Do nose breathing FIRST in the age of COVID-19

nose breathingBreathing affects every cell of our body and should be the first intervention strategy to improve physical and mental well-being (Peper & Tibbetts, 1994). Breathing patterns are much more subtle than indicated by the respiratory function tests (spirometry, lung capacity, airway resistance, diffusing capacity and blood gas analysis) or commonly monitored in medicine and psychology (breathing rate, tidal volume, peak flow, oxygen saturation, end-tidal carbon dioxide) (Gibson, Loddenkemper, Sibille & Lundback, 2019).

When a person feels safe, healthy and peaceful, the breathing is effortless and the breath flows in and out of the nose without awareness. Functional and dysfunctional breathing patterns includes an assessment of the whole body pattern by which breathing occurs such as nose versus mouth breathing, alternation of nasal patency, the rate of  air flow rate during inhalation and exhalation, the length of time during inhalation and exhalation, the post exhalation pause time. the pattern of transition between inhaling and exhaling,  the location  and timing of expansion in the truck, the range of diaphragmatic movement, and the subjective quality of breathing effort (Gilbert, 2019; Peper, Gilbert,  Harvey & Lin, 2015; Nestor, 2020).

Breathing patterns affect sympathetic and parasympathetic nervous systems (Levin & Swoap, 2019).  Inhaling tends to activate the sympathetic nervous system (fight/flight response) while exhaling activates the parasympathetic nervous system (rest and repair response) (Lehrer & Gevirtz, 2014). To observe how breathing affects your heart rate, monitor your pulse from either the radial artery in the wrist or the carotid artery in your neck as shown in Figure 1 and practice the following.radial and carotid arteru

After sensing the baseline rate of your pulse, continue to feel your radial artery pulse in your wrist or at the carotid artery in your neck. Then inhale for the count of four hold for a moment and gently exhale for the count of 5 or 6. Repeat two or three times. 

Most people observe that during inhalation, their heart rate increased (sympathetic activation for action) and during exhalation, the heart rate decreases (restoration during safety).

Nearly everyone who is anxious tends to breathe rapidly and shallowly or when stressed, unknowingly gasp or holds their breath–they may even freeze up and blank out (Peper et al, 2016). In addition, many people habitually breathe through their mouth instead of their nose and wake up tired with a dry mouth with bad breath. Mouth breathing combined with chest breathing in the absence of slower diaphragmatic breathing (the lower ribs and abdomen expand during inhalation and constrict during exhalation) is a risk factor for disorders such as irritable bowel syndrome,  hypertension, tiredness, anxiety, panic attacks, asthma, dysmenorrhea, epilepsy, cold hands and feet, emphysema, and insomnia.  Many of our clients who aware of their dysfunctional breathing patterns and are able to implement effortless breathing report significant reduction in symptoms (Chaitow, Bradley, & Gilbert, 2013; Peper, Mason, Huey, 2017; Peper & Cohen, 2017; Peper, Martinez Aranda, & Moss, 2015).

Breathing is usually overlooked as a first treatment strategy-it is not as glamorous as drugs, surgery or psychotherapy. Teaching breathing takes skill since practitioners needs to be experienced. Namely, they need to be able to demonstrate in action how to breathe effortlessly before teaching it to others.  Although it seems unbelievable, a small change in our breathing pattern can have major physical, mental, and emotional effects as can be experienced in the following practice.

Begin by breathing normally and then exhale only 70% of the inhaled air, and inhale normally and again exhale only 70% of the inhaled air.  With each exhalation exhale on 70% of the inhaled air.  Continue this for 30 seconds. Stop and note how you feel.

Almost every reports that the 30 seconds feels like a minute and experience some of the following symptoms listed in table 1.

Capture

Table 1.  Symptoms experienced after 30-45 seconds of sequentially exhaling 70% percent of the inhales air (Peper & MacHose, 1993).

Even though many therapists have long pointed out that breathing is essential, it is usually the forgotten ingredient. It is now being rediscovered in the age of the COVID-19  as respiratory health may reduce the risk of COVID-19.

Simply having very sick patients lie on their side or stomach can improve gas exchange.  By lying on your side or prone, breathing is easier as the lung can expand more which appears to reduce the utilization of respirators and intubation (Long & Singh, 2020; Farkas, 2020).  This side or prone breathing approach is thousands of years old.

One of the natural and health promoting breathing patterns to promote lung health is to breathe predominantly through the nose. The nose filters, warms, moisturizes and slows the airflow so that airway irritation is reduced. Nasal breathing also increases nitric oxide production that significantly increases oxygen absorption in the body. More importantly for dealing with COVID-19, nitric oxide,  produced and released inside the nasal cavities and the lining of the blood vessels, acts as an anti-viral and is a secondary strategy to protect  against viral infections (Mehta, Ashkar & Mossman, 2012).   During inspiration through the nose, the nitric oxide helps dilate the airways in your lungs and blood vessels (McKeown, 2016).

To increase your health, breathe through your nose, yes, even at night (McKeown, 2020).  As you practice this during the day be sure that the lower ribs and abdomen expand during inhalation and decrease in diameter during exhalation.  It is breathing without effort although many people will report that it initially feels unnatural. Exhale to the count of about 5 or 6 and inhale (allow the air to flow in) to the count of 4 or 5. Mastering nasal breathing takes practice, practice and practice. See the following for more information.

Watch the Youtube presentation by Patrick McKeown author of the Oxygen Advantage, Practical 40 minute free breathing session with Patrick McKeown to improve respiratory health. https://www.youtube.com/watch?v=AiwrtgWQeDc&t=680s

Listen to Terry Gross interviewing James Nestor on “How The ‘Lost Art’ Of Breathing Can Impact Sleep And Resilience” on May 27, 2020 on the NPR radio show, Fresh Air.

https://www.npr.org/sections/health-shots/2020/05/27/862963172/how-the-lost-art-of-breathing-can-impact-sleep-and-resilience

Look at the Peperperspective blogs that focus on breathing in the age of Covid-19.

