Reversing Pandemic-Related Increases in Back Pain

Reversing Pandemic-Related Increases in Back Pain

By: Chris Graf

Reproduced by permission from: https://www.paintreatmentdirectory.com/posts/reversing-pandemic-related-increases-in-back-pain

Back pain increased significantly during the pandemic

Google searches for the words “back pain” reached an all-time high in January 2022. In a Harris Poll in September 2021, 56% of respondents said they had chronic pain, up from about 30% before the pandemic. There are probably multiple reasons for the uptick in pain in general and back pain in particular related to COVID, including added stress and ongoing symptoms of long COVID. Poor posture while working at home is another likely contributor.

Back pain and Ergonomics

According to Dr. Erik Peper, co-author of Tech Stress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, It is likely that poor ergonomics in the home office are partially to blame for the apparent rise in back pain. “With COVID, ergonomics have become a disaster—especially with people who use laptops.” Peper, an internationally known expert in biofeedback and Professor of Holistic Health Studies at San Francisco State University, said that it is “almost impossible” to sit correctly when using a laptop. “In order for the hands to be at the correct level for the keyboard, the head must be tilted down. The more the head tilts forward, the most stress that is placed on the cervical spine,” he said, noting that the arms will no longer be in the proper position if the laptop is placed on a stand to raise it to eye level.

For laptop users, Peper recommends using either an external monitor or external keyboard. When using an external keyboard, a laptop stand can be used to elevate the screen to the proper eye level. University of California at Berkeley recommends other tips for ergonomic laptop positioning. 

When using both laptops and desktops, attention should be focused on proper sitting posture. Ergonomic chairs are only part of the equation when it comes to achieving proper posture.

 “A good chair only gives you the opportunity to sit correctly,” Peper said. The goal is to achieve anterior pelvic tilt by having the seat pan slightly lower in the front that in the back. He recommends using a seat insert or cushion to achieve proper positioning (see figure 1).

Figure 1.  A small pillow or rolled up towel can be placed behind the back at kidney level in order to keep the spine slightly arched (see figure 2).

Figure 2. Sitting Disease: Cause of Back Pain and Much More

According to Peper, people who spend extended periods of time at their computers are at risk  of developing   sitting disease—a  condition of increased sedentary behavior associated with adverse health effects. A  study   that appeared in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases and conditions including chronic back and musculoskeletal pain. According to the study, “Being seated alters the activation patterns of multiple weight-bearing muscles and, therefore, excessive desk use is associated with adverse back curvature, back pain and upper extremity problems such as carpel tunnel syndrome.”

To Avoid Back Pain, Don’t Slouch!

Sitting for prolonged periods of time can cause back, neck, arm, and leg pain, but slouching is even worse and can damage spinal structures. “Most people slouch at computer, and when you slouch, our spine becomes more like the letter C, our abdomen is compressed, the diaphragm goes up which causes us to shallow breathe in our upper chest,” Peper said. “That impacts our back and digestion and many other things.”

According to Peper, slouching can also impact our mood. “Slouching is the posture associated with depression and low energy. That posture collapse may evoke negative and hopeless emotions. If I sit up and look up, I have less of that. I can have more positive and uplifting thinking.”

 Peper recommends a simple device to help people improve their posture. Called an Upright Go, it attaches to the neck and provides vibrational feedback when slouching occurs. “Every time it starts buzzing, it’s a reminder to stop slouching and to get up, wiggle, and move,” he said. “We have published some studies on it, but I have no investment in the company.”

Peper’s 4 Basic Tips for Avoiding Back Pain and Other Sitting Diseases:

#1 Get Up and Move

“Rule one is to take many breaks—wiggle and move,” he said. “People are unaware that they slightly raise their shoulders and their arm goes slightly forward—in their mousing especially. By the end of the day, they feel stiffness in their shoulders or back. So, you need to take many wiggly breaks. Get up from your chair every 15 minutes.”

Use Stretch Break or one of the other apps that remind people to get up out of their chairs and stretch. 

Walk around while on the phone and wear a headset to improve posture while on the phone. 

For back pain, skip in place or lift the right arm at the same time as the left knee followed by the left arm and right knee–exercises that cause a diagonal stretch along the back.

#2 Just Breathe

  • “Learn to practice lower breathing,” Peper said. “When you sit, you are forced to breath higher in your chest. You want to practice slow diaphragmatic breathing. Breathe deeply and slowly to restore a natural rhythm. Take three deep breaths, inhaling for five seconds, then exhale very slowly for six seconds.” For more instructions on slower diaphragmatic breathing visit Peper’s blog on the subject. 

#3 Take Visual Breaks:

  • Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes,” he said. By looking into the distance, near-focus muscle tension in the eyes is disrupted.
      
  • If you have children, make sure they are taking frequent visual breaks from their screens. According to Peper, there has been a 20 percent increase in myopia (nearsightedness) in young children as a result of COVID-related distance learning. “The eyes are being formed and shaped during childhood, and if you only focus on the screen, that changes the muscle structure of our eyes over time leading to more myopia.”

#4 Pay Attention to Ergonomics

  • “If you are working on a desktop, the top of screen should be at eyebrow level,” Peper said. “Your feet should be on the ground, and the angle of the knees should be about 110 degrees. You should feel support in mid back and low back and be able to sit, lean back, and be comfortable.”
      
  • Peper recommends adjustable sit/stand desks and regularly alternating between sitting and standing.  
     

For more specific guidance on ergonomics for prolonged sitting, UCLA School of Medicine offers detailed guidelines. And don’t forget to check out Dr. Peper’s book  on ergonomics as well as his blog, The Peper Perspective, where you can use the search feature to help you find exactly what you are looking for. 

But in the meantime, Dr. Peper said, “It’s time for you to get up and wiggle!”

Find a Provider Who Can Help with Back Pain

Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.    


Healing chronic back pain

Erik Peper, PhD, BCB, Jillian Cosby, and Monica Almendras

In at the beginning of 2021, I broke my L3 vertebra during a motor cycle accident and underwent two surgeries in which surgeons replaced my shattered L3 with a metal “cage” (looks like a spring) and fused this cage to the L4 and L2 vertebrae with bars. I also broke both sides of my jaw and fractured my left shoulder. I felt so overwhelmed and totally discouraged by the ongoing pain. A year later, after doing the self-healing project as part of the university class assignment, I feel so much better all the time, stopped taking all prescription pain medications and eliminated the sharp pains in my back. This project has taught me that I have the skill set needed to be whole and healthy. –J.C., 28-year-old college student

Chronic pain is defined as a pain that persist or recurs for more than 3 months (Treede et al., 2019). It is exhausting and often associated with reduced quality of life and increased medical costs (Yong, Mullins, & Bhattacharyya, 2022).  Pain and depression co-exacerbate physical and psychological symptoms and can lead to hopelessness (IsHak, 2018; Von Korff & Simon, 1996). To go to bed with pain and anticipate that pain is waiting for you as you wake up is often debilitating. One in five American adults experience chronic pain most frequently in back, hip, knee or foot (Yong, Mullins, & Bhattacharyya, 2022). Patients are often prescribed analgesic medications (“pain killers”) to reduce pain. Although, the analgesic medications can be effective in the short term to reduce pain, the efficacy is marginal for relieving chronic pain (Eriksen et al., 2006; Tan, & Jensen, 2007). Recent research by Parisien and colleagues (2022) reported that anti-inflammatory drugs were associated with increased risk of persistent pain. This suggest that anti-inflammatory treatments might have negative effects on pain duration. In addition, the long-term medication use is a major contributor to opioid epidemic and increased pain sensitivity (NIH NIDA, 2022; Higgins, Smith, & Matthews, 2019; Koop, 2020). Pain can often be successfully treated with a multidisciplinary approach that incorporates non-pharmacologic approaches. These include exercise, acceptance and commitment therapy, as well as hypnosis (Warraich, 2022). This paper reports how self-healing strategies as taught as part of an undergraduate university class can be an effective approach to reduce the experience of chronic pain and improve health.

Each semester, about 100 to 150 junior and senior college students at San Francisco State University enroll in a holistic health class that focused on ‘whole-person’ Holistic Health curriculum. The class includes an assessment of complementary medicine and holistic health. It is based upon the premise that mind/emotions affect body and body affect mind/emotions that Green, Green & Walters (1970) called the psychophysiological principle.

“Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state.”

The didactic components of the class includes the psychobiology of stress, the role of posture, psychophysiology of respiration, lifestyle and other health factors,  reframing internal language, guided and self-healing imagery. Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney, & Holt, 2002).

The self-practices during the last six weeks of the class focus on identifying, developing and implementing a self-healing project to optimize their personal health.  The self-healing project can range from simple life style changes to reducing chronic pain. Each student identifies their project such as increasing physical activity, eating a healthy diet and reducing sugar and junk food,  stopping vaping/smoking, reducing anxiety or depression, stopping hair pulling, reducing headaches, decreasing ezema, or back pain, etc.  At the end of the semester, 80% or more of the students report significant reduction in symptoms (Peper, Sato-Perry, & Gibney, 2003; Peper, Lin, Harvey, Gilbert, Gubbala, Ratkovich, & Fletcher, 2014; Peper, Miceli, & Harvey, 2016; Peper, Harvey, Cuellar, & Membrila, 2022).  During the last five semesters, 13 percent of the students focused reducing pain (e.g., migraines, neck and shoulder pain, upper or lower back pain, knee pain, wrist pain, and abdominal pain).   The students successfully improved their symptoms an average of 8.8 on a scale from 0 (No benefit) to 10 (total benefit/improvement). The success for improving their symptoms correlates 0.63 with their commitment and persistence to the project (Peper, Amendras, Heinz, & Harvey, in prep).  

The purposes of this paper is to describe a case example how a student with severe back pain reduced her symptoms and eliminated medication by implementing an integrated self-healing process as part of a class assignment and offer recommendations how this could be useful for others.

Participant: A 28-year-old female student (J.C.) who on January 28, 2021 broke her L3 vertebra in a motor cycle accident. She underwent two surgeries in which surgeons replaced her shattered L3 with a metal “cage” (which she describes as looking like a spring) and fused this cage to the L2 and L4 vertebrae with bars. She also broke both sides of her jaw and fractured her left shoulder. More than a year later, at the beginning of the self-healing project, she continue to take 5-10 mgs of Baclofen and 300 mgs of Gabapentin three times a day to reduce pain.

