went skiing and may be I had too much snow in my ski-binding and while turning, I slipped out of my binding and fell head first down into the hill. As I fell, I landed on my ski pole which hit my left upper chest and breast area. Afterwards, my head was humming and I assumed that I had a light concussion. I stopped skiing and stayed in bed for a while. The next day it started hurting and I couldn’t turn my head or put my shoulders back (they were rotated forward). Also, I couldn’t ski as I was not able to look down to my feet–my muscles were too contracted and I felt searing pain whenever I moved. I hoped that it would go away however, the pain and left forward shoulder rotation stayed.
Assessment
Observation and Palpation
T.´s left shoulder was rolled forward (adducted and in internal rotation). She was not able to breathe or laugh without pain or move her arm freely. All movements in vertical and horizontal directions and rotations were restricted by at least 50 % as compared to her right arm (limitations in shoulder extension, flexion and external rotation). Also, her hands were ice-cold and she breathed very shallowly and rapidly in her chest. She was not able to stand in an upright position or sit in a comfortable position without maintaining her left upper extremity in a protected position. Her left shoulder blade (scapula) was winging.
After visually observing her, the instructor placed his left hand on her left shoulder and pectoralis muscles and his right hand on the back of her shoulder. Using palpation and anchoring her back with his leg so that she could not rotate her trunk, he explored the existing range of shoulder movement. He also attempted to rotate the left shoulder outward and back–not by forcing or pulling—but by very gentle traction. No change in mobility was observed and the pectoralis muscle felt tight (SEMG monitoring is helpful to the therapist during such a diagnostic assessment by helping to identify the person’s reactivity and avoiding to evoke and condition even more bracing). T. reported afterwards that she was very scared by this assessment because there was one point in the back which was highly reactive to touch. T. appeared to tighten automatically out of fear and trigger a general flexor contraction pattern—a process that commonly occurs if a person is guarding an area.
Often a traumatic injury first induces a general shock that triggers an automatic freeze and fear reaction. Therefore, an intervention needed to be developed that did not trigger vigilance or fear and thereby allowed the muscle to relax. If pain is experienced or increased, it is another negative reinforcement for generalizing guarding and bracing and tightening the muscles. This guarding decreases mobility – a common reaction that may occur when health professionals in the process of assessment increase the client’s discomfort. T.’s vigilance was also “telegraphed” to the therapist by her ice-cold hands and very shallow chest breathing. Therefore, it was important to increase her comfort level and to not induce any further pain. We hypothesized that only if she felt safe it would be possible for her muscle tension to decrease and thereby increase her mobility.
Underlying concept: The very cold hands and shallow breathing probably indicated excessive vigilance and arousal—a possible indicator of a catabolic state that could limit regeneration. The chronic cold hands most likely implied that she was very sensitive to other people’s emotions and continuously searches/scans the environment for threats. In addition, she indicated that she liked to do/perform her best which induced more anxiety and fear of judgement.
Single Channel Surface Electromyographic (SEMG)Assessment
The triode electrode with sensor was placed over the left pectoralis muscle area as shown in Figure 1. The equipment was a MyoTrac™ produced by Thought Technology Ltd. which is a small portable SEMG with the preamplifiers at the triode sensor to eliminate electrode lead and movement artefacts (Peper & Gibney, 2006). Such a device is an inexpensive option for people who may use biofeedback for demonstrating and teaching awareness and control over muscle tension from a single electrode location.
Figure 1. Location of the Triode electrode placement on the left pectoralis muscle area of another participant.
The MyoTrac was placed on a table within view, so that the therapist and the subject could simultaneously see the visual feedback signal and observe what was going on as well as demonstrate expected changes. The feedback was used for T. as a tool to see if she could reduce her SEMG activity. It was also used by the therapist to guide his interventions: To keep the SEMG activity low and to stop any intervention that would increase the SEMG activity as this would prevent bracing as a possible reaction to, or anticipation of, pain.
1. Assessment of Muscle Reactivity. After the electrode was attached on her pectoralis muscle and with her arm resting on her lap, she was asked to roll her left shoulder slightly more forward, hold the tension for the count of 10 and then let go and relax. Even with feedback, the muscle activity stayed high and did not relax and return to a lower level of activity as shown in Figure 2. This lack of return to baseline is often a diagnostic indicator of muscle irritability or injury (Sella, 1998; Sella, 2006). If the muscle does not relax immediately after contraction, movement or exercise should not be prescribed, since it may aggravate the injury. Instead, the person first needs to learn how to relax and then learn how to relax between activation and tensing of the muscle. The general observation of T. was that at the initiation of any movement (active or passive) muscle tension increased and did not return to baseline for more than two minutes.