Read science writer James Nestor’s book, Breath The new science of a lost art, Breath The new science of a lost art.

Breathe Nestor

References

Allen, R. (2017).The health benefits of nose breathing. Nursing in General Practice.

Chaitow, L., Bradley, D., & Gilbert, C. (2013). Recognizing and treating breathing disorders: A multidisciplinary approach, 2nd ed. London: Churchill Livingstone.

Christopher, G. (2019). A Guide to Monitoring Respiration. Biofeedback, 47(1), 6-11.

Farkas, J. (2020). PulmCrit – Awake Proning for COVID-19. May 5, 2020. 

Gibson, J., Loddenkemper, R., Sibille, Y., &Lundback, B. (eds).(2019) European Lung white book. Sheffield, United Kingdom:  European Respiratory Society.

Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work?. Frontiers in psychology5, 756. 

Levin, C.J. & Swoap, S.J. (2019). The impact of deep breathing and alternate nostril breathing on heart rate variability: a human physiology laboratory. Adv Physiol Educ, 43, 270–276.

Long, L. & Singh, S. (2020). COVID-19: Awake Repositioning / Proning. EmDocs

McKeown, P. (2016). Oxygen advantage. New York: William Morrow.

McKeown, P. (2020).  Practical 40 minute free breathing session with Patrick McKeown to improve respiratory health.

Mehta, D. R., Ashkar, A. A., & Mossman, K. L. (2012). The nitric oxide pathway provides innate antiviral protection in conjunction with the type I interferon pathway in fibroblasts. PloS one, 7(2), e31688. 

Nestor, James. (2020). Breath The new science of a lost art. New York: Riverhead Books

Peper, E. & Cohen, T. (2017). Inhale to breathe away pelvic floor pain and enjoy intercourse. Biofeedback.45(1), 21–24.

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., 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. & Tibbetts, V. (1994). Effortless diaphragmatic breathing. Physical Therapy Products. 6(2), 67-71.  Also in:  Electromyography:  Applications in Physical Therapy. Montreal: Thought Technology Ltd


Reduce initial dose of the virus and optimize your immune system

Erik Peper and Richard Harvey

COVID-19 can sometimes overwhelm young and old immune systems and in some cases can result in ‘Severe Acute Respiratory Syndrome’ pneumonia and death (CDC, 2020). The risk is greater for older people who may simultaneously be dealing with cancers, cardiovascular heart disease, obesity, diabetes, emphysema, immune suppression or other health issues.  As we age the immune system deteriorates  (immunosenescence) that reduces the response of the adaptive immune system that needs to respond to the virus infection (Aw, Silva & Palmer, 2007; Osttan, Monti, Gueresi, et al., 2016).

Severity of disease may depend upon initial dose of the virus

In a brilliant article, How does the coronavirus behave inside a patient? We’ve counted the viral spread across peoples; now we need to count it within people, assistant professor of medicine at Columbia University and cancer physician Siddhartha Mukherjee points out that severity of the disease may be related to the initial dose of the virus.  Namely, if you receive a very small dose (not too many virus particles), they will infect you; however, the body can activate its immune response to cope with the infection.  The low dose exposure act similar to vaccination.  If on the other hand you are exposed to a very high dose then your body is overwhelmed with the infection and is unable to respond effectively.  Think of a forest fire. A small fire can easily be suppressed since there is enough time to upgrade the fire-fighting resources; however, during a fire-storm with multiple fires occurring at the same time, the fire-fighting resources are overwhelmed and there is not enough time to recruit outside fire-fighting resources.

As Mukherjee points out this dose exposure relationship with illness severity has a long history. For example, before vaccinations for childhood illnesses were available, a child who became infected at the playground usually experienced a mild form of the disease.  However, the child’s siblings who were infected at home develop a much more severe form of the disease.

The child infected in the playground most likely received a relatively small dose of the virus over a short time period (viral concentration in the air is low).  On the other hand, the siblings who were infected at home by their infected brother or sister received a high concentration of the virus over an extended period which initially overwhelmed their immune system. Higher virus concentration is more likely during the winter and in well insulated/sealed houses where the air is recirculated without going through HEPA or UV filters to sterilize the air. When there is no fresh air to decrease or remove the virus concentration, the risk of severity of illness may be higher (Heid, 2020).

The risk of becoming sick with COVID-19 can only occur if you are exposed to the coronavirus and the competency of your immune system. This can be expressed in the following equation.Risk ratioThis equation suggests two strategies to reduce risk:  reduce coronavirus load/exposure and strengthen the immune system.

How to reduce the coronavirus load/dose of virus exposure

Assume that everyone is contagious even though they may appear healthy.  Research suggests that people are already contagious before developing symptoms or are asymptomatic carriers who do not get sick and thereby unknowingly spread the virus (Furukawa, Brooks, Sobel, 2020). Dutch researchers have reported that, “The proportion of pre-symptomatic transmission was 48% for Singapore and 62% for Tianjin, China (Ganyani et al, 2020). Thus, the intervention to isolate people who have symptoms of COVID-19 (fever, dry cough, etc.) most likely will miss the asymptomatic carriers who may infect the community without awareness.  Only if you have been tested, do you know if you been exposed or recovered from the virus. To reduce exposure to the virus, avoid the  “Three C’s” — closed spaces with poor ventilation, crowded places and close contactand do the following:

  1. Follow the 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 to prevent microorganisms and viruses to enter the body through mucosal surfaces of the nose mouth and eyes.
    • Cleaning surfaces which could have been touched by other such as door bell, door knobs, packages.
    • Wearing a mask and gloves to reduce spreading the virus to others.
  1. Avoid the person’s slipstream that may contain the droplets in the exhaled air. The purpose of social distancing is to have enough distance between you and another person so that the exhaled air of the other person would not reach you. The distance between people depends upon their activities and the direction of airflow.

