Healing from the Inside Out: How Your Mind–Body Shapes Pain
Posted: June 9, 2025 Filed under: attention, behavior, Breathing/respiration, CBT, emotions, healing, health, mindfulness, Pain/discomfort, placebo, self-healing, Uncategorized | Tags: health, meditation, mental-health, mindfulness, Sufism, yoga 2 CommentsAdapted from Peper, E., Booiman, A. C., & Harvey, R. (2025). Pain-There is Hope. Biofeedback, 53(1), 1-9. http://doi.org/10.5298/1081-5937-53.01.16
Pain is more than a physical sensation—it’s shaped by our breath, thoughts, emotions, and beliefs. A striking example: a four-year-old received a vaccination with no pain, revealing the disconnect between what science knows about pain relief and what’s practiced.
The article highlights five key ways to reduce pain:
- Exhale during the painful moment – This activates the parasympathetic nervous system, calming the body. A yogi famously demonstrated this by pushing skewers through his tongue without bleeding or feeling pain.
- Create a sense of safety – Feeling secure can lessen pain and speed healing. Sufi mystics have shown this by pushing knives through their chest muscles without long-term damage, often healing rapidly.
- Distract the mind – Shifting focus can ease discomfort.
- Reduce anticipation – Fear of pain often amplifies it.
- Explore the personal meaning of pain – Understanding what pain symbolizes can shift how we experience it.
The blog also explores how the body regulates pain through mechanisms which influence inflammation and pain signals. In the end, hope, trust, and acceptance, along with mindful breathing, healing imagery, and meaningful engagement, emerge as powerful tools not just to reduce pain—but to promote true healing.
I took my four-year-old daughter to the pediatrician for a vaccination. As the nurse prepared to administer the shot in her upper arm. I instructed my daughter to exhale while breathing, understanding that this technique could influence her perception of pain. Despite my efforts, my daughter did not follow my instructions. At that point, the nurse interjected and said, “Please sit in front of your daughter.” Then turned to my daughter and said, “Do you see your father’s curly hair? Do you think you could blow the curls to move them back and forth?” My daughter thought this playful game was fun! As she blew at my hair, the curls moved back and forth while the nurse administered the injection. My daughter was unaware that she had received the shot and felt no pain.
My experience as a father and as a biofeedback practitioner was enlightening–it demonstrated the difference between theoretical knowledge of breathing techniques associated with pain perception and practical applications of clinical skills used by a pediatric nurse practitioner while administering an injection with children. An obvious question raised is: What processes are involved in the perception of pain?
There are many factors influencing pain perception, such as physical/physiological, behavioral and psychological/emotional factors related to the injection as described by St Clair-Jones et al., (2020). Physical and physiological considerations include device type such as needle gauge size as well as formulation volume and ingredients (e.g., adjuvants, pH, buffers), fluid viscosity, temperature, as well as possible sensitivity to coincidental exposures associated with an injection (e.g., sensitivity to latex exam gloves or some other irritant in the injection room).
There are overlapping physical and behavioral-related moderators that include weight and body fat composition, proclivity towards movements (e.g., activity level or ‘squirminess’), as well as co-morbid factors such as whether the person has body sensitization due to rheumatoid arthritis and/or fibromyalgia, for example. Other behavioral factors include a clinician selecting the injection site, along with the angle, speed or duration of injection. Psychological influences center around patient expectations including injection-anxiety or needle phobia, pain catastrophizing, as well as any nocebo effects such as white-coat hypertension.
Although the physical, behavioral and psychological categories allow for considering many physical and physiological factors (e.g., product-related factors), behavioral factors (e.g., injection-related behaviors) and psychological factors (e.g., person-related psychological attitudes, beliefs, cognitions and emotions), this article focuses on a figurative recipe for success associated with benefits of simple breathing to reduce pain perceptions.
Of the many categories of consideration related to pain perceptions, following are five key ‘recipe ingredients’ that contributed to a relatively painless experience:
- Exhaling During Painful Stimuli: Exhaling during a painful stimulus can activate parts of the parasympathetic nervous system leading to promotion of self-healing.
- Creating a Sense of Safety: Ensuring that the child feels safe and secure is crucial in managing pain. My lack of worry and concern and the nurse’s gentle and engaging approach created a comforting environment for my daughter.
- Using Distraction: Distraction techniques, such as focusing on the movement of the curls of the hair served to redirect my daughter’s attention away from the anticipated pain.
- Reducing Anticipation of Pain: My daughter’s previous visits were always enjoyable and as a parent, I was not anxious and was looking forward to the pediatrician visit and their helpful advice.
- Understanding the Personal Meaning of Pain: The approach taken by the nurse allowed the injection to be perceived as a non-event, thereby minimizing the psychological impact of the pain.
Exhaling During Painful Stimuli
Exhaling during painful stimuli facilitates a reduction in discomfort through several physiological mechanisms. During exhalation the parasympathetic nervous system is activated, which slows the heart rate and promotes relaxation, regeneration, reduces anxiety, and may counteract the effects of pain (Magnon et al., 2021). Breathing moderation of discomfort is observable through heart rate variability associated with slow, resonant breathing patterns, where heart rate increases with inhalation and decreases with exhalation (Lehrer & Gevirtz, 2014; Steffen et al., 2017). Physiological studies show that slow, resonant breathing at approximately six breaths per minute for adults, and a little faster for young children, causes the heart rate to increase during inhalation and decrease during exhalation, as illustrated in Figure 1.
Figure 1. Changes in heart rate as modulated by slower breathing at about six breaths per minute
One can experience how breathing affects discomfort when taking a cold shower under two conditions: As the cold water hits your skin: (1) gasping and holding your breath versus (2) exhaling slowly as the cold water hits you. Most people will report that slowly exhaling feels less uncomfortable, though they may still prefer a warm shower.
An Exercise for Use During Medical Procedures: Paring the procedure with inhalation and exhalation
A simple breathing technique can be used to reduce the experience of pain during a procedure or treatment, or during uncomfortable movement post-injury or post-surgery. Physiologically, inhalation tends to increase heart rate and sympathetic activation while exhalation reduces heart rate and increases parasympathetic activity. Often inhalation increases tension in the body, while during exhalation, one tends to relax and let go. The goal is to have the patient practice longer and slower breathing so that a procedure that might be uncomfortable is initiated during the exhalation phase. Applications of long, slow breathing techniques include having blood drawn, insertion of acupuncture needles in tender points, or movement that causes discomfort or pain. Slowly breathing is helpful in reducing many kinds of discomfort and pain perceptions (Joseph et al., 2022; Jafari et al., 2020).
Implementing the technique of exhaling during painful experiences can be deceptively simple yet challenging. When initially practicing this technique, the participants often try too hard by quickly inhaling and exhaling as the pain stimulus occurs. The effective technique involves allowing the abdomen to expand while inhaling, then allowing exhaled air to flow out while simultaneously relaxing the body and smiling slightly, and initiating the painful procedure only after about 25 percent of the air is exhaled.
Some physiological mechanisms that explain how slow breathing influences on pain perceptions have focused on baroreceptors that are mechanically sensitive to pressure and breathing dynamics. According to Suarez-Roca et al. (2021, p 29): “Several physiological factors moderate the magnitude and the direction of baroreceptor modulation of pain perception, including: (a) resting systolic and diastolic AP, (b) pain modality and dimension, (c) type of activated vagal afferent, and (d) the presence of a chronic pain condition It supports the parasympathetic activity that exert an anti-inflammatory influence, whereas the sympathetic activity is mostly pro-inflammatory. Although there are complex physiological interactions between cardiorespiratory systems, arterial pressure and baroreceptor sensitivity that influence pain perceptions, this report focuses on simpler reminders, such as creating a sense of safety for people as a result of better breathing techniques.
