“Although I knew I slouched and often corrected myself, I never realized how often and how long I slouched until the vibratory posture feedback from the UpRight Go 2™ cued me to sit up (see Figure 1).” -Erik Peper
Figure 1. Wearing an UpRight Go 2™ to increase awareness of slouching and as a reminder to change position.
For thousands of years we sat and stood erect. In those earlier times, we looked down to identify specific plants or animal track and then looked up and around to search for possible food sources, identify friends, and avoid predators. The upright, not slouched posture body posture, is innate and optimizes body movement as illustrated in Figure 2 (for more information, see Gokhale, 2013).
Figure 2. The normal aligned spine of a toddler and the aligned posture of a man carrying a heavy load.
Being tall and erect allows the head to freely rotate. Head rotation is reduced when we look down at our cell phones, tablets or laptops (Harvey, Peper, Booiman, Heredia Cedillo, & Villagomez, 2018). Our digital world captures us as illustrated in Figure 3.
Figure 3. Captured by the screen with a head forward positions.
Looking down and focusing on the screen for long time periods is the opposite of what supported us to survive and thrive when we lived as hunters and gatherers. When we look down, we become more oblivious to our surroundings and unaware of the possible predators that would have been hunting us for food.
This slouched position increases back, neck, head and eye tension as well as affecting respiration and digestion (Devi, Lakshmi, & Devi, 2018; Peper, Lin, & Harvey, 2017). After looking at the screens for a long time, we may feel tired or exhausted and lack initiative to do something else. Our mood may turn more negative since it is easier to evoke hopeless, helpless and powerless thoughts and memories when looking down than when looking up (Wilson, & Peper, 2004; Peper, Lin, Harvey, & Perez, 2017). In the down position, our brain has to work harder to evoke positive thoughts and memories or perform cognitive tasks as compared to when the head is erect (Tsai, Peper, & Lin, 2016; Peper, Harvey, Mason, & Lin, 2018). By looking down and focusing at the screen, our eyes may begin to strain. To be able to see objects near us, the extraocular muscles of the eyes contract to converge the eyes and the cilia muscles around the lens contract to increase the curvature of the lens so that the reading material is in focus.
Become aware how nearby vision increases eye strain.
Hold your arm straight ahead of you at eye level with your thumb up. While focusing on your thumb, slowly bring your thumb closer and closer to your nose. Observe the increase in eyestrain as you bring your thumb closer to your nose.
Eyestrain tends to develop when we do not relax the eyes by periodically looking away from the screen. When we look at the horizon or trees in the far distance the ciliary muscles and the extraocular muscles relax (Schneider, 2016).
Head forward posture increases neck and back tension
When we look down and concentrate, our head moves significantly forward. The neck and back muscles have to work much harder to hold the head up when the neck is in this flexed position. As Dr. Kenneth Hansraj, Chief of Spine Surgery New York Spine Surgery & Rehabilitation Medicine reported, “The weight seen by the spine dramatically increases when flexing the head forward at varying degrees. An adult head weighs 10-12 pounds in the neutral position. As the head tilts forward the forces seen by the neck surges to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees and 60 pounds at 60 degrees.” (Hansraj, 2014). Our head tends to tilt down when we look at the text, videos, emails, photos, or games and stay in this position for long time periods. We are captured by the digital display and are unaware of our tight overused neck and back muscles. Straightening up so that the back of the head is re-positioned over the spine and looking into the distance may help relax those muscles.
To reduce discomfort caused by slouching, we need to reintegrate our prehistoric life style pattern of alternating between looking down to being tall and looking at the distant scenery or across the room. The first step is awareness of knowing when slouching begins. Yet, we tend to be unaware until we experience discomfort or are reminded by others (e.g, “Don’t slouch! Sit up straight!”). If we could have immediate posture feedback when we begin to slouch, our awareness would increase and remind us to change our posture.
Posture feedback with UpRight Go
Simple posture feedback device such as an UpRight Go 2™ can provide vibratory feedback each time slouching starts as the neck as the head goes forward. The wearable feedback device consists of a small sensor that is attached to the back of the neck or back (see Figure 1). After being paired with a cellphone and calibrated for the upright position, the software algorithm detects changes in tilt and provides vibratory feedback each time the neck/back tilts forward.