Figure 2. Simulation of the effect on the pectoralis sEMG (this is a recording from another subject who showed a similar response pattern that was visually observed from T. with the Myotrac). After the muscle is contracted it takes a long time to return to baseline level
2. Exploration. Self-exploration with feedback was encouraged. T. was instructed to let go of muscle tension in her left shoulder girdle. In addition the therapist tried to induce her letting go by gently and passively rocking her left arm. The increased SEMG activity and the protective bracing in her shoulder showed that she couldn’t reduce the muscle tension. Each time her arm was moved, however slightly, she helped with the movement and kept control. In addition, T. was asked to reduce the muscle tension using the biofeedback signal; again she was not able to reduce her muscle tension with feedback.
3. Passive Stretch and Movements. The next step was to passively stretch the pectoralis muscle by holding the shoulder between both hands and very gently externally rotate the shoulder — a process derived from the Alexander technique (Barlow, 1991). Each time the instructor attempted to rotate her shoulder, the SEMG increased and T. reported an increased fear of pain. T.’s SEMG response most likely consisted of the following components:
- Movement induced pain
- Increased splinting and guarding
- Increased arousal/vigilance to perform well
These three assessment and self-regulation procedures were unsuccessful in reducing muscle tension or increasing shoulder movement. This suggested that another therapeutic intervention would need to be developed to allow the left pectoralis area to relax. The SEMG could be used as an indicator whether the intervention was successful as indicated by a reduction in SEMG activity. Finally, the inability to relax after tightening (bracing and splinting) probably aggravated her discomfort.
Multiple levels of injury: The obvious injury and discomfort was due to her left chest wall being hit by the ski pole. She then guarded the area by bracing the muscles to protect it which limited movement. The guarding tightened the muscles and limited blood circulation and lymphatic flow which increased local ischemia, irritation and pain. This led to a self-perpetuating cycle: Pain triggers guarding and guarding increases pain and impedes self-healing.
As the SEMG and passive stretching assessment were performed, the therapist concurrently discussed the pain process. Namely, from this perspective, there were at least two types of pains:
- Pain caused by the physiological injury
- Pain as the result of guarding
The pain from the guarding is similar to having exercised for a long time after not having exercised. The next day you feel sore. However, if you feel sore, you know that it was due to the exercise therefore it is defined as a good pain. In T.’s case, the pain indicated that something was wrong and did not heal and therefore she would need to protect it. We discussed this process as a way to use cognitive reframing to change her attitude toward guarding and pain.
Rationale: The intention was to interrupt her negative image of pain that acted as a post hypnotic suggestion. The objective was to change her image and thoughts from “pain indicates the muscle is damaged” to “pain indicates the muscle has worked too hard and long and needs time to regenerate.”
Treatment interventions
The initial intervention focused upon shifting shallow thoracic breathing to diaphragmatic breathing. Generally, when people breathe rapidly and predominantly in their chest, they usually tighten their neck and shoulder muscles during inhalation. One of the reasons T. breathed in her chest was that her clothing–very tight jeans–constricted her waist (MacHose & Peper, 1991; Peper et al., 2015). This breathing pattern probably contributed to sub-clinical hyperventilation and was part of a fear or flexor response pattern. When she loosened the upper buttons of her jeans and allowed her stomach to expand her pectoralis muscle relaxed as she breathed as shown in Figure 3. As she began to breathe in this pattern, each time she exhaled her pectoralis muscle tension decreased.
Figure 3. Illustration of the effect of loosening tight waist constriction (eliminating designer’s jean syndrome) on blood flow and pectoralis sEMG. Abdominal breathing became possible and finger temerature increased (this recording is from another subject whose physiological responses were similar to that was observed with the Myotrac from T.)
