Reduce anxiety

Posted: March 23, 2022 | Author: | Filed under: behavior, Breathing/respiration, CBT, cognitive behavior therapy, digital devices, education, emotions, health, mindfulness, posture, relaxation, self-healing, stress management | Tags: | Leave a comment

The purpose of this blog is to describe how a university class that incorporated structured self-experience practices reduced self-reported anxiety symptoms. 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.

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

Healing irritable bowel syndrome with diaphragmatic breathing*
Breathing reduces acid reflux and dysmenorrhea discomfort
Resolving a chronic headache with posture feedback and breathing
Enjoy sex: Breathe away the pain*
Do nose breathing FIRST in the age of COVID-19

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 couples. PNAS, 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 investigation, 14(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 Medicine, 74(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., & 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 Science, 5(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

Posted: February 27, 2021 | Author: | Filed under: behavior, ergonomics, Exercise/movement, health, Pain/discomfort, posture, relaxation, screen fatigue, Uncategorized, vision, zoom fatigue | 2 Comments

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 Behavior, 2(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),3–8.  doi: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

Posted: August 13, 2020 | Author: | Filed under: ADHD, behavior, computer, digital devices, emotions, ergonomics, Evolutionary perspective, Exercise/movement, health, Neck and shoulder discomfort, Nutrition/diet, Pain/discomfort, posture, relaxation, self-healing, stress management, Uncategorized | 2 Comments

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

Posted: June 29, 2020 | Author: | Filed under: Breathing/respiration, computer, digital devices, ergonomics, Exercise/movement, health, laptops, Neck and shoulder discomfort, Pain/discomfort, relaxation, stress management, Uncategorized, vision | Tags: , , , , , | 10 Comments

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 care, 7(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?

Posted: April 1, 2020 | Author: | Filed under: Breathing/respiration, health, relaxation, self-healing, Uncategorized | Tags: , | 9 Comments

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, 1992; Peper 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

Posted: September 21, 2019 | Author: | Filed under: behavior, Breathing/respiration, emotions, health, mindfulness, Pain/discomfort, relaxation, self-healing, stress management, Uncategorized | Tags: , , , | 4 Comments

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

 

Hope for teens with pain

Posted: August 31, 2019 | Author: | Filed under: behavior, health, Pain/discomfort, relaxation, self-healing, stress management, Uncategorized | Tags: , | 3 Comments

Erik Peper, PhD and Rachel Zoffness, PhD*

 KM was 14 years old when he came to my (Zoffness) office for treatment. He’d been diagnosed with migraine and cyclical vomiting syndrome and had been in bed for about 3 years. He had long, unwashed hair; was a sickly, pasty white; and rocked himself back and forth from the pain. He’d seen 15 doctors and had been prescribed 30 medications, including occipital nerve injections and Thorazine. Nothing had worked. Like most teens with chronic pain, KM was depressed, stressed, and terrified he’d never get his life back.

We started Cognitive Behavioral Therapy (CBT), beginning with pain neuroscience education. This involved teaching KM and his family how pain works in the brain, and how thoughts, emotions, physical sensations and behaviors work together to trigger and maintain flares. He then learned a variety of cognitive, behavioral and mind-body techniques to help manage and change pain. His parents received parent-training to support him behind the scenes. After a few weeks of treatment, KM was able to get out of bed and walk to the corner mailbox. After a few more weeks, he was able to walk his dog to the dog park and get a haircut. Within a few months he was jogging around the block, then running. As his functioning increased, his brain desensitized and his body strengthened, his pain started to recede. Gradually he returned to school and social relationships, eventually rejoining his soccer team. I attended his high school graduation a year ago. He got onstage and told the audience that, if you’d told him 4 years ago that he’d graduate high school, he’d never have believed you. He is currently in college, successfully managing his pain, living his important life.

Chronic pain (CP) in teens can be devastating. Teens are already tasked with managing the turbulence of hormone changes, social stress, academic stress, social media, family dynamics, and developing autonomy and independence. CP impacts not only the teen, but also the entire family. Because CP is framed as a biomedical problem, it is frequently treated with opioids and other minimally-helpful (and sometimes harmful) medications. Opioids are ineffective for long-term treatment of chronic pain, and are only useful in acute crises or to control pain at the end of life (Dowell, 2016; King et al, 2011).