In a simulation study, Professor Bert Blocken and his colleagues at KU Leuven and Eindhoven University of Technology reported that the plume of the exhaled air that potentially could contain the virus  droplets could extend much more than 5 feet. It  would depends upon the direction of the wind and whether the person is walking or jogging as show in Figure 1 (Blocken, 2020).

Slipstream

Figure 1. The plume of exhaled droplets that could contain the virus extends behind the person in their slipstream (photo from KU Leuven en TU Eindhoven).

The plume of exhaled droplets in the person’s slipstream may extend more than 15 feet while walking and more than 60 feet while jogging or bicycling.  Thus. social distancing under these conditions is much more than 6 feet and it means avoiding their slipstream and staying much further away from the person. 

  1. Increase fresh air to reduce virus concentration. By increasing the fresh outside air circulation, you dilute the virus concentration that may be shed by an infected asymptomatic or sick person  (Qian & Zheng, 2018).  The CDC recommends ventilation with 6 to 12 room air changes per hour for effective air disinfection (Nardell & Nathavitharana, 2020). Thus, if you are exposed to the virus, you may receive a lower dose and increase the probability that you experience a milder version of the disease. To increase fresh air (this assumes that outside air is not polluted), explore the following:
    • Open the windows to allow cross ventilation through your house or work setting. One of the major reasons that the flu season spikes in the winter is that people congregate indoors to escape weather extremes. People keep their windows closed to conserve heat and reduce heating bill costs. Lack of fresh air circulation increases the viral density and risk of illness severity (Foster, 2014).
    • Use an exhaust fans to ventilate a building. By continuously replacing the inside “stale” air  with fresh outside air, the concentration of the virus in the air is reduced.
    • Use High-efficiency particulate air (HEPA) air purifiers to filter the air within a room. These devices will filter out particles whose diameter is equal to 0.3 µ m. They will not totally filter out the virus; however, they will reduce it.
    • Avoid buildings with recycled air unless the heating and air conditioning system (HAC) uses HEPA filters.
    • 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.
  1. Avoid long-term exposure to air pollution. People exposed to high levels of air pollution and fine particulate matter (PM2.5)  are more at risk to develop chronic respiratory conditions and COVID-19 death rates. In the 2003 study of SARS, ecologic analysis conducted among 5 regions in China with 100 or more SARS cases showed that case fatality rate increased with the increment of air pollution index (Cui, Zhang, Froines, et al. , 2003). The higher  the concentration of fine particulate matter (PM2.5), the higher the death rate (Conticini, Frediani, & Caro, 2020).  As researchers, Xiao Wu, Rachel C. Nethery and colleagues (2020) from the Harvard T.H. Chan School of Public Health point out,  “A small increase in long-term exposure to PM2.5 leads to a large increase in COVID-19 death rate, with the magnitude of increase 20 times that observed for PM2.5 and all cause mortality. The study results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis.
  2. Breathe only through your nose. The nose filters, warms, moisturizes and slows the airflow so that airway irritation is reduced. Nasal breathing increases nitric oxide production that significantly increases oxygen absorption in the body. During inspiration through the nose the nitric oxide helps dilate the airways in your lungs and blood vessels (McKeown, 2016). More importantly for dealing with COVID-19, Nitric Oxide,  produced and released inside the nasal cavities and the lining of the blood vessels, acts as an antiviral and a secondary strategy to protect against viral infections (Mehta, Ashkar & Mossman, 2012).   

How to strengthen your immune system to fight the virus

The immune system is dynamic and many factors as well as individual differences affect its ability to fight the virus.  It is possible that a 40 year-old person may have an immune systems that functions as a 70 year old, while some 70 year-olds have an immune system that function as a 40 year-old. Factors that contribute to immune competence include genetics, aging, previous virus exposure, and lifestyle (Lawton, 2020).

It is estimated that 70-80% mortality caused by Covid-19 occurred in people with comorbidity who are: 1) over 65,  2) male,  3) lower socioeconomic status (SES),  4) non white, 5) overweight/obesity, 6) cardiovascular heart disease, and 7) immunocompromised. The majority of these risk factors are the result of economic inequality and life style patterns such as the Western inflammatory diet (Pollan, 2020).  

By taking charge of your lifestyle habits through an integrated approach, you may be able to strengthen your immune system (Alschuler et al, 2020; Lawton, 2020). The following tables, adapted from the published articles by Lawton (2020) and Alschuler et al, (2020), list some of the factors that may support or decrease the immune system.

Factors that may support immune competence

increase immune competence rev1

Phytochemicals and vitamins that may support immune competence

immune system vitamins

Factors that may decrease immune competence

decrease immune competence rev

Conclusion

An ounce of prevention is worth a pound of cure.  Thus, to reduce the risk of covid-19 disease severity, implement strategies to reduce viral dosage exposure and strengthen the immune system.  Many of these factors are within our control. Thus, increase fresh air circulation, reduce stress, decrease foods that tend to increase inflammation (the industrialized western diet that significant contributes to the development of chronic disease), and increase foods, vitamins and nutrients that support immune competence.

These factors have been superbly summarized by the World Health Organization Director General Dr. Tedros Adhanom in his presentation, Practical tips how to keep yourself safe.

REFERENCES

Abhanon, T. (2020 March 26). Practical tips how to keep yourself safe.

Alschuler, L., Weil, A., Horwitz, R. Stamets, P., Chiasso, A.M., Crocker, R., & Maizes, V. (2020 March 26). Integrative considerations during the CPVID-19 pandemic. Explore, 26.

Aranow C. (2011). Vitamin D and the immune system. Journal of investigative medicine : the official publication of the American Federation for Clinical Research59(6), 881–886. 

Aw, D., Silva, A. B., & Palmer, D. B. (2007). Immunosenescence: emerging challenges for an ageing population. Immunology120(4), 435–446.

Blocken, B. (2020-04-08). Cited in, Belgishch onderzoek: fietsen, joggen of wandelen do je best niet achtr elkaar in tijden van corona. DeMorgen. 