Creating a Sense of Safety
My young daughter did not know what to expect and totally trusted me and I was relaxed because the purpose was to enhance my daughter’s future health by giving her a vaccination to prevent being sick at a future time. Often, a parent’s anxiety is contagious to the child since expectations and emotional states influence the experience of medical procedures and pain (Sullivan et al., 2021). For my daughter, the nurse’s calm and confident demeanor contributed to a safe and reassuring environment. As a result, she was more engaged in a playful distraction, blowing at my hair, rather than focusing on the impending shot. This observation underscores an important psychological principle: when individuals do not anticipate pain and feel safe, they are more likely to experience surprise rather than distress. Conversely, anticipation of pain can amplify the perception of discomfort.
For instance, many people have experienced heightened anxiety at the dentist, where they may feel the pain of the needle before it is inserted. Anticipation evocates a past memory of pain that triggers a defensive reaction, increasing sympathetic arousal and sharpening awareness of potential danger. By providing the experience of feeling of safety, parents, caretakers, and medical professionals can play a crucial role in reducing the perceived pain of medical interventions.
Using Distraction
It is inherently difficult to attend to two tasks simultaneously; thus, focusing one’s attention on one task often diminishes awareness of pain and other stimuli (Rischer et al., 2020). For instance, when the nurse asked my daughter to see if she could blow hard enough to make the curls move back and forth, this task captured her attention in a fun and multisensory way. She was engaged visually by the movement of the curls, audibly by the sound of the rushing air, physically by the act of exhalation, and cognitively by following the instructions. Additionally, her success in moving the curls reinforced the activity as a positive and enjoyable experience.
In contrast, it is challenging to allow oneself to be distracted when anticipating discomfort, as numerous cues can continuously refocus attention on the procedure that may induce pain. This experience is akin to attempting to tickle oneself, which typically fails to elicit laughter due to the predictability and lack of external stimulation. Most of us have experienced how challenging it is to be self-directive and not focus on the sensations during dental procedures as discussed in the overview of music therapy for use in dentistry by Bradt and Teague (2018). The challenges are illustrated by my own experience during a dental cleaning
During a dental cleaning, I often attempt to distract myself by mentally visualizing the sensation of breathing down my legs while repeating an internal mantra or evoking joyful memories. Despite these efforts, I frequently find myself attending to the sound of the ultrasonic probe and the sensations in my mouth. To manage this distraction more effectively, I have found that external interventions such as listening to music or an engaging audio story through earphones is more beneficial.
From this perspective, we wished that the dentist could implement an external intervention by collaborating with a massage therapist to provide a simultaneous foot massage during the teeth cleaning. This dual stimulation would offer enough competing sensations to divert attention from the dental procedure to the comfort of the foot massage.
Reducing Anticipation of Pain
A crucial factor in the experience of pain is the anticipation and expectation of discomfort, which is often shaped by previous experiences (Henderson et al., 2020; Reicherts et al., 2017). When encountering a novel experience, we might interpret the sensations as novel rather than painful. Similar phenomena can be observed in young children when they fall or get hurt on the playground. They may initially react with surprise or shock and may look for their caretaker. Depending the reaction of their caregiver, they may begin to cry or they might cry briefly, stop and resume playing.
Conversely, the anticipation of pain can heighten sensitivity to any stimuli, causing them to be automatically perceived as painful. Anticipatory responses function as a form of mental rehearsal, where the body responds in a manner similar to the actual experience of pain. For example, Peper, et al. (2015) showed that when a pianist imagined playing the piano, her forearm flexor and extensor muscles exhibited slight contractions, even though there was no observable movement in her arm and the pianist was unaware of these contractions (see Figure 2).
Figure 2. The covert SEMG increase in forearm SEMG as the participant imagined playing the piano (reproduced by permission from Peper et al., 2015).
These kind of muscle reactions are also visible in sportsmen. For example, while mentally racing a lap on a motorbike, the arm muscles act like as if the person is racing in the dust of the circuit (Booiman 2018). The blood flow (BVP) and blood vessels are reacting even quicker than muscle tension on thoughts and expected (negative) experiences.
These findings underscore how anticipatory responses can mirror actual physical experiences, providing insights into how anticipation and expectancy can modify pain perception (Henderson et al., 2020). Understanding these mechanisms allows for the development of interventions aimed at managing pain through the modification of expectations and the introduction of distraction techniques.
The Personal Meaning of Pain (adapted from Peper, 2015)
The personal meaning of pain is a complex construct that varies significantly based on context and individual perception. For example, consider the case of a heart attack. Initially, the person might experience chest pain and dismiss it, which can be attributed to societal norms where people are conditioned to ignore pain. However, once the pain is assumed or diagnosed to be a heart attack, the same pain may become terrifying as it may signify the potential for life-threatening consequences. Following bypass surgery, the pain might actually be worse, but it is now reframed positively as a sign of the surgery’s success and a symbol of hope for survival. Thus, the meaning of pain evolves from one of fear to one of reassurance and recovery.
This notion that pain is defined by the context in which it occurs is crucial (Carlino et al., 2014). For instance, childbirth, despite being intensely painful, is understood within the context of a natural and temporary process that leads to the birth of a child. This perception is often reinforced nonverbally by a supportive midwife or doula. It may be helpful if the midwife or doula has given birth herself. Without words she communicates, “This is an experience that you can transcend, just as I did.” Psychologically/emotionally, the pain serves a higher purpose, to deliver a child into the world, which may also make the pain more bearable. There is a reward, namely the child. In addition, women who have had training and information about the process of childbirth have a significant faster delivery (about 2 hours faster).
Piercing the body without reporting pain or bleeding
To further illustrate this concept, Peper et al. (2006) and Kakigi et al. (2005) physiologically monitored the experiences of a Japanese Yogi Master, Mitsumasa Kawakami,who performed voluntary body piercing with unsterilized skewers, as depicted in Figure 3 (Peper, 2015).
Figure 3. Demonstration Japanese Yogi Master, Mitsumasa Kawakami, voluntary piercing the tongue and neck with unsterilized skewers while experiencing no pain, bleeding or infection (reproduced by permission from Peper et al., 2006).
See the video recording of tongue piercing study recorded November 11, 2000, at the annual Biofeedback Society Meeting of California, Monterey, CA, https://youtu.be/f7hafkUuoU4 (Peper & Gunkelman, 2007).
Despite the visual discomfort of seeing this procedure, physiological data from pulse, EEG and breathing patterns revealed that the yogi did not experience pain. During the piercing, his heart rate was elevated, his electrodermal activity was low and unresponsive, and his EEG showed predominant alpha waves, indicating a state of focused meditation rather than pain. This study suggests that conscious self-regulation, rather than dissociation, can be employed to control attention and responsiveness to painful stimuli and possibly benefit individuals with chronic pain (Peper et al., 2005).