Goal of the self-healing project: To decrease the sharp pain/discomfort in her lower back that resulted from the motor cycle accident and, although not explicitly listed, to decrease the pain medications.

Self-healing process

During the last six weeks of the 2022 Spring semester, the student implemented her self-healing practices for her personal project which consisted of the following steps. 

1. Create a self-healing plan that included exploring the advantage and disadvantage of her illness.

2. Develop a step-by-step plan with specific goals to relief her tension and pain in her lower back. This practice allowed her to quantify her problem and the solutions. Like so many people with chronic pain, she focused on the problem and feelings (physical and emotional) associated with the pain. As a result, she often feel hopeless and worried that it would not change.

3. Observe and evaluate when pain sensations changed. She recognized that she automatically anticipated and focused on the pain and anxiety whenever she needed to bend down into a squat. She realized that she had been anticipating pain even before she began to squat. This showed that she needed to focus on healing the movement of this area of her body.

Through her detailed observations, she realized that her previous general rating of back pain could be separated into muscle tightness/stiffness and pain. With this realization, she changed the way she was recording her pain level. She changed it from “pain level” into into two categories: tightness and sharp pains.

4. Ask questions of her unconscious through a guided practice of accessing an inner guide through imagery (For detailed instructions, see Peper, Gibney, & Holt, 2002, pages 197-206). In this self-guided imagery the person relaxes and imagines being in a special healing place where you felt calm, safe and secure. Then as you relaxed, you become aware of another being (wise one or guide) approaching you (the being can be a person, animal, light, spirit, etc.). The being is wise and knows you well. In your mind, you ask this being or guide questions such as, “What do I need to do to assist in my own healing?”  Then you wait and listen for an answer.  The answer may take many forms such as in words, a pictures, a sense of knowing, or it may come later in dreams or in other forms.  When students are assigned this practice for a week, almost all report experiencing some form of guide and many find the answers meaningful for their self-healing project.

Through this imagery of the inner guide script, she connected with her higher self and  the wise one told her to “Wait.”  This connecting with the wise one was key in accepting that the project was not as daunting as she initially thought.  She realized that pain was not going to be forever in her future. She also interpreted that as reminder to have patience with herself. Change takes practice, time and practice such as she previously experienced while correcting her posture to manage her emotions and edit her negative thoughts into positive ones (Peper, Harvey, Cuellar, & Membrila, 2022). Whenever she would have pain or feel discouraged because of external circumstances, she would remind herself of three things:

A. I need to have patience with myself.

B. I have all the healing tools inside me and I am learning to use them.

C. If I do not make time for my wellness, I’ll be forced to make time for my illness.

5. Practice self-healing imagery as described by Peper, Gibney, & Holt (2002) and adapted from the work by Dr. Martin Rossman (Rossman, 2000). Imagery can be the communication channel between the conscious/voluntary and the unconscious/autonomic/involuntary nervous system (Bressler, 2005; Hadjibalassi et al, 2018; Rossman, 2019). It appears to act as the template and post-hypnotic suggestion to implement behavior change and may offer insight and ways to mobilize the self-healing potential (Battino, 2020). Imagery is dynamic and changeable.

The process of self-healing imagery consists of three parts.

  1. Inspection the problem and drawing a graphic illustration of the problem as it is experienced at that moment of time.
  2. Drawing of how that area/problem would look when being completely well/whole or disappeared.
  3. Creation of a self-healing process by which the problem would become transformed into health (Peper, Gibney & Holt, 2002, pp. 217-236). The process focused on what the person could do for themselves; namely, each time they became aware of, anticipated, or felt the problem, they would focus on the self-healing process. It provideshope; since, the person now focuses on the healing of the problem and becoming well.  

The drawings of inspection of the pain and problem she experienced at that moment of time are shown in Figure 1.

Figure 1. Illustration of the problem of the pain. Thorns dug deep, muscles tight, and frozen vertebrates grinding.

The resolution of the problem and being well/whole are illustrated in Figure 2.

Figure 2. Resolution of the problem in which her muscles are warm, full of blood, free of thorns, relaxed and flexible and being whole happy and healthy in which her spine is warm, her muscles are warm, her back is flexible and full of movement.

Although she utilized the first image of the muscles warm, full of blood, free of thorns and the muscles relaxed and flexible, her second image of her fully being healed was inspired through a religious statue of Yemaya that she had in her room (Yemaya is a major water spirit from the Yoruba religion Santeria and Orisha of the seas and protector of women).  Each time she saw the statue, she thought of the image of herself fully healed and embodying the spirit Orisha. Therefore, this image remained important to her all the time.

Her healing imagery process by which she transforms the image of inspecting of the problem to being totally well are illustrated in Figure 3.

Figure 3. The healing process: The sun’s warm fingers thaw my muscles, lubricate my vertebra, thorns fall out, and blood returns.

For five weeks as she implemented her self-healing project by creating a self-healing plan, asking questions of her unconscious, drawing her self-healing imagery. She also incorporated previously learned skills from the first part of the semester such diaphragmatic breathing, hand warming, shifting slouching to upright posture, and changing language. Initially she paired hand warming with the self-healing imagery and she could feel an increase in body warmth each time she practiced the imagery.  She practiced the self-healing imagery as an in-depth daily practice and throughout the day when she became aware of her back as described in one of her log entries. 

I repeated the same steps as the day prior today. I did my practice in the early morning but focused on the details of the slowed down movements of the sun’s hands. I saw them as they stretched out to my back, passed through my skin, wrapped around my muscles, and began to warm them. I focused on this image and tried to see, in realistic detail, my muscles with a little ice still on them, feeling hard through and through, the sun’s glowing yellow-orange fingers wrapped around my muscles. I imaged the thorns still in my muscles, though far fewer than when I started, and then I imaged the yellow-orange glow start to seep out from the sun’s palms and fingers and spread over my muscles. I imaged the tendons developing as the muscle tissue thawed and relaxed, the red of the muscle brightened, the ice on and within my muscles started to melt, and the condensation formed as it ran down into collected droplets at the bottom of my muscles. I imaged the thorns lose their grip and fall out, one at a time, in tandem with the droplets falling. I continued this process and imaged my muscles expanding with warmth and relaxation as they stayed engulfed in the warmth of the sun.

At the end of my practice, I did a small stretch session. I felt extremely refreshed and ready for yet another extremely busy day between internship, graduation, and school. I would say I felt warm and relaxed all the way into the afternoon, about 6 hours after my practice. This was by far the most detailed and impactful imagery practice I have had.

The self-healing imagery practice provided me with the ability to conceptualize more than my problem as it showed me the tools to (and the importance of) conceptualizing my solution, both the tool and end result.

Results

Pain and tightness decreased and she stopped her medication by the third week as shown in Figure 4.  

Figure 4. Self-rating of sharp pains and tightness during the self-healing project.

At the 14-week follow-up, she has continued to improve, experiences minimal discomfort, and no longer takes medication. As she stated, I was so incredibly shocked how early on [in the project] I was able to stop taking pain medications that I had already taken every day for over a year.

Discussion

This individual case example provides hope that health can be improved when shifting the focus from pain and discomfort to focusing on actively participating in the self-healing process.  As she wrote, The lesson was self- empowerment in regard to my health. I brought comfort to my back. There is metal in my back for the rest of my life and this is something I have accepted. I used to look at that as a horrible thing to have to handle forever. I now look at it as a beautiful contraption that has allowed me to walk across a graduation stage despite having literally shattered a vertebra. I am reintegrating these traumatized parts of my body back into a whole health state of mind and body. Doctors did not do this, surgeries did not, PT didn’t and neither did pain medications. MY body and MY mind did it. I did this.

Besides the self-healing imagery and acting upon the information she received from the asking questions from the unconscious there were many other factors contributed to her healing.  These included the semester long self-practices and  mastery of different stress management techniques, learning how stress impacts health and what can the person can do to self-regulate, as well as being introduced to  the many case examples and research studies that suggested healing could be possible even in cases where it seemed impossible.

The other foundational components that was part of the class teachings included attending the weekly classes session and completing the assign homework practices. These covered discussion about placebo/nocebo, possibilities and examples of self-healing with visualization, the role of nutrition, psychophysiology of stress and factors are associated with healthy aging across cultures. The asynchronous assignments investigated factors that promoted or inhibited health and the role of hope. The discussions pointed out that not everyone may return to health; however, they can always be whole.  For example, if a person loses a limb, the limb will not regrow. The healing process includes acceptance and creating new goals to achieve and live a meaningful life. 

The possibility that students could benefit by implementing the different skills and concepts taught in the class were illustrated by sharing previous students’ successes in reversing disorders such as hair pulling, anxiety, psoriasis, and pain. In addition, students were assigned to watch and comment on videos of people who had overcome serious illness. These included Janine Shepherd’s  2012 TED talk, A broken body isn’t a broken person, and  Dr. Terry Wahl’s 2011 TEDxIowaCity talk, Minding your mitochondria.  Janine Shepard shared how she recovered from a very serious accident in which she became paralyzed to becoming an aecrobatic pilot instructor while Dr. Terry Wahl shares how she he used diet to cure her MS and get out of her wheelchair (Shepherd, 2012; Wahl, 2011).  Other assignments included watching Madhu Anziani’s presentation, Healing from paralysis-Music (toning) to activate health, in which he discussed his recovery from being a quadriplegic to becoming an inspirational musician (Anziani, & Peper, 2021). The students as read and  commented on  student case examples of reversing acid reflux, irritable bowel and chronic headaches (Peper, Mason, & Huey, 2017a; Peper, Mason, & Huey, 2017b; Peper, 2018; Peper et al., 2020; Peper, Covell, & Matzembacker, 2021; Peper, 2022).

Although self-healing imagery appears to be the major component that facilitated the healing, it cannot be separated from the many other concepts and practices that may have contributed. For example, the previous practices of learning slow diaphragmatic breathing and hand warming may have allowed the imagery to become a real kinesthetic experience. In addition, by seeing how other students overcame chronic disorders, the class provided a framework to mobilize one’s health.

Lessons extracted from this case example that others may be able use to mobilize health.