In our initial exploration, employees, students and clients used the UpRight feedback devices at work, at school, at home, while driving, walking and other activities to identify situations that caused them to slouch. The most common triggers were:
- Ergonomic caused movement such as bring the head closer to the screen or looking down at their cell phone (for suggestions to improve ergonomics see recommendations at the end of the article)
- Negative self-critical/depressive thoughts
- Crossing the legs protectively, shallow breathing, and other factors
After having identified some of the factors that were associated with slouching, we compared the health outcome of students who used the device for a minimum for 15 minutes a day for four weeks as compared to a control group who did not use the device. The students who received the UpRight feedback were also encouraged to use the feedback to change their posture and behavior and implemented some of the following strategies.
- Head down when looking at their laptop, tablet or cellphone.
- Change the ergonomics such as using a laptop stand and an external keyboard so that they could be upright while looking at the screen.
- Take many movement breaks to interrupt the static tension.
- Feeling tired.
- Take a break or nap to regenerate.
- Do fun physical activity especially activities where you look upward to re-energize.
- Negative self-critical, powerless, self-critical and depressive thoughts and feelings.
- Reframe internal language to empowering thoughts.
- Change posture by wiggling and looking up to have a different point of view.
- Crossing the legs.
- Sit in power position and breathe diaphragmatically.
- Get up and do a few movements such as shoulder rolls, skipping, or arm swings.
- Other causes.
- Identify the trigger and explore strategies so that you can sit erect without effort.
- Wiggle, move and get up to interrupt static muscle tension.
- Stand up and look out of the window and the far distance while breathing slowly
Posture feedback improves health
After four weeks of using the feedback device and changing behavior, the treatment group reported significant improvements in physical and mental health as shown in Figure 4 & 5.
Figure 4. Using the posture feedback significantly improved the Physical Health and Mental Health Composite Scores for the treatment group as compared to the control group (reproduced from Mason, L., Joy, Peper, & Harvey, 2018).
Figure 5. Pre to post changes after using posture feedback (reproduced from Colombo, Joy, Mason, L., Peper, Harvey, & Booiman, 2017).
Slouched posture and head forward and down position usually occurs without awareness and often results in long-term discomfort. We recommend that practitioners integrate wearable biofeedback devices to facilitate home practice especially for people with neck, shoulder, back and eye discomfort as well as for those with low energy and depression (Mason et al., 2018). We observed that a small wearable posture feedback device helped participants improve posture and decreased symptoms. The vibratory posture feedback provided the person with the opportunity to identify the triggers associated with slouching and the option to change their posture, behavior and environment.
As one participant reported, “I have been using the Upright device for a few weeks now. I mostly use the device while studying at my desk and during class. I have found that it helps me stay focused at my desk for longer time. Knowing there is something monitoring my posture helps to keep me sitting longer because I want to see how long I can keep an upright posture. While studying, I have found whenever I become frustrated, tired, or when my mind begins to wander I slouch. The Upright then vibrates and I become aware of these feelings and thoughts, and can quickly correct them. This device has improved my posture, created awareness, and increased my overall study time.”
Suggestions to reduce slouching and improve ergonomics
How to arrange your computer and laptop: https://peperperspective.com/2014/09/30/cartoon-ergonomics-for-working-at-the-computer-and-laptop/
Relieve neck and shoulder stiffness: https://peperperspective.com/2019/05/21/relieve-and-prevent-neck-stiffness-and-pain/
Colombo, S., Joy, M., Mason, L., Peper, E., Harvey, R., & Booiman, A. (2017). Posture Change Feedback Training and its Effect on Health. Poster presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Chicago, IL March, 2017. Abstract published in Applied Psychophysiology and Biofeedback.42(2), 147.
Devi, R. R., Lakshmi, V.V., & Devi, M.G. (2018). Prevalence of discomfort and visual strain due to the use of laptops among college going students in Hyderabad. Journal of Scientific Research & Reports, 20(4), 1-5.
Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Mason, L., Joy, M., Peper, E., & Harvey, R. (2018).Wearable Posture Feedback Training: Effects on Health. Poster presented at the 2018 meeting of the 49th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Orlando, FL. April 11-14.