A similar phenomenon was observed among a spiritual gathering of Kasnazani Sufi initiates in Amman, Jordan and physiologically monitored during demonstrations as part of a scientific meeting. The Kasnazani order is a branch of Sufism that has gained widespread popularity in Iraq and Iran, particularly among the Kurdish population. What sets the Kasnazani order apart is its inclusive approach—it welcomes both Sunni and Shia Muslims, making no distinction between them. During spiritual gatherings, some followers perform acts that might seem extreme to outsiders: piercing their bodies. These acts are seen as expressions of deep spiritual devotion and are performed in a state believed to be beyond normal physical sensation. With the permission of their Sheikh Mohammed Abdul Kareem Kasnazani, they pierced their face, neck arms, or chest and reported no pain or bleeding and heal quickly, as shown in Figure 4.
Figure 4. Voluntary piercing and with unsterilized skewers by Sufi initiates and subsequent tissue healing after 14 hours.
See the video recording of the actual piercing study organized by Erik Peper and Howard Hall with Thomas Collura recording the QEEG at the 2013 Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback, Portland, OR (Peper & Hall, 2013; Collura et al., 2014), https://www.youtube.com/watch?v=56nLZyG87oc
What Factors Decrease the Experience of Pain and Promote Rapid Healing with the Absence of Bleeding?
In the case of the Kasnazani Sufis, they framed their experience as a normal, spiritual phenomenon that occurs in a setting of religious faith and total trust in their spiritual leader (Hall, 2011). The Sufis reported that they had permission and support from their master, Sheikh Mohammed Abdul Kareem Kasnazani. Thus, they felt totally safe and protected—they had no doubt they could experience the piercing with reasonable composure and that their bodies would totally heal. Even if pain occurred, it was not to be feared but part of the process. The experience may be modulated by the psychological context of the group, the drumming, and the chanting. The phenomenon was not simply a matter of belief; they knew that healing would occur because they had seen it many times in the past. The knowledge that healing would occur rapidly was transmitted as a felt sense in the group that this is possible and following the expected normal pattern.
The most impressive finding was that the physiology markers (heart rate, skin conductance, and breathing) were normal and there was no notable change (Booiman et al., 2015; Peper & Hall, 2013) and the QEEG indicated the inhibition of pain (Collura et al., 2014).
Clinical implications
These observations underscore that the context of pain—whether through personal meaning, spiritual belief, or communal support—can significantly alter its perception and management. This concept is also reflected in clinical settings, where a lack of diagnosis or acknowledgment of pain can exacerbate suffering. An isolated individual, alone at night with the physical sensation of pain, may find the pain tremendously stressful, which tends to intensify the experience. In this situation, there are concerns about the future: “It may get worse, it will not go away, I’m going to die from this, maybe I’ll die alone,” and the worry continues.
If one can let go of these thoughts, breathe through the pain, relax the muscles and experience a feeling of hope, the pain is often reduced. On the other hand, focusing on the pain may intensify it. On the other hand, the meaning of pain implies survival or hope as sometimes is observed in injured soldiers. In context of the hospital setting: “I have survived and I am safe.”
What are the implications of these experiences in clinical settings in which the patient is in constant pain and yet has not received an accurate diagnosis? Or, in cases in which the patient has a diagnosis, such as fibromyalgia, but treatment has not reduced the pain significantly? Experiencing pain or illness that goes undiagnosed, and/or that is not acknowledged, may increase the level of stress and tension, which can contribute to more pain and discomfort. As long as we are resentful/angry/resigned to the pain or especially to the event that we believe has caused the pain, the pain often increases. Another way to phrase this is that chronic sympathetic arousal increases the sensitivity to pain and reduces healing potential (Kyle & McNeil, 2014).
Acknowledgement means having an accurate diagnosis, validating that the pain experience is legitimate and that it is not psychosomatic (imagined), because that simply makes the experience of pain worse. Once the patient has a more accurate diagnosis, treatment may be possible.
When one has constant, chronic, or unrelenting pain, this evokes hopelessness and the patient is more likely to get depressed (Sheng et al., 2017; Meda et al., 2022). The question is, What can be done? The first step for the patients is to acknowledge to themselves that it does not mean that the situation is unsolvable. It is important to focus on other options for diagnosis and treatment and take one’s own lead in the healing/recovery process. We have observed that a creative activity that uses the signals of pain to evoke images and thoughts to promote healing may reduce pain (Peper et al., 2022). Pain awareness may be reduced when the person initiates actions that contribute to improving the well-being of others.
Overall, pain appears to decrease when a person accepts without resignation what has happened or is happening. A useful practice that may change the pain experience is to do an appreciation practice. Namely, appreciate what that part of the body has done for you and how so often in the past you may have abused it. For example, if you experience hip pain, each time you are aware of the pain, thank the hip for all the work it has done for you in the past and how often you may have neglected it. Keep thanking it for how it has supported you.
Pain often increases when the person is resentful or wished that what has happened had not happened (Burns et al., 2011). If the person can accept where they are and focus on the new opportunities and new goals can achieve, pain may still occur; however, the quality is different. Focus on what you can do and not on what you cannot do. See Janine Shepherd’s 2012 empowering TED talk, “A broken body isn’t a broken person.”
Conclusion
The primary lessons from studying the yogi and the Sufis are the concepts that a sense of safety, acceptance, and purpose can transform the experience of pain. Expressing confidence in a patient’s recovery prospects places the focus on their ability to recover. Incorporating these elements into clinical care may offer new avenues for addressing chronic pain and improving patient outcomes (Booiman & Peper, 2021).
We propose the first step is to create an atmosphere of hope, trust and safety and to emphasize the improvements made (even small ones). Then master effortless breathing to increase slow diaphragmatic breathing and teach clients somato-cognitive techniques to refocus their attention during painful stimuli (mindfulness) (Pelletier & Peper, 1977; Peper et al., 2022). Using the slow breathing as the overlearned response would facilitate the recovery and regeneration following the painful situation. To develop mastery and be able to apply it under stressful situations requires training and over-learning. Yoga masters overlearned these skills with many years of meditation. With mastery, patients may learn to abort the escalating cycle of pain, worry, exhaustion, more pain, and hopelessness by shifting their attention and psychophysiological responses. In clinical practice, strategies such as hypnotic induction, multisensory distraction, self-healing visualizations, and mindfulness techniques can be employed to manage pain. A foundational principle is that healing is promoted when the participant feels safe and accepted, experiences suffering without blame, and looks forward to life with meaning and purpose.
Acknowledgement
We thank Mitsumasa Kawakami, Sheikh Mohammed Abdul Kareem Kasnazani, and Safaa Saleh for their generous participation in this research and I thank our research collegues Thomas Collura, Howard Hall and Jay Gunkelman for their support and collaboration.
Listen to the expanded podcast created from this blogpost by Google Notebook LM.
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Fever can save your life
Posted: March 22, 2025 Filed under: attention, cancer, health, Pain/discomfort, Uncategorized | Tags: acetaminophen, books, classical conditioning, fever, food, immune response, lifestyle, mental-health, self-care, travel 4 CommentsErik Peper, PhD and Robert Gorter, MD, PhD
Adapted from: Peper, E. & Gorter, R. (2025). Fever can save your life. Townsend Letter-Innovative Health Perspective. Published March 27, 2025. https://townsendletter.com/fever-can-save-your-life/
My child’s fever was 102 F° and I was worried. I made my daughter comfortable, gave her some liquids and applied a lemon wrap around the calves. Fifteen minutes later the fever was down by a degree and a half to 100.5 F.° I continue to check how my child was doing. I touched her forehead and noted that it became slightly cooler. By the next day the fever had broken, and my daughter felt much better.