  • Take action to shifts from being hopeless and powerless to becoming empowered and active agent in the healing process.
  • Change personal beliefs through experiential practices and storytelling that provides a framework that healing and improvement are possible.
    • Teach the person self-regulation skills such as slower breathing, muscle relaxation, cognitive internal language changes, hand warming by which the person experiences changes.
    • Provide believable role models who shared their struggle in overcoming traumatic injury, watch inspirational talks, and share previous clients or students’ self-reports who had previously improved.
  • Transform the problem from global description into behavioral specific parts. For example, being depressed is a global statement and too big to work on. Breaking the global concept into specific behaviors such as, my energy is too low to do exercise or I have negative thoughts, would provide specific interventions to work on such as, increasing exercise or changing thoughts. In JC’s case, she changed the general rating of pain into ratings of muscle tightness and sharp pains. This provided the bases for strategies to relax and warm her muscles.
  • Focus on what you can do at that moment versus focusing on the past, what happened, who caused it, or blaming yourself and others.  Explore and ask what you now can do now to support your healing process and reframe the problem as a new opportunity for growth and development.
  • Practice, practice, and practice with a childlike exploratory attitude.  Focus on the small positive benefits that occur as a result of the practices.  It is not mindless practice; it is practice while being present and being gentle with yourself. Do not discard very small changes.  The benefits accrue as you practice more and more, just many people have experienced when learning to play a musical instrument or mastering a sport.  Even though many participants think that practicing 15 minutes a day is enough, it usually takes much more time.  Reflect on how a baby learns to walk or climb. The toddler practices day-long and takes naps to regenerate and grow. When the toddler is not yet successful in walking or climbing, it does not give up or interpret it as failure or blaming himself that he cannot do it, it just means more practice.
  • Have external reminders to evoke the self-healing practices.  In JC’s case, the small statue of Yemaya in her room was the reminder. It reminded her to thinks of the image of herself fully healed each time she saw it.
  • Guide yourself through the wise one imagery, ask yourself a question and listen and act on the intuitional answers.
  • Develop a self-healing imagery process that transforms the dysfunction to health or wholeness.  Often the person only perceives the limitations and focusses on describing the problem. Instead, acknowledge, accept what was and is, and focus on developing a process to promote healing. What many people do not realize that if they think/imagine how their injury/illness was caused, it may reactivate and recreate the initial trauma. This can be illustrated through imagery. When we think or imagine something, it changes our physiology. For example, when one imagines eating a lemon, many people will salivate. The image affects physiology. Thus, focus on processes that support healing.
  • While practicing the imagery, experience it as if it is real and feel it happening inside yourself.  Many people initially find this challenging as they see it outside themselves.  One way to increase the “felt sense” is to incorporate more body involvement such as acting out the imagery with hand and body movements.
  • When having a relapse, remind yourself to keep going. Every morning  is the beginning of a new day, do each practices anew. In addition, reflect of something that was challenging in the past but that you successfully overcame. Focus on that success. As JC wrote, I was also successful in that I gave myself slack and reminded myself that relapses will happen and what matters more is the steps I take to move forward.
  • Make your healing a priority that means doing it often during the day. Allow the self-healing imagery and process to run in the back of the head all the time just as a worry can be present in the background. So often people practice for a few minutes (which is great and better than not practicing at all); however, at other times during the day they are captured by their worry, negative thoughts or focus on the limitations of the disorder. When a person focuses on the limitations, it may interrupt the self-healing process.  The analogy we often use is that the healing process is similar to healing from a small cut in the skin. Initially a scab forms and eventually the scab falls off and the skin is healed. On the other hand, if you keep moving the skin or pick on the scab, healing is much slower. By focusing on the limitations and past visualization of the injury, self-healing is reduced. This is similar to removing the scab before the skin has healed.   As JC stated, “If you don’t make time for your wellness, you’ll be forced to make time for your illness” was 100% a motivating factor in my success.
  • Explore resources for providers and people living with pain. See Dr. Rachel Zoffness website which provides a trove of high quality articles, books, videos, apps, and podcasts. https://www.zoffness.com/resources

In summary, we do not know the limits of self-healing; however, this case example illustrates that by implementing self-healing strategies health and recovery occurred. As JC wrote:

To have broken a vertebra in my back and experience all the injuries that came with the accident when I already did not have the strongest mind-body connection was incredibly intense and really heartbreaking and discouraging in my life. And, that made things difficult because I was not able to 100% focus on my healing because I felt so overwhelmed by the feeling of discouragement that I felt. Experiencing this self-healing project, seeing the imagery that helped me not just feel so much better all the time but be able to stop taking all prescription pain medications and eliminate the sharp pains in my back has taught me that I have the skill set needed to be whole and healthy.

Watch the interview will Jillian Cosby inwhich she describes her self-healing process.

References

Anziani, M. & Peper, E. (2021). Healing from paralysis-Music (toning) to activate health. The peperperspective.  https://peperperspective.com/2021/11/22/healing-from-paralysis-music-toning-to-activate-health/

Battino, R. (2020). Using Guided Imagery and Hypnosis in Brief Therapy and Palliative Care. New York: Routledge.

Bresler, D. (2005).Physiological Consequences of Guided Imagery. Pract Pain Manag, 5(6). https://www.practicalpainmanagement.com/treatments/complementary/biobehavioral/physiological-consequences-guided-imagery

Eriksen, J., Sjøgren, P., Bruera, E., et al. (2006). Critical issues on opioids in chronic non-cancer pain: An epidemiologic study. Pain, 125,172–179. https://doi.org/10.1016/j.pain.2006.06.009

Green, E. E., Green, A. M., & Walters, E. D. (1970). Voluntary control of internal states: Psychological and physiological. The Journal of Transpersonal Psychology2(1), 1. https://atpweb.org/jtparchive/trps-02-70-01-001.pdf

Hadjibalassi, M., Lambrinou, E.., Papastavrou,E., & Papathanassoglou, E. (2018). The effect of guided imagery on physiological and psychological outcomes of adult ICU patients: A systematic literature review and methodological implications, Australian Critical Care, 31(2), 73-86. https://doi.org/10.1016/j.aucc.2017.03.001

Higgins, C, Smith, B.H., & Matthews, K. (2019). Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis, British Journal of Anaesthesia, 122(6), e114-e126. https://doi.org/10.1016/j.bja.2018.09.019

IsHak, W.W., Wen, R.Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., Dascal, J., Lobsang, Gohar, Y.,; Eskander, L., Yadegar, J.,   Hanna, S., Sadek, A., Aguilar-Hernandez, L.,  Danovitch, I.,  Louy, C. (2018).  Pain and Depression: A Systematic Review, Harvard Review of Psychiatry, 11/12, 26(6), 352-363. https://doi.org/10.1097/HRP.0000000000000198

Koob, G.F. (2020). Neurobiology of Opioid Addiction: Opponent Process, Hyperkatifeia, and Negative Reinforcement, Biological Psychiatry, 87(1), 44-53. https://doi.org/10.1016/j.biopsych.2019.05.023

Mullins, P.M., & Bhattacharyya, N. (2022). Prevalence of chronic pain among adults in the United States, Pain, 163(2), e328-e332.  https://doi.org/10.1097/j.pain.0000000000002291NIH

NIDA (2022). Opioid Overdose Crisis. Downloaded June 30, 2022. https://nida.nih.gov/research-topics/opioids/opioid-overdose-crisis

Parisien, M., Lima, L.V., Dagostino, C., El-Hachem, N., Drury, G.L., Grant, A.V., Huising, J., Verma, V…. .(2022). Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Science Translational Medicine, 14(644). https://doi.org/10.1126/scitranslmed.abj99

Peper, E. (2018). Breathing reduces acid reflux and dysmenorrhea discomfort. the peperperspective. https://peperperspective.com/2018/10/04/breathing-reduces-acid-reflux-and-dysmenorrhea-discomfort/

Peper, E. (2022). Resolving a chronic headache with posture feedback and breathing. the peperperspective. https://peperperspective.com/2022/01/04/resolving-a-chronic-headache-with-posture-feedback-and-breathing/

Peper, E., Almedras, M., Heinz, N. & Harvey, R. (in prep). How attending a Holistic Health class reduced symptoms.

Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194

Peper, E., Gibney, K.H. & Holt. C. (2002).  Make Health Happen: Training Yourself to Create Wellness.  Dubuque, IA: Kendall-Hunt.ISBN: 978-0787293314 https://he.kendallhunt.com/make-health-happen

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91  https://www.neuroregulation.org/article/view/22815/14575

Peper, E., Lin, I-M., Harvey, r., Gilbert, M.  Gubbala, P, Ratkovich, A., & Fletcher, L. (2014). Transforming Chained Behaviors: Case Studies of Overcoming Smoking, Eczema, and Hair Pulling (Trichotillomania), Biofeedback, 42 (4), 154–160. https://doi.org/10.5298/1081-5937-42.4.06

Peper, E., Mason, L, & Huey, C. (2017a). Healing irritable bowel syndrome with diaphragmatic breathing. the peperperspective. https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/

Peper, E., Mason, L., Huey, C. (2017b).  Healing irritable bowel syndrome with diaphragmatic breathing. Biofeedback. (45-4). https://doi.org/10.5298/1081-5937-45.4.04

Peper, E., Mason, L., Harvey, R., Wolski, L, & Torres, J. (2020). Can acid reflux be reduced by breathing? Townsend Letters-The Examiner of Alternative Medicine, 445/446, 44-47. https://www.townsendletter.com/article/445-6-acid-reflux-reduced-by-breathing/

Peper, E., Miceli, B., & Harvey, R. (2016). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137.  https://doi.org/10.5298/1081-5937-44.3.03

Peper, E., Sato-Perry, K & Gibney, K. H. (2003). Achieving Health: A 14-Session Structured Stress Management Program—Eczema as a Case Illustration. 34rd Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract in: Applied Psychophysiology and Biofeedback, 28(4), 308. https://biofeedbackhealth.files.wordpress.com/2013/12/2003-aapb-poster-peper-keiko-long1.pdf

Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160. https://doi.org/10.5298/1081-5937-42.4.06

Rossman, M. L.(2000). Guided imagery for self-healing. New York: New World Library. https://www.amazon.com/Guided-Imagery-Self-Healing-Martin-Rossman/dp/091581188X/ref=sr_1_3?crid=3M8I1Y1NV3A5N&keywords=martin+rossman&qid=1657649675&s=books&sprefix=rossman%2C+M%2Cstripbooks%2C131&sr=1-3