Brandhorst, S., Choi, I.Y., Wei, M., Cheng, C.W., Sedrakyan, S., Navarrete, G., Dubeau, L., et al. (2015). A Periodic Diet that Mimics Fasting Promotes Multi-System Regeneration, Enhanced Cognitive Performance, and Healthspan. Cell Metabolism, 22(1), 86-99. 

Campbell, J.P. & Turner, J.E. (2018). Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Frontiers in Immunology, 9, 648.  

Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14(4):245‐254. 

CDC (2020, March 26). Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. Morbidity and Mortality Weekly Report. CDC. March 26, 2020.

Conticini, D., Frediani, F., & Caro, D. (2020). Can atmospheric pollution be considred a co-factdor in the extremely high level of SARS-CoV-2 lethality in Northern Italy.  Environmental Pollution, available online, 4 April 2020, 114465.

D’Acquisto F. (2017). Affective immunology: where emotions and the immune response converge. Dialogues in clinical neuroscience19(1), 9–19.

Foster, H. (2014 December 1). The reason for the season: why flu strikes in winter. SITN Science in the News.

Furukawa, N.W., Brooks, J.T., & Sobel, J. (2020, July). Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. [June3, 2020]. https://doi.org/10.3201/eid2607.201595

Ganyani, T., Kremer, C., Chen, D., Torneri, A, Faes, C., Wallinga, J., & Hensm N. (2020).    Estimating the generation interval for COVID-19 based on symptom onset data     doi:https://doi.org/10.1101/2020.03.05.20031815

Glaser, R. & Kiecolt-Glaser, J.K. (2005). Stress-induced immune dysfunction: implications for health. Nature Reviews of Immunology, 5(3), 243-251. 

Heid, M. (2020-04-09).  The Germ-Cleaning Power of an Open Window. Elemental by Medium. 

Jagetia GC, Aggarwal BB. “Spicing up” of the immune system by curcumin. J Clin Immunol. 2007;27(1):19‐35. 

Kaplow, S. (2020, April 29). COVID-19 and the Risk from Recirculated Air in Buildings. Green Building Law Update.

Koh, K.B. (2018). Stress, Emotion, and Immunity. In: Stress and Somatic Symptoms. Springer, Cham, 43-54.

Kuo M. (2015). How might contact with nature promote human health? Promising mechanisms and a possible central pathway. Frontiers in psychology6, 1093. 

Lawton, G. (2020). You’re only as young as your immune system. New Scientist, 245(3275), 44-48.

Lee, G. Y., & Han, S. N. (2018). The Role of Vitamin E in Immunity. Nutrients10(11), 1614. 

Lewis ED, Meydani SN, Wu D. Regulatory role of vitamin E in the immune system and inflammation. IUBMB Life. 2019;71(4):487‐494.

Li, Y., Yao, J., Han, C., Yang, J., Chaudhry, M. T., Wang, S., Liu, H., & Yin, Y. (2016). Quercetin, Inflammation and Immunity. Nutrients8(3), 167. 

Malaguarnera L. (2019). Influence of Resveratrol on the Immune Response. Nutrients11(5), 946. 

McKeown, P. (2020). Practical 40 minute free breathing session with Patrick McKeown to improve respiratory health.

Mehta, D. R., Ashkar, A. A., & Mossman, K. L. (2012). The nitric oxide pathway provides innate antiviral protection in conjunction with the type I interferon pathway in fibroblasts. PloS one, 7(2), e31688. 

Mukherjee, S. (2020). How does the coronavirus behave inside a patient? We’ve counted the viral spread across peoples; now we need to count it within people. The New Yorker, April 6, 2020.

Nardell, E.A. & Nathavitharana, R.R. (2020). Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection. JAMA. Published online June 01, 2020. doi:10.1001/jama.2020.7603 

Mukherjee, S., Dudley, J. I., & Das, D. K. (2010). Dose-dependency of resveratrol in providing health benefits. Dose-response : a publication of International Hormesis Society8(4), 478–500. 

Neupane, B., Jerrett, M., Burnett, R.T., Marrie, T., Arain, A., Loeb, M. (2018).  Long-term exposure to ambient air pollution and risk of hospitalization with community-acquired pneumonia in older adults. Am J Respir Crit Care Med, 181(1), 47‐53.

Ostan, R., Monti, D., Gueresi, P., Bussolotto, M., Franceschi, C., & Baggio, G. (2016). Gender, aging and longevity in humans: An update of an intriguing/neglected scenario paving the way to a gender-specific medicine. Clinical Science, 130(19), 1711-1725.

Qian, H., & Zheng, X. (2018). Ventilation control for airborne transmission of human exhaled bio-aerosols in buildings. Journal of thoracic disease10(Suppl 19), S2295–S2304. https://doi.org/10.21037/jtd.2018.01.24

Panche, A. N., Diwan, A. D., & Chandra, S. R. (2016). Flavonoids: an overview. Journal of nutritional science5, e47. 

Perez de Heredia, F., Gomez-Martinez, S., &Marcos, A. (2012). Chronic and degenerative diseases Obesity, inflammation and the immune system. Proceedings of the Nutrition Society, 71, 332–338.

Pollan, M. (2020). The sickness in our food supply. The New York Review of Books. June 11, 2020 issue. https://www.nybooks.com/articles/2020/06/11/covid-19-sickness-food-supply/

Prasad A. S. (2008). Zinc in human health: effect of zinc on immune cells. Molecular medicine (Cambridge, Mass.)14(5-6), 353–357. 

Price MA, Butow PN, Bell ML, et al. Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?. Support Care Cancer. 2016;24(6):2627‐2634. 

Reed, R.G. & Raison, C.L. (2016). Stress and the Immune System. In: Esser, C. (eds) Environmental Influences on the Immune System. Springer, Vienna, 97-126.

Sarkar, D., Jung, M. K., & Wang, H. J. (2015). Alcohol and the Immune System. Alcohol Research : Current Reviews37(2), 153–155. 

Segerstrom, S. C. & Miller, G. E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological bulletin130(4), 601–630.