Most people are worried when they or their children have a fever, as it may indicates an illness. They quickly rush to take a Tylenol or other medications to reduce the fever and discomfort. We question whether this almost automatic response to inhibit fever is the best approach. It is important to note that fever is seldom the cause of illness; instead, fever is the body’s response to support healing by activating the immune system so that it can fight the infection. In most cases, the fever may last for a day or two and then disappears. Watchful waiting does not mean, not seeking medical help. It means careful monitoring so that the fever does not go too high versus automatically taking medications to suppress the fever.
Although fever can be uncomfortable, in most casest is not something to be feared. Rather than suppressing it, allow the fever to run its course, as fevers can improve clinical outcomes. Research findings indicate that individuals who experience an increase in body temperature (i.e., a fever) have higher survival rates following infection (Repasky et al., 2013). Spontaneous remissions of cancer—altogether a rarer event—have been observed repeatedly in connection with febrile infectious diseases, especially those of bacterial origin (Kienle, 2012). Late in 19th and early 20th century, Prof Coley observed that in patients who had wound fever or fevers that were induced by injecting bacterial toxins, their cancer sometimes disappeared (Kienle, 2012). In the early 20th century, inducing fever with injecting a bacterial toxin became an acceptable and somewhat successful treatment strategy for treating cancer (Karamanou, et al., 2013; Kendell et al, 1969). It was even a fairly successful treatment for neuro-syphilis before advent of antibiotics. Malaria-induced fevers were used as a treatment for neurosyphilis from the 1920s until the 1950s,—the spiking fevers associated with malaria killed the bacteria that caused the syphilitic infection (Gambino, 2015). The fever therapy slowly disappeared as antibiotics (penicillin), chemotherapy and radiation tended to be more effective.
Although suppressing fever with medication may make you feel more comfortable, and in some cases allow a child to go to day care, it may be harmful. Dr. Schulman and colleagues at the University of Miami Leonard M. Miller School of Medicine demonstrated in a randomized controlled study that, among similar patients admitted to the ICU, the risk of death was seven times higher for those who received fever-reducing medication compared to those who did not (Schulman et al., 2005).(Schulman et al., 2005).
Fever reducing medication may in rare cases lead to complications. For example, aspirin may cause stomach irritation and ulcers as well as being cofactor in Reye’s syndrome (Temple, 1981; Schrör 2007). While acetaminophen (also known as paracetamol), often given to young children, may increase the risk of allergic rhinitis and possibly asthma by the age of six (Caballero, et al., 2015; McBride, 2011). As McBride point out, there appears to be a correlation between acetaminophen use and asthma across all groups, ages and location. This correlation even holds up for mothers who took acetaminophen during pregnancy as their children have increased risk for asthma by age six.
As Bauer and colleagues (Bauer et al., 2021) point out: “Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications (Excedrine) used to relieve mild to moderate pain and reduce fever. Research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.”
Finally, we wonder whether active fever suppression during childhood might condition the immune system not to initiate a fever response through the process of classical conditioning, thereby reducing the immune system’s overall competence. This could be a contributing factor to the increasing rates of allergies, immune disorders, and the earlier onset of certain cancers (Gorter & Peper, 2011). Specifically, if a person begins to develop a fever and medication was used to reduce it, over time the fever response may become automatically inhibited through covert classical conditioning.
Simple home remedy when having a fever?
- Practice watchful waiting. This means monitoring the person and only use medication to reduce fever if necessary. When in doubt contact your physician. Remember, in almost all cases, fever is not the illness; it is the body’s response to fight the illness and regain health.
- Hydrate. When having a fever, we perspire and need more fluids. Thus, increase fluid intake. Almost all cultural traditions recommend drinking some fluids such as hot water with lemon juice and honey, chicken soup broth, etc.
- Reframe the experience as a healing experience versus an illness experience. For example, when a fever, reframe it possitively such as, I feel pleased that my body is responding and I trust that my body is fighting the illness well (or even better).
- Implement the following gentle self-care approaches (Schirm, 2018).
Lemon wrap around calves or feet may help reduce fevers by using the cooling properties of lemon and evaporating water. How to make lemon wraps:
• Fill a bowl with water that’s 2–3° C below your fever temperature.
• Add 1–2 lemon halves.
• Score the lemon peel with a knife to release essential oils.
• Mash the lemons in the water.
• Soak a cloth in the lemon water.
• Wrap the cloth around your calves from ankle to knee.
• Cover with a blanket and rest for 10–15 minutes.
• Repeat as needed.
“Tips for using lemon wraps
• Change the wraps when they become warm.
• If your feet get cold, stop using the wraps.
• Don’t over-bundle a child with blankets, as babies can’t regulate their body temperatures as well as adults.
The information in this blog is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.
References
Bauer, A.Z., Swan, S.H., Kriebel, D. et al. Paracetamol use during pregnancy — a call for precautionary action. Nat Rev Endocrinol (2021). https://doi.org/10.1038/s41574-021-00553-7
Caballero, N., Welch, K. C., Carpenter, P. S., Mehrotra, S., O’Connell, T. F., & Foecking, E. M. (2015). Association between chronic acetaminophen exposure and allergic rhinitis in a rat model. Allergy & rhinology (Providence, R.I.), 6(3), 162–167. https://doi.org/10.2500/ar.2015.6.0131
Gambino, M. (2015). Fevered Decisions: Race, Ethics, and Clinical Vulnerability in the Malarial Treatment of Neurosyphilis, 1922-1953. Hastings Center Report. https://doi.org/10.1002/hast.451
Gorter, R. & Peper, E. (2011). Fighting Cancer: A Nontoxic Approach to Treatment. Berkeley, CA: North Atlantic Books. https://www.amazon.com/Fighting-Cancer-Nontoxic-Approach-Treatment/dp/1583942483
Karamanou, M., Liappas, I., Antoniou, C.h, Androutsos, G., & Lykouras, E. (2013). Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis. Psychiatrike = Psychiatriki, 24(3), 208–212. https://pubmed.ncbi.nlm.nih.gov/24185088/
Kendell, H. W., Rose, D. L., & Simpson, W. M. (1969). Fever therapy technique in syphilis and gonococcic infections. Archives of physical medicine and rehabilitation, 50(10), 603–608. https://pubmed.ncbi.nlm.nih.gov/4981888/
Kienle G. S. (2012). Fever in Cancer Treatment: Coley’s Therapy and Epidemiologic Observations. Global advances in health and medicine, 1(1), 92–100. https://doi.org/10.7453/gahmj.2012.1.1.016
McBride, J.T. (2011). The Association of Acetaminophen and Asthma Prevalence and Severity. Pediatrics, 128(6), 1181–1185. https://doi.org/10.1542/peds.2011-1106
Repasky, E. A., Evans, S. S., & Dewhirst, M. W. (2013). Temperature matters! And why it should matter to tumor immunologists. Cancer immunology research, 1(4), 210–216. https://doi.org/10.1158/2326-6066.CIR-13-0118
Schirm, J. (2018). Essentials of homecare-A gentle approach to healing. Holistic Essence. https://www.amazon.com/Essentials-Home-Care-II-Approach/dp/0692121250
Schulman, C. I., Namias, N., Doherty, J., Manning, R. J., Li, P., Elhaddad, A., Lasko, D., Amortegui, J., Dy, C. J., Dlugasch, L., Baracco, G., & Cohn, S. M. (2005). The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surgical infections, 6(4), 369–375. https://doi.org/10.1089/sur.2005.6.369
Schrör K. (2007). Aspirin and Reye syndrome: a review of the evidence. Paediatric drugs, 9(3), 195–204. https://doi.org/10.2165/00148581-200709030-00008
Temple, A.R. (1981). Acute and Chronic Effects of Aspirin Toxicity and Their Treatment. Arch Intern Med, 141(3), 364–369. https://doi.org/10.1001/archinte.1981.00340030096017
Use the power of your mind to transform health and aging
Posted: February 18, 2025 Filed under: attention, behavior, cancer, CBT, cognitive behavior therapy, COVID, education, health, meditation, mindfulness, Pain/discomfort, placebo, stress management, Uncategorized | Tags: health, imimune function, longevity, mental-health, mind-body, nutrition, Reframing, wellness Leave a commentMost of the time when I drive or commute by BART, I listen to podcasts (e.g., Freakonomics, Hidden Brain, this podcast will kill you, Science VS, Huberman Lab). although many of the podcasts are highly informative; , rarely do I think that everyone could benefit from it. The recent podcast, Using your mind to control your health and longevity, is an exception. In this podcast, neuroscientist Andrew Huberman interviews Professor Ellen Langer. Although it is three hours and twenty-two minute long, every minute is worth it (just skip the advertisements by Huberman which interrupts the flow). Dr. Langer delves into how our thoughts, perceptions, and mindfulness practices can profoundly influence our physical well-being.