Rossman, M. L. (2019). Imagine health! Imagery in medical self-care. InSheikh, A.A. (ed).  Imagination and healing (pp. 231-258). Routledge. https://www.amazon.com/Imagination-Healing-Imagery-Human-Development-ebook/dp/B07QB4RGSW/ref=sr_1_9?crid=3C7V3E5ZN92R&keywords=Imagination+and+healing&qid=1657818303&s=books&sprefix=imagination+and+healing+%2Cstripbooks%2C105&sr=1-9

Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The link between depression and chronic pain: Neural mechanisms in the brain. Neural Plasticity, 2017, Article 9724371. https://doi.org/10.1155/2017/9724371

Shepherd, Janine. (2012). A broken body isn’t a broken person. TEDxKC. https://www.ted.com/talks/janine_shepherd_a_broken_body_isn_t_a_broken_person

Tan, G., & Jensen, M. P. (2007). Integrating complementary and alternative medicine into multidisciplinary chronic pain treatment. In Chronic Pain Management (pp. 75-99). CRC Press. https://www.taylorfrancis.com/chapters/edit/10.3109/9781420045130-6/integrating-complementary-alternative-medicine-multidisciplinary-chronic-pain-treatment-gabriel-tan-mark-jensen

Treede, R-D.,  Rief, W.,  Barke, A.,  Aziz, Q., Bennett, M.I.,  Benoliel, R.,  Cohen, M.,  Evers, S.,  Finnerup, N.B.,  First, M.B.,  Giamberardino, M.A.,  Kaasa, S.,  Korwisi, B., Kosek, E.,  Lavand’homme, P., ; Nicholas, M.,  Perrot, S.,  Scholz, J.,  Schug, S.,  Smith, B.H., ; Svensson, P.,  Vlaeyen, J.S., & Wang, S-J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11), Pain, 160(1), 19-27.  https://do.org/10.1097/j.pain.0000000000001384

Von Korff, M. & Simon, G. (1996). The relationship between pain and depression. British Journal of Psychiatry, 168(S30), 101-108. https://doi.org/10.1192/S0007125000298474

Wahl, T. (2011). Minding your mitochondria. TEDzIowaCity. https://www.youtube.com/watch?v=KLjgBLwH3Wc

Warraich, H. (2022). Medicine has failed chronic pain patients. Here’s what they need. Pscyhe, Aeon, https://psyche.co/ideas/medicine-has-failed-chronic-pain-patients-heres-what-they-need

Yong, R. J., Mullins, P. M., & Bhattacharyya, N. (2022). Prevalence of chronic pain among adults in the United States. Pain163(2), e328-e332. https://doi.org/10.1097/j.pain.0000000000002291



Hope for insomnia, depression, anxiety, ADHD, exhaustion, and nasal congestion -Breathe light, slow and deep

Anxiety, depression, insomnia, exhaustion, ADHD, allergies, poor performance have all increased (Barendse et al., 2021; London & Landes, 2021; Peper et al, 2022a; Peper et al, 2022b; Vasileiadou et al, 2021). One of the unrecognized contributing factor is dysfunctional mouth breathing (McKeown, 2022). Improve health by learning to breathe in and out through the nose during the day and night. Listen to the inspiring presentation by Patrick McKeown, author of the superb book, The breathing cure-Develop  new habits for a healthier, happier & long life (McKeown, 2022). In this presentation, he describes the science behind these disorders, the rationale for breathing light, slow and deep and offers simple breathing exercises to reduce symptoms and improve performance.

References

Barendse, M., Flannery, J., Cavanagh, C., Aristizabal, M., Becker, S. P., Berger, E., … & Pfeifer, J. (2021). Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: A collaborative of 12 samples from 3 countries. https://doi.org/10.31234/osf.io/hn7us

London, A.S. & Landes, S.D. (2021). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect.  Journal of attention disorders, 25(6), 771-782. https://doi.org/10.1177/1087054719855689

McKeown, P. (2022). The breathing cure-Develop  new habits for a healthier, happier & long life.  West Palm Beach, FL: Humanix Books.

Peper, E. (2022). Reduce anxiety. the peperperspective. https://peperperspective.com/2022/03/23/reduce-anxiety/

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022b). Reduce  anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91  

Vasileiadou, S., Ekerljung, L., Bjerg, A., & Goksor, E. (2021). Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking. PLoS ONE, 16(6): e0253322. https://doi.org/10.1371/journal.pone.0253322    


Reduce anxiety

The purpose of this blog is to describe how a university class that incorporated structured self-experience practices reduced self-reported anxiety symptoms (Peper, Harvey, Cuellar, & Membrila, 2022). This approach is different from a clinical treatment approach as it focused on empowerment and mastery learning (Peper, Miceli, & Harvey, 2016). 

As a result of my practice, I felt my anxiety and my menstrual cramps decrease. — College senior

When I changed back to slower diaphragmatic breathin, I was more aware of my negative emotions and I was able to reduce the stress and anxiety I was feeling with the deep diaphragmatic breathing.– College junior

Background

More than half of college students now report anxiety (Coakley et al., 2021). In our recent survey during the first day of the spring semester class, 59% of the students reported feeling tired, dreading their day, being distracted, lacking mental clarity and had difficulty concentrating.

Before the COVID pandemic nearly one-third of students had or developed moderate or severe anxiety or depression while being at college (Adams et al., 2021. The pandemic accelerated a trend of increasing anxiety that was already occurring.  “The prevalence of major depressive disorder among graduate and professional students is two times higher in 2020 compared to 2019 and the prevalence of generalized anxiety disorder is 1.5 times higher than in 2019” As reported by Chirikov et al (2020) from the UC Berkeley SERU Consortium Reports.

This increase in anxiety has both short and long term performance and health consequences. Severe anxiety reduces cognitive functioning and is a risk factor for early dementia (Bierman et al., 2005; Richmond-Rakerd et al, 2022). It also increases the risk for asthma, arthritis, back/neck problems, chronic headache, diabetes, heart disease, hypertension, pain, obesity and ulcer (Bhattacharya et al., 2014; Kang et al, 2017).

The most commonly used treatment for anxiety are pharmaceutical and cognitive behavior therapy (CBT) (Kaczkurkin & Foa, 2015).  The anti-anxiety drugs are usually benzodiazepines (e.g., alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium) and lorazepam (Ativan).  Although these drugs they may reduce anxiety, they have numerous side effects such as drowsiness, irritability, dizziness, memory and attention problems, and physical dependence (Shri, 2012; Crane, 2013).

Cognitive behavior therapy techniques based upon the assumption that anxiety is primarily a disorder in thinking which then causes the symptoms and behaviors associated with anxiety. Thus, the primary treatment intervention focuses on changing thoughts.

Given the significant increase in anxiety and the potential long term negative health risks, there is need to provide educational strategies to empower students to prevent and reduce their anxiety.  A holistic approach is one that assumes that body and mind are one and that soma/body, emotions and thoughts interchangeably affect the development of anxiety. Initially in our research, Peper, Lin, Harvey & Perez (2017) reported that it was easier to access hopeless, helpless, powerless and defeated memories in a slouched position than an upright position and it was easier to access empowering positive memories in an upright position than a slouched position. Our research on transforming hopeless, helpless, depressive thought to empowering thoughts, Peper, Harvey & Hamiel (2019) found that it was much more effective if the person first shifts to an upright posture, then begins slow diaphragmatic breathing and finally reframes their negative to empowering/positive thoughts. Participants were able to reframe stressful memories much more easily when in an upright posture compared to a slouched posture and reported a significant reduction in negative thoughts, anxiety (they also reported a significant decrease in negative thoughts, anxiety and tension as compared to those attempting to just change their thoughts).

The strategies to reduce anxiety focus on breathing and posture change. At the same time there are many other factors that may contribute the onset or maintenance of anxiety such as social isolation, economic insecurity, etc. In addition, low glucose levels can increase irritability and may lower the threshold of experiencing anxiety or impulsive behavior (Barr, Peper, & Swatzyna, 2019; Brad et al, 2014). This is often labeled as being “hangry” (MacCormack & Lindquist, 2019). Thus, by changing a high glycemic diet to a low glycemic diet may reduce the somatic discomfort (which can be interpreted as anxiety) triggered by low glucose levels.  In addition, people are also sitting more and more in front of screens.  In this position, they tend to breathe quicker and more shallowly in their chest. 

Shallow rapid breathing tends to reduce pCO2 and contributes to subclinical hyperventilation which could be experienced as anxiety (Lum, 1981; Wilhelm et al., 2001; Du Pasquier et al, 2020).  Experimentally, the feeling of anxiety can rapidly be evoked by instructing a person to sequentially exhale about 70 % of the inhaled air continuously for 30 seconds. After 30 seconds, most participants reported a significant increase in anxiety (Peper & MacHose, 1993).  Thus, the combination of sitting, shallow breathing and increased stress from the pandemic are all cofactors that may contribute to the self-reported increase in anxiety.

To reduce anxiety and discomfort, McGrady and Moss (2013) suggested that self-regulation and stress management approaches be offered as the initial treatment/teaching strategy in health care instead of medication. One of the useful approaches to reduce sympathetic arousal and optimize health is breathing awareness and retraining (Gilbert, 2003).  

Stress management as part of a university holistic health class

Every semester since 1976, up to 180 undergraduates have enrolled in a three-unit Holistic Health class on stress management and self-healing (Klein & Peper, 2013).  Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney & Holt, 2002).

82% of students self-reported that they were ‘mostly successful’ in achieving their self-healing goals. Students have consistently reported achieving positive benefits such as increasing physical fitness, changing diets, reducing depression, anxiety, and pain, eliminating eczema, and even reducing substance abuse (Peper et al., 2003; Bier et al., 2005; Peper et al., 2014).

This assessment reports how students’ anxiety decreased after five weeks of daily practice. The students filled out an anonymous survey in which they rated the change in their discomfort after practicing effortless diaphragmatic breathing. More than 70% of the students reported a decrease in anxiety. In addition, they reported decreases in symptoms of stress, neck and shoulder pain as shown in Figure 1.

Figure 1. Self-report of decrease in symptoms after practice diaphragmatic breathing for a week.

In comparing the self-reported responses of the students in the holistic health class to those of the control group (N=12), the students in the holistic health class reported a significant decrease in symptoms since the beginning of the semester as compared to the control group as shown in Figure 2.

Figure 2. Change in self-reported symptoms after 6 weeks of practice the integrated holistic health skills as compared to the control group who did not practice these skills.