Following the demonstration that breathing significantly lowered her chest muscle tension, the discussion focussed on the importance of effortless diaphragmatic breathing for health and reduction of vigilance. Being awkward and uncomfortable at loosening her pants, she struggled with allowing her abdomen to expand and her pants to be looser because she thought that she looked much more attractive in tight clothing. Yet, she agreed that her boy friend would love her regardless whether she wore loose or tight clothing. To encourage an acceptance for wearing looser clothing and thereby permit diaphragmatic breathing during the day, an informal discussion focused on “designer jeans syndrome” (chest breathing induced by tight clothing) with humorous examples such as discussing the name of the room that is located on top of the stairs in the Victorian houses in San Francisco. It is called the fainting room–in the 19th century women who wore corsets and had to climb the stairs would have to breathe rapidly and then would faint when they reached the top of the stairs (Peper, 1990).
Rationale: Rapid shallow chest breathing can induce a catabolic state that inhibits healing while diaphragmatic breathing may induce an anabolic state that promotes regeneration. Moreover, effortless diaphragmatic breathing would increase respiratory sinus arhythmia (RSA)–heart rate variability linked to breathing– and thereby facilitate sympathetic-parasympathetic balance that would promote self-healing.
The discussion included the use of the YES set which meant asking a person questions in such a way that she/he answers the question with YES. When a person answers YES at least three times in a row rapport is often facilitated (Erikson, 1983, pp. 237-238). Questions were framed in such a way that the client would answer with YES. For example, if the therapist thought the person did not do their homework, a yes question could be framed as, “It must have been difficult to find time to do the homework this week?” In T.’s case, the therapist said, “I see, you would rather wear tight clothing than allow your shoulder to heal.” She answered, “Yes.” This was the expected answer, however, the question was framed in an intuitive guess on the therapist’s part. Nevertheless, the strategy would have been successful either way because if she had answered “No,” it would have broken the “Yes: set, but she would then be committed to change her clothing.
Throughout this discussion, the therapist placed his left hand on her abdomen over her belly button and overtly and covertly guided her breathing movement. As she exhaled, he pressed gently on her abdomen; as she inhaled he drew his hand away–as if her abdomen was like a balloon that inflated during inhalation and deflated during exhalation. To enhance learning diaphragmatic breathing and slower exhalation, the therapist covertly breathed at the same rhythm and gently exhaled as she exhaled while allowing the breathing movement to be mainly in his abdomen. In this process, learning occurred without demand for performance and she could imitate the breathing process that was covertly modelled by the therapist.
The Change
The central observation was that each time she tried to relax or do something, she would slight brace which increased her pectoralis SEMG activity. The chronic tension from guarding probably induced localized ischemia, inhibited lymphatic flow and drainage, and reduced blood circulation which would increase tissue irritation. Whenever the therapist began to move her arm, she would anticipate and try to help with the movement. Overall she was vigilant (also indicated by her very cold hands) and wanted to perform very well (a possible need for approval). Her muscle bracing and helping with movement was reframed as a combined activity that consisted of guarding to prevent further injury and as a compliment that she would like to perform well.
Labelling her activity as a “compliment” was part of a continuing YES set approach. The therapist was deliberately framing whatever happened as adaptive behaviour, with positive intent. Further, if one tries and does something with too much effort while being vigilant, the arousal would probably induce hand cooling. If the activity can be performed with passive attention, then increased blood flow and warmth may occur. The therapeutic challenge was how to reduce vigilance, perfectionism and guarding so that the muscles that were guarding the traumatized area would relax.
Therapeutic concept: If a direct approach does not work, an indirect approach needs to be employed. Through an indirect approach, the person experiences a change without trying to focus on doing or achieving it. Underlying this approach is the guideline: If something does not work, try it once more and then if it does not work, do something completely different. This is analogous to sexual arousal: If you demand from a male to have an erection: The more performance you demand the less likely will there be success. On the other hand, if you remove the demand for performance and allow the person to become interested and thereby feel an erotic experience an erection may occur without effort.
The shift to an indirect intervention was done through active somatic visualization. T. was encouraged to visualize and remember a positive image or memory from her past. She chose a memory of a time when she was in Paris with her grandmother. While T. visualized being with her grandmother, the therapist asked another older women participant to help and hold T’s right hand in a grandmother-like way as if she was her grandmother. The “grandmother” then moved T.’s hand in a playful way as if dancing with T.’s right arm. Through this kinesthetic experience, T. became more and more absorbed in her memory experience. At the same time, T´s left hand was being held and gently rocked by the therapist. During this gentle rocking, the SEMG activity decreased completely in her left pectoralis area. The therapist used the SEMG feedback to guide him in the gentle rocking motion of T.’s left arm and very slowly increased the range of her arm and shoulder motion. Gentle movement was done only as long as the SEMG activity did not increase. It allowed the muscle to stay relaxed and facilitated the experience of trust. The following is T. report two days later of what happened.