She presents compelling evidence that our mental states are intricately linked to our physical health. She discusses how our perceptions of time and control can significantly impact healing rates, hormonal balance, immune function, and overall longevity. By reframing our understanding of mindfulness—not merely as a meditative practice but as an active, moment-to-moment engagement with our environment—we can harness our mental faculties to foster better health outcomes. The episode also highlights practical applications of Dr. Langer’s research, offering insights into how adopting a mindful approach to daily life can lead to remarkable health benefits. By noticing new things and embracing uncertainty, individuals can break free from mindless routines, reduce stress, and enhance their overall quality of life. This podcast is a must-listen for anyone interested in the profound connection between mind and body. It provides valuable tools and perspectives for those seeking to take an active role in their health and well-being through the power of mindful thinking. It will change your perspective and improve your health. Listen to or watch the interview:
Youtube: https://www.youtube.com/watch?v=QYAgf_lfio4
Useful blogs to reduce stress
From Conflict to Calm: Reframing Stress and Finding Peace with Difficult People
Posted: February 6, 2025 Filed under: attention, behavior, Breathing/respiration, CBT, emotions, healing, health, Neck and shoulder discomfort, Pain/discomfort, stress management | Tags: anger, anger management, conflict resolution, Reframing, resentment 8 Comments
Adapted from: Peper, E. (2025, Feb 15). From Conflict to Calm: Reframing Stress and Finding Peace with Difficult People. Townsend Letter-Innovative Health Perspectives. https://townsendletter.com/from-conflict-to-calm-reframing-stress-and-finding-peace-with-difficult-people/
After living in our house for a few years, a new neighbor moved in next door. Within months, she accused us of moving things in her yard, blamed us when there was a leak in her house, dumped her leaves from her property onto other neighbors’ properties, and even screamed at her tenants to the extent that the police were called numerous times.
Just looking at her house through the window was enough to make my shoulders tighten and leave me feeling upset. When I drove home and saw her standing in front of her house, I would drive around the block one more time to avoid her while feeling my body contract. Often, when I woke up in the morning, I would already anticipate conflict with my neighbor. I would share stories of my disturbing neighbor and her antics with my friends. They were very supportive and agreed with me that she was crazy.
However, this did not resolve my anger, indignation, or the anxiety that was triggered whenever I saw her or thought of her. I spent far too much time anticipating and thinking about her, which resulted in tension in my own body—my heart rate would increase, and my neck and shoulders would tighten. I decided to change. I knew I could not change her; however, I could change my reactivity and perspective.
Thus, I practiced the “Pause and Recenter” technique described in the blog. At the first moment of awareness that I was thinking about her or her actions, I would change my posture by sitting up straight and looking upward, breathe lower and slower, and then, in my mind’s eye, send a thought of goodwill streaming to her like an ocean wave flowing through and around her in the distance. I choose to do this because I believe that within every person, no matter how crazy or cruel, there is a part that is good, and it is that part I want to support.
I repeated this many times—whenever I looked in the direction of her house or saw her in her yard. I also reframed her aggressive, negative behavior as her way of coping with her own demons. Three months later, I no longer react defensively. When I see her, I can say hello and discuss the weather without triggering my defensive reaction. I feel so much more at peace living where I am.
When stressed, angry, rejected, frustrated, or hurt, we so often blame the other person. The moment we think about that person or event, our anger, indignation, resentment, and frustration are triggered. We keep rehashing what happened. As we do this, we are unaware that we are reliving the past event and are often unaware of the harm we are doing to ourselves until we experience symptoms such as high blood pressure, gastrointestinal distress, insomnia, anxiety, or muscle tightness. As we think of the event or interact again with that person, our body automatically responds with a defense reaction as if we are actually being threatened. This response activates the defense to protect ourselves from harm— the person is not a threat like the saber-toothed tiger ready to attack. Yet we respond as if the person is the tiger.
This defense reaction activates our “fight or flight” responses and increases sympathetic activation so that we can run faster and fight more ferociously to survive; however, it reduces blood flow through the frontal cortex—a process that reduces our ability to think rationally (Willeumier, et al., 2011; van Dinther et al., 2024). When we become so upset and stressed that our mind is captured by the other person, it contributes to an increase in hypertension, myofascial pain, depression, insomnia, cardiovascular disease, and other chronic disorders (Russel et al., 2015; Suls, 2013; Duan et al., 2022).
Our initial response of sharing our frustrations with others is normal. It feels good to blame the other; however, over time, the only person who gets hurt is yourself (Fast & Tiedens, 2010; Lou et al., 2023). The time spent rehashing and justifying our feelings diminishes our time we are in the present moment or focus on upcoming opportunities.
We may not realize that we have a choice. We can keep living and reacting to past hurt or losses, or we can let go and/or forgive and make space for new opportunities. Although the choice is ours, it is often very challenging to implement—even with the best intentions—as we react automatically when reminded of the past hurt (seeing that person, anticipating meeting or actually meeting that person who caused the hurt, or being triggered by other events that evoke memories of the pain).
What can you do
If choose to change your response and reactivity, it does not mean you condone what happened or agree that the other person was right. You are just choosing to live your life and not continue to be captured and react to the previous triggers. Many people report that after implementing some of the practices described below or others stress management techniques frequently their automatic reactivity was significantly reduced. They report that their symptoms are reduced and have the freedom to live in present instead of being captured by the painful past.
Pause and recenter
Our automatic reaction to the trigger elicits a defense reaction that reduces our ability to think rationally. Therefore, the moment you anticipate or begin to react, take three very slow diaphragmatic breaths. As you inhale, allow your abdomen to expand; then, as you exhale slowlymake your yourself tall and look up. Looking up allows easier access to empowering and positive memories (Peper et al., 2017). Continue looking up and inhale slowly allow the abdomen to expand. Repeat this slow breath again.
On the third breath, while looking up, evoke a memory of someone in whose presence you felt at peace and who loves –you such as your grandmother, aunt or uncle or your dog. Reawaken that feeling associated with that memory. Allow a smile with soft eyes to come to your face as you experience the loving memory. Then, put your hands on your chest, take a breath as your abdomen to expands, and as you exhale, bring your hands away from your chest and stretch them out in front of you. At the same time, in your mind’s eye imagine sending good will to that person or conflict that previously evoked your stress response.