Mason, L., Joy, M., Colombo, S., Peper, E., & Harvey, R. (2017). Biofeedback Strategies to Increase Social Justice and Health Equity: A wearable device to teach awareness of posture and improve self-care. Presented at the 19th Annual meeting of the Biofeedback Federation of Europe, Aveiro, Portugal, April 24-29th, 2017. Abstract in Applied Psychophysiology and Biofeedback,43(1), 93
“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.
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/
Trichotillomania (hair pulling) https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/
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.
Is your neck stiff, uncomfortable and painful?
When driving is it more difficult to turn your head?
Neck and shoulder pain affect more than 30% of people (Fejer et al, 2006; Cohen, 2015). This blog explores some strategies to reduce or prevent neck stiffness and discomfort and suggests practices to reduce discomfort and increase flexibility if you already are uncomfortable.
Shifts in posture may optimize neck flexibility
In our modern world, we frequently engage in a forward head position while looking at electronic devices or typing on computers. Prolonged smart phone usage has the potential to negatively impact posture and breathing functions (Jung et al., 2016) since we tilt our head down to look at the screen. Holding the head in a forward position, as displayed in Figure 1, can result in muscle tension in the spine, neck, and shoulders.
Fig 1. Forward head and neck posture in comparison to a neutral spine. Source: https://losethebackpain.com/conditions/forward-head-posture/
Whenever you bring your head forward to look at the screen or tilt it down to look at your cellphone, your neck and shoulder muscles tighten and your breathing pattern become more shallowly. The more the head is forward, the more difficulty is it to rotate your head as is describe in the blog, Head position, it matters! (Harvey et al, 2018). Over time, the head forward position may lead to symptoms such as headaches and backpain. On the other hand, when we shift to an aligned upright position throughout the day, we create an opportunity to relieve this tension as shown in Figure 2.
Figure 2. EMG and respiration recording from a subject sitting with a forward head position and a neutral, aligned head position. The neck and shoulder muscle tension was recorded from the right trapezius and left scalene muscles (Mason et all, unpublished). .
The muscle tension recorded from scalene and trapezius muscles (neck and shoulder) in Figure 2 shows that as the head goes forward or tilts down, the muscle tension significantly increases. In most cases participants are totally unware that their neck tightens. It is only after looking at the screen or focus our eyes until the whole day that we notice discomfort in the late afternoon.
Experience this covert muscle tension pattern in the following video, Sensing neck muscle tension-The eye, head, and neck connection.
Interrupt constant muscle tension
One possible reason why we develop the stiffness and discomfort is that we hold the muscles contracted for long time in static positions. If the muscle can relax frequently, it would significantly reduce the probability of developing discomfort. Experience this concept of interrupting tension practice by practicing the following:
- Sit on a chair and lift your right foot up one inch up from the floor. Keep holding it up? For some people, as soon as five seconds, they will experience tightening and the onset of discomfort and pain in the upper thigh and hip.
How long could you hold your foot slight up from the floor? Obviously, it depends on your motivation, but most people after one minute want to put the foot down as the discomfort become more intense. Put the foot down and relax. Notice the change is sensation and for some it takes a while for the discomfort to fade out.
- The reason for the discomfort is that the function of muscle is to move a joint and then relax. If tightening and relaxation occurs frequently, then there is no problem
- Repeat the same practice except lift the foot, relax and drop it down and repeat and repeat. Many people can easily do this for hours when walking.
What to do to prevent neck and shoulder stiffness.
Interrupt static muscle neck tension by moving your head neck and shoulder frequently while looking at the screen or performing tasks. Explore some of the following:
- Look away from the screen, take a breath and as you exhale, wiggle your head light heartedly as if there is a pencil at reaching from the top of your head to the ceiling and you are drawing random patterns on the ceiling. Keep breathing make the lines in all directions.
- Push the chair back from the desk, roll your right shoulder forward, up and back let it drop down and relax. Then roll you left shoulder forward up and back and drop down and relax. Again, be sure to keep breathing.
- Stand up and skip in place with your hands reaching to the ceiling so that when your right foot goes up you reach upward with your left hand toward the ceiling while looking at your left hand. Then, as your left foot goes up your reach upward to the ceiling with your right hand and look at your right hand. Smile as you are skipping in place.