Simpson, N., Haack, M., Mullington, J.M. (2017). Sleep and Immune Regulation. In: Chokroverty S. (eds). Sleep Disorders Medicine. Springer, New York, NY, 195-203.

Uchino, B. N., Vaughn, A. A., Carlisle, M., & Birmingham, W. (2012). Social support and immunity. In S. C. Segerstrom (Ed.), Oxford library of psychology. The Oxford handbook of psychoneuroimmunology (p. 214–233). Oxford University Press. 

Witek, L, Tell, J. D., & Mathews, L. (2019). Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control. Brain, behavior, and immunity, 80, 358-373. 

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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

 


Reduce TechStress at Home

Adapted from the upcoming book, Peper, E., Harvey, R., & Faass, (in press). Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

fig 1 extended neck

Numerous people report that working at the computer at home is more tiring than working in the office.  Although there are obvious advantages to working at home, there are also disadvantages (e.g., no space to work, challenging ergonomics, no escape from the family, lack of nonverbal cues used to communicate, less informal sharing at the water cooler, increased multitasking by working and having to take care of the children).

A major challenge is having a comfortable work space in your home.  This may mean finding a place to put the computer, keyboard and screen.  For some it is the kitchen table, desk in the corner of the bedroom, or coffee table while other it is in a totally separate room.

Incorrect ergonomic arrangement and stressed work style often increases neck, shoulder discomfort and aggravates eye strain and tiredness. Regardless how your digital work space is organized, implement the following life and work style suggestions and ergonomics recommendations to promote health.

LIFE AND WORK STYLE SUGGESTIONS

Take many, many, many breaks.  Movement breaks will reduce the covert static tension that builds up as we sit in static positions and work at the computer.

  • Every few minutes take a small break such as stand up and wiggle or role your shoulders. When performing the movements, stop looking at the screen and look around the room or out the window.
  • Every 30 minutes get up walk around for and move your body. Use timers to notify you every 30 minutes to take a break (e.g., cellphone alarms or personal digital assistants such as Hey Google, Siri, or Alexa).

Improve vision.

  • Take vision breaks to reduce eye fatigue.
    • Every few minutes look away from the screen and into the far distance and blink. If at all possible look outside at green plants which relaxes the near vision induced tension.
    • Blink and blink again. When working at the computer we reduce our blinking rate. Thus, blink each time you click on a new link, finishing entering a column of numbers, etc.
    • Close your eyes by letting the eye lids drop down as you also relax your jaw. Imagine a hook on top of your head which is pulling your head upward and at the same time drop your shoulders.
  • Reduce glare and bright backgrounds
    • Arrange your computer screen at 90 degrees to the brightest light source.
    • Have a darker background behind you when participating in video conferencing (e.g., Zoom, Skype, GoToMeeting, WhatsApp, FaceTime). Your face will be visible.

Regenerate

  • When stressed remember to breathe. As you inhale let your stomach expand as you exhale let the air flow out slowly.
  • Stop watching and listening to the negative news (check the news no more than once a day). Watch positive and humorous movies.
  • Get fresh air, go for a walk, and be in the sun
  • Reconnect with friends and share positive experiences.
  • Remind yourself, that this too shall pass.

ERGONOMIC RECOMMENDATIONS: MAKE THE WORLD YOURS

Good ergonomics means adapting the equipment and environment to you and not the other way around. Optimizes the arrangement of the chair, desk, keyboard, mouse, camera, screen and yourself as shown in Figure 1.

Workstation-Setup1

Figure 1. Recommended arrangement for working at the computer.

Arrange the laptop

The laptop is challenging because if your hands are at the right height for data entry on the keyboard, then you must look down to see the screen.  If the screen at the right height, then you have to raise your hands to reach the keyboard. There are two solutions for this challenge.

  1. Use an external keyboard and mouse, then raise the laptop so that the top of the screen is at eye level. Use a laptop stand or a stack of books to raise the lap top.
  2. Use an external monitor for display, then use the laptop as your keyboard.

If these solutions are not possible, take many, many, many breaks to reduce the neck and shoulder stress.

Arrange the computer workstation

  1. Adjust the chair so that your forearms can rest on the table without raising your shoulders. This may mean sitting on a pillow. If the chair is then too high and your legs dangle, create a foot stool on which you can rest your feet.
  2. Adjust the monitor so that the top of the screen is at eye level. If the monitor is too low, raise it by putting some books underneath it.
  3. If possible, alternate standing and sitting while working.

RESOURCES

Ergonomic suggestions for working at the computer and laptop.

https://peperperspective.com/2014/09/30/cartoon-ergonomics-for-working-at-the-computer-and-laptop/

https://peperperspective.com/2014/02/24/optimizing-ergonomics-adapt-the-world-to-you-and-not-the-other-way-around/

11 tips for working at home

https://www.bakkerelkhuizen.com/knowledge-center/11-productivity-tips-for-homeworkers/?utm_campaign=US+-+19+03+20&utm_source=Newsletter&utm_medium=email

How our digital world activates evolutionary response patterns.

https://peperperspective.com/2020/01/17/evolutionary-traps-how-screens-digital-notifications-and-gaming-software-exploits-fundamental-survival-mechanisms/

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

How posture affects health

https://peperperspective.com/2019/07/01/dont-slouch-improves-health-with-posture-feedback/

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

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

https://peperperspective.com/2019/01/23/head-position-it-matters/


Coronavirus risk in context: How worried should you be?

The coronavirus which causes coronavirus disease 2019 (COVID-19) appears to be a highly contagious disease. Some older people and those who are immune compromised are more at risk.  The highest risk are for older people who already have cardiovascular, diabetes, respiratory disease, and hypertension. In addition, older men over 65 years are much more at risk; however, the majority are smokers who have a compromised pulmonary system. Previous meta analysis showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection. Nevertheless, it is reasonable to assume that over time all most all of us will become exposed to the virus, a few will get very sick, and even fewer will die.