Changes in symptoms Most students also reported an increase in mental clarity and concentration that improved their study habits. As one student noted: Now that I breathe properly, I have less mental fog and feel less overwhelmed and more relaxed. My shoulders don’t feel tense, and my muscles are not as achy at the end of the day.

The teaching components for the first five weeks included a focus on the psychobiology of stress, the role of posture, and psychophysiology of respiration. The class included didactic presentations and daily self-practice

Lecture content

  1. Diadactic presentation on the physiology of stress and how posture impacts health.
  2. Self-observation of stress reactions; energy drain/energy gain and learning dynamic relaxation.
  3. Short experiential practices so that the student can experience how slouched posture allows easier access to helpless, hopeless, powerless and defeated memories.
  4. Short experiential breathing practices to show how breathing holding occurs and how 70% exhalation within 30 seconds increases anxiety.
  5. Didactic presentation on the physiology of breathing and how a constricted waist tends to have the person breathe high in their chest (the cause of neurasthemia) and how the fight/flight response triggers chest breathing, breath holding and/or shallow breathing.
  6. Explanation and practice of diaphragmatic breathing.

Daily self-practice

Students were assigned weekly daily self-practices which included both skill mastery by practicing for 20 minutes as well and implementing the skill during their daily life.  They then recorded their experiences after the practice. At the end of the week, they reviewed their own log of week and summarized their observations (benefits, difficulties) and then met in small groups to discuss their experiences and extract common themes. These daily practices consisted of:

  1. Awareness of stress.  Monitoring how they reacted to daily stressor
  2. Practicing dynamic relaxation. Students practiced for 20 minutes a modified progressive relaxation exercise and observed and inhibit bracing pattern
  3. Changing energy drain and energy gains. Students observed what events reduced or increased their subjective energy and implemented changes in their behavior to decrease events that reduced their energy and increased behaviors that increase their enery
  4. Creating a memory of wholeness practice
  5. Practicing effortless breathing. Students practiced slowly diaphragmatic abdominal breathing for 20 minutes per day and each time they become aware of dysfunctional breathing (breath holding, shallow chest breathing, gasping) during the day, they would shift to slower diaphragmatic breathing.

Discussion

Almost all students were surprised how beneficial these practices were to reduce their anxiety and symptoms. Generally, the more the students would interrupt their personal stress responses during the day by shifting to diaphragmatic breathing the more did they experience success. We hypothesize that some of the following factors contributed to the students’ improvement.

  • Learning through self-mastery as an education approach versus clinical treatment.
  • Generalizing the skills into daily life and activities. Practicing the skills during the day in which the cue of a stress reaction triggered the person to breathe slowly. The breathing would reduce the sympathetic activation.
  • Interrupting escalating sympathetic arousal. Responding with an intervention reduced the sense of being overwhelmed and unable to cope by the participant by taking charge and performing an active task.
  • Redirecting attention and thoughts away from the anxiety triggers to a positive task.
  • Increasing heart rate variability. Through slow breathing heart rate variability increased which enhanced sympathetic parasympathetic balance.
  • Reducing subclinical hyperventilation by breathing slower and thereby increasing pC02.
  • Increasing social support by meeting in small groups.  The class discussion group normalized the anxiety experiences.
  • Providing hope. The class lectures, assigned readings and videos provide hope; since,  it included reports how other students had reversed their chronic  disorders such as irritable bowel disease, acid reflux, psoriasis with behavioral interventions.

Although the study lacked a control group and is only based upon self-report, it offers an economical non-pharmaceutical approach to reduce anxiety. These stress management strategies may not resolve anxiety for everyone. Nevertheless, we recommend that schools implement this approach as the first education intervention to improve health in which students are taught about stress management, learn and practice relaxation and diaphragmatic breathing and then practice these skills during the day  whenever they experience stress or dysfunctional breathing.

I noticed that breathing helped tremendously with my anxiety. I was able to feel okay without having that dreadful feeling stay in my chest and I felt it escape in my exhales. I also felt that I was able to breathe deeper and relax better altogether. It was therapeutic, I felt more present, aware, and energized.

See the following blogs for detailed breathing instructions

References

Adams. K.L., Saunders KE, Keown-Stoneman CDG, et al. (2021). Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study. BMJ Open 2021; 11:e047393. https://doi.org/10.1136/bmjopen-2020-047393

Barr, E. A., Peper, E. & Swatzyna, R.J. (2019).  Slouched Posture, Sleep Deprivation, and Mood Disorders: Interconnection and Modulation by Theta Brain Waves. Neuroregulation, 6(4), 181–189 https://doi.org/10.15540/nr.6.41.181

Bhattacharya, R., Shen, C. & Sambamoorthi, U. (2014). Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry 14, 10 (2014). https://doi.org/10.1186/1471-244X-14-10

Bier, M., Peper, E., & Burke, A. (2005). Integrated stress management with ‘Make Health Happen: Measuring the impact through a 5-month follow-up. Poster presentation at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract published in: Applied Psychophysiology and Biofeedback, 30(4), 400. https://biofeedbackhealth.files.wordpress.com/2013/12/2005-aapb-make-health-happen-bier-peper-burke-gibney3-12-05-rev.pdf

Bierman, E.J.M., Comijs, H.C. , Jonker, C. & Beekman, A.T.F.  (2005). Effects of Anxiety Versus Depression on Cognition in Later Life. The American Journal of Geriatric Psychiatry,13(8),  686-693, https://doi.org/10.1097/00019442-200508000-00007.

Brad, J., Bushman, C., DeWall, N., Pond, R.S., &. Hanus, M.D. (2014).. Low glucose relates to greater aggression in married couplesPNAS, April 14, 2014.  https://doi.org/10.1073/pnas.1400619111

Chirikov, I., Soria, K. M, Horgos, B., & Jones-White, D. (2020). Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic. UC Berkeley: Center for Studies in Higher Education. Retrieved from https://escholarship.org/uc/item/80k5d5hw

Coakley, K.E., Le, H., Silva, S.R. et al. Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic. Nutr J 20, 45 (2021). https://doi.org/10.1186/s12937-021-00701-9

Crane,E.H. (2013).Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. 2013 Feb 22. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384680/

Du Pasquier, D., Fellrath, J.M., & Sauty, A. (2020). Hyperventilation syndrome and dysfunctional breathing: update. Revue Medicale Suisse, 16(698), 1243-1249. https://europepmc.org/article/med/32558453

Gilbert C. Clinical Applications of Breathing Regulation: Beyond Anxiety Management. Behavior Modification. 2003;27(5):692-709. https://doi.org/10.1177/0145445503256322

Kaczkurkin, A.N. & Foa, E.B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 17(3):337-46.  https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Kang, H. J., Bae, K. Y., Kim, S. W., Shin, H. Y., Shin, I. S., Yoon, J. S., & Kim, J. M. (2017). Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population. Psychiatry investigation14(3), 240–248. https://doi.org/10.4306/pi.2017.14.3.240

Klein, A. & Peper, W. (2013). There is Hope: Autogenic Biofeedback Training for the Treatment of Psoriasis. Biofeedback, 41(4), 194–201. https://doi.org/10.5298/1081-5937-41.4.01

Lum, L. C. (1981). Hyperventilation and anxiety state. Journal of the Royal Society of Medicine74(1), 1-4. https://journals.sagepub.com/doi/pdf/10.1177/014107688107400101

MacCormack, J. K., & Lindquist, K. A. (2019). Feeling hangry? When hunger is conceptualized as emotion. Emotion, 19(2), 301–319. https://doi.org/10.1037/emo0000422

McGrady, A. & Moss, D. (2013). Pathways to illness, pathways to health. New York: Springer. https://link.springer.com/book/10.1007/978-1-4419-1379-1

Peper, E., Gibney, K.H., & Holt, C.F. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall/Hunt Publishing Company. https://he.kendallhunt.com/make-health-happen

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91  https://www.neuroregulation.org/article/view/22815/14575

Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy.  NeuroRegulation, 6(3),153-169.  doi:10.15540/nr.6.3.1533-1   https://www.neuroregulation.org/article/view/19455/13261

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

Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160. https://doi.org/10.5298/1081-5937-42.4.06

Peper, E., MacHose, M. (1993). Symptom prescription: Inducing anxiety by 70% exhalation. Biofeedback and Self-Regulation 18, 133–139). https://doi.org/10.1007/BF00999790

Peper, E., Miceli, B., & Harvey, R. (2016). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137.  https://doi.org/10.5298/1081-5937-44.3.03

Peper, E., Sato-Perry, K & Gibney, K. H. (2003). Achieving Health: A 14-Session Structured Stress Management Program—Eczema as a Case Illustration. 34rd Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract in: Applied Psychophysiology and Biofeedback, 28(4), 308. Proceeding in:  http://www.aapb.org/membersonly/articles/P39peper.pdf

Richmond-Rakerd, L.S., D’Souza, S, Milne, B.J, Caspi, A., & Moffitt, T.E. (2022). Longitudinal Associations of Mental Disorders with Dementia: 30-Year Analysis of 1.7 Million New Zealand Citizens. JAMA Psychiatry. Published online February 16, 2022. https://doi.org/10.1001/jamapsychiatry.2021.4377

Shri, R. (2012). Anxiety: Causes and Management. The Journal of Behavioral Science5(1), 100–118. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/2205

Wilhelm, F.H., Gevirtz, R., & Roth, W.T. (2001). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and treatment. Behav Modif, 25(4), 513-45. https://doi.org/10.1177/0145445501254003


You heard it before. Now do it! Three tips to reduce screen fatigue

Monica Almendras and Erik Peper

For almost a year, we have managed to survive this pandemic. As we work in front of screen many people experience screen fatigue (Bailenson, 2021). The tiredness, achiness and depressive feelings have many causes such as sitting disease, reduced social contact, constantly looking at the screen for work, education, socializing, and entertaining, and the increased stress from family illness and economic insecurity. The result is that many people experience low energy, depression, loneliness, anxiety, neck, shoulder, back pain at the end of the day (Son, Hegde, Smith, Wang, & Sasangohar, 2020; Peper & Harvey, 2018).

Yet there is hope to reduce discomfort and increase by implementing simple tips.

Take breaks and take more breaks by getting up from your chair and moving. Taking breaks helps us to clear our minds and it interrupts any ongoing rumination we may have going on. Doing this helps a person be more productive at work or when studying, and at the same time it helps retain more information (Peper, Harvey, & Faass, 2020; Kim, Park, & Headrick, 2018). How many of you reading this actually take a short break at least once during work? We stay in the same sitting position for long periods of time, even holding off to go to the restroom. We tell ourselves ‘one more minute’ or ‘I’ll just finish this and then I’ll go”. Sounds familiar? We know it is not healthy and yet, we continue doing it.