- Install a break reminder program on your computer such as Stretch Break to remind you to stretch and move.
- Learn how to sit and stand aligned and how to use your body functionally such as with the Gokhale Method or the Alexander Technique (Gokhale, 2013; Peper et al, in press, Vineyard, 2007).
- Learn awareness and control neck and shoulder muscle tension with muscle biofeedback. For practitioners certified in biofeedback BCB, see https://certify.bcia.org/4dcgi/resctr/search.html
- Become aware of your collapsed and slouching wearing a posture feedback device such as UpRight Go on your upper back. This device provides vibratory feedback every time you slouch and reminds you to interrupt slouching and be upright and alighned.
Arrange your computer screen and keyboard so that the screen is at eye level instead of having to reach forward or look down. Similarly, hold your cell phone so that it is at eye level as shown in Figure 3 and 4.
Figure 3. Slouching forward to see the laptop screen can be avoided by using an external keyboard, mouse and desktop riser. Reproduced by permission from www.backshop.nl
Figure 4. Avoid the collapsed while looking down at a cell phone by resting the arms on a backpack or purse and keeping the spine and head alighned. Photo of upright position reproduced with permission from Imogen Ragone, https://imogenragone.com/
If you are squinting, bringing your nose to the screen, or if the letters are too small or blurry, have your eyes checked to see if you need computer glasses. Generally do not use bifocals or progressive glasses as they force you to tilt your head up or down to see the material at a specific focal length. Other options included changing the display size on screen by making the text and symbols larger may allow you see the screen without bending forward. Just as your muscle of your neck, your eyes need many vision breaks. Look away from the screen out of the window at a distant tree or for a moment close your eyes and breathe.
What to do if you have stiffness and discomfort
My neck was stiff and it hurt the moment I tried to look to the sides. I was totally surprised that I rapidly increased my flexibility and reduced the discomfort when I implemented the following two practices.
Begin by implementing the previous described preventative strategies. Most important is to interrupt static positions and do many small movement breaks. Get up and wiggle a lot. Look at the blog, Freeing the neck and shoulder, for additional practices.
Then, practice the following exercises numerous times during the day to release neck and shoulder tension and discomfort. While doing these practices exhale gently when you are stretching. If the discomfort increases, stop and see your health professional.
Cohen, S.P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90 (2), 284-299. https://doi.org/10.1016/j.mayocp.2014.09.008
Fejer, R., Kyvik, K.Ohm, & Hartvigesen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834-848. https://doi.org/10.1007/s00586-004-0864-4
Gokhale, E. (2013). 8 Steps to a Pain-Free Back. Pendo Press.
Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Mason, L., Peper, E., Harvey, R., & Hernandez, W. (unpublished). Healing headaches. Does success sustain over time?
Peper, E., Krüger, B., Gokhale, E., & Harvey, R. (in press). Comparing Muscle Activity and Spine Shape in Various Sitting Styles. Biofeedback.
Vineyar, M. (2007). How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery. Boston: Da Capo Lifelong Books.
When randomized controlled studies of pharmaceuticals or surgery find that the treatment is no more effective than the placebo, the authors conclude that surgery or drugs have no therapeutic value (Moseley et al, 2002; Jonas et al, 2015). Even though the patients may have gotten better, the researchers often do not explore questions such as, why did some of the patients improve just with the placebo treatment; what are the components of the placebo process; and, how can clinicians integrate placebo components into their practice to enhance the body’s own natural healing response.
To explore these topics further, listen to Shankar Vedantam’s outstanding podcast, A Dramatic Cure, from the NPR program, Hidden Brain-A conversation about life’s unseen patterns. Also, read the background materials on the website https://www.npr.org/2019/04/29/718227789/all-the-worlds-a-stage-including-the-doctor-s-office
Placebo effects can be a powerful healing strategy as demonstrated by numerous research studies that have persuasively explored the central features of the placebo effect. The research has found that the more dramatic and impressive the procedure, the more powerful the placebo effect. For example, branded medicine with brightly colored packaging is more effective than generic medicine in plain boxes, an injection of a saline or sugar solution is more effective than taking a sugar pill, and placebo surgery is more effective than simply receiving an injection (Branthwaite & Cooper, 1981; Colloca & Benedetti, 2005). For a detailed exploration of placebo, nocebo and the important role of active placebo, see the blog, How effective is treatment? The importance of active placebos.