The preliminary data suggests that most people who become infected may not even know they are infectious. Make the assumption that everyone could be contagious unless tested for the virus or antibodies to the virus since people appear to be infectious for the first four days before experiencing symptoms.

corona virus infection

The absolute risk that one would die of this disease is low although if you do become very sick it is more dangerous than the normal flu; however, the fear of this disease may be out of proportion compared to other health risks. For detailed analysis and graphic summaries see the updated research reports on the Coronavirus disease (COVID-19) by Our World in Data and Information is beautiful. These reports make data and research on the world’s largest problems understandable and accessible.

It is worthwhile to look at the absolute risk of COVID-19.  To read that more than 332,000 people world wide have died in the last five months is terrifying especially with the increasing death rate in Europe and New York; however, it needs to be understood in context of the size of the population.  The epicenter of this disease was Wuhan and Hubei Provence, China with a total population of about 60 million people.  Each year about 427,200 people die in the Wuhan and Hubei Province (the annual death rate in China is 7.12 deaths per 1000 people). Without this new viral disease, about 71,200 people would have died during the same two month period.  The question that has not been discussed is how much did the total death rate increase.  Would it be possible that some of the people who died would have died of other natural causes such as the flu?

The World Health Organization (WHO) and governments around the world should be lauded for their attempt to reduce the spread of the virus. On March 6, 2020, the United States Congress allocated $8. billion dollars to fight and prevent the spread of COVID-19. 

This funding will only partially prevent the spread of the virus because some people have no choice but to go to work when they are sick–they do not receive paid sick leave! This is true for about 30 percent of the American workers who have no coverage at work or the millions of self-employed workers (e.g. gig/freelance workers, waiters, cashiers, drivers, nannies, house cleaners).

To reduce the risk of the spreading COVID-19, anyone who feels sick or thinks they have been exposed, should receive paid sick leave so that they can stay home and self-isolate. The paid sick leave should be Federally funded and provide basic income for those whose income would be lost if they did not work.  Although it is possible that a few people will cheat and take the paid sick leave when they are well, this is worth the risk to keep the rest of population healthy. To provide possible relief, at the moment the House and Senate are working on a greater than $2 trillion dollar stimulus package. 

Personal and government responses to health risks are not always rational. 

Funding for health and illness prevention is driven by politics. For example, gun violence results in more than 100,000 people being injured each year and more than 36,000 killed—an average of 100 per day. Gun violence is a much more virulent disease than COVID-19 and more than 1.7 million Americans have died from firearms since 1968.

The Federal Government response to this gun violence epidemic has been minimal. For the first time since 1996 did the 2020 federal budget include $25 million funding for the CDC and NIH to research reducing gun-related deaths and injuries.

It is clear that the government response does not always focuses its resources on what would reduce injury and death rates the most.  Look at the difference in the national response to COVID-19 virus that has killed more than 82,000 people in the USA ($8.5 billion for the initial response and then $2 trillion stimulus package) as compared gun violence that kills 36,000 people a year in the USA ($25 million funding to study the causes of gun violence).

Be realistic about the actual risk of COVID-19 without succumbing to fear.

COVID-19 is a pandemic and I expect that 30% to 70% of us will be infected this year.  Hopefully, in the next 18 months an effective vaccine will be developed.  In the mean time, there is no known treatment, thus optimize health and reduce the exposure to the coronavirus.

To make sense of the danger of COVID-19, look at it in context to the flu. Depending upon the severity the  flu, 9,000,000 to 45,000,000 people get sick from flu and between 12,000 to 61,000 die from its complications. as shown below in Figure 1.  

influenza-burden-chart2-960pxFigure 1. The estimated U.S. influenza burden by year (from: https://www.cdc.gov/flu/about/burden/index.html)

This year the CDC estimates that there have been 20,000 to 40,000 deaths in the United States so far this year.  For comparison that is a thousand times  more deaths in the United States than have been blamed on the coronavirus so far.

 


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

Erik Peper and Richard Harvey

If athletes, psychologists, business executives, actors, students, politicians, job seekers and others use mental and actual rehearsal to improve their performances, would repeated watching of violent and aggressive streaming-videos, or playing hours and hours of first-shooter computer games be a form of rehearsal for aggressive behavior?

Arguably, mental and actual rehearsal is positively associated with improving health, such as preparing for an athletic competition or an academic exam and is negatively associated with health when playing aggressive, violent first-person shooter video games, or continuously watching aggressive or violent content on a variety of streaming platforms. Rehearsal–whether physical or in our imagination–impacts our health and performance in school, sports, therapy, politics, business and health.  Choose to rehearse activities that improve health and well-being.

  • Athletes use mental rehearsal to improve sports performance (Peper & Aita, 2017; Schenk & Miltenberger, 2019).
  • Surgeons use mental rehearsal and actual practice to improve performance (Spiotta et al., 2018).
  • Psychologists use cognitive behavioral therapy (CBT) rehearsal techniques to reduce anxiety and depression (Dobson & Dobson, 2018; Yamada et al, 2018; Cook, Mostazir, & Watkins, 2019)
  • Successful business executives rehearse presentations before a staff meeting (Couch & Citrin, 2018).
  • Actors and performers spend hours and days rehearsing their roles so that they portray and act it realistically during the performance .
  • Students take practice exams so that they will perform better on the actual exam.
  • Politicians, lawyers, and many others rehearse and practice being able to answer unexpected questions.
  • Job seekers rehearse elevator pitches so that they transmit in a few words what is important

Mechanisms of rehearsal

Both mental and physical rehearsal strengthens neurochemical connections in the brain so that the rehearsed behaviors become more automated, fluid and unconscious.  There is a saying in neurosciences,  “Neurons that fire together wire together.” –the more you rehearse a task, the more those specific neurological pathways are strengthened, leading to automatic and efficient outcomes.