Although we typically think of chronic pain as an issue primarily affecting adults coping with issues such as post-surgical pain and arthritis, CP affects up to 1 in 3 youth in the USA – more than 10 million children and teens (Friedrichsdorf,  2016; ).  Pain impacts self-esteem, hope, and functioning, relegating teens to their beds and denying them normal educations and healthy social interactions.  Like adults, teens often feel powerless and blamed.  In a superb workbook, The Chronic Pain & Illness Workbook for Teens, psychologist Rachel Zoffness describes what pain is; how pain is constructed by the brain; how mind, body and emotions interact to affect pain; and offers a sequence of assessments and practices to reduce pain and improve health in language children and teens can easily understand.  The approach combines cognitive behavioral therapy (CBT) with imagery, mindfulness, breathing, handwarming with biofeedback, and somatic practices (Turk & Gatchel, 2018; Peper, Gibney, & Holt, 2002).

This simple graphic of the pain cycle is helpful to clients (see Fig. 1).

pain cycle

 Fig 1. CBT Pain Cycle

The pragmatic practices in this book offer tools and guided instructions that any child or teen can use for themselves, with parents, or with health providers.  Therapists can use and adapt these activities with their clients of all ages. Although these scientifically-supported pain management techniques are written for teens, they can equally be used with adults. Below are two of many different practices described in the book that are useful for chronic pain.

Practice 1: Assessment: What sets off your pain?

The first step is to help youth identify factors that “trigger” – or set off – their pain. It’s helpful to define a trigger as a difficult emotion, situation, or event that causes pain to increase. Difficult situations and events of all kinds – biological, social, etc (situational triggers) can trigger difficult thoughts and emotions (cognitive and emotional triggers), and vice versa. For example, Adam was recovering from back surgery (situational trigger), got into a big fight with his sister about the car (situational trigger), and became angry and frustrated (emotional trigger). He felt the anger in his body, his muscles got hot and tight, and his back started spasming. Gina is an example of the reverse. She believed that nothing could cure her fibromyalgia (cognitive trigger), which made her feel depressed and hopeless (emotional trigger). She stayed home for weeks on end without school, friends, or distractions (situational trigger), and started feeling worse.

We can help youth with pain by asking:

  • What emotions trigger your pain?
    • Frustration
    • Anger
    • Stress
    • Anxiety
    • Loneliness
    • Sadness
  • What situations trigger your pain?
    • Not getting enough sleep
    • Arguing with family members
    • Inflammation after physical therapy
    • Missing fun events because you’re sick
    • Thinking about upcoming exams
    • Doctor’s appointments and hospital visits

Sometimes, the teen needs to keep a log for a week to identify the situations or triggers related to the pain.  Once these have been identified then the teen can explore strategies to reduce the negative reactivity triggered by the emotions or situations.

Practice 2: Changing the voice of pain (Note: this is a summary of a longer activity)

One technique we use in CBT for chronic pain is identifying and tracking cognitive distortions, also known as “thinking traps.” I (Zoffness) call these traps “Pain Voice.” This is the catastrophic, pessimistic, critical, and negative voice that tells us awful, worrisome things, particularly about our pain or health.

For example:

Pain Voice pretends she can predict the future, and says it’s going to be terrible. She says: “You’ll never get better. Nothing will ever help you.” But since she can’t predict the future (who can?), Pain Voice is a liar! Pain Voice is also very bossy about what you can and can’t do: “You can’t see your friends this week,” or “You can’t go for a bike ride, and you definitely can’t have any fun.” Science teaches us that negative thoughts increase pain by turning up the brain’s “pain dial,” so we must make sure not to listen to or believe them. To stop Pain Voice, we first catch negative thoughts.