As you do this, you are not condoning what happened; instead, you are sending goodwill to that person’s positive aspect. From this perspective, everyone has an intrinsic component—however small—that some label as Christ nature or Buddha nature.
Why could this be effective? This practice short-circuits the automatic stress response and provides time to recenter. It interrupts ongoing rumination by shifting the mind away from thoughts about the person or event that induces stress and toward a positive memory. Evoking a loving memory from the past facilitates a reduction in arousal, evokes a positive mood, and decreases sympathetic nervous system activation (Speer & Delgado, 2017). Additionally, slower diaphragmatic breathing reduces sympathetic activation (Birdee et al., 2023; Siedlecki et al., 2022). By combining body and mind, we can pause and create the opportunity to respond positively rather than reacting with anger and hurt.
Practice sending goodwill the moment you wake up
So often when we wake up, we already anticipate the challenges and even the prospect of interacting with person or event heightens our defense reaction. Therefore, as soon as you wake up, sit at the edge of the bed, repeat the previous practice, Pause and Center. Then, as you sit at the edge of the bed, slightly smile with soft eyes, look up, inhale as your abdomen expand. Then, stamp your right foot into the floor while saying, “Today is a new day.” Next, inhale allowing your abdomen expand; as you look up, stamp your left foot on the floor while saying, “Today is a new day.” Finally, send goodwill to the person who previously triggered your defensive reaction.
Why could this be effective?
Looking up makes it easier to access positive memories and thoughts. Stamping your foot on the ground is a non-verbal expression of determination and anchors the thought of a new day, thereby focuses on new opportunities (Feldman, 2022).
Discuss your issue from the third-person perspective instead of the first-person perspective
When thinking, ruminating, talking, texting, or writing about the event, discuss it from the third-person perspective. Replace the first-person pronoun “I” with “she” or “he.” For example, instead of saying:
I was really pissed off when my boss criticized my work without giving any positive suggestions for improvement,
Say:
He was really pissed off when his boss criticized his work without offering any positive suggestions for improvement.
Why could this be effective? The act of substituting the third person pronoun for the first-person pronoun interrupts our automatic reactivity because it requires us to observe and change our language, which activating the frontal cortex. This process creates a psychological distance from our feelings, allowing for a more objective and calmer perspective on the situation. It effectively reducing stress by stepping back from the immediate emotional response (Moser et al., 2017). It means that you are no longer fully captured by the emotions, as you are simultaneously the observer of your own inner language and speech.
Compare yourself to others who are suffering more
When you feel sorry for yourself or hurt, take a breath, look upward, and compare yourself to others who are suffering much more. In that moment, consider yourself incredibly lucky compared to people enduring extreme poverty, bombings, or severe disfigurement. Be grateful for what you have.
Why could this be effective? The research data shows that if we have low self-esteem when we compare ourselves to people who are more successful (healthier, richer, or successful), we feel worse in comparison and if we compare ourselves to other who are suffering more we feel better (Aspinwall, & Taylor, 1993). The comparision relativize our suffering. Thus our own suffering become less significant compared to the other people’s severe suffering.
Research shows that when we compare ourselves to people who are more successful (healthier, richer, or more accomplished), we tend to feel worse—especially if we have low self-esteem. However, when we compare ourselves to others who are suffering more, we tend to feel better (Aspinwall, & Taylor, 1993). This comparison relativizes our suffering, making our own hardships and suffering seem less significant compared to the severe suffering of others.
Interrupt the stress response
When overwhelmed by a stress reaction, implement the recue techniques described in the article, Quick rescue techniques when stress (Peper, Oded and Harvey, 2024) and the blog to help reduce stress. https://peperperspective.com/2024/02/04/quick-rescue-techniques-when-stressed/
Conclusion
It is much easier to write and talk about these practices than to actually do them. Remembering and reminding yourself to implement them can be very challenging. It requires significant effort and commitment. In most cases, the benefits are not experienced immediately. However, when practiced many times over weeks and months, many people report feeling less resentment, experience a reduction in symptoms, and improvements in health and relationships.
*This blog was inspired by the podcast, No hard feelings, that featured psychologist Fred Luskin. It is an episode on Hidden Brain, produced by Shankar Vedantam (2025) and the wisdom taught by Dora Kunz (Kunz & Peper, 1983; Kunz and Peper, 1984a; Kunz and Peper, 1984b; Kunz and Peper, 1987).
Useful blog that complement the concepts in this blog
References
Aspinwall, L. G., & Taylor, S. E. (1993). Effects of social comparison direction, threat, and self-esteem on affect, self-evaluation, and expected success. Journal of Personality and Social Psychology, 64(5), 708–722. https://doi.org/10.1037/0022-3514.64.5.708
Birdee, G., Nelson, K., Wallston, K., Nian, H., Diedrich, A., Paranjape, S., Abraham, R., & Gamboa, A. (2023). Slow breathing for reducing stress: The effect of extending exhale. Complementary Therapies in Medicine, 73. https://doi.org/10.1016/j.ctim.2023.102937
Duan, S., Lawrence, A., Valmaggia, L., Moll, J. & Zahn, R. (2022). Maladaptive blame-related action tendencies are associated with vulnerability to major depressive disorder. Journal of Psychiatric Research, 145, 70-76. https://doi.org/10.1016/j.jpsychires.2021.11.043
Fast, N.J. & Tiedens, L.Z. (2010). Blame contagion: The automatic transmission of self-serving attributions. Journal of Experimental Social Psychology, 46(1), 97-106. https://doi.org/10.1016/j.jesp.2009.10.007
Feldman, Y. (2022). The Dialogical Dance-A Relational Embodied Approach to Supervision. In Butte, C. & Colbert, T. (Eds). Embodied Approaches to Supervision-The Listening Body. London: Routledge. https://www.amazon.com/Embodied-Approaches-Supervision-C%C3%A9line-Butt%C3%A9/dp/0367473348
Kunz, D. & Peper, E. (1983). Fields and Their Clinical Implications-Part III: Anger and How It Affects Human Interactions. The American Theosophist, 71(6), 199-203. https://www.researchgate.net/publication/280777019_Fields_and_their_clinical_implications-Part_III_Anger_and_how_it_affects_human_interactions
Kunz, D. & Peper, E. (1984a). Fields and Their Clinical Implications IV: Depression from the Energetic Perspective: Etiological Underpinnings. The American Theosophist, 72(8), 268-275. https://biofeedbackhealth.org/wp-content/uploads/2011/01/fields-and-their-clinical-implications-iv-depression-from-the-energetic-perspectivive.pdf
Kunz, D. & Peper, E. (1984b). Fields and Their Clinical Implications V: Depression from the Energetic Perspective: Treatment Strategies. The American Theosophist, 72(9), 299-306. https://biofeedbackhealth.org/wp-content/uploads/2011/01/fields-and-their-clinical-implications-part-v-depression-treatment-strategies.pdf
Kunz, D. & Peper, E. (1987). Resentment: A poisonous undercurrent. The Theosophical Research Journal. IV (3), 54-59. Also in: Cooperative Connection. IX (1), 1-5. https://www.researchgate.net/publication/387030905_Resentment_Continued_from_page_4
Lou, Y., Wang, T., Li, H., Hu, T. Y., & Xie, X. (2023). Blame others but hurt yourself: blaming or sympathetic attitudes toward victims of COVID-19 and how it alters one’s health status. Psychology & Health, 39(13), 1877–1898. https://doi.org/10.1080/08870446.2023.2269400