We now spend hours a day being exposed to digital displays on our phones, computers, gaming consoles and other digital devices, immersing ourselves in content reflecting life promoting, positive behavior and sometimes violent, negative behavior. Children and adults spend much of their free time looking at screens, texting, playing computer games, updating social media sites with moment by moment accounts of sometimes trivial activities, or going down the rabbit hole by following one hyperlinks after another.  As we do this, we are unaware how much time has frittered away without actually doing anything productive. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.

  • Facebook about an hour per day
  • Instagram just under an hour per day
  • Texting about 45 minutes per day
  • Internet browsing, about 45 minutes per day
  • Snapchat, about 30 minutes per day
  • Twitter, about 25 minutes per day

Adolescents interact with media for over 40 hours per week, or around 6 hours per day!

In spending much of our time with the screens, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional and social health.  Many researchers have lamented the loss of some social skills that develop during physical face-to-face contact.  The colloquial phrase, Use it or lose it, raises several questions about what is being lost when we spend so much of our waking time interacting with screens instead actually with other people?

It is almost impossible not to be distracted by the digital screen.  The powerful audiovisual formats override our desire to do something different that some of us become enslaved to watching streaming videos, playing computer games or texting. Moreover, the ongoing visual and auditory notifications from our apps interrupts and/or capture our attention. Why is it difficult to turn away from visual or auditory stimuli?  The answer has roots in our survival.

To attend to stimuli is an automatic evolutionary survival response. If we did not attend, we would not survive–Is the slight movement to the far right, just at the edge of our peripheral vision, a predator ready to attack?

tigera

Tiger in Kanha National Park, Madhya Pradesh, India 

Each time a stimulus occurs, we need to check it out to see if it is friend or foe, safety or danger. The response is so automatic that we are unaware that we have reacted until after we have responded. We all have experienced this. When a computer screen or cellphone screen is held by the stranger next to us, we automatically look at their screen and we may even begin to read their emails. Although we know that peering at some else’s screen is not proper, we are still feel compelled to do it!

Similarly, screens displaying computer games and other media can capture or hijack our attention by the rapid scene changes, primarily because the content is programmed so we receive intermittent rewards for our responses.  For example, the sound or visual notifications from our apps, cellphone messages, or social media trigger an impulse to scan the environment for information that may be critical to our survival. Even without receiving notifications, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notifications is long.  One student talking to another might say: “Don’t worry, they’ll respond; It’s only been 30 seconds.” Anticipating responses from the media can interrupt what we are otherwise doing.  For example, rather than finish our work, we check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.

The mechanisms that help us survive by scanning our environment for predators may  now become an evolutionary trap and is exploited  to capture as many eyeballs as possible to increase market share, advertising revenue, and corporate bottom line.

We usually blame the individual for lack of self-control instead of blaming the designers of the digital apps, games and displays who have exploited this biological survival mechanism.  We expect that children have voluntary control as their brains are developing–but how could they not react to the stimuli that for thousands of generations, helped them to survive. It is similar to asking children to have control and say “No” to fast foods and sweets. The foods that were previously necessary for survival represented by moderate amounts of ‘salt, fat, acid, heat and sweet’ tastes are often found in excess in our modern commercial or packaged ‘fast food nation’ making it likely that people may fall into an evolutionary trap related to what they eat.

Presently, high levels of exposure to violent and aggressive streaming videos and computer games can be harmful as they provide the practice to rehearse violence, killing and aggression mentally. It would be too strong a statement to assert that everyone who plays violent video games will become delinquent, criminal or homicidal in an extreme form of aggression.  According to the American Psychological Association Task Force on Video Game Violence in 2017, it may be asserted that high frequency, long duration, high intensity interactions with violent video games or similar media content is highly associated with angry and aggressive thoughts, desensitization to violence, and decreases in empathy or helping others (Calvert et al., 2017).  Some forms of social media interactions also lead to a form of social isolation,  loneliness (phoneliness) (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020; Kardaras, 2017).   Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested include not only media, but junk food as well .

The negative impact of watching digital media was prescient by Jerry Mander, one of the leading visionaries of the 20th century, in his 1978 book, Four Arguments for the Elimination of Television, as well as by Joseph C. Pearce, author of books on human development and child development, in his 1993 book, Evolution’s End.

More recently, two superb books detail the harm that the digital revolution has brought, along with recommended strategies for how to use modern technologies wisely and live successfully in an e-world.  We are not saying to avoid the beneficial parts of the digital age.   We are saying to be aware how some material and digital platforms prey upon our evolutionary survival mechanisms.  Unfortunately, most people —especially children– have not evolved skills to counter the negative impacts of some types of media exposure.  It may take parental control and societal policies to mitigate the damage and enhance the benefits of the digital age. We highly recommend the following two books.

Glow Kids by Nicholas Kardaras, PhD describes the impact of excessive texting and computer gaming as well as strategies how to use digital media wisely

Deep Work by Cal Newport, PhD describes the impact of constant interruptions and offers rules for focused success in a distracted world.

book covers

References:

Calvert, S. L., Appelbaum, M., Dodge, K. A., Graham, S., Nagayama Hall, G. C., Hamby, S., Fasig-Caldwell, L. G., Citkowicz, M., Galloway, D. P., & Hedges, L. V. (2017). The American Psychological Association Task Force assessment of violent video games: Science in the service of public interest. American Psychologist, 72(2), 126–143. https://doi.org/10.1037/a0040413

Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A. (2020). Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis. Journal of Adolescence, 78, 24-32.

Cook L, Mostazir M, Watkins E, (2019). Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res, 21(5):e11349

Couch, M. A., & Citrin, R. (2018). Retooling leadership development. Strategic HR Review, 17(6), 275-281.

Dobson, D. & Dobson, K.S. (2018). Evidence-Based Practice of Cognitive-Behavioral Therapy, 2nd ed. New York: Guilford Press.

Kardaras, N. (2017).  Glow Kids, New York: St. Martin’s Griffin

Mander, J. (1978).  Four arguments for the Elimination of Television. New York: William Morrow Paperbacks.