Solution: Set a reminder every twenty minutes to take a short break. Download a program on your computer that will remind you to take a break such as Stretch Break (www.stretchbreak.com). Every twenty minutes a window will pop up on your computer reminding you to stretch. It gives you simple exercises for you to move around and wiggle as shown in figure 1. You can say it breaks the spell from staying frozen in one position in front of your screen. The best part is that yet is free to download on your computer. What more can you ask for?

Figure 1.  Stretch break window that pops up on your computer to remind you to stretch.

Stop slouching in front of the screen. We tend to gaze downwards to our device and slouch, which creates tension on our neck and shoulders ((Peper, Lin, Harvey, & Perez, 2017). And yet, we still wonder why people suffer from neck-shoulder pain and headaches. It is time to make a transformation from slouching and feeling aches and pains, to an upright posture to be free of pain.

Solution: Use an UpRight Go 2 device on your upper back or neck is a great way to remind you that you are slouching (Harvey, Peper, Mason, & Joy, 2020). The UpRight is linked via Bluetooth to the App on the mobile phone, and once you calibrate it to an upright posture, you will see and feel a vibrate when you slouch. For people who are on the computer for long hours, this will help you to be aware of your posture.

If wearing a small device on your back is not your cup of tea, or perhaps it is not in your budget at the moment. There is a solution for this, and that means you can download the UpRight Desktop App on your computer or laptop (Chetwynd, Mason, Almendras, Peper, & Harvey, 2020). The desktop version uses the camera from your computer or laptop to monitor your posture; however, at the camera cannot simultaneous be in use with another program such as ZOOM. This version provides immediate feedback through the graphic on the screen as well as, an adjustable auditory signal when you slouch as shown in Figure 2. It is also free to download, and it is available for PC and Mac (https://www.uprightpose.com/desktop-app/).

Figure 2. Posture feedback app. When slouching, the app provides immediate feedback through the graphic on the screen (the posture of figure turns red) and/or an adjustable auditory sound (from: Chetwynd, Mason, Almendras, Peper, & Harvey, 2020)

Relax your eyes and look away from the screen.  Many people struggle with dry eyes and eyestrain from looking at the screen for extended time periods. We log out from work, meetings, and class; to staring at the television, tablets, and mobile phones on our free time. It is a nonstop cycle of looking at the screen, while our poor eyes never have a single break. To look at the screen, we tightened our extraocular muscles and ciliary muscles; and the result is near-vision stress (Peper, 2021).

SOLUTION: The solution to relax the eyes and reduce eyestrain will not be to buy new eyeballs online. Instead, here are three easy and free things to reestablish good eyeball health. These were adapted from the superb book, Vision for life: Ten steps for natural eyesight improvement, by Meir Schneider, PhD.

  • Look out through a window at a distance tree for a moment after reading an email or clicking a link
  • Look up at a distant tree and focus at the details of the branches and leaves each time you have finished a page from a book or eBook.
  • Rest and regenerate your eyes with palming (Peper, 2021). To do palming, all you need to do is sit upright, place an object under your elbows (pillow or books) to avoid tensing the neck and shoulders, and cover the eyes with your hands (see figure 3). Cup your hands to avoid pressure on your eyes and with your eyes closed, imagine seeing blackness while breathing slowing from your diaphragm. For five minutes, feel how your shoulders, head, and eyes are relaxing, while doing six breaths per minutes through your nose. Once your five minutes are up, stretch or wiggle around before returning to your work. For detailed instructions, see the YouTube video, Free Webinar by Meir Schneider: May 6, 2019.

Figure 3. Position for palming.

Implement these tips as an experiment for a week and note how it affects you. Many people report that after three weeks, they experience less pain and more energy. By taking charge of your own computer work patterns, you have taken a first e first step into transforming your health.

REFERENCES

Bailenson, J. N. (2021). Nonverbal Overload: A Theoretical Argument for the Causes of Zoom Fatigue. Technology, Mind, and Behavior2(1). https://doi.org/10.1037/tmb0000030

Chetwynd, J., Mason, L., Almendras, M., Peper, E., & Harvey, R. (2020). “Posture awareness training.” Poster presented at the 51st Annual meeting of the Association for Applied Psychophysiology and Biofeedback. https://doi.org/10.13140/RG.2.2.20194.76485

Harvey, R., Peper, E., Mason, L., & Joy, M. (2020). “Effect of posture feedback training on health”. Applied Psychophysiology and Biofeedback. 45(3). https://DOI.org/10.1007/s10484-020-09457-0

Kim, S., Park, Y., & Headrick, L. (2018). Daily micro-breaks and job performance: General work engagement as a cross-level moderator. Journal of Applied Psychology, 103(7), 772–786. https://doi.org/10.1037/apl0000308

Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation. 5(1),3–8doi:10.15540/nr.5.1.3  https://www.neuroregulation.org/article/view/18189/11842

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

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E. (2021). “Resolve eyestrain and screen fatigue.” Well Being Journal,.30, Winter 2021 https://www.researchgate.net/publication/345123096_Resolve_Eyestrain_and_Screen_Fatigue

Schneider, M. (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley, CA: North Atlantic Books.

Schneider, M. (2019. YouTube video Free Webinar by Meir Schneidere: May 6, 2019.

Son. C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. J Med Internet Res, 22(9):e21279 https://doi.org/10.2196/21279

 


Ways to reduce TechStress

We are excited about our book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, that was published August 25, 2020.

authors Erik and Rick1

Evolution shapes behavior — and as a species, we’ve evolved to be drawn to the instant gratification, constant connectivity, and the shiny lights, beeps, and chimes of our ever-present devices. In earlier eras, these hardwired evolutionary patterns may have set us up for success, but today they confuse our instincts, leaving us vulnerable and stressed out from fractured attention, missed sleep, skipped meals, aches, pains, and exhaustion and often addicted to our digital devices.

Tech Stress offers real, practical tools to avoid evolutionary pitfalls programmed into modern technology that trip us up. You will find a range of effective strategies and best practices to individualize your workspace, reduce physical strain, prevent sore muscles, combat brain drain, and correct poor posture. The book also provides fresh insights on reducing psychological stress on the job, including ways to improve communication with coworkers and family.

Although you will have to wait to have the book delivered to your home, you can already begin to implement ways to reduce physical discomfort, zoom/screen fatigue and exhaustion. Have a look the blogs below.

How evolution shapes behavior 

Evolutionary traps: How screens, digital notifications and gaming software exploits fundamental survival mechanisms 

How to optimize ergonomics

Reduce TechStress at Home

Cartoon ergonomics for working at the computer and laptop 

Hot to prevent and reduce neck and shoulder discomfort

Why do I have neck and shoulder discomfort at the computer? 

Relieve and prevent neck stiffness and pain 

How to prevent screen fatigue and eye discomfort

Resolve Eyestrain and Screen Fatigue 

How to improve posture and prevent slouching

“Don’t slouch!” Improve health with posture feedback 

How to improve breathing and reduce stress

Anxiety, lightheadedness, palpitations, prodromal migraine symptoms?  Breathing to the rescue! 

How to protect yourself from EMF

Cell phone radio frequency radiation increases cancer risk

book cover

Available from: https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/


Resolve Eyestrain and Screen Fatigue

Adapted from: Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

eyes
Forty percent of adults and eighty percent of teenagers report experiencing significant visual symptoms (eyestrain, blurry vision, dry eyes, headaches, and exhaustion) during and immediately after viewing electronic displays. These ‘technology-associated overuse’ symptoms are often labeled as digital eyestrain or computer vision syndrome (Rosenfield, 2016; Randolph & Cohn, 2017). Even our distant vision may be affected— after working in front of a screen for hours, the world looks blurry. At the same time, we may experience an increase in neck, shoulders and back discomfort. These symptoms increase as we spend more hours looking at computer screens, laptops, tablets, e-readers, gaming consoles, and cellphones for work, taking online classes, watching streaming videos for entertainment, and keeping connected with friends and family (Borhany et al, 2018; Turgut, 2018; Jensen et al, 2002).

Eye, head, neck, shoulder and back discomfort are partly the result of sitting too long in the same position and attending to the screen without taking short physical and vision breaks, moving our bodies and looking at far objects every 20 minutes or so.  The obvious question is, “Why do we stare at and are captured by, the screen?”  Two answers are typical: (1) we like the content of what is on the screen; and, (2) we feel compelled to watch the rapidly changing visual scenes.

From an evolutionary perspective, our sense of vision (and hearing) evolved to identify predators who were hunting us, or to search for prey so we could have a nice meal.  Attending to fast moving visual changes is linked to our survival.  We are unaware that our adaptive behaviors of attending to a visual or auditory signals activate the same physiological response patterns that were once successful for humans to survive–evading  predictors,  identifying food, and discriminating between friend or foe. The large and small screen (and speakers) with their attention grabbing content and notifications have become an evolutionary trap that may lead to a reduction in health and fitness (Peper, Harvey & Faass, 2020).

Near vision stress

To be able to see the screen, the eyes need to converge and accommodate. To converge,  the extraocular muscles of the eyes tighten; to focus (accomodation), the ciliary muscle around the lens tighten to increase the curvature of the lens.  This muscle tension is held constant as long as we look at the screen. Overuse of these muscles results is near vision stress that contributes to computer vision syndrome, development of myopia in younger people, and other technology-associated overuse syndromes (Sherwin et al, 2012; Enthoven et al, 2020).

Continually overworking the visual muscles related to convergences increases tension and contributes to eyestrain. While looking at the screen, the eye muscles seldom have the chance to relax.  To function effectively, muscles need to relax /regenerate after momentary tightening. For the eye muscles to relax, they need to look at the far distance– preferably objects green in color. As stated earlier, the process of  distant vision occurs by relaxing the extraocular muscles to allow the eyes to diverge along with relaxing the ciliary muscle to allow the lens to flatten.  In our digital age, where screen of all sizes are ubiquitous, distant vision is often limited to the nearby walls behind a screen or desk which results in keeping the focus on nearby objects and  maintaining muscular tension in the eyes.