To see the effect of the placebo in action, watch the well-known British stage hypnotist and illusionist, Derren Brown’s video, Fear and Faith (https://www.youtube.com/watch?v=hfDlfhHVvTY). He magically weaves together a narrative that addresses the powerful influences of the natural, physical, and clinical environment and language used during a ‘therapeutic’ interaction. He shows how the influences of role modeling, the words that increase hope, trust and social compliance, and other covert factors promote healing. It uses the cover of a drug trial to convince various members of the public to overcome their fears using a placebo medicine called “Rumyodin” (which is a made-up name of a fake pharmaceutical) and demonstrates that the limits of experience are the limits of your belief.
This blog post serves as a reminder to ask ourselves as educators and therapists, ‘what can I do to include placebo enhancing components into my practice so that my clinical and educational outcomes are more effective?’ Explore ways to optimize your clinical environment, language use during ‘therapeutic’ interactions, and role modeling to increase hope, trust and social compliance and thereby optimize your clients’ own natural healing response.
Jonas, W. B., Crawford, C., Colloca, L. , et al.(2015). To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open, 5: e009655. doi:10.1136/ bmjopen-2015-009655
*I thank Richard Harvey, PhD., for his constructive feedback and James Fadiman, PhD., for reminding me to reframe the term placebo into “the body’s natural healing response.”
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).
Figure 1. Increase in anxiety evoked by 70% exhalation.
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 that that offer instructions to learn effortless diaphragmatic breathing
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. & 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.
This blog describes a structured imagery that evokes past memories of joy and health and integrates them into a relaxation practice to support healing. First, a look at the logic for the practice and then the process of creating your own personal imagery script. A sample audio file is included as a model for creating your MP3 file. The blog is adapted from Peper, E., Gibney, K.H. & Holt. C. (2002). Make Health Happen: Training Yourself to Create Wellness. Dubuque, IA: Kendall-Hunt.
“I enjoyed regressing back into my childhood, remembered playing in the rain, making paper sailboats with my brother…. Placing my fingers in a bowl of water and stroking a paper sailboat enabled me to participate in the total experience… I felt tingling sensations all over my body, like tiny bundles of energy exploding inside of me. By the end of the week the simple word “rain” could induce these sensations inside my whole being.”–Student
Daydreaming! We all know how to do it. When we daydream, we feel, sense, hear, and taste our daydream—the image becomes tangible, as if we are living it. A well-developed relaxation image can also include colors, scents, sounds, flavors, temperature, and so forth. Evoking a past memory image of wholeness may contribute significant to healing, as illustrated in Pavlov’s experience with controlled conditioning and with self-healing.
THE POWER OF CONDITIONING
Most of us are probably familiar with the classical conditioning experiment of the famous Russian physiologist, Ivan Pavlov, who taught dogs to salivate on cue when they heard a bell ring—even when no food was provided. Pavlov accomplished this by giving the dogs food immediately after ringing a bell. Eventually, the dogs became conditioned to expect the food with the bell and simply hearing the bell ring would induce salivation (shown in Figure 1).
Figure 1. The process of classical conditioning. (Figure adapted from: https://opentextbc.ca/introductiontopsychology/chapter/7-1-learning-by-association-classical-conditioning/)
The conditioning effects of imagery can have an effect on health as well as physiology as reflected in an anecdote told by Theodore Melnechuk about Ivan Pavlov. As an old man, he became quite ill with heart disease and his doctors had no hope of curing him. They took his family aside and told them that the end was near. Pavlov himself, however, was not disheartened. He asked the nurse who was caring for him to bring him a bowl of warm water with a little dirt or mud in it. All day, as he lay in bed, he dabbled one hand in the water, with a dreamy, faraway look on his face. His family was quite sure that he had taken leave of his wits and would die soon. However, the next morning he announced that he felt fine, ate a large breakfast, and sat out in the sun awhile. By the end of the day, when the doctor came to check on him, there was no trace of the heart condition. When asked to explain what he had done, he said that he had reasoned that if he could recall a time when he was completely carefree and happy, it might have some healing benefit for him. As a young boy, he used to spend his summers playing with his friends in a shallow swimming hole in a nearby river. The memory of the warm, slightly muddy water was delightful to him. With his knowledge of the power of conditioned stimuli, he reasoned that having a physical reminder of that water might help him evoke that experience and those blissful feelings, and bring some of those memories into the present time. Using this strategy, he harnessed positive memory and the associated emotions that evoked the associated body changes to bring about his healing.