“Initially it was very difficult for me to let go of control because I found this idea somewhat strange and I was puzzled. I expected the therapist to intervene and I felt frightened. The therapist’s soft and gentle touch and his very soft voice in this kind of meditation helped me to let go of control and I was surprised about my own courage to give myself into the process without knowing what would happen next.”
Rationale: Every corresponding thought and emotion has an associated body response and every body response has an associated mental/emotional response (Green & Green, 1977; Green, 1999). Therefore, an image and experience of a happy and safe past memory will allow the body to evoke the same state and vigilance can be abated. The intensity of the experience is increased when multi-sensory cues are included such as actual handholding. The more senses are involved, the more the experience can become real. In addition, the tactile sensation of feeling the grandmother’s hand diverted her attention away from her shoulder into her hand and thereby reduced her active efforts of trying to relax the shoulder and pectoralis area. Doing something she did not expect to happen also helped her loose control – an implicit confusion approach.
SEMG feedback was used as the guide for controlling the movement. The therapist gently increased the range of the movements in abduction and external rotation directions while continuously rocking her arm until her injured arm was able to move unrestricted in full range of motion. The arm and shoulder relaxation and continuous subtle movement without evoking any SEMG activation facilitated blood flow and lymphatic drainage which probably reduced congestion. After a few minutes, the therapist gently dropped her arm on her lap. After her arm was resting on her lap, she reported that it felt very heavy and relaxed and that she didn’t feel any pain. However, she initially didn’t really realize that her mobility had increased dramatically.
Rationale: When previous movements that had been associated with pain are linked to an experience of pleasure, the movement is often easier. The conditioned muscle bracing patterns associated with anticipation of pain and/or concern for improvement/results are reduced.
Process to deepen and generalize the relaxation and breathing. She was asked to imagine breathing the air down and through her arms and legs–a strategy that she could then do at home with her boyfriend. We wanted to involve another person because it is often difficult to do homework practices without striving and concern for results and focussing on the area of discomfort. Her response to asking if her boyfriend would help was an automatic “naturally” (the continuation of the YES set). With her agreement, we role played how her boyfriend was to encourage diaphragmatic breathing. He was to gently stroke down her legs as she exhaled. She could then just focus on the sensations and allow the air to flow down her legs. Then, while she continued to breathe effortlessly, he would gently rock and move her arm.
To be sure that she knew how to give the instructions, the therapist role played her boyfriend and then asked her to rock his arm so that she would know how to teach her boy friend how to move her arm. The therapist sat on her left side, and, as she now held his right arm and gently rocked it with her left arm, the therapist gently moved backwards. This meant that she externally rotated her left arm and shoulder more and more. He moved in such a way that in the process of rocking his arm, she moved her “previously injured shoulder” in all directions (up, down, forward and backwards) and was unaware that she could move her arm and shoulder as she did not experience any discomfort. Afterwards, we shared our observations and she was asked to move her arm and shoulder. She moved it without any restrictions or discomfort.
Rationale: By focusing outside herself and not being concerned about herself, she did not think of herself or of trying to move her arm and shoulder. Hence, she did not evoke the anticipatory guarding and thus significantly increased her flexibility.
Process of acceptance. Often after an injury, we are frustrated with our bodies. This frustration may interfere with healing. Therefore, the session concluded by asking her to be appreciative of her shoulder and arm. She was asked to think of all the positive things her shoulder, chest and arm have done for her in the past instead of the many limitations and pains caused by the injury. Instead of being angry at her shoulder that it had not healed or restricted her movement, we suggested that she should appreciate her shoulder and pectoralis area for all it had done without her awareness such as: How the shoulder moved her arm during love-making, how without complaining her shoulder moved during walking, writing, skiing, eating, etc., and how many times in the past she had abused her shoulder without giving it proper respect and appreciation. This process reframes the way one symbolically relates to the injured area. Every thought of discomfort or negative judgement becomes the trigger and is transformed into breathing lower and slower and evokes an appreciation of the positive nice things her shoulder has done for her in the past.