As we evolved, we continuously alternated between between looking at the far distance and nearby areas for food sources as well as signals indicating danger. If we did not look close and far, we would not know if a predator was ready to attack us.  Today we tend to be captured by the screens.  Arguably, all media content is designed to capture our attention such as data entry tasks required for employment, streaming videos for entertainment, reading and answering emails, playing e-games, responding to text notifications, looking at Instagram and Snapchat photos and Tiktok videos, scanning Tweets and using social media accounts such as Facebook. We are unaware of the symptoms of visual stress until we experience symptoms. To illustrate the physiological process that covertly occurs during convergence and accommodation, do the following exercise.

Sit comfortably and lift your right knee a few inches up so that the foot is an inch above the floor.  Keep holding it in this position for a minute…. Now let go and relax your leg.

A minute might have seemed like  a very long time and you may have started to feel some discomfort in the muscles of your hip.  Most likely, you observed that when you held your knee up, you most likely held your breath and tightened your neck and back. Moreover, to do this for more than a few minutes would be very challenging. 

Lift your knee up again and notice the automatic patterns that are happening in your body. 

For muscles to regenerate they need momentary relaxation which allows blood flow and lymph flow to occur. By alternately tensing and relaxing muscles, they can work more easily for longer periods of time without experiencing fatigue and discomfort (e.g., we can hike for hours but can only lift our knee for a few minutes).

Solutions to relax the eyes and reduce eye strain 

  • Reestablish the healthy evolutionary pattern of alternately looking at far and near distances to reduce eyestrain, such as:
    • Look out through a window at a distant tree for a moment after reading an email or clicking link.
    • Look up and at the far distance each time you have finished reading a page or turn the page over.
  • Rest and regenerate your eyes with palming. While sitting upright, place a pillow or other supports under our elbows so that your hands can cover your closed eyes without tensing the neck and shoulders.palming
    • Cup the hands so that there is no pressure on your eyeballs, allow the base of the hands to touch the cheeks while the fingers are interlaced and resting your forehead.
    • Close your eyes, imagine seeing black. Breathe slowly and diaphragmatically while feeling the warmth of the palm soothing the eyes. Feel your shoulders, head and eyes relaxing. Palm for 5 minutes while breathing at about six breaths per minute through your nose.  Then stretch and go back to work.

Palming is one of the many practices that improves vision. For a comprehensive perspective and pragmatic exercises to reduce eye strain, maintain and improve vision, see the superb book by Meir Schneider, PhD., L.M.T., Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement.

Increased sympathetic arousal

Seeing the changing stimuli on the screen evokes visual attention and increases sympathetic arousal. In addition, many people automatically hold their breath when they see novel visual or hear auditory signals; since, they trigger a defense or orienting response. At the same time, without awareness,  we may tighten our neck and shoulder  muscles as we bring our nose literally to the screen.  As we attend and concentrate to see what is on the screen, our blinking rate decreases significantly.  From an evolutionary perspective, an unexpected movement in the periphery could be a snake, a predator, a friend or foe and the body responds by getting ready: freeze, fight or flight. We still react the same survival responses. Some of the physiological reactions that occur include:

  • Breath holding or shallow breathing. These often occur the moment we receive a text notification, begin concentrating and respond to the messages, or start typing or mousing.  Without awareness,  we activate the freeze, flight and fight response. By breath holding or shallow breathing, we reduce or limit our body movements, effectively becoming a non-moving object that is more difficult to see by many animal predators.  In addition, during breath holding, hearing become more acute because breathing noises are effectively reduced or eliminated.
  • Inhibition of blinking. When we blink it is another movement signal that in earlier times could give away our position. In addition, the moment we blink we become temporarily blind and cannot see what the predator could be doing next.
  • Increased neck, shoulder and back tension. The body is getting ready for a defensive fight or avoidance flight.

Experience some of these automatic physiological responses described above by doing the following two exercises.

Eye movement neck connection:  While sitting up and looking at the screen, place your fingers on the back of the neck on either side of the cervical spine just below the junction where the spine meets the skull.

neck

Feel the muscles of neck along the spine where they are attaching to the skull. Now quickly look to the extreme right and then to the extreme left with your eyes. Repeat looking back and forth with the eyes two or three times.

What did you observe?  Most likely, when you looked to the extreme right, you could feel the right neck muscles slightly tightening and when you looked the extreme left, the left neck muscles slightly tightening.  In addition, you may have held your breath when you looked back and forth.

Focus and neck connection:  While sitting up and looking at the screen, place your fingers on the back of the neck as you did before. Now focus intently on the smallest size print or graphic details on the screen.  Really focus and concentrate on it and look at all the details.

What did you observe?  Most likely, when you focused on the text, you brought your head slightly forward and closer to the screen, felt your neck muscles tighten,  and possibly held your breath or started to breathe shallowly.

As you concentrated, the automatic increase in arousal, along with the neck and shoulder tension and reduced blinking contributes to developing discomfort. This can become more pronounced after looking at screens to detailed figures, numerical data, characters and small images for hours (Peper, Harvey & Tylova, 2006; Peper & Harvey, 2008; Waderich et al, 2013).

Staying alert, scanning  and reacting to the images on a computer screen or notifications from text messages, can become exhausting. in the past, we scanned the landscape, looking for information that will help us survive (predators, food sources, friend or foe)  however today, we react to the changing visual stimuli on the screen. The computer display and notifications have become evolutionary traps since they evoke these previously adaptive response patterns that allowed us to survive.

The response patterns occur mostly without awareness until we experience discomfort. Fortunately, we  can become aware of our body’s reactions with physiological monitoring which makes the invisible visible as shown in the figure below (Peper, Harvey & Faass, 2020).

biofeedback

Representative physiological patterns that occur when working at a computer, laptop, tablet or cellphone are unnecessary neck and shoulder tension, shallow rapid breathing, and an increase in heart rate during data entry. Even when the person is resting their hands on the keyboard, forearm muscle tension, breathing and heart rate increased.

Moreover, muscle tension in the neck and shoulder region also increased, even when those muscles were not needed for data entry task.  Unfortunately, this unnecessary tension and shallow breathing contributes to exhaustion and discomfort (Peper, Harvey & Faass, 2020).

With biofeedback training, the person can learn to become aware and control these dysfunctional patterns and prevent discomfort (Peper & Gibney, 2006; Peper et, 2003).  However, without access to biofeedback monitoring, assume that you respond similarly while working. Thus, to prevent discomfort and improve health and performance, implement the following.

Finally, for a comprehensive overview based on an evolutionary perspective that explains why TechStress develops, why digital addiction occurs. and what can be done to prevent discomfort and improve health and performance, see our new book by Erik Peper, Richard Harvey and Nancy Faass, Tech Stress-How Technology is Hijack our Lives, Strategies for Coping and Pragmatic Ergonomics.

book cover

References

Borhany, T., Shahid, E., Siddique, W. A., & Ali, H. (2018). Musculoskeletal problems in frequent computer and internet users. Journal of family medicine and primary care7(2), 337–339. 

Enthoven, C. A., Tideman, W.L., Roel of Polling, R.J.,Yang-Huang, J., Raat, H., & Klaver, C.C.W. (2020). The impact of computer use on myopia development in childhood: The Generation R study. Preventtive Medicine, 132, 105988.

Jensen, C., Finsen, L., Sogaard, K & Christensen, H. (2002). Musculoskeletal symptoms and duration of computer and mouse use,  International Journal of Industrial Ergonomics, 30(4-5), 265-275.

Peper, E. & Gibney, K. (2006). Muscle Biofeedback at the Computer- A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. The Biofeedback Federation of Europe. Download free PDF version of the book:  http://bfe.org/helping-clients-who-are-working-from-home/

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E., Harvey, R. & Tylova, H. (2006). Stress protocol for assessing computer related disorders.  Biofeedback. 34(2), 57-62. 

Peper, E., Wilson, V.S., Gibney, K.H., Huber, K., Harvey, R. & Shumay. (2003). The Integration of Electromyography (sEMG) at the Workstation:  Assessment, Treatment and Prevention of Repetitive Strain Injury (RSI). Applied Psychophysiology and Biofeedback, 28 (2), 167-182.

Randolph, S.A. & Cohn, A. (2017).  Computer vision syndrome. Workplace, Health and Safety, 65(7), 328.

Rosenfield, M. (2016). Computer vision syndrome (a.k.a. digital eye strain). Optometry in Practice, 17(1), 1 1 – 10. 

Schneider, M. (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley: North Atlantic Books. https://self-healing.org/shop/books/vision-for-life-2nd-ed

Sherwin, J.C., Reacher, M.H., Keogh, R. H., Khawaja, A. P., Mackey, D.A.,& Foster, P. J. (2012). The association between time spent outdoors and myopia in children and adolescents. Ophthalmology,119(10), 2141-2151.

Turgut, B. (2018). Ocular Ergonomics for the Computer Vision Syndrome. Journal Eye and Vision, 1(2).

Waderich, K., Peper, E., Harvey, R., & Sara Sutter. (2013). The psychophysiology of contemporary information technologies-Tablets and smart phones can be a pain in the neck. Presented at the 44st Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Portland, OR.

 

 


Can changing your breathing pattern reduce coronavirus exposure?

sneeze

This blog is based upon our breathing  research that began in the 1990s, This  research helped identify dysfunctional breathing patterns that could contribute to illness. We developed coaching/teaching strategies with biofeedback to optimize breathing patterns, improve health and performance (Peper and Tibbetts, 1994; Peper, Martinez Aranda and Moss, 2015; Peper, Mason, and Huey, 2017).

For example, people with asthma were taught to reduce their reactivity to cigarette smoke and other airborne irritants (Peper and Tibbitts, 1992Peper and Tibbetts, 2003).  The smoke of cigarettes or vaping spreads out as the person exhales. If the person was infected, the smoke could represent the cloud of viruses that the other people would inhale as is shown in Figure 1.vaping

Figure 1. Vaping by young people in Riga, Latvia (photo by Erik Peper).

To learn how to breathe differently, the participants  first learned effortless slow diaphragmatic breathing. Then were taught that the moment they would become aware of an airborne irritant such as cigarette smoke, they would hold their breath and relax their body and move away from the source of the polluted air while exhaling very slowly through their nose. When the air was clearer they would inhale and continue effortless diaphragmatically breathing (Peper and Tibbetts, 1994).  From this research we propose that people may reduce exposure to the coronavirus by changing their breathing pattern; however, the first step is prevention by following the recommended public health guidelines.