We all performs many conditioned behaviors every day. Some of these behaviors can have implications for our health and wellness. There may be aspects of allergic reactions that are conditioned. For example, the literature reports that a woman who was allergic to roses developed a severe allergic reaction to a very realistic-looking paper rose, even though she was not allergic to paper. Her body reacted as if the paper rose was real. (Mackenzie, 1886; Vits et al, 2011).
Conditioning can also affect our immune system. When rats were injected with a powerful immune-suppressing drug, while being fed saccharin-flavored water, their immune function showed an immediate drop. After the drug and saccharine water were paired a number of times, the rats were then given just the saccharin water and a harmless injection of salt water. Their immune cells responded exactly as if they had received the drug! The reverse ability, increasing immune cell function, has been shown to be influenced through conditioning (Ader, Cohen & Felten, 1995; Ader and Cohen, 1993).
Belief can also play a role in these scenarios. Bernie Siegel, MD,(2011) has recounted the story of a woman scheduled for chemotherapy who was first given a saline solution, and cautioned that it could cause hair loss. Although this is an unlikely result of a saline injection, given her belief, her hair fell out.
Actions, thoughts, and images affect our physiology.
We often anticipate, react, and form conclusions with incomplete information. Thoughts and images affect our physiology and even our immune system. Re-evoking a positive memory and living in that memory could potentially improve your health. In a remarkable study by a Harvard psychologist, Ellen Langer, eight men in their 70s lived together for one week, recreating aspects of the world that they had experienced more than 20 years earlier. They were instructed to act as they had in 1959, while the control group was instructed to focus entirely on the present time.
In the experimental group, all the physical cues were reminiscent of the culture twenty years earlier. Black and white television and magazines were from 1959. There were no mirrors to remind them of their current age—only photos on the wall of their younger selves. After a week in which the participants acted as if they were younger and the cues around them evoked their younger selves, 63% of the experimental group had improved their cognitive performance as compared with 44% of the control group. Among participants in the experimental group, even their physical health had improved. Independent raters who looked at the before and after pictures of these participants rated their appearance a little younger than the photos taken before the experiment (Langer, 2009; Grierson, 2014; Friedman, 2015). It is possible that by acting and thinking younger, we actually stay younger!
The limits of our belief are the limits of our experience. This concept underlies the remarkable power of placebo. If one believes a drug or a procedure is helpful, that can have a powerful healing effect (Peper & Harvey, 2017; also see the blog, How effective is treatment? The importance of active placebos).
CREATE YOUR OWN VISUALIZATION
Begin by remembering a time when you felt happy, healthy, and whole. Draw inspiration from Pavlov, who evoked happy memories from his childhood, apparently dramatically changing his health. To develop your personal visualization, set aside the time to recreate a healing memory. Remember a time in your life when you felt healthy and joyous (possibly from your childhood). For some, this might be time in nature or with your family or with friends.
Once you remember the event, re-experience it as if you were there right now. Evoke as many senses as possible. Think of the memory and any associations such as an old teddy bear, a shell from the beach, a favorite song, a certain perfume or some other tangible aspect of the experience. The goal is to recreate the experience as if it was current reality. Olfactory and gustatory cues can be especially powerful. If possible include the actual objects and cues associated with that memory—articles, pictures, music, songs, fragrances, or even food.
Sounds, scents, or touching and objects from that era of your life can deepen your ability to recreate and experience the quality of that memory—to actually be in the memory. These sensory reminders will help to evoke the memory and increase the felt experience. You might find it helpful to review Ellen Langer’s experiment, recreating an environment from twenty years earlier. The actual cues will deepen the experience, just as aromas often evoke specific memories and emotions.
The underlying principle is that memories are associated with conditioned stimuli that evoke the physiological state(s) in the body present when the memory was created.