Rationale: When injured we often evoke negative mental and emotional images which become post- hypnotic suggestions. Those negative thoughts, images and emotions interfere with healing while positive thoughts, images and emotions tend to promote healing. A possible energetic process that occurs when injured is that we withdraw awareness/ consciousness from the injured area which reduces blood and lymph circulation. Caring and positive feelings about an area tends to increase blood flow and warmth (a heart-warming experience) and promotes healing.
RESULTS
She left the initial session without any pain and with total range of motion. At the two week follow-up she reported continued pain relief and complete range of motion. T.s reflection of the experience was:
“I really was not aware that I could move my arm freely like before the accident, I was just feeling a kind of trance and was happy to not feel any pain and to feel much more upright than before. Then I watched the faces of the two other therapists who sat there with big eyes and a grin on their face and then become aware of my own arms position which was rotated backwards and up, a movement that was impossible to do before. I remember this evening that I left with this feeling of trance and that I often tried to go back to my collapsed posture but this was not possible anymore and I felt very tall and straight. Now two weeks later I still feel like that and know that I had an amazing experience which I will store in my brain!
My father who is an orthopedic surgeon tested me and found out, that I had hurt my rib. He said that I have a contusion and it will go away in a few weeks. Before this experience, I would say that he was not open to Biofeedback. However he was so captivated by my experiences that he spontaneously promised me to pay for my own biofeedback equipment and to support me with my educational program and even offered me a job in his practice to do this work!”
Psychophysiological Follow-up: 3 Weeks Later
The physiological assessment included monitoring thoracic and abdominal breathing patterns, blood volume pulse, heart rate and SEMG from her left pectoralis muscle while she was asked to roll her left shoulder forward (adducted and internally rotated) for the count of 10 and then relax. The physiological recording showed that she breathed more diaphragmatically and that her pectoralis muscle relaxed and returned directly to baseline after rotation as shown in Fig. 4.
Figure 4. Physiological profile during the rolling left shoulder forward (tense) and relaxing at thethree week follow-up. Note that the pectoralis sEMG activity returned rapidly to baseline after contracting and her breathing pattern is abdomninal and slower.
Summary
This case example demonstrates the usefulness of a simple one-channel SEMG biofeedback device to guide the interventions during assessment and treatment. It suggests that the therapist and client can use the SEMG activity as an indicator of guarding–a visual representation of the subjective experience of fear, pain and range of mobility–that can be evoked during assessment and therapeutic interventions. The anticipation of increased pain commonly occurs during diagnosis and treatment and often becomes an obstacle for healing because increased pain may increase anticipation of pain and trigger even more bracing. To avoid triggering this vicious circle of guarding/fear, the feedback signal allows the therapist and the client to explore strategies that reduce muscle activity by indirect interventions.
By using an indirect approach that the client may not expect, the interventions shift the focus of attention and striving and may allow increased freedom and relaxation. The biofeedback signal may guide the therapeutic process to reduce the patterns of fear, panic, and bracing that are commonly associated with injury and illnesses. Once this excessive sympathetic activity is reduced, the actual pathophysiology may become obvious (in most cases is much less then before) and the healing process may be accelerated. This case description may offer an approach in diagnosis and treatment for many therapists and open a door for a gentle, painless and yet successful way of treatment and encourage therapists to be creative and use both experience/technique and intuition.
For additional intervention approaches see the following two blogs.
References
Barlow, W. (1991). The Alexander technique: How to use your body without stress. Rochester, VT: Healing Arts Press https://www.amazon.com/Alexander-Technique-Your-without-Stress/dp/0892813857#:~:text=Barlow%2C%20the%20foremost%20exponent%20and,and%20movement%20in%20everyday%20activities.
Erikson, M. H. (1983). Healing in hypnosis, volume 1 (Edited by E. L. Rossi, M. O. Ryan, M. & F. A. Sharp). New York: Irvington Publishers, Inc.. https://www.amazon.com/Hypnosis-Seminars-Workshops-Lectures-Erickson/dp/0829007393/ref=sr_1_1?keywords=9780829007398&linkCode=qs&qid=1692038804&s=books&sr=1-1
Green, E. (1999). Psychophysical Principal. Accessed August 14, 2023 https://www.elmergreenfoundation.org/psychophysiological-principal/
Green, E., & Green, A. (1977). Beyond biofeedback. New York:
Delacorte Press/Seymour. https://elmergreenfoundation.org/wp-content/uploads/2019/02/Beyond-Biofeedback-Green-Green-Searchable.pdf
MacHose, M., & Peper, E. (1991). The effect of clothing on inhalation volume. Biofeedback and Self-Regulation. 16(3), 261-265. https://doi.org/10.1007/BF01000020
Peper, E. (1990). Breathing for health. Montreal: Thought Technology Ltd.