Newport, C. (2019). Deep Work. New York: Grand Central Publishing

Pearce, J. C. (1993). Evolution’s End. New York: Harper One

Peper, E. & Aita, J. (2017). Winning the Gold in Weightlifting Using Biofeedback, Imagery and Cognitive Change. Biofeedback, 45(4), 77-82

Remland, M.S. (2016). Nonverbal Communication in Everyday Life, 4th ed.  London: Sage Publications Ltd.

Schenk, M. & Miltenberger, R. (2019). A review of behavioral interventions to enhance sports performance. Behavior Interventions, 33(2), 248-279.

Spiotta, A.M, Buchholz, A.L., Pierce, A. K., Dahlkoetter, J., & Armonda, R. (2018).  The Neurosurgeon as a High-Performance Athlete: Parallels and Lessons Learned from Sports Psychology. World Neurosurgery, 120, e188-e193

Yamada, F., Hiramatsu, Y., Murata, T., Seki, Y., Yokoo, M., Noguchi, R., … & Shimizu, E. (2018). Exploratory study of imagery rescripting without focusing on early traumatic memories for major depressive disorder. Psychology and Psychotherapy: Theory, Research and Practice91(3), 345-362.

 

 


Life has choices

When you woke up this morning, how did you feel? Were you looking forward to the day anticipating with joy what would occur or were you dreading the day as if once again you had to step on the treadmill of life?

photo

Whenever I ask this question of college students in their junior or senior year at an urban university about 20% will answer that they are looking forward to the day. The majority answer, “Well not really”, or even “Oh shit, another day”. For many students the burden of working 40 plus hours a week to pay for rent and tuition, worrying about financial debt, the challenge of commuting, and finding time to do the homework is overwhelming. Focusing on quality of life is not only a challenge for students, but for all of us.

Each day ask yourself, “Am I looking forward to my day and my activities?” If the answer is “No,” begin to explore new options. Ask yourself, “What would I like to do? Start to explore and imagine new options and then begin to plan how to implement them so that you are on the path to where you want to be.

Creating a worthwhile life is an ongoing challenge.  An inspiring essay by Steven James articulates this by exploring factors that contribute to sickness and health during the height of the AIDs epidemic.  He outline rules that contribute to 1) how to get sick, 2) how to get sicker (if you are already sick), and 3) how to stay well (or get better, if you are not so well to begin with).

Steven James’s Totally Subjective, Nonscientific Guide to Illness and Health: Ten-Step Programs

How to Get Sick

·       Don’t pay attention to your body. Eat plenty of junk food, drink too much, take drugs, have lots of unsafe sex with lots of different partners—and, above all, feel guilty about it. If you are overstressed and tired, ignore it and keep pushing yourself.

·       Cultivate the experience of your life as meaningless and of little value.

·       Do the things you don’t like, and avoid doing what you really want. Follow everyone else’s opinions and advice, while seeing yourself as miserable and “stuck.”

·       Be resentful and hypercritical, especially toward yourself.

·       Fill your mind with dreadful pictures, and then obsess over them. Worry most, if not all, of the time.

·       Avoid deep, lasting, intimate relationships.

·       Blame other people for all your problems.

·       Do not express your feelings and views openly and honestly. Other people wouldn’t appreciate it. If at all possible, do not even know what your feelings are.

·       Shun anything that resembles a sense of humor. Life is no laughing matter!

·       Avoid making any changes that would bring you greater satisfaction and joy.

 How to Get Sicker (If You’re Already Sick)

·       Think about all the awful things that could happen to you. Dwell upon negative, fearful images.

·       Be depressed, self-pitying, envious, and angry. Blame everyone and everything for your illness.

·       Read articles, books, and newspapers, watch TV programs, surf the net, and listen to people who reinforce the viewpoint that there is NO HOPE. You are powerless to influence your fate.

·       Cut yourself off from other people. Regard yourself as a pariah. Lock yourself up in your room and contemplate death.

·       Hate yourself for having destroyed your life. Blame yourself mercilessly and incessantly.

·       Go to see lots of different doctors. Run from one to another, spend half your time in waiting rooms, get lots of conflicting opinions and lots of experimental drugs, starting one program after another without sticking to any.

·       Quit your job, stop work on any projects, give up all activities that bring you a sense of purpose and fun. See your life as essentially pointless, and at an end.

·       Complain about your symptoms, and if you associate with anyone, do so exclusively with other people who are unhappy and embittered. Reinforce each other’s feelings of hopelessness.

·       Don’t take care of yourself. What’s the use? Try to get other people to do it for you, and then resent them for not doing a good job.

·       Think how awful life is, and how you might as well be dead. But make sure you are absolutely terrified of death, just to increase the pain.

 

How to Stay Well (Or Get Better, If You’re Not So Well to Begin With)

·       Do things that bring you a sense of fulfillment, joy, and purpose, that validate your worth. See your life as your own creation and strive to make it a positive one.

·       Pay close and loving attention to yourself, tuning in to your needs on all levels. Take care of yourself, nourishing, supporting, and encouraging yourself.

·       Release all negative emotions—resentment, envy, fear, sadness, anger. Express your feelings appropriately; don’t hold onto them. Forgive yourself.

·       Hold positive images and goals in your mind, pictures of what you truly want in your life. When fearful images arise, refocus on images that evoke feelings of peace and joy.

·       Love yourself, and love everyone else. Make loving the purpose and primary expression of your life.

·       Create fun, loving, honest relationships, allowing for the expression and fulfillment of needs for intimacy and security. Try to heal any wounds in past relationships, as with old lovers, and with your mother and father.

·       Make a positive contribution to your community, through some form of work or service that you value and enjoy.

·       Make a commitment to health and well-being, and develop a belief in the possibility of wholeness. Develop your own healing program, drawing on the support and advice of experts without becoming enslaved to them.

·       Accept yourself and everything in your life as an opportunity for growth and learning. Be grateful. When you fuck up, forgive yourself, learn what you can from the experience, and then move on.

·       Keep a sense of humor.

As you go into the New Year, remind yourself that life has choices.