Once you have created a vivid memory that engenders a sense of wholeness, develop a detailed description of your memory to help you evoke that experience. (For some, the memory calls up a timeless setting—relaxing on a warm beach, sitting in front of the fire on a winter evening, or sailing on a calm day. For others, the sense of trust may be associated with a specific person—someone you love—being with your grandmother, helping your mother bake a cake, or going fishing with your dad.). As you recreate the experience, engage all your senses (images, fragrance, tastes, textures, sounds, kinetics). Stay in your image: see it, smell it, taste it, touch it, hear it, be it and allow the experience to deepen.
Begin by writing up your imagery. Then record the introduction the structured relaxation and follow it with a description that evokes the memory as an MP3 audiofile. Use the following three-step process to create the script for your personal relaxation.
- Describe a time in your past when you felt joy, peace, love, or a sense of integration and wholeness.
- Identify the specific cues or stimuli associated with that memory.
- Write out a detailed description that will evoke your personal memory.
CREATING YOUR AUDIO FILE
In this approach, there are three components to your script: first, a relaxation practice to ease you into your visualization, then the visualization of your memory, closing with a brief script that brings you back into the present moment.
Begin the recording with progressive relaxation—use your favorite process for relaxing, or apply the script included here.
Generally tense the muscles for about 5 to 8 seconds and let go for 15 to 20 seconds as indicated by the …. While tightening and relaxing the muscles, sense the muscle sensations with passive attention. Tense only the muscles that you are instructed to tighten and continue to breathe while tensing and relaxing the muscles. If your attention wanders, gently bring it back to feeling the sensations in the specific muscles that you are instructed to tighten or relax.
First, find a comfortable position for relaxation… To fully relax your face, squeeze your eyes shut tight, press your lips and teeth together, and wrinkle up your nose… feel the tightness in your whole face… Now let it go completely and relax… Allow your face to soften, feel the eyes sinking in their sockets, and your breath to flow effortlessly in and out…
Tense both arms by making fists, and extend them straight ahead, while continuing to breathe deeply… study the tension… Now relax and let your arms drop as if you were a rag doll… To relax your shoulders, hunch them toward your ears and tighten your neck, while keeping the rest of your body loose and relaxed… Continue to breathe easily… Allow your shoulders to drop… Feel the weight of your arms… Feel the relaxation flowing from your shoulders, down your arms into your hands and out your fingers…
Now your stomach. Then let go and relax… Arch your back and feel the tightness in the back. Let go and relax….Allow your body to sink comfortably into the surface on which you are resting… Finally, tighten your butt, thighs, calves, and feet by pressing your heels down into the surface where you are lying, curling your toes and squeezing your knees together… Feel the tension as you continue to breathe, keeping your upper body relaxed… Now let go and relax… Allow relaxation to flow through your legs… Be aware of the sensations of letting go…
Feel the deepening relaxation, the calmness and the serenity… Feel each exhalation flowing down and through your arms, chest, and legs… Let the feelings of relaxation and heaviness deepen as you relax more… Notice the developing sense of inner peace… a calm indifference to external events… Let the feelings of relaxation, calmness, and serenity deepen for a few minutes. After a few minutes, evoke your memory of wholeness.
Insert your imagery script here.
Finish with the brief closing script
Allow yourself to just stay in this special place all your own… and know that you can return to this peaceful sanctuary any time you choose to do so. When you are ready to release the imagery, take a deep breath, gently stretch your body, and open your eyes.
Record these this whole script on your cell phone as an MP3 file.
When you record, it often takes a few tries before the pacing is correct. You may find it helpful to listen to the following audio file as a model for to create your own.
LISTENING TO YOUR VISUALIZATION
Create a sanctuary for yourself by turning off your cellphone, adjusting the heat to a comfortable temperature, and ensuring that you will have uninterrupted quiet time for 20 to 30 minutes. Loosen any constricting clothing or jewelry, your glasses, and so on. Settle into a comfortable chair, bed, or setting where you can easily relax. Enjoy letting yourself drift into and relive the memory experience.
Many participants report that this practice is an exceptionally relaxing and nurturing experience, one that supports regeneration. You’ll probably find that the more you practice, the more the relaxation deepens. You may find it helpful to keep notes and observe how you feel after each practice. Although it may feel strange to listen to your own voice, most people find that after a while it becomes more comfortable. After listening to it for a few times, you may want to rerecord the script. Finally, generalize this practice by smiling and evoking the memory scene as much as you desire during the day.