Peper, E. & Gibney, K.H. (2006). Muscle biofeedback at the computer-A manual to prevent repetitive strain injury (RSI) by taking the guesswwork out of assessment, monitoring and training. Biofeedback Foundation of Europe. https://thoughttechnology.com/muscle-biofeedback-at-the-computer-book-t2245/
Peper, E., Gilbert, C.D., Harvey, R. & Lin, I-M. (2015). Did you ask about abdominal surgery or injury? A learned disuse risk factor for breathing dysfunction. Biofeedback. 34(4), 173-179. https://doi.org/10.5298/1081-5937-43.4.06
Sella, G. E. (2006). SEMG: Objective methodology in muscular dysfunction investigation and rehabilitation. Weiner’s pain management: A practical guide for clinicians, CRC Press, 645-662. https://www.taylorfrancis.com/chapters/edit/10.1201/b14253-45/semg-objective-methodology-muscular-dysfunction-investigation-rehabilitation-gabriel-sella
Sella, G. E. (1998). Towards an Integrated Approach of sEMG Utilization: Quantative Protocols of Assessment and Biofeedback. Electromyography: Applications in Physical Medicine. Thought Technology, 13. https://www.bfe.org/protocol/pro13eng.htm
[1] We thank Theresa Stockinger for her significant contribution and Candy Frobish for her helpful comments.
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 1 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 6 CommentsAdapted from: Peper, E., Chen, S., Heinz, N., & Harvey, R. (2023). Hope for menstrual cramps (dysmenorrhea) with breathing. Biofeedback, 51(2), 44–51. https://doi.org/10.5298/1081-5937-51.2.04; Republished in Townsend E-Letter – 18 November, 2023 https://www.townsendletter.com/e-letter-22-breath-affects-stress-and-menstrual-cramps/ Google NotebookLM generated podcast:
“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
Chen, S. (2023). Diaphragmatic breathing reduces dysmenorrhea symptoms-a testimonial. YouTube. Accessed March 3, 2023. https://youtu.be/E45iGymVe3U
De Sanctis, V., Soliman, A., Bernasconi, S., Bianchin, L., Bona, G., Bozzola, M., Buzi, F., De Sanctis, C., Tonini, G., Rigon, F., & Perissinotto, E. (2015). Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge. Pediatr Endocrinol Rev. 13(2), 512-20. PMID: 26841639. https://pubmed.ncbi.nlm.nih.gov/26841639/
De Sanctis, V., Soliman, A. T., Daar, S., Di Maio, S., Elalaily, R., Fiscina, B., & Kattamis, C. (2020). Prevalence, attitude and practice of self-medication among adolescents and the paradigm of dysmenorrhea self-care management in different countries. Acta Bio Medica: Atenei Parmensis, 91(1), 182. https://doi.org/10.23750/abm.v91i1.9242
Dietvorst, T.F. & Osborne, D. (1978). Biofeedback-Assisted Relaxation Training
for Primary Dysmenorrhea: A Case Study. Biofeedback and Self-Regulation, 3(3), 301-305. https://doi.org/10.1007/BF00999298
Chesney, M. A., & Tasto, D. L. (1975).The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea. Behaviour Research and Therapy, 13, 245-253. https://doi.org/10.1016/0005-7967(75)90029-7
Ganesh, B.R., Donde, M.P., & Hegde, A.R. (2015). Comparative study on effect of slow and fast phased pranayama on quality of life and pain in physiotherapy girls with primary dysmenorrhea: Randomize clinical trial. International Journal of Physiotherapy and Research, 3(2), 960-965. https://doi.org/10.16965/ijpr.2015.115
Hart, A.D., Mathisen, K.S. & Prater, J.S. A comparison of skin temperature and EMG training for primary dysmenorrhea. Biofeedback and Self-Regulation 6, 367–373 (1981). https://doi.org/10.1007/BF01000661
Heczey, M. D. (1978). Effects of biofeedback and autogenic training on menstrual experiences: relationship among anxiety, locus of control and dysmenorrhea. City University of New York ProQuest Dissertations Publishing, 7805763. https://www.proquest.com/openview/088e0d68511b5b59de1fa92dec832cc8/1?pq-origsite=gscholar&cbl=18750&diss=y
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
Jacobson, E. (1938). Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice. Chicago: University of Chicago Press
Ju, H., Jones, M., & Mishra, G. (2014). The prevalence and risk factors of dysmenorrhea. Epidemiol Rev, 36, 104-13. https://doi.org/10.1093/epirev/mxt009
Karout, S., Soubra, L., Rahme, D. et al. Prevalence, risk factors, and management practices of primary dysmenorrhea among young females. BMC Women’s Health 21, 392 (2021). https://doi.org/10.1186/s12905-021-01532-w
Iacovides, S., Avidon,I, & Baker, F.C. (2015).What we know about primary dysmenorrhea today: a critical review, Human Reproduction Update, 21(6), 762–778. https://doi.org/10.1093/humupd/dmv039
Luthe, W. & Schultz, J.H. (1969). Autogenic Therapy, Volume II Medical Applications. New York: Grune & Stratton, pp144-148.