Moser, J. S., Dougherty, A., Mattson, W. I., Katz, B., Moran, T. P., Guevarra, D., Shablack, H., Ayduk, O., Jonides, J., Berman, M. G., & Kross, E. (2017). Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific reports, 7(1), 4519. https://doi.org/10.1038/s41598-017-04047-3
Oneda, B., Ortega, K., Gusmão, J. et al. (2010). Sympathetic nerve activity is decreased during device-guided slow breathing. Hypertens Res, 33, 708–712. https://doi.org/10.1038/hr.2010.74
Peper, E., Oded, Y, & Harvey, R. (2024). Quick somatic rescue techniques when stressed. Biofeedback, 52(1), 18–26. https://doi.org/10.5298/982312
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback.45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01
Russell, M. A., Smith, T. W., & Smyth, J. M. (2016). Anger Expression, Momentary Anger, and Symptom Severity in Patients with Chronic Disease. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 50(2), 259–271. https://doi.org/10.1007/s12160-015-9747-7
Siedlecki, P., Ivanova, T.D., Shoemaker, J.K. et al. (2022). The effects of slow breathing on postural muscles during standing perturbations in young adults. Exp Brain Res, 240, 2623–2631. https://doi.org/10.1007/s00221-022-06437-0
Speer, M. & Delgado, M. (2017).Reminiscing about positive memories buffers acute stress responses. Nat Hum Behav 1, 0093 (2017). https://doi.org/10.1038/s41562-017-0093
Suls J. (2013). Anger and the heart: perspectives on cardiac risk, mechanisms and interventions. Progress in cardiovascular diseases, 55(6), 538–547. https://doi.org/10.1016/j.pcad.2013.03.002
van Dinther, M., Hooghiemstra, A. M., Bron, E. E., Versteeg, A., Leeuwis, A. E., Kalay, T., Moonen, J. E., Kuipers, S., Backes, W. H., Jansen, J. F. A., van Osch, M. J. P., Biessels, G. J., Staals, J., van Oostenbrugge, R. J., & Heart-Brain Connection consortium (2024). Lower cerebral blood flow predicts cognitive decline in patients with vascular cognitive impairment. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, 20(1), 136–144. https://doi.org/10.1002/alz.13408
Vedantma, S. (2025). Hidden Brain episode, No hard feelings. Accessed February 5, 2025. https://hiddenbrain.org/podcast/no-hard-feelings/
Willeumier, K., Taylor, D. V., & Amen, D. G. (2011). Decreased cerebral blood flow in the limbic and prefrontal cortex using SPECT imaging in a cohort of completed suicides. Translational psychiatry, 1(8), e28. https://doi.org/10.1038/tp.2011.28
Pragmatic techniques for monitoring and coaching breathing
Posted: December 14, 2024 Filed under: attention, behavior, biofeedback, Breathing/respiration, emotions, meditation, mindfulness, neurofeedback, Pain/discomfort, posture, relaxation, self-healing, Uncategorized | Tags: art, books, Breathing rate, coaching, FlowMD app, nasal breathing, personal-development, self-monitoring, writing 5 CommentsDaniella Matto, MA, BCIA BCB-HRV , Erik Peper, PhD, BCB, and Richard Harvey, PhD
Adapted from: Matto, D., Peper, E., & Harvey, R. (2025). Monitoring and coaching breathing patterns and rate. Townsend Letter-Innovative Health Perspectives. https://townsendletter.com/monitoring-and-coaching-breathing-patterns-and-rate/
This blog aims to describe several practical strategies to observe and monitor breathing patterns to promote effortless diaphragmatic breathing. The goal of these strategies is to foster effortless, whole-body diaphragmatic breathing that promote health.
Breathing is usually covert and people are not usually aware of their breathing rate (breaths per minute) or pattern (abdominal or thoracic, breath holding or shallow breathing) unless they have an illness such as asthma, emphysema or are performing physical activity (Boulding et al, 2015)). Observing breathing is challenging; awareness of respiration often leads to unaware changes in the breath pattern or to an attempt to breathe perfectly (van Dixhoorn, 2021). Ideally breathing patterns should be observed/monitored when the person is unaware of their breathing pattern and the whole body participates (van Dixhoorn, 2008). A useful strategy is to have the person perform a task and then ask, “What happened to your breathing?”. For example, ask a person to simulate putting a thread through the eye of a needle or quickly look to the extreme right and left while keeping their head still. In almost all cases, the person holds their breath (Peper et al., 2002).
Teaching effortless slow diaphragmatic breathing is a precursor of Heart rate variability (HRV) biofeedback and is based on slow paced breathing (Lehrer & Gevirtz, 2014; Steffen et al., 2017; Shaffer and Meehan, 2020). Mastering effortless diaphragmatic breathing is a powerful tool in the treatment of a variety of physical, behavioural, and cognitive conditions; however, to integrate this method into clinical or educational practice is easier said than done. Clients with dysfunctional breathing patterns often have difficulty following a breath pacer or mastering effortless breathing at a slower pace.
The purpose of this paper is to describe a few simple strategies that can be used to observe and monitor breathing patterns, provide economic strategies for observation and training, and suggestions to facilitate effortless diaphragmatic breathing.
Strategies to observe and monitor breathing pattern
Observation of the breathing patterns
- Is the breathing through the nose or mouth? Nose is usually better (Watso et al., 2023; Nestor, 2020).
- Does the abdomen expand during inhalation and constricts during exhalation or does the chest expand and rise during inhalation and fall during exhalation? Abdominal movement is usually better.
- Is exhalation flow softly or explosively like a sigh? Slow flow exhalation is preferred.
- Is the breath held or continues during activities? In most cases continued breathing is usually better.
- Does the person gasp before speaking or allows to speak while normally exhaling?
- What is the breathing rate (breaths per minute)? When sitting peacefully less than 14 breaths/minute is usually better and about 6 breaths per minute to optimize HRV
Physiological monitoring.
- Monitoring breathing with strain gauges around the abdomen and chest, and heart rate is the most common approach to identify the location of breath, the breathing pattern and heart rate variability. The strain gauges are placed around the chest and abdomen and heart rate is monitored with a blood volume pulse amplitude sensor from the finger. representative recording shows the effect of thoughts on breathing, heartrate and pulse amplitude of which the participant is totally unaware as shown in Figure 1.
Figure 1. Physiological recording of breathing patterns with strain gauges.
- Monitoring breathing with a thermistor placed at the entrance of the nostril that has the most airflow (nasal patency) (Jovanov et al., 2001; Lerman et al., 2016). When the person exhales through the nose, the thermistor temperature increases and decreases when they inhale. A representative recording of a person being calm, thinking a stressful thought. and being calm. Although there were significant changes as indicated by the change in breathing patterns, the person was unaware of the changes as shown in Figure 2.
Figure 2. Use of a thermistor to monitor breathing from the dominant nostril compared to the abdominal expansion as monitored by a strain gauge around the abdomen.
- Additional physiological monitoring approaches. There are many other physiological measures can be monitored to such as end-tidal carbon dioxide (EtCO2), a non-invasive measurement of the amount of carbon dioxide (CO2) in exhaled breath (Meuret et al., 2008; Meckley, 2013); scalene/trapezius EMG to identify thoracic breathing (Peper & Tibbett, 1992; Peper & Tibbets, 1994); low abdominal EMG to identify transfers and oblique tightening during exhalation and relaxation during inhalation (Peper et al., 2016; and heart rate to monitor cardiorespiratory synchrony (Shaffer & Meehan, 2020). Physiological monitoring is useful; since, the clinician and the participant can observe the actual breathing pattern in real time, how the pattern changes in response the cognitive and physical tasks, and used for feedback training. The recorded data can document breathing problems and evidence of mastery.