As soon as you learn how to recognize Pain Voice, you gain the power to change negative thoughts into more helpful “Wise Voice” thoughts. One way to bust Pain Voice is to start tracking your negative thoughts. First, list these critical, self-defeating, catastrophic Pain Voice thoughts. Notice if they’re helpful or harmful. Then check and question them, thoughtfully determining whether they’re the truth or a trap. Next, gather evidence as to why Pain Voice might be wrong by asking yourself, is this thought a fact? What evidence do I have that this thought might not be true? What else might happen other than what I’m predicting? Write out your Wise Voice responses, and use them to fight back every time you hear Pain Voice!

Jason’s example: Jason had terrible, daily back pain and hadn’t gone outside in 6 weeks. His friends texted, inviting him to watch a movie. Immediately he heard the thought, “I can’t go, I’m broken. If I leave my house my pain will spike and I won’t be able to function.” He recognized this as his Pain Voice and knew he had to fight back. He sat down with his worksheet and filled in the answers: yes, the thoughts were harmful, not helpful, and they were trying to trap him! He examined the evidence and wrote the Wise Voice thought, “This negative prediction is not a fact, it’s a trap. I’ve had back pain for 2 years, and sometimes going out and seeing friends actually reduces my pain.” Tuning into his Wise Voice gave him the strength to get the social support and distraction he needed to feel a little better! He went to his friend’s house, watched movies, ate popcorn, giggled, and had a great time. For the first time in 6 weeks, his pain went down. An example of his log is shown in table 1.

 Situation

Pain Voice

 Helpful or Harmful?

Trap or

Truth

 Wise Voice
Returning to school after missing 3 weeks If I go back to school, I’ll be so far behind that I won’t understand anything the teacher is talking about. Harmful Trap This negative prediction is not a fact. I’m smart and competent, I’ll probably understand some things. Last time I was behind, I made up the work and everything was fine.
 

 

Pain flare-up

 

 

 

 I can’t handle this! Harmful Trap This negative prediction is not a fact. I’ve had 42 pain flare-ups this year, and I handled all of them. I’ve proven that I’m strong and resilient. There is a 0% chance I can’t handle this.

Table 1. Example from Jason’s log

Summary: There is hope for youth with chronic pain. Interventions like CBT, mindfulness, biofeedback and other mind-body approaches are scientifically-supported and have evidence of effectiveness. Adhering to the biopsychosocial model – targeting biological, psychological and social factors – is proven to be the most effective treatment for chronic pain across conditions and ages. For more information, see Rachel Zoffness’ book, The chronic pain & illness workbook for teens,  for pragmatic treatment practices and user-friendly pain education. 

book cover

References

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624-1645.

Friedrichsdorf, S. J., Giordano, J., Desai Dakoji, K., Warmuth, A., Daughtry, C., & Schulz, C. A. (2016). Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints. Children (Basel, Switzerland), 3(4), 42. doi:10.3390/children3040042

King, S., Chambers, C., Huguet, A., MacNevin, R., McGrath, P., Parker, L., & MacDonald, A. (2011). The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 152(12), 2729-2738.

Peper, E. Gibney, K.H., & Holt, C.F. (2002). Make Health Happen-Training Yourself to Create Wellness. Kendall Hunt Publishing. ISBN-13: 978-0787293314

Turk, D. C., & Gatchel, R.J. (2018). Psychological approaches to pain management-A Practionere’s Handbook.  New York: The Guilford Press, ISBN-13: 978-1462528530

Zoffness, R. (2019). The Chronic Pain & Illness Workbook for Teens. Oakland, CA; New Harbinger Publications, ISBN: 978168403352

*Dr. Rachel Zoffness is a pain psychologist, consultant, writer and educator in Northern California’s East Bay specializing in chronic pain and illness.

 

Do self-healing first

Posted: May 27, 2019 | Author: | Filed under: behavior, Breathing/respiration, emotions, Exercise/movement, health, mindfulness, Neck and shoulder discomfort, Nutrition/diet, Pain/discomfort, placebo, relaxation, self-healing, stress management, surgery, Uncategorized | 2 Comments

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“I am doing very well, and I am very healthy. The vulvodynia symptoms have never come back. Also,my stomach (gastrointestinal discomfort) has gotten much, much better. I don’t really have random pain anymore, now I just have to be watchful and careful of my diet and my exercise, which are all great things!”  —A five-year follow-up report from a 28-year-old woman who had previously suffered from severe vulvodynia (pelvic floor pain).