MacHose, M. & Peper, E. (1991). The effect of clothing on inhalation volume. Biofeedback and Self-Regulation, 16(3), 261–265. https://doi.org/10.1007/BF01000020
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://doi.org/10.5298/1081-5937-44.1.03
Peper, E., Gibney, H. K. & Holt, C. (2002). Make Health Happen. Dubuque, Iowa: Kendall-Hunt. ISBN: 978-0787293314 https://he.kendallhunt.com/make-health-happen
Peper, E., Gilbert, C.D., Harvey, R. & Lin, I-M. (2015). Did you ask about abdominal surgery or injury? A learned disuse risk factor for breathing dysfunction. Biofeedback. 34(4), 173-179. https://doi.org/10.5298/1081-5937-43.4.06
Peper, E. & Tibbetts, V. (1994). Effortless diaphragmatic breathing. Physical Therapy Products. 6(2), 67-71. Also in: Electromyography: Applications in Physical Therapy. Montreal: Thought Technology Ltd. https://biofeedbackhealth.files.wordpress.com/2011/01/peper-and-tibbets-effortless-diaphragmatic.pdf
Proctor, M. & Farquhar, C. (2006). Diagnosis and management of dysmenorrhoea. BMJ. 13, 332(7550), 1134-8. https://doi.org/10.1136/bmj.332.7550
Proctor, M.L, Murphy, P.A., Pattison, H.M., Suckling, J., & Farquhar, C.M. (2007). Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev, (3):CD002248. https://doi.org/10.1002/14651858.CD002248.pub3
Suryantini, N. P. (2022). Effleurage Massage: Alternative Non-Pharmacological Therapy in Decreasing Dysmenorrhea Pain. Women, Midwives and Midwifery, 2(3), 41-50. https://wmmjournal.org/index.php/wmm/article/view/71/45
Thakur, P. & Pathania, A.R. (2022). Relief of dysmenorrhea – A review of different types of pharmacological and non-pharmacological treatments. MaterialsToday: Proceedings.18, Part 5, 1157-1162. https://doi.org/10.1016/j.matpr.2021.08.207
Vagedes, J., Fazeli, A., Boening, A., Helmert, E., Berger, B. & Martin, D. (2019). Efficacy of rhythmical massage in comparison to heart rate variability biofeedback in patients with dysmenorrhea—A randomized, controlled trial. Complementary Therapies in Medicine, 42, 438-444. https://doi.org/10.1016/j.ctim.2018.11.009
Vonkeman, H.E. & van de Laar, M,A. (2010). Nonsteroidal anti-inflammatory drugs: adverse effects and their prevention, Semin Arthritis Rheum, 39(4), 294-312. https://doi.org/10.1016/j.semarthrit.2008.08.001
Wang, L., Wand, X., Wang, W., Chen, C. Ronnennberg, A.G., Guang, W. Huang, A. Fang, Z. Zang, T., Wang, L. & Xu, X. (2003).Stress and dysmenorrhoea: a population based prospective study. Occupation and Environmental Medicine, 61(12). http://dx.doi.org/10.1136/oem.2003.012302
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 3 CommentsErik 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 4 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).
the peper perspective 