Additional strategies to enhance the relaxation
- Have a massage or take a warm shower or soak and then do the practice. Compare your level of relaxation afterwards to the result of using the audio alone.
- Practice gentle stretches to loosen tight muscles or “shake out” your arms and legs just before doing your relaxation practice.
- Draw or paint the relaxing image or actually go to the location where your memory occurred (if possible) and do your practice. Or practice outdoors in the most relaxing place you can find. Nature can be a great healer.
- Create an atmosphere that helps to evoke and augment your relaxation image (e.g., play background music or use fragrances that you associated with the image).
- Inability to evoke a memory of wholeness. When this occurs, it is as if one draws a blank. This is common, especially if one has experienced abuse or feels depressed. In that case, use the image presented in the script or make one up and create a totally imaginary peaceful image.
- Positive memories of wholeness evoke a bitter/sweet feeling. This occurs when images of wholeness include a loved one who has passed on or who is no longer in your life. On the one hand, this may call up strongly positive feelings, but it may evoke a sense of loss and sadness. If this occurs, simply chose a different memory or create a different script. Let the memory of loss go. Accept your experience and your feelings as much as possible, and know that at least you have been loved. For your image, it may be easier to focus on a natural setting you love—one you associate with peace and tranquility.
- Lack of experience with places in nature. Some people have only urban experiences and find nature alien. See what comes up for you. Does your favorite memory as a city kid recall a day of freedom on your bike or skateboarding, or an afternoon with your playmates? Perhaps you have treasured memories as a teen or an adult of long walks in the city or time spent with close friends. You also have the option of creating new images such as sitting by a fireplace, in a walled garden, or some other scene of peace and safety.
- Difficulty using progressive relaxation. If you’re having trouble isolating a muscle: touch it, stroke it with your hands, and then tense it fully (without strain) and feel the tension in your hands; feel the difference with your hands as you let go of the tension. Or, you may tighten only as much as is needed to feel the tension.
- The desire to stay in the imagery and not wanting to return to reality. If the imagery is much more pleasant than the present, use this process as a stimulus to reorganize your life and set new goals and priorities.
Ader, R. & Cohen, N. (1993). Psychoneuroimmunology, Conditioning,_and_Stress. Annual Review of Psychology, 44(1), 53-85.
Ader, R., Cohen, N. and Felten, D. (1995) Psychoneuroimmunology: Interactions between the Nervous System and the Immune System. The Lancet, 345, 99-103.
Grierson, B. (2014). What if age is nothing more than a mind-set? New York Times Magazine. October 22.
Langer, E. (2009). Counterclockwise: Mindful Health and the Power of Possibility . New York: Ballantine Books.
McKenzie, J. (1886). The production of the so-called rose effect by means of an artificial rose, with remarks and historical notes. Am. J. Med. Sci. 91, 45–57
Peper, E., Gibney, K.H. & Holt. C. (2002). Make Health Happen: Training Yourself to Create Wellness . Dubuque, IA: Kendall-Hunt. ISBN-13: 978-0787293314
Peper, E. & Harvey, R. (2017). The fallacy of placebo controlled clinical trials: Are positive outcomes the result of indirect treatment side effects? NeuroRegulation. 4(3–4), 102–113. doi:10.15540/nr.4.3-4.102
Siegel, B. (2011, May). Remarkable recoveries. Retrieved from: http://berniesiegelmd.com/resources/articles/remarkable-recoveries/
Each time when I commute with BART to San Francisco State University, I put on my sound cancelling headphones to block out the screeching sounds of the wheels scrapping against the rails and listen to the superb pod cast, Hidden Brain. This podcast is hosted by NPR social science correspondent Shankar Vedantam and links research from psychology and neurobiology with findings from economics, anthropology, and sociology, among other field
It uses science and storytelling to reveal the unconscious patterns that drive human behavior, and the biases that shape our choices (text adapted from: Hidden Brain.
I continue to be surprised by the remarkable knowledge presented in a storytelling format that is “a conversation about life’s unseen patterns.” As I listen, the commute time disappears and I have a front row seat to an outstanding podcast.