Numerous clients and students have reported that implementing self-healing strategies–common sense suggestions often known as “grandmother’s therapy”—significantly improves their health and find that their symptoms decreased or disappeared (Peper et al, 2014). These educational self-healing approaches are based upon a holistic perspective aimed to reduce physical, emotional and lifestyle patterns that interfere with healing and to increase those life patterns that support healing. This may mean learning diaphragmatic breathing, doing work that give you meaning and energy, alternating between excitation and regeneration, and living a life congruent with our evolutionary past.

If you experience discomfort/symptoms and worry about your health/well-being, do the following:

  • See your health professional for diagnosis and treatment suggestions.
    • Ask what are the benefits and risks of treatment.
    • Ask what would happen if you if you first implemented self-healing strategies before beginning the recommended and sometimes invasive treatment?
  • Investigate how you could be affecting your self-healing potential such as:
    • Lack of sleep
    • Too much sugar, processed foods, coffee, alcohol, etc.
    • Lack of exercise
    • Limited social support
    • Ongoing anger, resentment, frustration, and worry
    • Lack of hope and purpose
  • Implement self-healing strategies and lifestyle changes to support your healing response. In many cases, you may experience positive changes within three weeks. Obviously, if you feel worse, stop  and reassess. Keep a log and monitor what you do so that you can record changes.

This self-healing process has often been labeled or dismissed as the “placebo effect;” however, the placebo effect is the body’s natural self-healing response (Peper & Harvey, 2017).  It is impressive that many people report feeling better when they  take charge and become active participants in their own healing process. A process that empowers and supports hope and healing. When participants change their life patterns, they often feel better. Their health worries and concerns become reminders/cues to initiate positive action such as:

  • Practicing self-healing techniques throughout the day (e.g., diaphragmatic breathing, self-healing imagery, meditation, and relaxation)
  • Eating organic foods and eliminating processed foods
  • Incorporating daily exercise and movement activities
  • Accepting what is and resolving resentment, anger and fear
  • Taking time to regenerate
  • Resolving stress
  • Focusing on what you like to do
  • Be loving to yourself and others

For suggestions of what to do, explore some of the following blogs that describe self-healing practices that participants implemented to improve or eliminate their symptoms.

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

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

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

Eczema https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/

Headache https://peperperspective.com/2016/11/18/education-versus-treatment-for-self-healing-eliminating-a-headaches1/

Epilepsy https://peperperspective.com/2013/03/10/epilepsy-new-old-treatment-without-drugs/

Irritability/hangry https://peperperspective.com/2017/10/06/are-you-out-of-control-and-reacting-in-anger-the-role-of-food-and-exercise/

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

Internet addiction https://peperperspective.com/2018/02/10/digital-addiction/

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

Math and test anxiety https://peperperspective.com/2018/07/03/do-better-in-math-dont-slouch-be-tall/

Neck stiffness https://peperperspective.com/2017/04/06/freeing-the-neck-and-shoulders/

Neck tension https://peperperspective.com/2019/05/21/relieve-and-prevent-neck-stiffness-and-pain/

Posture and mood https://peperperspective.com/2017/11/28/posture-and-mood-implications-and-applications-to-health-and-therapy/

Psoriasis https://peperperspective.com/2013/12/28/there-is-hope-interrupt-chained-behavior/

Smoking https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/

Surgery https://peperperspective.com/2018/03/18/surgery-hope-for-the-best-but-plan-for-the-worst/

Trichotillomania (hair pulling) https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/

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

References

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.

Peper, E. & Harvey, R. (2017). The fallacy of the placebo-controlled clinical trials: Are positive outcomes the result of “indirect” treatment effects? NeuroRegulation, 4(3–4), 102–113.