The challenges of using physiological monitoring arethat the equipment may be expensive, takes skill to operate and interpret the data, and is usually located in the office and not at home.
Economic strategies for observation and training breathing
To complement the physiological monitoring and allow observations outside the office and at home, some of the following strategies may be used to observe breathing pattern (rate and expansion of the breath in the body), and suggestion to facilitate effortless diaphragmatic breathing. These exercises make excellent homework for the client. Practicing awareness and internal self-regulation by the client outside the clinic contributes enormously to the effect of biofeedback training (Wilson et al., 2023),
Observe breathing rate: Draw the breathing pattern
Take a piece of paper, a pen and a timer, set to 3 minutes. Start the timer. Upon inhalation draw the line up and upon exhalation draw the line down, creating a wave. When the timer stops, after 3 minutes, calculate the breathing rate per minute by dividing the number of waves by 3 as shown in Figure 3.
Figure 3. Drawing the breathing pattern for three minutes during two different days.
From these drawings, the breathing rate become evident. Many individuals are often surprised to discover that their breathing rate increased during periods of stress, such as a busy day with no breaks, compared to their normal days.
Monitoring and training diaphragmatic breathing
The scarf technique for abdominal feedback
Many participants are unaware that they are predominantly breathing in their chest and their abdomen expansion is very limited during inhalation. Before beginning, have participant loosen their belt and or stand upright since sitting collapsed/slouched or having the waist constriction such as a belt of tight constrictive clothing that inhibits abdominal expansion during inhalation.
Place the middle part of a long scarf or shawl on your lower back, take the ends in both hands and cross the ends: your left hand is holding the right part of the scarf, and the right hand is holding the left end of the scarf. Give a bit of a pull, so you can feel any movement of the scarf. When breathing more abdominally you will feel a pull at the ends of the scarf as you lower back, and flanks will expand as shown in Figure 4.
Figure 4. Using a scarf as feedback.
FlowMD app
A recent cellphone app, FlowMD, is unique because it uses the cellphone camera to detect the subtle movements of the chest and abdomen (FlowMD, 2024). It provides real time feedback of the persons breathing pattern. Using this app, the person sits in front of their cellphone camera and after calibration, the breathing pattern is displayed as shown in Figure 5.
Figure 5. Training breathing with FlowMD,.
Suggestions to optimize abdominal breathing that may lead to a slower breath rate when the client practices the technique
Beach pose
By locking the upper chest and sitting up straight it is often easier to breathe so that the abdomen can expand and constrict. Place your hands behind your head and Interlock your finger of both hands, pull your elbows back and up. The person can practice this either laying down on their back or sitting straight up at the edge of the chair as shown in Figure 6.
Figure 6. Sitting erect with the shoulders pulled back and up to allow abdominal expansion and constriction as the breathing pattern.
Observe the effect of posture on breathing
Have the person sit slouched/collapsed like a letter C and take a few slow breath, then have them sit up in a tall and erect position and take a few slow breaths. Usually they will observe that it is easier to breathe slower and lower and tall and erect.
Using your hands for feedback to guide natural breathing
Holding your hands with index fingers and thumbs touching the lower abdomen. When inhaling the fingers and thumbs separate and when exhaling they touch again (ensuring a full exhale and avoiding over breathing). The slight increase in lower abdominal muscle tension during the exhalation and relaxation during inhalation and the abdominal wall expands can also be felt with fingertips as shown in Figure 7.
Figure 7. Using your hands and finger for feedback to guide the natural breathing of expansion and constriction of the abdomen. Reproduced by permission from 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.
Coaching suggestions
There are many strategies to observe, teach and implement effortless breathing (Peper et al., 2024).. Even though breathing is natural and babies and young children breathe diaphragmatically as their large belly expands and constricts. Yet, in many cases the natural breathing shifts to dysfunctional breathing for multiple reasons such as chronic triggering defense reactions to avoiding pain following abdominal surgery (Peper et al, 2015). When participants initially attempt to relearn this natural pattern, it can be challenging especially, if the person habitually breathes shallowly, rapidly and predominantly in their chest.
When initially teaching effortless breathing, have the person exhale more air than normal without the upper chest compressing down and instead allow the abdomen comes in and up thereby exhaling all the air. If the person is upright then allow inhalation to occur without effort by letting the abdominal wall relaxes and expands. Initially inhale more than normal by expanding the abdomen without lifting the chest. Then exhale very slowly and continue to breathe so that the abdomen expands in 360 degrees during inhalation and constricts during exhalation. Let the breathing go slower with less and less effort. Usually, the person can feel the anus dropping and relaxing during inhalation.
Another technique is to ask the person to breathe in more air than normal and then breathe in a little extra air to completely fill the lungs, before exhaling fully. Clients often report that it teaches them to use the full capacity of the lungs.
The goal is to breath without effort. Indirectly this can be monitored by finger temperature. If the finger temperature decreases, the participant most likely is over-breathing or breathing with too much effort, creating sympathetic activity; if the finger temperature increases, breathing occurs slower and usually with less effort indicating that the person’s sympathetic activation is reduced.
Conclusion
There are many strategies to monitor and coach breathing. Relearning diaphragmatic breathing can be difficult due to habitual shallow chest breathing or post-surgical adaptations. Initial coaching may involve extended exhalations, conscious abdominal expansion, and gentle inhalation without chest movement. Progress can be monitored through indirect physiological markers like finger temperature, which reflects changes in sympathetic activity. The integration of these techniques into clinical or educational practice enhances self-regulation, contributing significantly to therapeutic outcomes. In this article we provided a few strategies which may be useful for some clients.
Additional blogs on breathing
https://peperperspective.com/2015/09/25/resolving-pelvic-floor-pain-a-case-report/
REFERENCES
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FlowMD. (2024). FlowMD app. Accessed December 13, 2024. https://desktop.flowmd.co/
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Nestor, J. (2020). Breath: The New Science of a Lost Art. New York: Riverhead Books. https://www.amazon.com/Breath-New-Science-Lost-Art/dp/0735213615/
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., 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., Gibney, K.H., & Holt, C.F. (2002). Make Health Happen. Dubuque, IA: Kendall/Hunt Publishing Company. https://he.kendallhunt.com/product/make-health-happen-training-yourself-create-wellness
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/
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Shaffer, F. and Meehan, Z.M. (2020). A Practical Guide to Resonance Frequency Assessment for Heart Rate Variability Biofeedback. Frontiers in Neuroscience, 14. https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2020.570400
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van Dixhoorn, J.V. (2021). Functioneel ademen-Adem-en ontspannings oefeningen voor gevorderden. Amersfoort: Uiteveriy Van Dixhoorn. https://www.bol.com/nl/nl/p/functioneel-ademen/9300000132165255/
Watso, J. C., Cuba, J.N., Boutwell, S.L, Moss, J…(2023). Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults. American Journal of Physiology Regulatory, Integrative and Comparative Physiology.
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[1] Correspondence should be addressed to:
Erik Peper, Ph.D., Institute for Holistic Health Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 Tel: 415 338 7683 Email: epeper@sfsu.edu web: www.biofeedbackhealth.org blog: www.peperperspective.com
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 4 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 6 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/