  • Social distancing (physical distancing while continuing to offer social support)
  • Washing your hands with soap for at least 20 seconds
  • Not touching your face
  • Cleaning surfaces which could have been touched by other such as door bell, door knobs, packages.
  • Wear a mask to protect other people and your community. The mask will reduce the shedding of the virus to others by people with COVID-19 or those who are asymptomatic carriers.

Reduce your exposure to the virus when near other people by changing your breathing pattern 

Normally when startled or surprised, we tend to gasp and inhale air rapidly. When someone sneezes, coughs or exhales near you, we often respond with a slight gasp and inhale their droplets. To reduce inhaling their droplets (which may contain the coronavirus virus), implement the following:

  • When a person is getting too close
    • Hold your breath with your mouth closed and relax your shoulders (just pause your breathing) as you move away from the person.
    • Gently exhale through your nose (do not inhale before exhaling)-just exhale how little or much air you have
    • When far enough away, gently inhale through your nose.
    • Remember to relax and feel your shoulders drop when holding your breath.  It will last for only a few seconds as you move away from the person.  Exhale before inhaling through your nose.
  • When a person coughs or sneezes
    • Hold your breath, rotate you head away  from the person and move away from them while exhaling though your nose.
    • If you think the droplets of the sneeze or cough have landed on you or your clothing, go home, disrobe outside your house, and put your clothing into the washing machine. Take a shower and wash yourself with soap.
  • When passing a person ahead of you or who is approaching you
    • Inhale before they are too close and exhale through your nose as you are passing them.
    • After you are more than 6 feet away gently inhale through your nose.
  • When talking to people outside
    • Stand so that the breeze/wind hits both people from the same side so that the exhaled droplets are blown away from both of you (down wind).

These  breathing skills seem so simple; however, in our experience with people with asthma and other symptoms, it took practice, practice, and practice to change their automatic breathing patterns. The new pattern is pause (stop) the breath and then exhale through your nose. Remember, this breathing pattern is not forced and with practice it will occur effortlessly.

The following blogs offer instructions for mastering effortless diaphragmatic breathing.

https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/

https://peperperspective.com/2018/10/04/breathing-reduces-acid-reflux-and-dysmenorrhea-discomfort/

https://peperperspective.com/2019/03/24/anxiety-lightheadedness-palpitations-prodromal-migraine-symptoms-breathing-to-the-rescue/

https://peperperspective.com/2017/03/19/enjoy-sex-breathe-away-the-pain/

https://peperperspective.com/2015/02/18/reduce-hot-flashes-and-premenstrual-symptoms-with-breathing/

https://peperperspective.com/2015/09/25/resolving-pelvic-floor-pain-a-case-report/

References

Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback. 43(2), 103-109.

Peper, E., Mason, L., Huey, C. (2017).  Healing irritable bowel syndrome with diaphragmatic breathing. Biofeedback. (45-4). /

Peper, E., and Tibbetts, V. (1992).  Fifteen-Month follow up with asthmatics utilizing EMG/Incentive inspirometer feedback. Bio­feedback and Self-Regulation. 17 (2), 143-151. 

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. 

Peper, E.  and Tibbitts, V.  (2003). Protocol for the treatment of asthma.  In:  Zheng, Y. (ed).  Clinical Practice of Biofeedback. Beijing:  High Education Press (HEP). 163-176. ISBN 7-04-011420-8

 


Toning quiets the mind and increases HRV more quickly than mindfulness practice

Adapted from: Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133. 

Disruptive thoughts, ruminations and worrying are common experiences especially when stressed. Numerous clinical strategies such as cognitive behavioral therapy attempt to teach clients to reduce negative ruminations (Kopelman-Rubin, Omer, & Dar, 2017). Over the last ten years, many people and therapists practice meditative techniques to let go and not be captured by negative ruminations, thoughts, and emotions.  However, many people continue to struggle with distracting and wandering thoughts.

Just think back when you’re upset, hurt, angry or frustrated. Attempting just to observe without judgment can be very, very challenging as the mind keeps rehearsing and focusing on what happened. Telling yourself to stop being upset often doesn’t work because your mind is focused on how upset you are. If you can focus on something else or perform physical activity, the thoughts and feelings often subside.

Over the last fifteen years, mindfulness meditation has been integrated and adapted for use in behavioral medicine and psychology (Peper, Harvey, & Lin, 2019). It has also been implemented during bio- and neurofeedback training (Khazan, 2013; Khazan, 2019).  Part of the mindfulness instruction is to recognize the thoughts without judging or becoming experientially “fused” with them. A process referred to as “meta-awareness” (Dahl, Lutz, & Davidson, 2015). Mindfulness training combined with bio- and neurofeedback training can improve a wide range of psychological and physical health conditions associated with symptoms of stress, such as anxiety, depression, chronic pain, and addiction (Creswell, 2015, Khazan, 2019).

Mindfulness is an effective technique; however, it may not be more effective than other self-regulations strategies (Peper et al, 2019). Letting go of worrying thoughts and rumination is even more challenging when one is upset, angry, or captured by stressful life circumstances. Is it possible that other strategies beside mindfulness may more rapidly reduce wandering and intrusive thoughts?  In 2015, researchers van der Zwan, de Vente, Huiznik, Bogels, & de Bruin found that physical activity, mindfulness meditation and heart rate variability biofeedback were equally effective in reducing stress and its related symptoms when practiced for five weeks.

Our research explored whether other techniques from the ancient wisdom traditions could provide participants tools to reduce rumination and worry. We investigated the physiological effects and subject experiences of mindfulness and toning.  Toning is vocalizing long and sustained sounds as a form of mediation. (Watch the video  the toning demonstration by sound healer and musician, Madhu Anziani  at the end of the blog.)

COMPARING TONING AND MINDFULNESS

The participants were 91 undergraduate college students (35 males, 51 females and 5 unspecified; average age, 22.4 years, (SD = 3.5 years).

After sitting comfortably in class, each student practiced either mindfulness or toning for three minutes each. After each practice, the students rated the extent of mind wandering, occurrence of intrusive thoughts and sensations of vibration on a scale from 0 (not all) to 10 (all the time).  They also rated pre and post changes in peacefulness, relaxation, stress, warmth, anxiety and depression. After completing the assessment, they practice the other practice and after three minutes repeated the assessment.

The physiological changes that may occur during mindfulness practice and toning practice was recorded in a separate study with 11 undergraduate students (4 males, 7 females; average age 21.4 years. Heart rate and respiration were monitored with ProComp Infiniti™ system (Thought Technology, Ltd., Montreal, Canada).  Respiration was monitored from the abdomen and upper thorax with strain gauges and heartrate was monitored with a blood volume pulse sensor placed on the thumb.

After the sensors were attached, the participants faced away from the screen so they did not receive feedback.  They then followed the same procedure as described earlier, with three minutes of mindfulness, or toning practice, counterbalanced.  After each condition, they completed a subjective assessment form rating experiences as described above.

RESULTS:  SUBJECTIVE FINDINGS

Toning was much more successful in reducing mind wandering and intrusive thoughts than mindfulness. Toning also significantly increased awareness of body vibration as compared to mindfulness as shown in Figure 1.0 Intrusive wandering thoughts comparison

Figure 1. Differences between mindfulness and toning practice.

There was no significant difference between toning and mindfulness in the increased self-report of peacefulness, warmth, relaxation, and decreased self-report of anxiety and depression as shown in Figure 2.

Figure 2. No significant difference between toning and mindfulness practice in relaxation or stress reports.0 relax comparison

RESULTS: PHYSIOLOGICAL FINDINGS

Respiration rate was significantly lower during toning (4.6 br/min) as compared to mindfulness practice (11.6 br/min); heart rate standard deviation (SDNN) was much higher during toning condition (11.6) (SDNN 103.7 ms) than mindfulness (6.4) (SDNN 61.9 ms). Two representative physiological recording are shown in Figure 3.

0 physiological comparison black white a

Figure 3. Representative recordings of breathing and heart rate during mindfulness and toning practice. During toning the respiration rate (chest and abdomen) was much slower than during mindfulness and baseline conditions.  Also, during toning heart rate variability was much larger than during mindfulness or baseline conditions.

DISCUSSION

Toning practice is a useful strategy to reduce mind wandering as well as inhibit intrusive thoughts and increase heart rate variability (HRV). Most likely toning uses the same neurological pathways as self-talk and thus inhibits the negative and hopeless thoughts. Toning is a useful meditation alternative because it instructs people to make a sound that vibrates in their body and thus they attend to the sound and not to their thoughts.

Physiologically, toning immediately changed the respiration rate to less than 6 breaths per minute and increases heart rate variability. This increase in heart rate variability occurs without awareness or striving. We recommend that toning is integrated as a strategy to complement bio-neurofeedback protocols. It may be a useful approach to enhance biofeedback-assisted HRV training since toning increases HRV without trying and it may be used as an alternative to mindfulness, or used in tandem for maximum effectiveness.

TAKE HOME MESSAGE

1) When people report feeling worried and anxious and have difficulty interrupting ruminations that they first practice toning before beginning mindfulness meditation or bio-neurofeedback training.

2) When training participants to increase heart rate variability, toning could be a powerful technique to increase HRV without striving

TONING DEMONSTRATION AND INSTRUCTION BY SOUND HEALER MADHU ANZIANI

For the published article see: Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133.

REFERENCES

Creswell, J. D. (2015). Mindfulness Interventions. Annual Review of Psychology, 68, 491-516.

Dahl, C. Lutz, A., & Davidson, R. J. (2015). Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends in Cognitive Science, 19(9), 515-523.

Khazan, I. Z. (2013). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness. John Wiley & Sons.

Khazan, I. Z. (2019). Biofeedback and Mindfulness in Everyday Life.  New York: W. W. Norton & Company.

Kopelman-Rubin, D., Omer, H., & Dar, R. (2017). Brief therapy for excessive worry: Treatment model, feasibility, and acceptability of a new treatment. Journal of Psychotherapy Integration, 29(3), 291-306. 

Peper, E., Harvey, R., & Lin, I-M. (2019).  Mindfulness training has themes common to other technique. Biofeedback. 47(3),

van der Zwan, J. E., de Vente, W., Huizink, A. C., Bogels, S. M., & de Bruin, E. I.  (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: A randomized controlled trial. Applied Psychophysiology and Biofeedback, 40(4), 257-268. https://doi.org/10.1007/s10484-015-9293-x