 

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

Posted: March 24, 2019 | Author: | Filed under: behavior, Breathing/respiration, emotions, health, Pain/discomfort, relaxation, Uncategorized | Tags: , , , , , , , | 5 Comments

I quickly gasped twice and a sharp pain radiated up my head and into my eye.  I shifted to slow breathing and it faded away.

I felt anxious and became aware of my heart palpitations at the end of  practicing 70% exhalation for 30 seconds.  I was very surprised how quickly my anxiety was triggered when I changed my breathing pattern. 

Breathing is the body/mind/emotion/spirit interface which is reflected in our language with phrases such as a sigh of relief, all choked up, breathless, full of hot air, waiting with bated breath, inspired or expired, all puffed up, breathing room, or it takes my breath away. The colloquial phrases reflect that breathing is more than gas exchange and may have the following effects.

  • Changes the  lymph and venous blood return from the abdomen (Piller, Leduc, & Ryan, 2006). The downward movement of the diaphragm with the corresponding expansion of the abdomen occurs during inhalation as well as slight relaxation of the pelvic floor. The constriction of the abdomen and slight tightening of the pelvic floor causing the diaphragm to go upward and allows exhalation. This dynamic movement increases and decreases internal abdominal and thoracic pressures and acts a pump to facilitate the venous and lymph return from the abdomen. In many people this dynamic pumping action is reduced because the abdomen does not expand during inhalation as it is constricted by tight clothing (designer jean syndrome), holding the abdomen in to maintain a slim self-image, tightening the abdomen in response to fear, or the result of learned disuse to reduce pain from abdominal surgery, gastrointestinal disorders, or abdominal insults (Peper et al, 2015).
  • Increases spinal disk movement. Effortless diaphragmatic breathing is a whole body process and associated with improved functional movement (Bradley, & Esformes, 2014). The spine slightly flexes when we exhale and extends when we inhale which allows dynamic disk movement unless we sit in a chair.
  • Communicates our emotional state as our breathing patterns reflect our emotional state. When we are anxious or fearful the breath usually quickens and becomes shallow while when we relax the breath slows and the movement is more in the abdomen (Homma, & Masoka, 2008).
  • Evokes, maintains, inhibits symptoms or promotes healing. Breathing changes our physiology, thoughts and emotions. When breathing slowly to about 6 breaths a minute, it may enhance heart rate variability and thereby increase sympathetic and parasympathetic balance (Lehrer & Gevirtz, 2014; Moss  &  Shaffer, 2017).

Can breathing trigger symptoms?

A fifty-five year old woman asked  for suggestions what she could do to prevent the occurrence of  episodic prodrome and aura symptoms of visual disturbances and problems in concentration that would signal the onset of a migraine.  In the past, she had learned to control her migraines with biofeedback; however, she now experienced these prodromal sensation more and more frequently without experiencing the migraine. As she was talking, I observed that she was slightly gasping before speaking with shallow rapid breathing in her chest.

To explore whether breathing pattern may contribute to evoke, maintain or amplify symptoms, the following two  behavioral breathing challenges can suggest whether breathing is a factor: Rapid fearful gasping or 70% exhalation.

Behavioral breathing challenge: Rapid fearful gasping

Take a rapid fearful gasp when inhaling as if your feel scared or fearful.  Let the air really quickly come in and repeat two or three times as described in the video. Then describe what you experienced.

If you became aware of the onset of a symptom or that the symptom intensified, then your dysfunctional breathing patterns (e.g.,  gasping, breath holding or shallow chest breathing) may contribute to development or maintenance of these symptoms. For many people when they gasp–a big rapid inhalation as if they are terrified–it may evoke their specific symptom such as a pain sensation  in the back of the eye,  slight pain in the neck,  blanking out, not being able to think clearly, tightness and stiffness in their  back, or even an increase in achiness in their joints (Peper et al, 2016).

To reduce or avoid triggering the symptom, breathe diaphragmatically without effort; namely each time you gasp, hold your breath or breathe shallowly, shift to effortless diaphragmatic breathing.

The above case of the woman with the prodromal migraine symptoms, she experienced visual disturbances and fuzziness in her head after the gasping.  This experience allowed her to realize that  her breathing style could be a contributing in triggering her symptoms.  When she then practiced slow diaphragmatic breathing for a few breaths her symptoms disappeared.  Hopefully, if she replaces gasping and shallow breathing with effortless diaphragmatic breathing then there is a possibility that her symptoms may no longer occur.

Behavioral breathing challenge: 70% exhalation

While sitting, breathe normally for a minute. Now change your breathing pattern so that you exhale only 70% or your previous inhaled air.  Each time you exhale, exhale only 70% of the inhaled volume. If you need to stop, just stop, and then return to this breathing pattern again by exhaling only 70 percent of the inhaled volume of air.  After 30 seconds, let go and breathe normally as guided by the video clip.  Observe what happened?

In our research study with 35 volunteers, almost all participants experienced an increase in arousal and symptoms such as lightheadedness, dizziness, anxiety, breathless, neck and shoulder tension after 30 seconds of incomplete exhalation  as shown in Figure 1 and Table 1 (Peper and MacHose, 1993).

anxiety

Figure 1. Increase in anxiety evoked by 70% exhalation.

symptoms

Table 1. Symptoms experienced after exhalation 70%.

Although these symptoms may be similar to those evoked by hyperventilation and overbreathing, they are probably not caused by the reduction of end-tidal carbon dioxide (CO2). The apparent decrease in end-tidal PCO2 is cause by the room air mixing with the exhaled air and not a measure of end-tidal CO2 (Peper and Tibbets, 1992).  Most likely the symptoms are associated by the shallow breathing that occurs when we were scared or terrified.

People who have a history of anxiety, panic, nervousness and tension as compared to those who report low anxiety  tend to report more symptoms when exhaling 70% of inhaled air for 30 seconds. If this practice evoked symptoms, then changing the breathing patterns to slower diaphragmatic breathing may be a useful self-regulation strategy to optimize health.

These two behavior breathing challenges are useful demonstrations for students and clients that breathing patterns can influence symptoms. By experiencing ON and OFF control over their symptoms with breathing,  the person now knows that breathing can affect their health and well being.  

BLOGS WITH INSTRUCTIONS FOR LEARNING EFFORTLESS DIAPHRAGMATIC BREATHING

https://peperperspective.com/2017/11/17/breathing-to-improve-well-being/

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/2016/04/26/allow-natural-breathing-with-abdominal-muscle-biofeedback-1-2/

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

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

REFERENCES

Bradley, H. & Esformes, J. (2014). Breathing pattern disorders and functional movement. International Journal of Sports Physical Therapy, 9(1), 28-39.

Homma, I. & Masoka, Y. (2008). Breathing rhythms and emotions. Experimental Physiology, 93(9), 1011-1021.

Lehrer, P.M. & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 5 

Moss, D. &  Shaffer, F. (2017). The application of heart rate variability biofeedback to medical and mental health disorders. Biofeedback, 45(1), 2-8.

Peper, E., Gilbert, C.D., Harvey, R. & Lin, I-M. (2015). Did you ask about abdominal surgery or injury? A learned disuse risk factor for breathing dysfunction. Biofeedback. 34(4), 173-179.  DOI: 10.5298/1081-5937-43.4.06

Peper, E., Lee, S., Harvey, R., & Lin, I-M. (2016). Breathing and math performance: Implication for performance and neurotherapy. NeuroRegulation, 3(4),142–149.

Peper, E. & MacHose, M. (1993).  Symptom prescription:  Induc­ing anxiety by 70% exhalation. Biofeedback and Self-Regulation. 18(3), 133-139.

Peper, E. & Tibbetts, V. (1992). The effect of 70% exhalation and thoracic breathing upon end-tidal C02. Proceedings of the Twenty-Third Annual Meeting of the Association for Applied Psy­chophysiology and Biofeedback.  Wheat Ridge, CO: AAPB, 126-129. Abstract in: Biofeedback and Self-Regulation. 17(4), 333-334.

Piller, N., Leduc, A., & Ryan, T. (2006). Does breathing have an influence on lymphatic drainage? Journal of Lymphoedema, 1(1), 86-88.

 

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